NCG100215_Renewal COC Request_20190123 1:44:42 PM

'rl n
NORTH CAFOLINA
Emlre -.1 Qd Wy
Permit COC
NCGl00215
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 "NOG'
Name of Person
Amanda Matlock
Obtaining COC*
First and LastNarra
Phone Number* 7048802258
Email * [e-mail]
The COC will be e-rrailed to this contact.
Additional Email [e-mail]
(Optional) Enter an additional email 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.
NCGl00215
Permittee
Matlocks Used Cars & Parts Inc
Facility Name
Matlock's Used Cars & Parts
Address
810 Old Wilkesboro Rd Ext
City
Taylorsville
County
Alexander
Waterbody
Muddy Fork
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 * 01 /23/2019