NCG120072_Owner Affiliation Change Request_20210624

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/24/2021 9:59:41 AM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 7/1/2021 8:42:30 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 6/24/2021 9:59 AM

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Default Page
NPDES Permit
Enter your NPIDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG120072
NCS)00000(orNQG)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Caroline LaFave
Phone Number*
Reaseenter your phone nurrber
9197389583
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 Rease upload the signed "Permit Owner Affiliation Designation Forn'
Upload* Permit Owner Affiliation Designation Form_-
503KB
20191104-DEMLR-SW SIGNED 06232021.pdf
pdt only

Initial Review
Project ID * Peviewer rmy revise perrrit nunber below if incorrect.
NCG120072