NCS000236_Owner Affiliation Change Request_20201130

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 11/30/2020 3:36:57 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 12/2/2020 10:34:34 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 11/30/2020 3:37 PM

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Default Page
NPDES Permit Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number* NCS000236
NCS)00000(or NCC)00000(
Submittor's Name* Reaseenter your FIRST and LAST narre
Randall F. Andrews
Phone Number* Rease enter your phone nurrber
9108432121
Any format is fine.
Email Address * Rease enter a valid a-rrail address
[e-mail]
A confirmation of submission 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 "Fbrrrit CWner Affiliation Designation Forn1'
Upload* NPDES Permit Name_Ownership Change
75.56KB
Request.pdf
pdt only

Initial Review
Project ID * Reviewer may revise permt nunber below if incorrect.
NCS000236