NCG060126_Owner Affiliation Change Request_20210611

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/11/2021 8:45:52 AM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 6/18/2021 2:37:51 PM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 6/11/2021 8:45 AM

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*
NCG060126
NCS)00000(or NCC)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Keith Bailey
Phone Number*
Reaseenter your phone nunber
7576131283
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 "Rarnit Cwner Affiliation Designation Forn1'
Upload* Signed SW Form.pdf 119.87KB
pdf only

Initial Review
Project ID * Peviewer nay revise perrrit nunber below if incorrect.
NCG060126