NCC230139_NOI 122792 Payment Verification_20230118

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/16/2023 1:50:16 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 1/17/2023 7:55:00 AM (Review - NOI 122792 Bridgefork Dairy Mitigation Site)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 1/16/2023 1:50 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 19, 2023 5:00
PM 1/16/2023 1:50 PM
by Workflow 1/17/2023 7:55:08 AM (Workflow Start Event)
Submit by Holloman, Tevye L 1/18/2023 8:23:48 AM (Payment Verification for NCC230139)
* Sydney Katuszonek
• Holloman, Tevye L assigned the task to Holloman, Tevye L 1/18/2023 8:22 AM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: February 28, 2023 5:00 PM
1/17/2023 7:55 AM

5 A7
Payment Verification
NORTH CAROLINA
Envlrmmm(af Quafhy
Project Name
Bridgefork Dairy Mitigation Site
Lot Numbers
(If listed on the eNOI)
2585495005
NC Reference No.*
NCG01-2023-0139
Certificate of
NCC230139
Coverage (COC) No.*
Invoice Date
1/17/2023
Initial Invoice No.
NCC230139-2023
Initial Fee
$ 100.00
Invoice Due Date
2/16/2023
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
1/18/2023
Received *
(Or, if not received, date rejected for no payment)
Method of Payment*
• electronic
check
Other
ePayment
672004049
Transaction Number*
NOI Tracking No.
122792
Tracking ID referenced upon submittal
This is an Express
• No
Review Project
Yes
Project Tracking ID
NCC-CLEVE-2023-Bridgefork Dairy Mitigation Site