NCG060047_Owner Affiliation Change Request_20191218

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/18/2019 2:02:51 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 1/13/2020 7:23:26 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 12/18/2019 2:02 PM

1 S
�i.
mnvV��
NORTH CARCLINA
Emlmnm MI Quat<ty
Default Page
NPDES Permit
Enter your NPIDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG060047
NCS)00000(or NCC)00000(
Submittor's Name*
Please enter your FIRST and LAST narre
TONICRAWFORD
Phone Number*
Rease enter your phone nurrber
910-223-6667
Any format is fine.
Email Address *
Rease enter a valid a -mail address
[e-mail]
A confirmation of submssion will be e-mailed to this address.
Need a copy of the Permit Owner Affiliation Designation Form? You must upload a signed copy of that form below.
Questions? Call Bethany Georgoulias at [phone] or e-mail her at.bethany.georgouliasencdenr.gov.
Completed Form Reaseupload the signed "FbrrritOwner Affiliation DesignationForn'
Upload* Permit Owner Affiliation Designation Form 12.19.pdf 122.94KB
pdr only

Initial Review
Project ID * Peviewer rmy revise perrrit nunber below if incorrect.
NCG060047