NCC222807_NOI 101291 Payment Verification_20220808

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/4/2022 1:11:47 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 8/5/2022 7:01:03 AM (Review - NOI 101291 Pinehurst Surgical - 3 North)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 8/4/2022 1:12 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: August 9, 2022 5:00 PM
8/4/2022 1:12 PM
by Workflow 8/5/2022 7:01:08 AM (Workflow Start Event)
Submit by Tran, Kieu M 8/8/2022 9:25:43 AM (Payment Verification for NCC222807)
F Pinehurst Surgical Clinic Accounts Payable
• Tran, Kieu M assigned the task to Tran, Kieu M 8/8/2022 9:25 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: September 16, 2022 5:00
PM 8/5/2022 7:01 AM

VerificationPayment
NORTH CAROLINA
Environmental Quallty
Project Name
Pinehurst Surgical - 3 North
Lot Numbers
(If listed on the eNOI)
205 Pavillon
NC Reference No.*
NCG01-2022-2807
Certificate of
NCC222807
Coverage (COC) No.*
Invoice Date
8/5/2022
Initial Invoice No.
NCC222807-2022
Initial Fee
$ 100.00
Invoice Due Date
9/4/2022
Important: If you change the choice below to Payment NOT RECEIVED, the application will be rejected, and a COC will
not be issued. This is the ONLY way to reject an eNOI at this step.
Payment Received*
Payment Received.
Payment NOT RECEIVED.
Payment Status
PAID
Date Payment
8/8/2022
Received *
(Or, if not received, date rejected for no payment)
Method of Payment*
• electronic
check
Other
ePayment
646926188
Transaction Number*
NOI Tracking No.
101291
Tracking ID referenced upon submittal
This is an Express
• No
Review Project
Yes
Project Tracking ID
NCC-MOORE-2022-Pinehurst Surgical - 3 North