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HomeMy WebLinkAboutNCG100215_Renewal COC Request_20190123 1:44:42 PM'rl n NORTH CAFOLINA Emlre -.1 Qd Wy Permit COC NCGl00215 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 "NOG' Name of Person Amanda Matlock Obtaining COC* First and LastNarra Phone Number* 7048802258 Email * amatlock.muparts@gmail.com The COC will be e-rrailed to this contact. Additional Email amatlock.muparts@gmail.com (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 (919) 707-3641 or bethany.georgoulias@ncdenr.gov. Master General NCG100000 Permit No. COC No. NCGl00215 Permittee Matlocks Used Cars & Parts Inc Facility Name Matlock's Used Cars & Parts Address 810 Old Wilkesboro Rd Ext City Taylorsville County Alexander Waterbody Muddy Fork Classification C River Basin Catawba 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 /23/2019