NCG020150_Owner Affiliation Change Request_20200909

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 9/9/2020 8:20:57 AM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 9/9/2020 3:54:31 PM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 9/9/2020 8:21 AM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (CCC) nunber.
Number*
NCG020150
NCS)00000(or NCC)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Jason Conner
Phone Number*
Reaseenter your phone nunber
8287129009
Any format is fine.
Email Address *
Rease enter a valid a-rrail 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 "FbrnitCwnerAffiliation Designation Fornl'
Upload* Grove Stone NCG020150.pdf 612.13KB
pdf only

Initial Review
Project ID * Reviewer may revise permt nunber below if incorrect.
NCG020150