NCG120017_Renewal COC Request_20190104 8:46:23 AM

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NORTH CAFOLINA
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Permit COC
NCG120017
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
Amanda Bader
Obtaining COC*
First and LastNarre
Phone Number* 910-438-4041
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
NCG120000
Permit No.
COC No.
NCG120017
Permittee
Cumberland Co
Facility Name
Cumberland Co- Ann St
Address
698 Ann St
City
Fayetteville
County
Cumberland
Waterbody
CAPE FEAR RIVER
Classification
C
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 * 01 /04/2019