NCG060174_Owner Affiliation Change Request_20210614

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/14/2021 12:05:32 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 6/28/2021 8:57:23 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 6/14/2021 12:05 PM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG060174
NCS)00000(or NCC)00000(
Submittor's Name*
Please enter your FIRST and LAST narre
Tina Pedley
Phone Number*
Rease enter your phone nurrber
9198953457
Any format is fine.
Email Address *
Rease enter a valid e-rmil 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 "FbrrritOwner Affiliation Designation Forn1'
Upload* permit owner174.pdf 68.18KB
pdf only

Initial Review
Project ID * Peviewer rmy revise perrrit nunber below if incorrect.
NCG060174