NCC223623_NOI 109737 Payment Verification_20221021

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/20/2022 8:18:55 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 10/20/2022 8:42:19 AM (Review - NOI 109737 Rolesville Dental Office)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 10/20/2022 8:19 AM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 25, 2022 5:00
PM 10/20/2022 8:19 AM
by Workflow 10/20/2022 8:42:28 AM (Workflow Start Event)
Submit by Holloman, Tevye L 10/21/2022 8:23:58 AM (Payment Verification for NCC223623)
F Jamie Linenberg
Holloman, Tevye L assigned the task to Holloman, Tevye L 10/21/2022 8:23 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 1, 2022 5:00 PM
10/20/2022 8:42 AM

STA—
NORTH CAROLINA
Environmental Quallty
Project Name Rolesville Dental Office
Lot Numbers (If listed on the eNOI)
NC Reference No.* NCG01-2022-3623
Certificate of NCC223623
Coverage (COC) No.*
Invoice Date 10/20/2022
Initial Invoice No. NCC223623-2022
Initial Fee $ 100.00
Invoice Due Date 11/19/2022
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 10/21/2022
Received * (Or, if not received, date rejected for no payment)
Method of Payment* electronic
check
Other
ePayment 658775197
Transaction Number*
NOI Tracking No. 109737
Tracking ID referenced upon submittal
This is an Express No
Review Project Yes
Project Tracking ID NCC-WAKE-2023-Rolesville Dental Office