NCS000240_Owner Affiliation Change Request_20220217

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 2/17/2022 6:59:07 PM (Owner Affiliation Change Submission)
Approve by Tran, Kieu M 3/14/2022 10:51:31 AM (Review Assigned to Admin)
* Owner Affiliation has been updated in BIMS 3/14/2022
• Georgoulias, Bethany A reassigned the task to Tran, Kieu M 3/11/2022 9:32 AM
• The task was assigned to DEMLR SW Admin 2/17/2022 6:59 PM

Default Page
N PDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage (COC) number.
Number* NCS000240
Begins with NCS, NCG, or NCGNE (no exposure)
Submittor's Name* Please enter your FIRST and LAST name
Steve Jadlocki
Phone Number* Please enter your phone number
704-336-4398
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.
Upload a copy of the completed and signed Permit Owner Affiliation Designation Form below. Please note that you must
mail in the original signed copy to our office (see instructions on that form), in accordance with requirements in
40 CFR 122.22.
Questions? Contact [e-mail].
Completed Form Please upload the signed "Permit Owner Affiliation Designation Form"
Upload* Charlotte MS4 NCS000240 - Designation of Legally
772.87KB
Responsible Person -Sep 2021-Signed.pdf
pdf only

Initial Review
Project ID * Reviewer may revise permit number below if incorrect.
NCS000240