NCG110114_Renewal COC Request_20181220 1:39:20 PM

'rl n
NORTH CAFOLINA
Emlre -.1 Qd Wy
Permit COC
NCG110114
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
Jacqueline Jarrell
Obtaining COC*
First and LastNarre
Phone Number* 704-336-5433
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].
Master General NCG110000
Permit No.
COC No.
NCG110114
Permittee
Charlotte Water
Facility Name
Mallard Creek WWTP
Address
12400 US Hwy 29 N
City
Charlotte
County
Mecklenburg
Waterbody
Mallard Creek
Classification
C
River Basin
Yadkin
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 * 12/20/2018