NCG110042_Renewal COC Request_20180626 10:36:54 AM

Environmental
Quality
Permit COC
NCG110042
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit number (e.g., NOG030222 is the OOC, not
NCG030000) MUST BEGIN WITH CARTAL "NO3'
Name of Person
Derek Clayton
Obtaining COC*
First and Last Name
Phone Number*
3365998232
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.
NCG110042
Permittee
City of Roxboro
Facility Name
Roxboro WWTP
Address
902 Cavel-Chub Lake Rd
City
Roxboro
County
Person
Waterbody
Marlowe Creek
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 *
Date * 06/26/2018