NCG110019_Renewal COC Request_20180820 6:44:59 PM

JI
Environmental
Quality
Permit COC
NCG110019
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
Duane Hamby
Obtaining COC*
First and Last Name
Phone Number* [phone]
Email * [e-mail]
The OOCw ill 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.
NCG110019
Permittee
City of High Point
Facility Name
East Side WWTP
Address
5898 Riverdale Rd
City
Jamestown
County
Guilford
Waterbody
Richland Creek
Classification
WS-IV;CA:*
River Basin
Cape Fear
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 * 08/20/2018