NCC191628_Annual Fee Payment Record_20210803

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 7/29/2021 6:05:27 PM (Workflow Start Event)
Submit by Selkane, Aziza 8/3/2021 12:55:15 PM (2021 Annual Fee Payment Verification for NCC191628-2021)
* John Marcella
• Selkane, Aziza assigned the task to Selkane, Aziza 8/3/2021 12:53 PM
The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: September 9, 2021 5:00
PM 7/29/2021 6:05 PM

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s
Li Annuai i�ee
NORTH cAR(DUNA
Environmental Quvllty
Certificate of
NCC191628
Coverage (COC)
This is passed fromthe workflow when the invoice is filed.
No.*
NC Reference COC
NCG01-2019-1628
No.*
Permit Status:
Active
Year COC Issued
2019
This field will be hidden.
2020 Fee Status
Check last year's fee status
PAID
Project Name*
Walkertown Mavis
Project Address*
5212 WALKERTOWN COMMONS CIRCLE, Walkertown, NC
Permittee *
Mavis Tire Supply, LLC
County
Forsyth
Invoice No.*
NCC191628-2021
This is passed fromthe workflow when the invoice is filed.
Annual Fee *
$ 100.00
Invoice Date*
8/1/2021
This is passed fromthe workflow when the invoice is filed.
Invoice Due Date*
9/1/2021
This is passed fromthe workflow when the invoice is filed.
An automated email reminder is sent to the permittee when the invoice is due. Wait until invoice is 15 days overdue
before proceeding to a Notice of Deficiency.
Important: If you change the choice below to Payment NOT RECEIVED, the fee status becomes PAST DUE, and the
permittee will receive a Notice of Deficiency.
Annual Fee Payment r Fee Payment Received or Not Applicable.
Received* r Fee Payment NOT RECEIVED.
Date Payment 8/3/2021
Received* Or, if WAN® or NOT FECBV®, this is the date that status is recorded.
Method of Payment* r electronic
f check
f other

ePayment 585584154
Transaction
Number*
Fee Status* PAID
Legally Responsible Jeff Gordon
Person (Orig.)
Original Permittee E- [e-mail]
mail *
CONFIRM Permittee [e-mail]
E-mail * Opportunity to rrodify probleme-mail address or pernittee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail * Opportunity to correct probleme-nail address or site contact info
Original Billing E- (If available)
mail
CONFIRM Billing E- Opportunity to correct problem e-mail address or billing contact info
mail
Billing Telephone
No.
Permittee Email for [e-mail]
30-day Reminder This is the mail for the 30-day reminder if needed (passed fromworldlow).
Site Contact Email [e-mail]
for 30-day Reminder This is the errail for the 3aday reminder if needed (passed fromworldlow)
Billing Contact Email This is theerrail for the 3aday reminder if needed (passed fromworldlow).
for 30-day Reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 8/3/2021