NCG080698_Renewal COC Request_20181221 2:00:49 PM

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NORTH CAFOLINA
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Permit COC
NCG080698
Number *
Enter the Certificate of Coverage (OOC) number, not the General Fbrmt nurrber (e.g., NCGO30222 is the COC, not
NOG030000) M-ST BEGIN WTTH CAFTTAL "NCG'
Name of Person
Wilmer Melton, III
Obtaining COC*
First and LastNarre
Phone Number* 704-920-4231
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.
NCG080698
Permittee
City of Kannapolis
Facility Name
Kannapolis Public Works Operation Center
Address
1401 Bethpage Rd
City
Kannapolis
County
Cabarrus
Waterbody
Irish Buffalo Creek
Classification
C
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 *
V11111111"t. mil&
Date * 12/21 /2018