NCG110059_Renewal COC Request_20180621 11:15:19 AM

JI
Environmental
Quality
Permit COC
NCG110059
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
COC No.
NOW30000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Elizabeth Jenkins
Obtaining COC*
First and Last Name
Phone Number* 2525080311
Email * [e-mail]
The COCwill be e-mailed to this contact.
Additional Email (Optional) Enter an additional enail 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.
NCG110059
Permittee
Town of Robersonville
Facility Name
Robersonville WW -FP
Address
1149 Rogerson Rd
City
Robersonville
County
Martin
Waterbody
Flat Swamp
Classification
C;Sw,NSW
River Basin
Tar -Pamlico
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 * 06/21/2018