NCC213968_NOI 58355 Payment Verification_20210707

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 7/6/2021 8:56:57 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 7/6/2021 9:00:11 AM (Review- Construction NOI 58355)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 7/6/2021 8:57 AM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: July 8, 2021 5:00 PM
7/6/2021 8:57 AM
Submit by Selkane, Aziza 7/7/2021 11:46:48 AM (Payment Verification for NCC213968)
* Richard Baker
• Selkane, Aziza assigned the task to Selkane, Aziza 7/7/2021 11:45 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: August 17, 2021 5:00 PM
7/6/2021 9:00 AM

�.• �,+STA7E o�
VerificationPayrmnt
NORTH CAROLINA
Environmental Quvllly
Project Name
Circle K - NTI Cabin Jacksonville - NC.114
Lot Numbers
(If listed on the eNOI)
NC Reference No.*
NCG01-2021-3968
Certificate of
NCC213968
Coverage (COC)
No.*
Invoice Date
7/6/2021
Initial Invoice No.
NCC213968-2021
Initial Fee
$ 100.00
Invoice Due Date
8/5/2021
Important: If you change
the choice below to Payment NOT RECEIVED, the application will be rejected, and a COC will
not be issued. This is the ONLY way to reject an eNOI at this step.
Payment Received* r Payment Received.
f Payment NOT RECEIVED.
Payment Status
PAID
Date Payment
7/7/2021
Received*
(Or, if not received, date rejected for no payrrent)
Method of Payment*
r electronic
f check
f Other
ePayment
580742216
Transaction
Number*
NOI Tracking No.
58355
Tracking ID referenced upon subrrittal
This is an Express
r No
Review Project
r Yes
Project Tracking ID
NCC-ONSLO-2021-Circle K- NTI Cabin Jacksonville - NC.114