NCG100182_Renewal COC Request_20191211 9:08:21 AM

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Permit COC
NCG100182
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Pernit nurrber (e.g., N00030222 is the OOC, not
N00030000) M-ST BEGIN WTTH CARTAL "NCG'
Name of Person
David Casey
Obtaining COC*
First and Last Name
Phone Number* 919-920-8051
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.
NCG100182
Permittee
Youngs Auto Center & Salvage
Facility Name
Young's Auto Center & Salvage -Dudley
Address
4172 US Hwy 117 S Alt
City
Dudley
County
Wayne
Waterbody
Poplar Branch
Classification
B;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 *
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12/11/2019