NCG080713_Renewal COC Request_20181211 3:57:40 PM

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NORTH CAFOLINA
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Permit COC
NCG080713
Number *
Enter the Certificate of Coverage (COC) number, not the General Fbrmt number (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAFTTAL "NCG'
Name of Person
Frank Frazier
Obtaining COC*
First and LastNarre
Phone Number* 252-430-5701
Email * [e-mail]
The COC will be e-rrailed 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].
M aste r Ge ne ral
NCG080000
Permit No.
COC No.
NCG080713
Permittee
City of Henderson
Facility Name
Operations & Service Center
Address
900 S Beckford Dr
City
Henderson
County
Vance
Waterbody
Nutbush Creek (Including Nutbush Creek
Arm of John H. Kerr Reservoir below normal
pool elevation)
Classification
C
River Basin
Roanoke
RENEWAL STATUS
Active
Issuance Date *
10/29/2018
Effective Date
11/01/2018
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 *
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Date * 12/11 /2018