NCG060264_Owner Affiliation Change Request_20210129

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 1/29/2021 12:55:03 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 2/4/2021 8:45:17 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 1/29/2021 12:55 PM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG060264
NCS)00000(or NCC)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Roy Bartlett Jr
Phone Number*
Reaseenter your phone nurrber
802.490.4996
Any format is fine.
Email Address *
Rease enter a valid a -mail address
BARTLETT. [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-Signed by Ron
73.61 KB
Matusiak 1.29.2021.pdf
pdt only

Initial Review
Project ID * Reviewer may revise perrrit nunber below if incorrect.
NCG060264