NCC230183_NOI 123373 Payment Verification_20230124

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 1/19/2023 4:44:49 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 1/20/2023 7:25:54 AM (Review - NOI 123373 Take 5 Oil Change)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 1/19/2023 4:45 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: January 24, 2023 5:00
PM 1/19/2023 4:45 PM
by Workflow 1/20/2023 7:26:02 AM (Workflow Start Event)
Submit by Holloman, Tevye L 1/24/2023 11:25:00 AM (Payment Verification for NCC230183)
F Jacksonville Take Five. LLC
Holloman, Tevye L assigned the task to Holloman, Tevye L 1/24/2023 11:24 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: March 3, 2023 5:00 PM
1/20/2023 7:26 AM

5 A7
Payment •
NORTH CAROLINA
Envlrmmm(af Quafhy
Project Name
Take 5 Oil Change
Lot Numbers
(If listed on the eNOI)
Lot 2A
NC Reference No.*
NCG01-2023-0183
Certificate of
NCC230183
Coverage (COC) No.*
Invoice Date
1/20/2023
Initial Invoice No.
NCC230183-2023
Initial Fee
$ 100.00
Invoice Due Date
2/19/2023
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
1/24/2023
Received *
(Or, if not received, date rejected for no payment)
Method of Payment*
electronic
check
Other
Check Number*
104
NOI Tracking No.
123373
Tracking ID referenced upon submittal
This is an Express
• No
Review Project
Yes
Project Tracking ID
NCC-ONSLO-2023-Take 5 Oil Change