NCC223709_NOI 110602 Payment Verification_20221114

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/28/2022 1:01:21 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 10/31/2022 6:52:46 AM (Review - NOI 110602 Washington Medical)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 10/28/2022 1:02 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 2, 2022 5:00
PM 10/28/2022 1:02 PM
by Workflow 10/31/2022 6:52:51 AM (Workflow Start Event)
Submit by Holloman, Tevye L 11/14/2022 11:35:39 AM (Payment Verification for NCC223709)
F White Construction & Design LLC
Holloman, Tevye L assigned the task to Holloman, Tevye L 11/14/2022 11:28 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 12, 2022 5:00
PM 10/31/2022 6:52 AM

Payment •
NORTH CAROLINA
Environmental Quallty
Project Name
Washington Medical
Lot Numbers
(If listed on the eNOI)
NC Reference No.*
NCG01-2022-3709
Certificate of
NCC223709
Coverage (COC) No.*
Invoice Date
10/31/2022
Initial Invoice No.
NCC223709-2022
Initial Fee
$ 100.00
Invoice Due Date
11/30/2022
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
11/14/2022
Received *
(Or, if not received, date rejected for no payment)
Method of Payment*
electronic
check
Other
Check Number*
12864
NOI Tracking No.
110602
Tracking ID referenced upon submittal
This is an Express
No
Review Project
Yes
Project Tracking ID
NCC-BEAUF-2022-Washington Medical