NCS000218_Owner Affiliation Change Request_20201110

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/10/2020 4:37:10 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 11/12/2020 2:16:48 PM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 11/10/2020 4:37 PM

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Default Page
NPDES Permit
Enter your NPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCS000218
NCS)00000(or NCC)00000(
Submittor's Name*
Please enter your FIRST and LAST narre
Joseph Mark
Phone Number*
Reaseenter your phone nunber
[phone]
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 "FbrnitC,vnerAffiliation Designation Fornl'
Upload* 214 - Signed Owner Affiliation Change.pdf 53.12KB
pdr only

Initial Review
Project ID * Reviewer may revise permt nunber below if incorrect.
NCS000218