NCG080671_Renewal COC Request_20181218 11:49:49 AM

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Permit COC
NCG080671
Number *
Enter the Certificate of Coverage (OOC) number, not the General Fbrmt nurrber (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAPITAL "NCG'
Name of Person
Mike Apke
Obtaining COC*
First and LastNarre
Phone Number* 910-295-3159
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email (Optional) Enter an additional email address to whom to send the CDC
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
M aste r Ge ne ral NCG080000
Permit No.
COC No. NCG080671
Permittee Town of Southern Pines
Facility Name Southern Pines Town - Garage
Address 140 Memorial Park Ct
City Southern Pines
County Moore
Waterbody McDeeds Creek
Classification WS-III;HQW:@
River Basin Cape Fear
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 *
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Date * 12/18/2018