NCG100202_Renewal COC Request_20191212 1:20:26 PM

NORTH C W Q-rA
EnHmnmertm! dafny
Permit COC
NCGl00202
Number *
Enter the Certificate of Coverage (COC) nun ber, not the General Pen-rit nurrber (e.g., N00030222 is the OOC, not
NCG030000) M-ST BEGIN WTTH CARTAL "NCG'
Name of Person
William Combs
Obtaining COC*
First and Last Name
Phone Number* 2524479618
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.
NCGl00202
Permittee
Foss Recycling Inc
Facility Name
Foss Auto Recycling
Address
901 Lake Rd
Havelock
County
Craven
Waterbody
Southwest Prong Slocum Creek
Classification
C;Sw,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 *
�ll�.�r• �`�v�cdd

Date * 12/12/2019