NCG110041_Renewal COC Request_20200121 8:33:05 AM

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EnHmnmertm! dafny
Permit COC
NCG110041
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Pen-rit nurrber (e.g., N00030222 is the OOC, not
NCG030000) M-ST BEGIN WTTH CARTAL "NCG'
Name of Person
Deanna Rosario
Obtaining COC*
First and Last Name
Phone Number*
9108504348
Email *
[e-mail]
The COC w ill be e-nailed to this contact.
Additional Email
(Optional) Enter an additional email address towhom tosend the OOC
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.
NCG110041
Permittee
Town of Spring Lake
Facility Name
Spring Lake WWTP
Address
350 Harps St
City
Spring Lake
County
Cumberland
Waterbody
Little River (Lower Little River)
Classification
C
River Basin
Cape Fear
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 *
401W�G a c CGS "4;'
Date * 01 /21 /2020