NCC215471_NOI 66956 Payment Verification_20211001

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/29/2021 5:21:42 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 9/30/2021 8:00:01 AM (Review- Construction NOI 66956)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 9/29/2021 5:22 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 1, 2021 5:00
PM 9/29/2021 5:22 PM
Submit by Evans, Shaundra M 10/1/2021 9:54:04 AM (Payment Verification for NCC215471)
* David Dohr
• Evans, Shaundra M assigned the task to Evans, Shaundra M 10/1/2021 9:53 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 11, 2021 5:00
PM 9/30/2021 8:00 AM

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VerificationPayrmnt
NORTH CAROLINA
Environmental Quvllly
Project Name
Wayne Memorial Hospital
Lot Numbers
(If listed on the eNOI)
NC Reference No.*
NCG01-2021-5471
Certificate of
NCC215471
Coverage (COC)
No.*
Invoice Date
9/30/2021
Initial Invoice No.
NCC215471-2021
Initial Fee
$ 100.00
Invoice Due Date
10/30/2021
Important: If you change
the choice below to Payment NOT RECEIVED, the application will be rejected, and a COC will
not be issued. This is the ONLY way to reject an eNOI at this step.
Payment Received* r Payment Received.
f Payment NOT RECEIVED.
Payment Status
PAID
Date Payment
10/1 /2021
Received*
(Or, if not received, date rejected for no payrrent)
Method of Payment*
r electronic
f check
f Other
ePayment
595298672
Transaction
Number*
NOI Tracking No.
66956
Tracking ID referenced upon subrrittal
This is an Express
r No
Review Project
r Yes
Project Tracking ID
NCC-WAYNE-2021-Wayne Memorial Hospital