NCG060265_Owner Affiliation Change Request_20220216

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 2/16/2022 2:55:54 PM (Owner Affiliation Change Submission)
Approve by Tran, Kieu M 3/14/2022 7:55:09 AM (Review Assigned to Admin)
* Owner Affiliation has been updated in BIMS 3/14/2022
• Georgoulias, Bethany A reassigned the task to Tran, Kieu M 3/11/2022 9:32 AM
• The task was assigned to DEMLR SW Admin 2/16/2022 2:56 PM

Default Page
N PDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage (COC) number.
Number* NCG060265
Begins with NCS, NCG, or NCGNE (no exposure)
Submittor's Name* Please enter your FIRST and LAST name
AMILCAR GALICIA
Phone Number* Please enter your phone number
5702005611
Any format is fine.
Email Address* Please enter a valid e-mail address
[e-mail]
A confirmation of submission will be e-mailed to this address.
Upload a copy of the completed and signed Permit Owner Affiliation Designation Form below. Please note that you must
mail in the original signed copy to our office (see instructions on that form), in accordance with requirements in
40 CFR 122.22.
Questions? Contact [e-mail].
Completed Form Please upload the signed "Permit Owner Affiliation Designation Form"
Upload* Owner Affiliation.pdf 219.11 KB
pdf only

Initial Review
Project ID * Reviewer may revise permit number below if incorrect.
NCG060265