NCG030722_Owner Affiliation Change Request_20211213

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/13/2021 10:21:41 AM (Owner Affiliation Change Submission)
Approve by Tran, Kieu M 4/4/2022 8:18:16 AM (Review Assigned to Admin)
* Owner affiliation has been updated
• Georgoulias, Bethany A reassigned the task to Tran, Kieu M 3/11/2022 9:29 AM
• The task was assigned to DEMLR SW Admin 12/13/2021 10:21 AM

Default Page
N PDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage (COC) number.
Number* NCG030722
Begins with NCS, NCG, or NCGNE (no exposure)
Submittor's Name* Please enter your FIRST and LAST name
Edward Fields
Phone Number* Please enter your phone number
336-495-2115
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* D00008.pdf 77.43KB
pdf only

Initial Review
Project ID * Reviewer may revise permit number below if incorrect.
NCG030722