NCG080774_Owner Affiliation Change Request_20210218

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 2/18/2021 3:53:38 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 2/19/2021 8:40:10 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 2/18/2021 3:53 PM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG080774
NCS)00000(or NCC)00000(
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 Rease upload the signed "R=rrrit CWner Affiliation Designation Forn1'
Upload* CWA NC_Charlotte_NCG080774_sig update
325.66KB
021821.pdf
pdf only

Initial Review
Project ID * Peviewer rmy revise perrrit nunber below if incorrect.
NCGO80774