NCG080665_Renewal COC Request_20210806 6:56:22 AM

Permit COC NCG080665
Number * Enter the Certificate of Coverage (COC) nun ber. MIST BEGIN WITH CARTAL "NOG'
Please review the information below for accuracy before submitting. If there are inconsistencies, please contact
[e-mail], or check the box below that says "permit information is incorrect".
Permittee * City of Goldsboro
Facility Name Goldsboro City -Centralized Maintenance Complex
Address 1601 N Clingman St
City Goldsboro
County Wayne
Name of Person Woodrow Carter
Requesting COC* First and LastNarre
Phone Number* 919-739-7415
Email* [e-mail]
The COC w ill be e-nailed to this contact.
Additional Email (Optional) Enter an additional enailaddress towhom tosend the OOC
Master General Permit NCG080000
Issuance Date 06/30/2021
Master General Fbrnit Issuance
Effective Date 07/01/2021
Master General Fbrnit Effective
NOTE: You can verify the COC facility information and renewal status by running this Permit Summary Report (check the
Permit Status at the top of the report). If the permit is expired, a renewal COC will not be available. This may be
because fees are owed. You can check for outstanding invoices at https://deq.nc.gov/sw-epayments.
«Before checking this box, please verify the OOCis expired with the report above. >>
r owed fees have been paid, but the COC is still expired.
r- permit information is incorrect or old.
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. If a COC is not available, I request a
follow-up from Stormwater Program staff.
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 * 08/06/2021
Time 06:56:22 AM
If you do not receive an email with a copy of your renewal COC within a day, please contact
[e-mail] or [e-mail]