NCG110138_Renewal COC Request_20180621 9:20:10 AM

Environmental
Quality
Permit COC
NCG110138
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
NOW30000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Michael Glass
Obtaining COC*
First and Last Narre
Phone Number*
3364957500
Email *
[e-mail]
The COCwill be e -n -ailed 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.
NCG110138
Permittee
City of Randleman
Facility Name
Randleman WWTP
Address
3475 Applewood Rd
City
Randleman
County
Randolph
Waterbody
DEEP RIVER
Classification
C
River Basin
Cape Fear
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 *
��r¢y(rri0171 el I��Irra
Date * 06/21/2018