NCG080258_Owner Affiliation Change Request_20210616

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/16/2021 4:02:42 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 7/1/2021 8:05:07 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 6/16/2021 4:03 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*
NCG080258
NCS)00000(orNCG)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Eddie Greene
Phone Number*
Reaseenter your phone nunber
336-475-6101
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* doc00179320210616145610.pdf 1.75MB
pdf only

Initial Review
Project ID * Reviewer may revise permt nunber below if incorrect.
NCG080258