NCG100127_Renewal COC Request_20181123 8:55:30 AM

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Permit COC
NCGlOO127
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
T Nine
Obtaining COC*
First and LastNarra
Phone Number* 9195282513
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
NCGl00000
Permit No.
COC No.
NCG100127
Permittee
T Nine
Facility Name
Nine's Auto Parts
Address
3649 Bruce Garner Rd
City
Wake Forest
County
Granville
Waterbody
Smith Creek
Classification
WS-V;NSW
River Basin
Neuse
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 * 11 /23/2018