NCG110152_Renewal COC Request_20180705 2:03:25 PM

Envirnnmun tat
Quality
Permit COC
NCG110152
Number *
Enter the Certificate of Coverage (COC) number, not the General Pernit nunber (e.g., NOG030222 is the OCC, not
N00030000) MJST BEGIN WTTH CAPRAL "NO3'
Name of Person
Pat Donovan-Bradenburg
Obtaining COC*
First and Last WTe
Phone Number*
910-358-0558
Email*
[e-mail]
The COCwill be e-mailed to this contact.
Additional Email
(Optional) Enter an additional errail address to whom to send the OOC
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.
NCG110152
Permittee
City of Jacksonville
Facility Name
City of Jacksonville WWTF
Address
716 Firetower Rd
City
Jacksonville
County
Onslow
Waterbody
Deep Run
Classification
QNSW
River Basin
White Oak
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 * 07/05/2018