NCG080715_Owner Affiliation Change Request_20210723

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 7/23/2021 1:05:26 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 7/29/2021 4:50:21 PM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 7/23/2021 1:05 PM

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Default Page
NPDES Permit
Enter your NPD6 storrrwater pernit nunber or Certificate of Coverage (CCC) nunber.
Number*
NCG080715
NCS)00000(or NCC)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Jorge Carrasco
Phone Number*
Reaseenter your phone number
9102416302
Any format is fine.
Email Address *
Rease enter a valid a -mail address
[e-mail]
A confirmation of submssion will be e-rrailed 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 "FbrmitCwnerAffiliation Designation Forn1'
Upload* Owner Affiliation Change Signed 07232021.pdf 641.16KB
pdf only

Initial Review
Project ID * Peviewer rmy revise perrrit nunber below if incorrect.
NCGO80715