NCC200814_Annual Fee Payment Record_20210312

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 1/29/2021 2:22:25 PM (Workflow Start Event)
Submit by Selkane, Aziza 3/12/2021 6:31:03 AM (2021 Annual Fee Payment Verification for NCC200814-2021)
* Cone Health
• Selkane, Aziza assigned the task to Selkane, Aziza 3/12/2021 6:30 AM
The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: March 12, 2021 5:00
PM 1/29/2021 2:22 PM

C �
s
Li Annuai i�ee
NORTH cAROLINA
Environmental Quvllty
Certificate of
NCC200814
Coverage (COC)
This is passed fromthe workflow when the invoice is filed.
No.*
NC Reference COC
NCG01-2020-0814
No.*
Permit Status:
Active
Year COC Issued
2020
This field will be hidden.
2020 Fee Status
Check last year's fee status
Project Name*
Womens Outpatient Center
Project Address*
930 Third Street, Greensboro, NC
Permittee *
Cone Health
County
Guilford
Invoice No.*
NCC200814-2021
This is passed fromthe workflow when the invoice is filed.
Annual Fee *
$ 100.00
Invoice Date*
2/1/2021
This is passed fromthe workflow when the invoice is filed.
Invoice Due Date*
3/1/2021
This is passed fromthe 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 11
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 3/12/2021
Received* Or, if WAN®or NOT FECBV®, this is the date that status is recorded.
Method of Payment* r electronic
r check
f other
Check Number* 2089186

Fee Status* PAID
Legally Responsible Ronald Galloway
Person (Orig.)
Original Permittee E- [e-mail]
mail *
CONFIRM Permittee [e-mail]
E-mail * Opportunity to rrodify probleme-nail address or perrrittee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail * Opportunity to correct probleme-msil address or site contact info
Original Billing E- (If available)
mail
CONFIRM Billing E- Opportunity to correct problem e-mail address or billing contact info
mail
Billing Telephone
No.
Permittee Email for [e-mail]
30-day Reminder This is the errail for the 3t}day rer finder if needed (passed fromworldlow).
Site Contact Email [e-mail]
for 30-day Reminder This is the errail for the 3t}day rerrinder if needed (passed fromworldlow)
Billing Contact Email This is theerrail for the 30-day rerrinder if needed (passed fromworldlow).
for 30-day Reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 3/12/2021