NCG050218_Owner Affiliation Change Request_20200708

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/8/2020 3:25:29 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 7/16/2020 8:55:33 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 7/8/2020 3:25 PM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG050218
NCS)00000(orNQG)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Teddy Fayst
Phone Number*
Rease enter your phone nurrber
7322723733
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 Reaseupload the signed "FbrrritC,vnerAffiliation Designation Forn1'
Upload* NPDES-Owner-Affiliation-Change-Signed.pdf 108.44KB
pdf only

Initial Review
Project ID * Peviewer rmy revise perrrit nunber below if incorrect.
NCG050218