NCC191770_Annual Fee Payment Record (Recovered)_20210903

4/14/23, 4:06 PM
2021 Annual Fee Payment Verification for NCC191770-2021
SrArl
2021 Annual Fee Payment Verification
NORTH CAROLINA
Envlrunmental Quality
Certificate of NCC191770
Coverage (COC) This is passed from the workflow when the invoice is filed.
No. *
NC Reference COC NCG01-2019-1770
No.*
Permit Status: INACTIVE
Already Rescinded:
9/3/2021
This field appears if the permit has already been terminated.
Year COC Issued
2019
This field will be hidden.
2020 Fee Status
Check last year's fee status
PAID
WAIVE FEE? *
Yes, Payment Not Applicable
No, Payment Still Applies
Project Name* Eastern Roseburg Office
Project Address * US Hwy 125, Roanoke Rapids, NC
Permittee* Roseburg Resources Co.
County Halifax
Invoice No.* NCC191770-2021
This is passed from the workflow when the invoice is filed.
Annual Fee* $ 100.00
Invoice Date* 9/1/2021
This is passed from the workflow when the invoice is filed.
https://edocs.deq.nc.gov/Forms/form/submission/history/63382/150973?hideHeader=true&show InstanceDetaiIs=false&fromInstances=true 1 /3

4/14/23, 4:06 PM 2021 Annual Fee Payment Verification for NCC191770-2021
Invoice Due Date* 10/1/2021
This is passed from the 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 Fee Payment Received or Not Applicable.
Received* Fee Payment NOT RECEIVED.
Date Payment 9/3/2021
Received * Or, if WAIVED or NOT RECEIVED, this is the date that status is recorded.
ePayment
Transaction
Number*
Check Number*
Fee Status * WAIVED
Legally Responsible Pete Hancock
Person (Orig.)
Original Permittee E- [e-mail]
mail*
CONFIRM Permittee [e-mail]
E-mail* Opportunity to modify problem e-mail address or permittee contact info
Original Site Contact
[e-mail]
E-mail*
CONFIRM Site
[e-mail]
Contact E-mail*
Opportunity to correct problem e-mail 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
https://edocs.deq.nc.gov/Forms/form/submission/history/63382/150973?hideHeader=true&showlnstanceDetails=false&frominstances=true 2/3

4/14/23, 4:06 PM
2021 Annual Fee Payment Verification for NCC191770-2021
Billing Telephone
No.
Permittee Email for
30-day Reminder
Site Contact Email
[e-mail]
This is the email for the 30-day reminder if needed (passed from workflow).
[e-mail]
for 30-day Reminder This is the email for the 30-day reminder if needed (passed from workflow)
Billing Contact Email This is the email for the 30-day reminder if needed (passed from workflow).
for 30-day Reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date* 9/3/2021
https://edocs.deq.nc.gov/Forms/form/submission/history/63382/150973?hideHeader=true&show InstanceDetaiIs=false&fromInstances=true 3/3