NCG100072_Renewal COC Request_20181126 10:19:15 AM

'rl n
NORTH CAFOLINA
Emlre -.1 Qd Wy
Permit COC
NCG100072
Number *
Enter the Certificate of Coverage (COC) number, not the General Fbrmt number (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTH CAPRAL "NCG'
Name of Person
Tracy Stallings
Obtaining COC*
First and LastNarre
Phone Number* 252-235-4841
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].
Master General NCG100000
Permit No.
COC No.
NCG100072
Permittee
Midway Automotive
Facility Name
Midway Automotive
Address
13635 Old Raleigh Wilson
City
Middlesex
County
Nash
Waterbody
Moccasin Creek (Bunn Lake)
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
IV eWt 7a

Date * 11 /26/2018