NCG210321_Owner Affiliation Change Request_20210226

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 2/26/2021 10:06:34 AM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 3/4/2021 12:11:56 PM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 2/26/2021 10:06 AM

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Default Page
NPDES Permit
Enter your NPD6 storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG210321
NCS)00000(orNQG)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Jordan Geras
Phone Number*
Reaseenter your phone nunber
13364147047
Any format is fine.
Email Address *
Rease enter a valid e-rmil address
[e-mail]
A confirmation of submssion will be e-rrailed 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 "FbrnitCwnerAffiliation Designation Fornl'
Upload* Change request.pdf 115.03KB
pdf only

Initial Review
Project ID * Peviewer rmy revise perrrit nunber below if incorrect.
NCG210321