NCG110142_Renewal COC Request_20180621 4:21:37 PM

JI
Environmental
Quality
Permit COC
NCG110142
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
Melessa K Hopper
Obtaining COC*
First and Last Narre
Phone Number*
3364270241
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.
NCG110142
Permittee
Town of Mayodan
Facility Name
Mayodan WWTP
Address
293 Caldwell Rd
City
Mayodan
County
Rockingham
Waterbody
Mayo River
Classification
C
River Basin
Roanoke
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 *
Naa AC #Ylrk
Date * 06/21/2018