NCG100171_Renewal COC Request_20181205 1:00:59 PM

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NORTH CAFOLINA
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Permit COC
NCGlOO171
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 "NOG'
Name of Person
Elizabeth Pittman
Obtaining COC*
First and LastNarra
Phone Number* 252-236-3678
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.
NCG100171
Permittee
Pittman's Used Parts
Facility Name
Pittman's Used Parts
Address
6236 US 301 Hwy N
City
Elm City
County
Wilson
Waterbody
Town Creek
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 *
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Date * 12/05/2018