NCG100025_Renewal COC Request_20181127 10:03:53 AM

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NORTH CAFOLINA
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Permit COC
NCGl00025
Number *
Enter the Certificate of Coverage (COC) number, not the General Fbrmt number (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAFTTAL "NCG'
Name of Person
Charles Dixon
Obtaining COC*
First and LastNarra
Phone Number* 704-922-5791
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 NCGl00000
Permit No.
COC No.
NCG100025
Permittee
Strawberry Motor Co Inc
Facility Name
Strawberry Motor Co Incorporated
Address
5604 Dallas High Shoals Hwy
City
Dallas
County
Gaston
Waterbody
South Fork Catawba River
Classification
WS-IV
River Basin
Catawba
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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Date * 11 /27/2018