NCG030170_Owner Affiliation Change Request_20210706

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 7/6/2021 3:58:02 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 7/15/2021 6:51:10 PM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 7/6/2021 3:58 PM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG030170
NCS)00000(or NCC)00000(
Submittor's Name*
Rease enter your FIRST and LAST narre
Brian Freeman
Phone Number*
Rease enter your phone number
7044716550
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 "FbrmitCwner Affiliation Designation Form'
Upload* Permit Owner Affliation Designation Form.pdf 415.72KB
pdr only

Initial Review
Project ID * Peviewer rmy revise perrrit nunber below if incorrect.
NCG030170