NCG020689_Owner Affiliation Change Request

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 8/31/2020 1:44:03 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 9/4/2020 8:55:32 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 8/31/2020 1:44 PM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG020689
NCS)00000(or NCC)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Jay Nivens
Phone Number*
Reaseenter your phone number
7044091475
Any format is fine.
Email Address *
Rease enter a valid a-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 Reaseupload the signed "FbrmitCwnerAffiliation Designation Forn1'
Upload* Alexander NPDES-Owner-Affiliation-Change-
637.48KB
20191104-DEMLR-SW. pdf
pdf only

Initial Review
Project ID * Reviewer may revise permt nunber below if incorrect.
NCG020689