NCC200074_Annual Fee Payment Record_20210218

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 1/1/2021 4:55:36 PM (Workflow Start Event)
Submit by Morman, Alaina 2/18/2021 5:35:40 PM (2021 Annual Fee Payment Verification for NCC200074-2021)
p NOT approved 2/18/2021.
• Morman, Alaina assigned the task to Morman, Alaina 2/18/2021 3:38 PM
The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: February 12, 2021 5:00
PM 1/1/2021 4:55 PM

NORTH CAROLINA
Environmental Quvllty
Certificate of NCC200074
Coverage (COC) This is passed fromtheworkflowwhen the invoice isfiled.
No.*
NC Reference COC NCG01-2020-0074
No.*
Permit Status: INACTIVE
Already Rescinded:
2/18/2021
This field appears if the permt has already been termnated.
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
f No, Payment Still Applies
Project Name *
CIRCLE K - R&R 2723188
Project Address* 1065 BETHANIA-RURAL HALL ROAD, RURAL HALL, NC
Permittee * CIRCLE K STORES, INC
County Forsyth
Invoice No. NCC200074-2021
This is passed fromthe 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.
Days Overdue 14
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 2/18/2021
Received * Or, if WANBD or NOT FECBV®, this is the date that status is recorded.

e Payme nt
Transaction
Number*
Check Number*
Fee Status* WAIVED
Legally Responsible WILL RICE, JR
Person (Orig.)
Original Permittee E- [e-mail]
mail *
CONFIRM Permittee [e-mail]
E-mail * Opportunity to rrodify probleme-rrail address or perrrittee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail * Opportunity to correct problem e-rrail address or site contact info
Original Billing E- (If available)
mail
CONFIRM Billing E- Opportunity to correct probleme-nail address or billing contact info
mail
Billing Telephone
No.
Permittee Email for [e-mail]
30-day Reminder This is the mail for the 30-day rerrinder if needed (passed fromworldlow).
Site Contact Email [e-mail]
for 30-day Reminder This is the mail for the 30-day reminder if needed (passed fromworldlow)
Billing Contact Email This is theenailforthe30-dayreninderifneeded (passed fromworldlow).
for 30-day Reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 2/18/2021