NCG060014_Owner Affiliation Change Request_20210719

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 7/19/2021 12:02:50 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 7/29/2021 4:42:30 PM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 7/19/2021 12:03 PM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (CCC) nunber.
Number*
NCG060014
NCS)00000(orNQG)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Pahola Salas
Phone Number*
Rease enter your phone nunber
9197232140
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 "Rarnit Cwner Affiliation Designation Forn1'
Upload* scan (4).pdf 1.13MB
pdf only

Initial Review
Project ID * Reviewer may revise permt nunber below if incorrect.
NCG060014