NCG160232_Owner Affiliation Change Request_20210317

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/17/2021 3:15:52 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 3/19/2021 11:17:07 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 3/17/2021 3:16 PM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG160232
NCS)00000(or NCC)00000(
Submittor's Name*
Please enter your FIRST and LAST narre
James Washburn
Phone Number*
Rease enter your phone nurrber
2522905912
Any format is fine.
Email Address *
Rease enter a valid e-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 "Permit C,vner Affiliation Designation Forn1'
Upload* NPDES-Owner-Affiliation-Change-20191104-
650.76KB
DEMLR-SW.pdf
pdt only

Initial Review
Project ID * Reviewer may revise perrrit nunber below if incorrect.
NCG160232