NCG110105_Renewal COC Request_20180815 2:50:43 PM

JI
Environmental
Quality
Permit COC
NCG110105
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
NCG030000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Doug Barrick
Obtaining COC*
First and Last Name
Phone Number*
8282873520
Email *
[e-mail]
The OOC will be e-mailed to this contact.
Additional Email
[e-mail]
(Optional) Enter an additional email address to whom to send the COC
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
Master General
NCG110000
Permit No.
COC No.
NCG110105
Permittee
Town of Rutherfordton
Facility Name
Rutherfordton WWTP
Address
INC Hwy 221
City
Rutherfordton
County
Rutherford
Waterbody
Cleghorn Creek
Classification
C
River Basin
Broad
RENEWAL STATUS
Active
Issuance Date*
05/31/2018
Effective Date
06/01/2018
1 hereby request a copy of the Certificate of Coverage (COC) entered above. I understand that the COC e-mailed as a
result of this request will serve as the Permittee's record of renewed coverage under the General Permit, and that this
record must be maintained with the Permittee's NPDES Stormwater Permit records.
Signature *
dCJOtG� t�1�I.=� I:CC.+1
Date * 08/15/2018