NCG100074_Renewal COC Request_20181128 11:59:07 AM

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NORTH CAFOLINA
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Permit COC
NCGl00074
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 CAFTTAL "NCG'
Name of Person
Charles Hoffman
Obtaining COC*
First and LastNarre
Phone Number* 8439083889
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.
NCG100074
Permittee
140 Auto Parts Inc
Facility Name
140 Auto Parts Incorporated
Address
1233 Bethel Rd
City
Morganton
County
Burke
Waterbody
Silver Creek
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 *
Date * 11 /28/2018