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HomeMy WebLinkAboutNCG150029_Permit Contact Update Request_20220513Action History (UTC-05:00) Eastern Time (US & Canada) Submit by Anonymous User 5/13/2022 1:38:40 PM (Permit Contact Update Request) Approve by Tran, Kieu M 5/16/2022 8:31:57 AM (Contact Update Review) • The task was assigned to Tran, Kieu M. The due date is: June 24, 2022 5:00 PM 5/13/2022 1:38 PM Request Submitted NPDES Permit Enter your NPDES stormwater permit number or Certificate of Coverage (COC) number. Number* NCG150029 Begins with NCS, NCG, or NCGNE (no exposure) Facility Name* Moore County Airport (Used to verify permit number) 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 Permit Contact Update Provide new permit contact information This person should REPLACE the current permit contact. This person should just be added as another permit contact. New Contact Name* First and Last Name Scotty Malta E-mail Address* smalta@moorecountyairport.com Phone No.* 9106923212 Mailing Address* PO Drawer 5809, Pinehurst, NC 28374 Physical Address If different than mailing address 7825 Aviation Drive, Carthage, NC 28327 Add another permit contact if needed by clicking the'Add' button below Submitter's Name* Please enter your FIRST and LAST name Paul Puszynski Phone Number* Please enter your phone number 19106923212 Any format is fine. Email Address* Please enter a valid e-mail address paulp@moorecountyairport.com 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 5/13/2022 Questions? Contact bethany.georgoulias@ncdenr.gov. Review Verify Permit No.* Revise permit number below if incorrect. N CG 150029