NCG100030_Renewal COC Request_20190123 1:45:48 PM

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Permit COC
NCG100030
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
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.
NCG100030
Permittee
Matlocks Used Cars & Parts Inc
Facility Name
Matlocks Used Cars & Parts Inc
Address
16055 Cool Springs Rd
City
Cleveland
County
Rowan
Waterbody
Fourth Creek
Classification
C
River Basin
Yadkin
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