NCG200360_Owner Affiliation Change Request_20210629

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/29/2021 1:00:23 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 7/15/2021 6:41:31 PM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 6/29/2021 1:00 PM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG200360
NCS)00000(or NCC)00000(
Submittor's Name*
Please enter your FIRST and LAST narre
Bob Hayes
Phone Number*
Reaseenter your phone nunber
4044434571
Any format is fine.
Email Address *
Rease enter a valid a-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 Reaseupload the signed "FbrnitCwnerAffiliation Designation Fornl'
Upload* NCG200360 Permit Owner Affilation Designation
615.34KB
Form Signed.pdf
pdt only

Initial Review
Project ID * Reviewer may revise permt nunber below if incorrect.
NCG200360