NCG060022_Owner Affiliation Change Request_20210608

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/8/2021 2:13:09 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 6/10/2021 10:06:22 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 6/8/2021 2:13 PM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG060022
NCS)00000(or NCC)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Kevin Haynes
Phone Number*
Rease enter your phone nurrber
7045462602
Any format is fine.
Email Address *
Rease enter a valid e-rmil address
[e-mail]
A confirmation of submission 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 "FbrrritC,vnerAffiliation Designation Forn1'
Upload* NPDES-Owner-Affiliation-Change-20191104-
649.2KB
DEMLR-SW.pdf
pdt only

Initial Review
Project ID * Reviewer may revise permt nunber below if incorrect.
NCG060022