NCG110148_Renewal COC Request_20180626 9:57:41 AM

JI
Environmental
Quality
Permit COC
NCG110148
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
COC No.
NCG030000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Brantley Price
Obtaining COC*
First and Last Name
Phone Number* 3362463551
Email * [e-mail]
The COCwill be e-mailed to this contact.
Additional Email (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.
NCG110148
Permittee
Town of West Jefferson
Facility Name
West Jefferson WWTP
Address
US HM 221
City
West Jefferson
County
Ashe
Waterbody
Little Buffalo Creek
Classification
C;Tr:+
River Basin
New
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 * 06/26/2018