NCG060003_Owner Affiliation Change Request_20210629

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/29/2021 8:55:19 AM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 7/15/2021 6:36:32 PM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 6/29/2021 8:55 AM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG060003
NCS)00000(or NCGX)0000C
Submittor's Name*
Reaseenter your FIRST and LAST narre
Brian Dearman
Phone Number*
Rease enter your phone nurrber
336-878-4339
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 C,vner Affiliation Designation Forn1'
Upload* NPDES-Owner-Affiliation-Change-20191104-
110.85KB
DEMLR-SW (signed).pdf
pdt only

Initial Review
Project ID * Reviewer may revise permt nunber below if incorrect.
NCG060003