NCS000346_Owner Affiliation Change Request_20201201

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 12/1/2020 10:08:09 AM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 12/2/2020 10:38:55 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 12/1/2020 10:08 AM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCS000346
NCS)00000(or NCC)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Stephanie Ellis
Phone Number*
Reaseenter your phone nurrber
336-786-2141x3012
Any format is fine.
Email Address *
Rease enter a valid e-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 Rease upload the signed "Permit C,vner Affiliation Designation Forn1'
Upload* NPDES-Owner-Affiliation-Change-20191104-
1.17MB
DEMLR-SW - NCW Updates 20201201 - Signed.pdf
pdt only

Initial Review
Project ID * Reviewer may revise permt nunber below if incorrect.
NCS000346