NCC215568_NOI 67960 Payment Verification_20211007

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 10/5/2021 2:32:24 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 10/6/2021 8:06:49 AM (Review- Construction NOI 67960)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 10/5/2021 2:33 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 7, 2021 5:00
PM. The priority is: High 10/5/2021 2:33 PM
Submit by Evans, Shaundra M 10/7/2021 8:25:05 AM (Payment Verification for NCC215568)
* Daniel Shelton
• Evans, Shaundra M assigned the task to Evans, Shaundra M 10/7/2021 8:24 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 17, 2021 5:00
PM. The priority is: High 10/6/2021 8:07 AM

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NORTH CAROLINA
Environmental Quvllty
Project Name Sentara Albemarle Medical Center - Phase 1 Medical Office Building
Lot Numbers (If listed on the eNOI)
NC Reference No.* NCG01-2021-5568
Certificate of NCC215568
Coverage (COC)
No.*
Invoice Date 10/6/2021
Initial Invoice No. NCC215568-2021
Initial Fee $ 100.00
Invoice Due Date 11/5/2021
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 10/7/2021
Received* (Or, if not received, date rejected for no payrrent)
Method of Payment* r electronic
f check
f Other
ePayment 596367582
Transaction
Number*
NOI Tracking No. 67960
Tracking ID referenced upon subrrittal
This is an Express f No
Review Project r Yes
Project Tracking ID NCC-PASQU-2021-Sentara Albemarle Medical Center - Phase 1 Medical Office
Building