NCG100064_Renewal COC Request_20190322 5:20:12 PM

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NORTH CAFOLINA
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Permit COC
NCGl00064
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. NCG100064
Permittee Foss Recycling Inc
Facility Name Foss Auto Salvage
Address 4558 US 13
City Greenville
County Pitt
Waterbody Gum Swamp
Classification C;Sw,NSW
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 *
Date * 03/22/2019