NCG100122_Renewal COC Request_20190129 2:28:24 PM

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NORTH CAFOLINA
Emlre -.1 Qd Wy
Permit COC
NCG100122
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 CAFTTAL "NCG'
Name of Person
Fred Cox
Obtaining COC*
First and LastNarre
Phone Number* 252-236-4127
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 NCG100000
Permit No.
COC No.
NCG100122
Permittee
Cox Auto Salvage
Facility Name
Cox Auto Salvage
Address
7622 D E Langley Rd
City
Elm City
County
Wilson
Waterbody
Town Creek
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 *

Date * 01 /29/2019