NCG120110_Owner Affiliation Change Request_20210628

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/28/2021 4:10:55 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 7/29/2021 4:36:25 PM (Notification to Admin)
* need to consolidate Owners
• The task was assigned to McCoy, Suzanne 6/28/2021 4:11 PM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG120110
NCS)00000(or NCC)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Dave Sanders
Phone Number*
Reaseenter your phone nunber
478-743-7175
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 Reaseupload the signed "FbrnitC,vnerAffiliation Designation Fornl'
Upload* Shotwell LF -Owner Affiliation Designation Form.pdf 1.7MB
pdr only

Initial Review
Project ID * Peviewer rmy revise perrrit nunber below if incorrect.
NCG120110