NCG080939_Owner Affiliation Change Request_20210218

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 2/18/2021 3:38:01 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 2/19/2021 8:32:48 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 2/18/2021 3:38 PM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCGO80939
NCS)00000(or NCG00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Tiffanee Grumbly
Phone Number*
Reaseenter your phone nurrber
9048612819
Any format is fine.
Email Address *
Rease enter a valid a-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 Reaseupload the signed "FbrrritOwner Affiliation Designation Forn1'
Upload* CWA NC_Bostic NCG080939_sig update
325.64KB
021821.pdf
pdt only

Initial Review
Project ID * Peviewer nay revise perrrit nunber below if incorrect.
NCGO80939