NCG100199_Renewal COC Request_20181130 4:58:20 PM

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NORTH CAFOLINA
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Permit COC
NCGlOO199
Number *
Enter the Certificate of Coverage (OOC) number, not the General Fbrmt nurrber (e.g., NCGO30222 is the COC, not
NCG030000) M-ST BEGIN WTTH CAFTTAL "NCG'
Name of Person
George Vagnieres
Obtaining COC*
First and LastNarre
Phone Number* 252-977-3710
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.
NCG100199
Permittee
G & N Used Auto Parts
Facility Name
G & N Used Auto Parts
Address
3850 S Church St
City
Rocky Mount
County
Nash
Waterbody
Cokey Swamp
Classification
QNSW
River Basin
Tar -Pamlico
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 *
Plit VATI'r, u
Date * 11 /30/2018