NCG030004_Owner Affiliation Change Request_20200522

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 5/22/2020 10:19:01 AM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 5/26/2020 3:42:01 PM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 5/22/2020 10:19 AM

1 S
�i.
mnvV��
NORTH CARCLINA
Emlmnm MI Quat<ty
Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG030004
NCS)00000(or NCC)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Lily Hans
Phone Number*
Reaseenter your phone nurrber
7049165739
Any format is fine.
Email Address *
Rease enter a valid a -mail 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 Owner Affiliation Designation Forn1'
Upload* Signed NPDES-Owner-Affiliation-Change-
1.15MB
05.22.2020-DEMLR-SW. pdf
pdf only

Initial Review
Project ID * Peviewer rmy revise perrrit nunber below if incorrect.
NCG030004