NCG110139_Renewal COC Request_20180628 1:59:12 PM

JI
Environmental
Quality
Permit COC
NCG110139
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
Nicole Johnston
Obtaining COC*
First and Last Narre
Phone Number*
336-835-9819
Email *
[e-mail]
The OOCw ill 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.
NCG110139
Permittee
Yadkin Valley Sewer Authority
Facility Name
Yadkin Valley Sewer Authority WWTP
Address
500 INC Hwy 268 W
City
Elkin
County
Surry
Waterbody
Dutchman Creek
Classification
C
River Basin
Yadkin
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 * 06/28/2018