NCG060405_Owner Affiliation Change Request_20210625

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/25/2021 2:07:42 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 7/1/2021 9:25:13 AM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 6/25/2021 2:08 PM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG060405
NCS)00000(or NCC)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Brigette Tinsley
Phone Number*
Rease enter your phone nurrber
980-900-2791
Any format is fine.
Email Address *
Rease enter a valid a -mail address
[e-mail]
A confirmation of submission 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 C,vner Affiliation Designation Forn1'
Upload* NCG060405_Legal Responsible Update.pdf 1.83MB
pdf only

Initial Review
Project ID * Reviewer may revise permt nunber below if incorrect.
NCG060405