NCS000166_Owner Affiliation Change Request_20200910

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/10/2020 2:55:30 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 9/11/2020 8:39:41 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 9/10/2020 2:55 PM

1 S
�i.
mnvV��
NORTH CARCLINA
Emlmnm MI Quat<ty
Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCS000166
NCS)00000(or NCC)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Ashton Weller
Phone Number*
Reaseenter your phone nunber
252-348-4390
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 "FbrnitCWnerAffiliation Designation Fornl'
Upload* NPDES Stormwater Owner Affiliation Change-
460.9KB
Signed 9-2020.pdf
pdt only

Initial Review
Project ID * Reviewer may revise permt nunber below if incorrect.
NCS000166