NCG080584_Renewal COC Request_20181212 1:26:34 PM

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Permit COC
NCG080584
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 CAPRAL "NOG'
Name of Person
Larry Campbell
Obtaining COC*
First and LastNarre
Phone Number* 704-597-8450
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 OOC
Please review the information below for accuracy before submitting. If there are inconsistencies, please
contact Bethany Georgoulias at [phone] or [e-mail].
M aste r Ge ne ral NCG080000
Permit No.
COC No.
NCG080584
Permittee
Larry Campbell's Towing & Recovery Inc
Facility Name
Larry Campbell's Towing & Recovery, Inc
Address
7327 Old Statesville Rd
City
Charlotte
County
Mecklenburg
Waterbody
Long Creek
Classification
C
River Basin
Catawba
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 * 12/12/2018