NCG030700_Owner Affiliation Change Request_20210812

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 8/12/2021 4:40:25 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 8/13/2021 12:36:43 PM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 8/12/2021 4:40 PM

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Default Page
NPDES Permit
Enter your NPIDES storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCG030700
NCS)00000(or NCC)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Sam Phillips
Phone Number*
Reaseenter your phone nurrber
252-237-8181 Ext. 44279
Any format is fine.
Email Address *
Rease enter a valid e-rrail address
[e-mail]
A confirmation of submssion will be e-rrailed 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 Reaseupload the signed "FbrrritOwner Affiliation Designation Forn1'
Upload* Permit Owner Affiliation Designation Form LFC2.pdf 115.75KB
pdr only

Initial Review
Project ID * Peviewer rmy revise perrrit nunber below if incorrect.
NCG030700