NCC224057_NOI 117735 Payment Verification_20221209

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/7/2022 1:40:57 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 12/8/2022 6:41:42 AM (Review - NOI 117735 Lots @ Laboratory: Carolina Elite)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 12/7/2022 1:41 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: December 12, 2022 5:00
PM 12/7/2022 1:41 PM
by Workflow 12/8/2022 6:41:51 AM (Workflow Start Event)
Submit by Holloman, Tevye L 12/9/2022 9:39:34 AM (Payment Verification for NCC224057)
* Igor Shiper
Holloman, Tevye L assigned the task to Holloman, Tevye L 12/9/2022 9:37 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: January 19, 2023 5:00 PM
12/8/2022 6:41 AM

5 A7
Payment Verification
NORTH CAROLINA
Envlrmmm(af Quafhy
Project Name
Lots @ Laboratory: Carolina Elite
Lot Numbers
(If listed on the eNOI)
Lot # 1, Lot # 2, Lot # 3, Lot # 4, Lot # 5, Lot # 6, Lot # 7, Lot # 8, Lot # 9
NC Reference No.*
NCG01-2022-4057
Certificate of
NCC224057
Coverage (COC) No.*
Invoice Date
12/8/2022
Initial Invoice No.
NCC224057-2022
Initial Fee
$ 100.00
Invoice Due Date
1/7/2023
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
12/9/2022
Received *
(Or, if not received, date rejected for no payment)
Method of Payment*
• electronic
check
Other
ePayment
666027142
Transaction Number*
NOI Tracking No.
117735
Tracking ID referenced upon submittal
This is an Express
• No
Review Project
Yes
Project Tracking ID
NCC-LINCO-2022-1-ots @ Laboratory: Carolina Elite