HomeMy WebLinkAboutNCG080711_Renewal COC Request_20181214 8:57:49 AM'rl n
NORTH CAFOLINA
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Permit COC
NCG080711
Number *
Enter the Certificate of Coverage (COC) number, not the General Fbrmt number (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAPITAL "NCG'
Name of Person
Sam Ingram
Obtaining COC*
First and LastNarre
Phone Number* 704-391-4327
Email * samuel.c.ingram2.mil@mail.mil
The COC will be e-rrailed to this contact.
Additional Email hanson.j.pedersen.mil@mail.mil
(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 (919) 707-3641 or bethany.georgoulias@ncdenr.gov.
M aste r Ge ne ral
NCG080000
Permit No.
COC No.
NCG080711
Permittee
North Carolina Air Guard
Facility Name
263rd Combat Communications Squadron
Address
39399 Hercules Dr
City
New London
County
Stanly
Waterbody
Little Mountain Creek
Classification
WS-IV
River Basin
Yadkin
RENEWAL STATUS
Active
Issuance Date *
10/29/2018
Effective Date
11/01/2018
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 * 12/14/2018