NCC200134_Annual Fee Payment Record_20210107

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 1/1/2021 4:57:11 PM (Workflow Start Event)
Submit by Morman, Alaina 1/7/2021 3:55:57 PM (2021 Annual Fee Payment Verification for NCC200134-2021)
p NOT approved on 11712021.
• Morman, Alaina assigned the task to Morman, Alaina 1/7/2021 3:35 PM
The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: February 12, 2021 5:00
PM 1/1/2021 4:57 PM

SfA7$ q,
NORTH CAROLINA
Envlrmmentuf Quuftty
Certificate of NCC200134
Coverage (COC) This is passed fromtheworkflowwhen the invoice isfiled.
No. *
NC Reference COC NCG01-2020-0134
No.*
Permit Status: INACTIVE
Already Rescinded:
1/7/2021
This field appears if the pernit has already been terminated.
Year COC Issued
2020
This field will be hidden.
2020 Fee Status
Check last year's fee status
WAIVE FEE? *
r Yes, Payment Not Applicable
r No, Payment Still Applies
Project Name *
7-Eleven #1045904
Project Address* 234 Turnersburg Highway, Statesville, NC
Permittee * C4 CStore Holdings II, LLC
County Iredell
Invoice No. * NCC200134-2021
This is passed from the workflow when the invoice is filed.
Annual Fee * $ 100.00
Invoice Date * 1/4/2021
This is passed from the workflow when the invoice is filed.
Invoice Due Date* 2/4/2021
This is passed from the workflow 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.
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 Payme nt 1 /7/2021
Received* Or, if WAN®or NOTFECBV®, this is the date that status is recorded.

e Payme nt
Transaction
Number*
Check Number*
Fee Status* WAIVED
Legally Responsible Timothy Sittema
Person (Orig.)
Original Permittee E- [e-mail]
mail*
CONFIRM Permittee [e-mail]
E-mail * Opportunity to modify probleme-rrail address or permttee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail* Opportunity to correct probleme-rail address or site contact info
Original Billing E- (It available)
mail
CONFIRM Billing E- Opportunity to correct probleme-rail address or billing contact info
mail
Billing Telephone
No.
Permittee Email for [e-mail]
30-day Reminder This is the email for the 30-day rerinder if needed (passed fromworldlow).
Site Contact Email [e-mail]
for30-day Reminder This is the erailfor the 3adayreminder ifneeded (passed fromworldlow)
Billing Contact Email This is theerailforthe3t}dayrerinderifneeded (passed fromworldlow).
for 30-day Reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 1 /7/2021