NCS000251_Owner Affiliation Change Request_20210608

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/8/2021 2:33:06 PM (Ovvner Affiliation Change Submission)
App— by McCoy, Suzanne 6/10/2021 11:44:41 AM (Notification to Admin)
* The task was assigned to McCoy, Suzanne 6/8/2021 2:33 PM

N PTHCARCLINA
E.k.-MI Q..ftty
Default Page
NPDES Permit
Enter your MPDES storrrw ater pernit nunber or Certificate of Coverage (00C) nunber.
Number*
NCS000251
NCS)00000(or NCG)00000(
Submittor's Name*
Flease enter your FIRST and LAST narre
Tim Riddick
Phone Number
Rease enter your phone nurrber
252-585-3819
Any forn-at is f ine.
Email Address
Rease enter a valid e-ryail address
[e-mail]
A conf irn-ation of subnission w ill be e-rnailed 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 "Perrrit Cwner Affiliation Designation Forn1'
Upload* SW Permit Owner Affiliation Designation Form - 692.78KB
RD--,Signed.pdf
pdf only

Initial Review
Project 1D* Review er may revise pernit nunber below if incorrect.
NCS000251