NCG030227_Owner Affiliation Change Request_20210630

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 6/30/2021 12:00:02 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 7/15/2021 6:49:30 PM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 6/30/2021 12:00 PM

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Default Page
NPDES Permit
Enter your MPDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG030227
NCS)00000(or NCC)00000(
Submittor's Name*
Rease enter your FIRST and LAST narre
Philip Cummings
Phone Number*
Rease enter your phone nurrber
336-771-8140
Any format is fine.
Email Address *
Rease enter a valid a -mail address
[e-mail]
A confirmation of submssion will be e-mailed to this address.
Need a copy of the Permit Owner Affiliation Designation Form? You must upload a signed copy of that form below.
Questions? Call Bethany Georgoulias at [phone] or e-mail her at.bethany.georgouliasencdenr.gov.
Completed Form Pease upload the signed "Permit C,vner Affiliation Designation Forn1'
Upload* NPDES-Owner-Affiliation-Change-20191104-
781.62KB
DEMLR-SW Koehler signed 6-28-2021.pdf
pdt only

Initial Review
Project ID * Peviewer rmy revise perrrit nunber below if incorrect.
NCG030227