NCG100023_Renewal COC Request_20181204 10:27:06 AM

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NORTH CAFOLINA
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Permit COC
NCG100023
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
Heath McCaskill
Obtaining COC*
First and LastNbrra
Phone Number* 3364984782
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email [e-mail]
(Optional) Enter an additional errail 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.
NCG100023
Permittee
M & M Motor Co Inc
Facility Name
M & M Motor Co Incorporated
Address
9316 US Hwy Bus 220 N
City
Randleman
County
Randolph
Waterbody
Polecat Creek and Simmons Branch
Classification
WS-III and WS-IV:*
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 * 12/04/2018