NCG080679_Renewal COC Request_20181220 8:22:53 AM

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Permit COC
NCG080679
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
City of Brevard
Obtaining COC*
First and LastNarre
Phone Number* 828-884-2171
Email * [e-mail]
The COC will be e-rrailed 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].
M aste r Ge ne ral NCG080000
Permit No.
COC No.
NCG080679
Permittee
City of Brevard
Facility Name
Brevard City -Public Works Facility
Address
405 Cashiers My Rd
City
Brevard
County
Transylvania
Waterbody
Nicholson Creek
Classification
C;Tr
River Basin
French Broad
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 * 12/20/2018