NCG100015_Renewal COC Request_20191203 11:12:37 AM

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
Number*
Name of Person
Obtaining COC*
Phone Number*
NCG100015
Enter the Certificate of Coverage (COC) nun ber, not the General Pen-rit nurrber (e.g., NOG030222 is the OOC, not
N00030000) M-ST BEGIN WTTH CARTAL "NCG'
Jimmy Marsh
First and Last Nacre
3363805686
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.
NCG100015
Permittee
Marsh Auto Parts
Facility Name
Marsh Auto Parts-Siler City
Address
211 E 11th St
City
Siler City
County
Chatham
Waterbody
Loves Creek
Classification
C
River Basin
Cape Fear
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 * 12/03/2019