NCG120082_Owner Affiliation Change Request_20210615

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/15/2021 11:40:09 AM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 6/28/2021 9:01:27 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 6/15/2021 11:40 AM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG120082
NCS)00000(or NCC)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Rebecca Shook
Phone Number*
Rease enter your phone nurrber
8286492311
Any format is fine.
Email Address *
Rease enter a valid a-rrail address
[e-mail]
A confirmation of subrrission 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* D00061521 storm water 9ermit-
65.54KB
06152021113628.pdf
pdt only

Initial Review
Project ID * Peviewer rmy revise perrrit nunber below if incorrect.
NCG120082