NCG030704_Owner Affiliation Change Request_20210625

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 6/25/2021 4:44:06 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 6/28/2021 8:51:59 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 6/25/2021 4:44 PM

1 S
�i.
mnvV��
NORTH CARCLINA
Emlmnm MI Quat<ty
Default Page
NPDES Permit
Enter your NPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG030704
NCS)00000(or NCC)00000(
Submittor's Name*
Rease enter your FIRST and LAST narre
Tyler Miles
Phone Number*
Rease enter your phone nurrber
919-846-7492
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 "R=rrrit Cwner Affiliation Designation Forn1'
Upload* NPDES Owner Affiliation Change Form DuBose NES
77.25KB
307 location signed 6.25.21.pdf
pdt only

Initial Review
Project ID * Peviewer rmy revise perrrit nunber below if incorrect.
NCG030704