NCG100182_Renewal COC Request_20181205 12:57:56 PM

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NORTH CAFOLINA
Emlre -.1 Qd Wy
Permit COC
NCGlOO182
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 CAPRAL "NOG'
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.
NCG100182
Permittee
Youngs Auto Center & Salvage
Facility Name
Young's Auto Center & Salvage -Dudley
Address
4172 US Hwy 117 S Alt
City
Dudley
County
Wayne
Waterbody
Poplar Branch
Classification
B;NSW
River Basin
Neuse
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 * 12/05/2018