NCG100219_Renewal COC Request_20181127 11:48:47 AM

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NORTH CAFOLINA
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Permit COC
NCGl00219
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 CAPITAL "NCG'
Name of Person
Dave Barzoff
Obtaining COC*
First and LastNarra
Phone Number* 704-218-3347
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.
NCGl00219
Permittee
Jake Zvanut
Facility Name
Weaver Parts & U Pull
Address
9001 Stitt St
City
Unionville
County
Union
Waterbody
Rays Fork
Classification
C
River Basin
Yadkin
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