NCG100084_Renewal COC Request_20181121 1:02:58 PM

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NORTH CAFOLINA
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Permit COC
NCGl00084
Number *
Enter the Certificate of Coverage (GOC) number, not the General Fbrmt nurrber (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAPITAL "NCG'
Name of Person
dale bevell
Obtaining COC*
First and LastNarra
Phone Number* 919-734-3958
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email (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
NCGl00000
Permit No.
COC No.
NCG100084
Permittee
Wayne Auto Salvage
Facility Name
Wayne Auto Salvage -Wayne
Address
1911 Hwy 117 S
City
Goldsboro
County
Wayne
Waterbody
NEUSE RIVER
Classification
QNSW
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 *
a+� G
Date * 11 /21 /2018