NCG080665_Renewal COC Request_20190320 8:11:13 AM

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NORTH CAFOLINA
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Permit COC
NCG080665
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
Woodrow Carter
Obtaining COC*
First and LastNarre
Phone Number* 919-739-7419
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email [e-mail]
(Optional) Enter an additional errail 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.
NCG080665
Permittee
City of Goldsboro
Facility Name
Goldsboro City -Centralized Maintenance
Complex
Address
1601 N Clingman St
City
Goldsboro
County
Wayne
Waterbody
Big Ditch
Classification
QNSW
River Basin
Neuse
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 *

Date * 03/20/2019