NCG030492_Permit Contact Update Request_20220304

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 3/4/2022 9:02:07 AM (Permit Contact Update Request)
Approve by Georgoulias, Bethany A 3/4/2022 9:58:20 AM (Contact Update Review)
* Corrected typo in permit number (NGC -> NCG). Did not provide complete address, but it was the
same street address as the company owner. Updated Facility Contact in BIMS on 3/4/2022, and
confirmed via email that Billing Contact also needs to be updated to same person. Reviewer will alert
SW Prog Billing Specialist.
The task was assigned to Georgoulias, Bethany A. The due date is: April 15, 2022 5:00 PM
3/4/2022 9:02 AM

Georgoulias, Bethany
From: Sayers, Mike <[e-mail]>
Sent: Friday, March 4, 2022 9:45 AM
To: Georgoulias, Bethany
Subject: [External] Re: Permit Contact Update Request for NGC030492 - Billing Contact?
Attachments: image001 jpg; NCG030492 Permit Summary Report.pdf
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Report Spam.
Please replace Michael Ellington with myself. He has retired
I will also be the billing contact. I see we owe $100.00 so I want to get that paid
Thanks
Michael Sayers
Sent from my iPhone
On Mar 4, 2022, at 9:25 AM, Georgoulias, Bethany <[e-mail]> wrote:
Good morning,
Should we replace Michael Ellington with your name as the facility contact, orjust add yours?
Also, Michael is still listed as the Billing contact (see the summary report). Is this correct, or should that
be updated too?
Thank you,
Bethany Georgoulias (she/her)
Environmental Engineer
Stormwater Program, Division of Energy, Mineral, and Land Resources
N.C. Department of Environmental Quality
919 707 3641 office
bethany.georgoulias@ncderingov
512 N. Salisbury Street, Raleigh, NC 27604 (location)
1612 Mail Service Center, Raleigh, NC 27699-1612 (mailing)
Website: http://deq.nc.gov/about/divisions/energy-mineral-land-resources/stormwater
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From: [e-mail] [mailto:[e-mail]]
Sent: Friday, March 4, 2022 9:02 AM
To: [e-mail]
Cc: Georgoulias, Bethany <[e-mail]>
Subject: Permit Contact Update Request for NGC030492
Your Permit Contact Update Request Form for permit no. NGC030492 has been accepted for
processing. In 30 days, please check the following link to verify the change has been
made: Permit Contact Summary Report
If you have any questions about the status, please contact Bethany Georgoulias at
bethany_geor og uliasgncdenr.gov.
The NC DEMLR Stormwater Program
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Request Submitted
NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage (COC) number.
Number* NGC030492
Begins with NCS, NCG, or NCGNE (no exposure)
Check permit contact information for your permit by running a Stormwater Permit Summary Report.
Guidance for COC holders: Do not enter the General Permit number with all 0's (for example, NCG030000) but instead
your Certificate of Coverge (COC) number.
Check all that Owner Affiliation (Legally Responsible Individual) Update
apply: * Permit Ownership Transfer or Facility Name Change
Delegation of Signature Authority (DOSA)
Permit Contact Update
Billing Contact Update
Facility Contact Update
Other Contact Update
Facility Contact Update
Provide new facility contact information
New Contact Name* First and Last Name
Michael Sayers
E-mail Address* [e-mail]
Phone No.* 17048657444
Mailing Address* 1201 Tulip Dr.
Physical Address If different than mailing address
..... __.............................................................................................................................
Add another facility contact if needed by clicking the 'Add' button below
Submitter's Name* Please enter your FIRST and LAST name
Michael Sayers
Phone Number* Please enter your phone number
704-865-7444
Any format is fine.
Email Address* Please enter a valid e-mail address
[e-mail]
A confirmation of submission will be e-mailed to this address.
* By checking the box and signing below, I certify that:
I have given true, accurate, and complete information on this form;
I agree that submission of this form is a "transaction" subject to Chapter 66, Article 40 of the NC General Statutes (the
"Uniform Electronic Transactions Act");

I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes (the
"Uniform Electronic Transactions Act');
I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature (except for any uploaded Owner Affiliation Change or Delegation of Signature of Authority forms, which
also must be mailed in with original signature); AND
I intend to electronically sign and submit this Permit Contact Update Request form.
Signature
Date 3/4/2022
Questions? Contact [e-mail].

Review
Verify Permit No.* Revise permit number below if incorrect.
NCG030492