NCG030134_Owner Affiliation Change Request_20200221

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 2/21/2020 9:05:54 AM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 2/27/2020 11:10:58 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 2/21/2020 9:05 AM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG030134
NCS)00000(orNQG)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Jeremy Putnam
Phone Number*
Rease enter your phone nurrber
8286582845
Any format is fine.
Email Address *
Rease enter a valid e-rrail address
[e-mail]
A confirmation of submssion will be e-mailed to this address.
Need a copy of the Permit Owner Affiliation Designation Form? You must upload a signed copy of that form below.
Questions? Call Bethany Georgoulias at [phone] or e-mail her at.bethany.georgouliasencdenr.gov.
Completed Form Rease upload the signed "Permit Cwner Affiliation Designation Forn1'
Upload* NPDES Owner Affiliation Change Signed.pdf 65.88KB
pdf only

Initial Review
Project ID * Peviewer rmy revise perrrit nunber below if incorrect.
NCG030134