NCG080677_Renewal COC Request_20190909 10:54:01 AM

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NORTH CAFOLINA
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Permit COC
NCG080677
Number *
Enter the Certificate of Coverage (GOC) number, not the General Fbrmt nurrber (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAFTTAL "NCG'
Name of Person
Lee Brown
Obtaining COC*
First and LastNarra
Phone Number* 252-459-4511
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.
NCG080677
Permittee
Town of Nashville
Facility Name
Nashville Town - Public Works Shop
Address
727 Bass Dr
City
Nashville
County
Nash
Waterbody
Stony Creek (Boddies Millpond)
Classification
QNSW
River Basin
Tar -Pamlico
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 * 09/09/2019