NCG120043_Owner Affiliation Change Request_20210909

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/9/2021 10:57:35 AM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 10/6/2021 2:45:19 PM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 9/9/2021 10:58 AM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG120043
NCS)00000(or NCC)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Richard Hill
Phone Number*
Reaseenter your phone nurrber
[phone]
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 "FbrrritC,vnerAffiliation Designation Forn1'
Upload* NPDES-Owner-Affiliation-Change-20191104-
414.39KB
DEMLR-SW signed.pdf
pdt only

Initial Review
Project ID * Peviewer rmy revise perrrit nunber below if incorrect.
NCG120043