NCG170228_Owner Affiliation Change Request_20210331

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 3/31/2021 9:18:58 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 4/15/2021 8:58:06 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 3/31/2021 9:19 PM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (CCC) nunber.
Number*
NCG170228
NCS)00000(or NCC)OOWO(
Submittor's Name*
Please enter your FIRST and LAST narre
Laval Choiniere
Phone Number*
Reaseenter your phone number
336.312.3611
Any format is fine.
Email Address *
Rease enter a valid a -mail 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 "FbrmitCwnerAffiliation Designation Forn1'
Upload* Burlington Legal Resp.pdf 700.12KB
pdr only

Initial Review
Project ID * Reviewer may revise perrrit nunber below if incorrect.
NCG170228