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HomeMy WebLinkAboutNCG100112_Renewal COC Request_20181130 2:58:28 PM'rl n NORTH CAFOLINA Emlre -.1 Qd Wy Permit COC NCG100112 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 Wiliam Dougherty Obtaining COC* First and LastNarre Phone Number* 434-489-1597 Email* dougherw@gmail.com The COC will be e-rrailed to this contact. Additional Email (Optional) Enter an additional errail 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 (919) 707-3641 or bethany.georgoulias@ncdenr.gov. Master General NCGl00000 Permit No. COC No. NCG100112 Permittee P and D Automotive Systems Facility Name P and D Automotive Systems Address 194 Red Marshall Rd City Pelham County Caswell Waterbody Tardy Branch Classification C River Basin Roanoke 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 * �lfx�ir ��rhz�/f�C Date * 11 /30/2018