NCG110123_Renewal COC Request_20180620 3:53:49 PM

Environmental
Quality
Permit COC
NCG110123
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
NCG030000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Charles Nichols
Obtaining COC*
First and Last Narre
Phone Number*
910-276-8324
Email *
[e-mail]
The COCwill be e-mailed to this contact.
Additional Email
[e-mail]
(Optional) Enter an additional email 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.
NCG110123
Permittee
City of Laurinburg
Facility Name
Leith Creek WWTP
Address
Hall St Extension
City
Laurinburg
County
Scotland
Waterbody
Leith Creek (Johns Pond)
Classification
C;Sw
River Basin
Lumber
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 *
Date * 06/20/2018