NCC223561_NOI 109254 Payment Verification_20221019

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/13/2022 1:17:16 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 10/14/2022 6:22:15 AM (Review - NOI 109254 Express Tire - University Parkway)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 10/13/2022 1:17 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 18, 2022 5:00
PM 10/13/2022 1:17 PM
by Workflow 10/14/2022 6:22:22 AM (Workflow Start Event)
Submit by Holloman, Tevye L 10/19/2022 8:07:43 AM (Payment Verification for NCC223561)
F Jessie Lester
Holloman, Tevye L assigned the task to Holloman, Tevye L 10/19/2022 8:07 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 25, 2022 5:00
PM 10/14/2022 6:22 AM

5 A7
Payment •
NORTH CAROLINA
Envlrmmm(af Quafhy
Project Name
Express Tire - University Parkway
Lot Numbers
(If listed on the eNOI)
L0001E 131-2048; L0006A BL2048
NC Reference No.*
NCG01-2022-3561
Certificate of
NCC223561
Coverage (COC) No.*
Invoice Date
10/14/2022
Initial Invoice No.
NCC223561-2022
Initial Fee
$ 100.00
Invoice Due Date
11/13/2022
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*
• Payment Received.
Payment NOT RECEIVED.
Payment Status
PAID
Date Payment
10/19/2022
Received *
(Or, if not received, date rejected for no payment)
Method of Payment*
• electronic
check
Other
ePayment
658473137
Transaction Number*
NOI Tracking No.
109254
Tracking ID referenced upon submittal
This is an Express
• No
Review Project
Yes
Project Tracking ID
NCC-FORSY-2022-Express Tire - University Parkway