NCG200509_Renewal COC Request_20191022 3:25:10 PM

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NORTH CAFOLINA
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Permit COC
NCG200509
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
Jerry Allen
Obtaining COC*
First and LastNarre
Phone Number* 7045095550
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].
M aste r Ge ne ral
NCG200000
Permit No.
COC No.
NCG200509
Permittee
Auto Parts U Pull Inc
Facility Name
Auto Parts U Pull, Inc.
Address
9820 Statesville Rd
City
Charlotte
County
Mecklenburg
Waterbody
Dixon Branch
Classification
C
River Basin
Catawba
RENEWAL STATUS
Active
issuance Date*
08/01/2019
Effective Date
08/01/2019
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 * 10/22/2019