NCC192278_Annual Fee Payment Record_20211005

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 9/30/2021 1:22:09 PM (Workflow Start Event)
Submit by Evans, Shaundra M 10/5/2021 10:28:27 AM (2021 Annual Fee Payment Verification for NCC192278-
2021)
p Mike Hill
• Evans, Shaundra M assigned the task to Evans, Shaundra M 10/5/2021 10:27 AM
The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: November 11, 2021 5:00
PM 9/30/2021 1:22 PM

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s
Li Annuai i�ee
NORTH cAROLINA
Environmental Quvllty
Certificate of
NCC192278
Coverage (COC)
This is passed fromthe workflow when the invoice is filed.
No.*
NC Reference COC
NCG01-2019-2278
No.*
Permit Status:
Active
Year COC Issued
2019
This field will be hidden.
2020 Fee Status
Check last year's fee status
PAID
Project Name*
Sam's Xpress Car Wash - Harrisburg
Project Address*
NC Hwy 49, Harrisburg, NC
Permittee *
Sam's Investments II, LLC
County
Cabarrus
Invoice No.*
NCC192278-2021
This is passed fromthe workflow when the invoice is filed.
Annual Fee *
$ 100.00
Invoice Date*
10/1/2021
This is passed fromthe workflow when the invoice is filed.
Invoice Due Date*
11/1/2021
This is passed fromthe workflow when the invoice is filed.
An automated email reminder is sent to the permittee when the invoice is due. Wait until invoice is 15 days overdue
before proceeding to a Notice of Deficiency.
Important: If you change the choice below to Payment NOT RECEIVED, the fee status becomes PAST DUE, and the
permittee will receive a Notice of Deficiency.
Annual Fee Payment r Fee Payment Received or Not Applicable.
Received* r Fee Payment NOT RECEIVED.
Date Payment 10/5/2021
Received* Or, if WAN® or NOT FECBV®, this is the date that status is recorded.
Method of Payment* r electronic
f check
f other

ePayment 596031688
Transaction
Number*
Fee Status* PAID
Legally Responsible Chris Morgan
Person (Orig.)
Original Permittee E- [e-mail]
mail *
CONFIRM Permittee [e-mail]
E-mail * Opportunity to modify probleme-nail address or perrrittee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail * Opportunity to correct probleme-nail address or site contact info
Original Billing E- (If available)
mail
CONFIRM Billing E- Opportunity to correct problem e-mail address or billing contact info
mail
Billing Telephone
No.
Permittee Email for [e-mail]
30-day Reminder This is the errail for the 3t}day reminder if needed (passed fromworldlow).
Site Contact Email [e-mail]
for 30-day Reminder This is the errail for the 3aday reminder if needed (passed fromworldlow)
Billing Contact Email This is theerrail for the 3aday reminder if needed (passed fromworldlow).
for 30-day Reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 10/5/2021