NCC190032_Annual Fee Payment Record_20201123

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 10/20/2020 9:48:12 AM (Workflow Start Event)
Submit by Selkane, Aziza 11/23/2020 9:34:37 AM (Annual Fee Payment Verification for NCC190032-2020)
Mike Bunch
• Selkane, Aziza assigned the task to Selkane, Aziza 11/23/2020 9:33 AM
The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: December 1, 2020 5:00
PM 10/20/2020 9:48 AM

NORTH CAROLINA
Environmental Quvllty
Certificate of
NCC190032
Coverage (COC)
This is passed fromtheworldlowwhen the invoice isfiled.
No.*
NC Reference COC
NCG01-2019-0032
No.*
Permit Status:
Active
Project Name*
CUNC Behavioral Health
Project Address*
407 Mulberry St, Lenoir, NC
Permittee *
Caldwell Memorial Hospital, Inc
County
Caldwell
Invoice No.*
NCC190032-2020
This is passed fromthe woMlow when the invoice is filed.
Annual Fee *
$ 100.00
Invoice Date*
10/20/2020
This is passed fromthe woMlow when the invoice is filed.
Invoice Due Date*
11/20/2020
This is passed fromthe worldlow when the invoice is filed.
An automated email reminder is sent to the permittee when the invoice is due. Wait until invoice is 15 days overdue
before proceeding to a Notice of Deficiency.
Days Overdue
3
Wait at least 15 days until proceeding to NOD.
Important: If you change the choice below to Payment NOT RECEIVED, the fee status becomes PAST DUE, and the
permittee will receive a Notice of Deficiency.
Annual Fee Payment r Fee Payment Received or Not Applicable.
Received*
r Fee Payment NOT RECEIVED.
Date Payment
11/23/2020
Received*
Or, if WAN®or NOT FECHV®, this is the date that status is recorded.
Method of Payment* r electronic
f check
f other
ePayment 545345337
Transaction
Number*
Fee Status* PAID

Legally Responsible Michael Bunch
Person (Orig.)
Original Permittee E- [e-mail]
mail *
CONFIRM Permittee [e-mail]
E-mail * Opportunity to rrndify probleme-nail address or perrrittee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail * Opportunity to correct problem e-mail address or site contact info
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 11/23/2020