NCG060383_Owner Affiliation Change Request_20200526

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 5/26/2020 8:35:15 AM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 5/26/2020 3:45:46 PM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 5/26/2020 8:35 AM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG060383
NCS)00000(or NCG00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Elizabeth Gordon
Phone Number*
Reaseenter your phone nurrber
919-663-6729
Any format is fine.
Email Address *
Rease enter a valid e-rmil 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 Rease upload the signed "Permit Owner Affiliation Designation Forn1'
Upload* 2020.05.26.NPDES-Owner-Affiliation-Change-
525.9KB
20191104-DEMLR-SW signed.pdf
pdt only

Initial Review
Project ID * Reviewer may revise permt nunber below if incorrect.
NCG060383