NCG060366_Owner Affiliation Change Request_20210525

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 5/25/2021 2:36:21 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 5/27/2021 3:13:50 PM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 5/25/2021 2:36 PM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG060366
NCS)00000(or NCG00000(
Submittor's Name*
Please enter your FIRST and LAST narre
Lucas Waller
Phone Number*
Reaseenter your phone nurrber
[phone] ext. 3202
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 Rease upload the signed "Permit C,vner Affiliation Designation Forn1'
Upload* NPDES-Owner-Affiliation-Change-
420.58KB
ncg060374_Filled.pdf
pdf only

Initial Review
Project ID * Reviewer may revise permt nunber below if incorrect.
NCG060366