NCS000246_Owner Affiliation Change Request_20201022

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/22/2020 3:41:07 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 10/30/2020 8:45:22 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 10/22/2020 3:41 PM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCS000246
NCS)00000(or NCC)00000(
Submittor's Name*
Please enter your FIRST and LAST narre
Shauna Haslem
Phone Number*
Rease enter your phone nurrber
9104331071
Any format is fine.
Email Address *
Rease enter a valid e-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 Rease upload the signed "Fbrrrit Owner Affiliation Designation Forn1'
Upload* Permit Owner Form-1 02020. pdf 705.05KB
pdr only

Initial Review
Project ID * Reviewer may revise permt nunber below if incorrect.
NCS000246