NCC230293_NOI 125519 Payment Verification_20230202

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/31/2023 11:19:44 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 2/1/2023 6:53:21 AM (Review - NOI 125519 Sam's Xpress Car Wash - High Point,
NC)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 1/31/2023 11:20 AM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: February 3, 2023 5:00
PM 1/31/2023 11:20 AM
by Workflow 2/1/2023 6:53:29 AM (Workflow Start Event)
Submit by Holloman, Tevye L 2/2/2023 11:19:35 AM (Payment Verification for NCC230293)
F Matthew Parker
• Holloman, Tevye L assigned the task to Holloman, Tevye L 2/2/2023 11:18 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: March 15, 2023 5:00 PM
2/1/2023 6:53 AM

STA—
NORTH CAROLINA
Environmental Quallty
Project Name Sam's Xpress Car Wash - High Point, NC
Lot Numbers (If listed on the eNOI)
Part of Lot 1
NC Reference No.* NCG01-2023-0293
Certificate of NCC230293
Coverage (COC) No.*
Invoice Date 2/1/2023
Initial Invoice No. NCC230293-2023
Initial Fee $ 100.00
Invoice Due Date 3/3/2023
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 2/2/2023
Received * (Or, if not received, date rejected for no payment)
Method of Payment* • electronic
check
Other
ePayment 674340441
Transaction Number*
NOI Tracking No. 125519
Tracking ID referenced upon submittal
This is an Express • No
Review Project Yes
Project Tracking ID NCC-GUILF-2023-Sam's Xpress Car Wash - High Point, NC