NCG100119_Renewal COC Request_20191212 9:50:32 AM

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EnHmnmertm! dafny
Permit COC
NCG100119
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Pen-rit nurrber (e.g., N00030222 is the OOC, not
NCG030000) M-ST BEGIN WTTH CARTAL "NCG'
Name of Person
Samuel Chastain
Obtaining COC*
First and Last Name
Phone Number* 9197503914
Email * [e-mail]
The COC w ill be e-nailed to this contact.
Additional Email [e-mail]
(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].
Master General NCG100000
Permit No.
COC No.
NCG100119
Permittee
Foss Recycling Inc
Facility Name
Foss Auto Salvage - Northeast Jacksonville
Address
199 Drummer Kellum Rd
City
Jacksonville
County
Onslow
Waterbody
Wolf Swamp
Classification
C;NSW
River Basin
White Oak
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 *
L5law rrr"I r,&I.11-1z �W

Date * 12/12/2019