NCG110128_Renewal COC Request_20180620 1:28:23 PM

JI
Environmental
Quality
Permit COC
NCG110128
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
COC No.
NCG030000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Danny Gabriel
Obtaining COC*
First and Last Narre
Phone Number* 7042784777
Email * [e-mail]
The OOC will be e-mailed to this contact.
Additional Email (Optional) Enter an additional eneil 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].
Master General
NCG110000
Permit No.
COC No.
NCG110128
Permittee
Town of Cleveland
Facility Name
Cleveland WWTP
Address
625 Third Creek Church Rd
City
Cleveland
County
Rowan
Waterbody
Third Creek (Third Creek WS No. 37)
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 *
KI'Irff �f
Date * 06/20/2018