NCG120055_Renewal COC Request_20190103 8:15:29 AM

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NORTH CAFOLINA
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Permit COC
NCG120055
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
Ronald E Tate
Obtaining COC*
First and LastNarre
Phone Number* 3363428104
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email [e-mail]
(Optional) Enter an additional errail 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 NCG120000
Permit No.
COC No.
NCG120055
Permittee
Rockingham County
Facility Name
Rockingham County Subtitle D Landfill
Address
281 Shuff Rd
City
Madison
County
Rockingham
Waterbody
Little Mill Creek
Classification
C
River Basin
Roanoke
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 * 01 /03/2019