NCG100079_Owner Affiliation Change Request_20210623

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/23/2021 4:11:11 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 7/1/2021 8:32:16 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 6/23/2021 4:11 PM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG100079
NCS)00000(or NCC)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Debbie Lassiter
Phone Number*
Reaseenter your phone nunber
19192426154
Any format is fine.
Email Address *
Rease enter a valid a -mail 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 "FbrnitCwnerAffiliation Designation Fornl'
Upload* EPA# 1.pdf 926.92KB
EPA # 2.pdf 660.51 KB
pdt only

Initial Review
Project ID * Peviewer rmy revise perrrit nunber below if incorrect.
NCG100079