NCC191257_Annual Fee Payment Record_20210917

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 7/29/2021 5:51:13 PM (Workflow Start Event)
Submit by Selkane, Aziza 9/17/2021 8:23:22 AM (2021 Annual Fee Payment Verification for NCC191257-2021)
• Selkane, Aziza assigned the task to Selkane, Aziza 9/17/2021 8:22 AM
The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: September 9, 2021 5:00
PM 7/29/2021 5:51 PM

NORTH CAROLINA
Environmental Quvllty
Certificate of NCC191257
Coverage (COC) This is passed fromthe workflow when the invoice is filed.
No.*
NC Reference COC NCG01-2019-1257
No.*
Permit Status: Active
Year COC Issued 2019
This field will be hidden.
2020 Fee Status Check last year's fee status
PAST DUE
An older fee is PAST DUE and must be resolved before payment for this invoice can be accepted! If you
received a payment, apply it to last year's invoice first.
Project Name* Sugar Creek C-Store
Project Address* 1339 W. Sugar Creek Road, Charlotte, NC
Permittee * Mansa Travel Center Charlotte, LLC
County Mecklenburg
Invoice No.* NCC191257-2021
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.
Days Overdue 16
Wait at least 15 days until proceeding to NOD.
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 f Fee Payment Received or Not Applicable.
Received* r Fee Payment NOT RECEIVED.
Date Payment 9/17/2021
Received* Or, if WAN®or NOT FECBV®, this is the date that status is recorded.

e Payme nt
Transaction
Number*
Check Number*
Fee Status* PAST DUE
Legally Responsible Jay Shah
Person (Orig.)
Original Permittee E- [e-mail]
mail*
CONFIRM Permittee [e-mail]
E-mail * Opportunity to modify probleme-rrail address or permttee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail* Opportunity to correct probleme-Trail address or site contact info
Original Billing E- (It available)
mail
CONFIRM Billing E- Opportunity to correct probleme-nail address or billing contact info
mail
Billing Telephone
No.
Permittee Email for [e-mail]
30-day Reminder This is the email for the 30-day reminder if needed (passed fromworldlow).
Site Contact Email [e-mail]
for30-day Reminder This is theenailforthe3adayreninderifneeded (passed fromworldlow)
Billing Contact Email This is theenailforthe3t}dayreninderifneeded (passed fromworldlow).
for 30-day Reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 9/17/2021