NCG110079_Renewal COC Request_20200130 2:45:47 PM

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EnHmnmertm! dafny
Permit COC
NCG110079
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
gary garrison
Obtaining COC*
First and Last Name
Phone Number*
704-994-3283
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.
NCG110079
Permittee
Anson County
Facility Name
Anson County Regional WWTP
Address
NCSR 1121
City
Wadesboro
County
Anson
Waterbody
South Fork Jones Creek
Classification
C
River Basin
Yadkin
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 *
Cam` ?,t'e, Y'W
Date * 01 /30/2020