NCS000435_Owner Affiliation Change Request_20210916

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/16/2021 4:39:51 PM (Owner Affiliation Change Submission)
Approve by McCoy, Suzanne 10/6/2021 2:56:55 PM (Notification to Admin)
• The task was assigned to McCoy, Suzanne 9/16/2021 4:40 PM

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Default Page
NPDES Permit
Enter your NPD6 storrrwater pernit nunber or Certificate of Coverage (COC) nunber.
Number*
NCS000435
NCS)00000(or NCC)00000(
Submittor's Name*
Reaseenter your FIRST and LAST narre
Keisha Lipe
Phone Number*
Reaseenter your phone nunber
8282595401
Any format is fine.
Email Address *
Rease enter a valid e-rmil 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 Reaseupload the signed "FbrnitCwnerAffiliation Designation Fornl'
Upload* Small MS4.pdf 660.76KB
pdr only

Initial Review
Project ID * Reviewer may revise permt nunber below if incorrect.
NCS000435