NCC210464_Annual Fee Payment Record (2023 Fee)_20230104

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 12/27/2022 1:27:41 PM (Workflow Start Event)
Submit by Holloman, Tevye L 1/4/2023 10:39:12 AM (2023 Annual Fee Payment Verification for NCC210464-2023)
F CIRCLE K STORES INC
• Holloman, Tevye L assigned the task to Holloman, Tevye L 1/4/2023 10:38 AM
• The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: February 7, 2023 5:00
PM 12/27/2022 1:27 PM

STA—
NORTH CAROLINA
Environmental Quallty
•
Certificate of NCC210464
Coverage (COC) No. * This is passed from the workflow when the invoice is filed.
NC Reference COC NCG01-2021-0464
No.*
Permit Status: Active
Year COC Issued 2021
This field will be hidden.
Check previous years for outstanding fees (years that do not apply will be blank):
2020 Fee Status 2021 Fee Status 2022 Fee Status
PAID
Project Name*
Circle K Store - Stanley, NC
Project Address*
506 HWY 27 S, Stanley, NC
Permittee*
Circle K Stores Inc.
County
Gaston
Invoice No.*
NCC210464-2023
This is passed from the workflow when the invoice is filed.
Annual Fee*
$ 100.00
Invoice Date*
1/1/2023
This is passed from the workflow when the invoice is filed.
Invoice Due Date*
2/1/2023
This is passed from the workflow when the invoice is filed.
An automated email reminder is sent to the permittee when the invoice is due. Wait until invoice is 15 days overdue
before proceeding to a Notice of Deficiency.
Important: If you change the choice below to Payment NOT RECEIVED, the fee status becomes PAST DUE, and the
permittee will receive a Notice of Deficiency.
Annual Fee Payment Fee Payment Received or Not Applicable.
Received* Fee Payment NOT RECEIVED.
Date Payment 1/4/2023
Received * Or, if WAIVED or NOT RECEIVED, this is the date that status is recorded.
Method of Payment* electronic
check
other

ePayment 669921140
Transaction Number*
Fee Status* PAID
Legally Responsible Mark Ostoits
Person (Orig.)
Permittee E-mail* [e-mail]
CONFIRM Permittee [e-mail]
E-mail * Opportunity to modify problem e-mail address or permittee contact info
Site Contact E-mail* [e-mail]
CONFIRM Site [e-mail]
Contact E-mail* Opportunity to correct problem e-mail address or site contact info
Billing E-mail (If available)
CONFIRM Billing E- Opportunity to correct problem e-mail address or billing contact info
mail
Billing Telephone No.
Permittee Email for [e-mail]
30-day Reminder This is the email for the 30-day reminder if needed (passed from workflow).
Site Contact Email for hkasem1 @circlek.com
30-day Reminder This is the email for the 30-day reminder if needed (passed from workflow)
Billing Contact Email This is the email for the 30-day reminder if needed (passed from workflow).
for 30-day Reminder
Project Name for 30- Circle K Store - Stanley, NC
day Reminder The project name is passed from workflow for the 30-day reminder
Permittee Name for Circle K Stores Inc.
30-day Reminder The permittee is passed from workflow for the 30-day reminder
County for 30-day Gaston
Reminder The county is passed from workflow for the 30-day reminder
Additional Billing Contact E-mails
.................
Additional E-mail for
CC:
Review Date* 1/4/2023