NCG110055_Renewal COC Request_20180621 4:57:47 PM

JI
Environmental
Quality
Permit COC
NCG110055
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
NOM30000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
David Shellenbarger
Obtaining COC*
First and Last Narre
Phone Number* 704-842-5106
Email * [e-mail]
The OOC will 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. NCG110055
Permittee City of Gastonia
Facility Name Crowders Creek WW -FP
Address 5642 S York Rd
City Gastonia
County Gaston
Waterbody South Fork Crowders Creek
Classification C
River Basin Catawba
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