NCG100026_Renewal COC Request_20181129 2:32:34 PM

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Permit COC
NCGl00026
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
PATRICIA WAGNER
Obtaining COC*
First and LastNarra
Phone Number* 9195441729
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.
NCG100026
Permittee
Wagner Auto Salvage Inc
Facility Name
Wagner Auto Salvage Incorporated
Address
4115 S Alston Ave
City
Durham
County
Durham
Waterbody
Northeast Creek
Classification
WS-V;NSW
River Basin
Cape Fear
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 /29/2018