NCG100095_Owner Affiliation Change Request_20210526

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 5/26/2021 2:23:18 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 5/27/2021 3:19:41 PM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 5/26/2021 2:23 PM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG100095
NCS)00000(or NCC)00000(
Submittor's Name*
Please enter your FIRST and LAST narre
Brandon Walsh
Phone Number*
Reaseenter your phone nurrber
615-477-9833
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 Rease upload the signed "Permit Owner Affiliation Designation Forn1'
Upload* 2021 1168 NPDES Owner Affiliation Change -
195.41 KB
Signed.pdf
pdt ony

Initial Review
Project ID * Peviewer rmy revise perrrit nunber below if incorrect.
NCG100095