NCG190002_Renewal COC Request_20201127 10:00:32 AM

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/27/2020 10:00:31 AM (COC Request Submission)

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCG190002
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Pen-rit nurrber (e.g., N00030222 is the OOC, not
N00030000) M-ST BEGIN WTTH CARTAL "NOG'
Name of Person
James Bailey
Obtaining COC*
First and Last Narre
Phone Number*
2522411200
Email * [e-mail]
The COC w ill be e-nailed to this contact.
Additional Email (Optional) Enter an additional enailaddress towhom tosend the OOC
Did you check the permit COC file in our repository to ensure this COC was not already available from a previous
request? If it is, please obtain it from there instead of this form.
rJ Yes, this COC was not already there.
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
Master General
NCG190000
Permit No.
COC No.
NCG190002
Permittee
Cape Lookout Marine Inc DBA Anchorage
Marina
Facility Name
Anchorage Marina
Address
517 E Fort Macon Rd
City
Atlantic Beach
County
Carteret
Waterbody
Bogue Sound (Including Intracoastal
Waterway)
Classification
SA;ORW
River Basin
White Oak
RENEWAL STATUS
Active
Issuance Date*
10/01/2020
Effective Date
10/01/2020
Effective Date
20201001
Reformatted

I 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.
In addition, I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC General
Statutes (the "Uniform Electronic Transactions Act"); and I agree to conduct this transaction by electronic means
pursuant to Chapter 66, Article 40 of the NC General Statutes (the "Uniform Electronic Transactions Act");
Signature *
Date * 11 /27/2020