NCG100034_Renewal COC Request_20190322 5:13:12 PM

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NORTH CAFOLINA
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Permit COC
NCGl00034
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 CAFTTAL "NCG'
Name of Person
Brandon Walsh
Obtaining COC*
First and LastNarra
Phone Number* 6159883371
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.
NCG100034
Permittee
Lkq Corporation
Facility Name
LKQ City Auto Parts
Address
1301 S Miami Blvd
City
Durham
County
Durham
Waterbody
Little Lick Creek (including portion of Little
Lick Creek Arm of Falls Lake)
Classification
WS-IV;NSW,CA
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 *
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Date * 03/22/2019