NCC223496_NOI 108730 Payment Verification_20221011

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 10/6/2022 2:26:48 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 10/10/2022 6:50:48 AM (Review - NOI 108730 C&B Toothland of Marion)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 10/6/2022 2:27 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: October 11, 2022 5:00
PM 10/6/2022 2:27 PM
by Workflow 10/10/2022 6:50:58 AM (Workflow Start Event)
Submit by Holloman, Tevye L 10/11/2022 7:56:51 AM (Payment Verification for NCC223496)
F Clay Mooney
• Holloman, Tevye L assigned the task to Holloman, Tevye L 10/11/2022 7:55 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: November 21, 2022 5:00
PM 10/10/2022 6:51 AM

STA—
NORTH CAROLINA
Environmental Quallty
Project Name C&B Toothland of Marion
Lot Numbers (If listed on the eNOI)
NC Reference No.* NCG01-2022-3496
Certificate of NCC223496
Coverage (COC) No.*
Invoice Date 10/10/2022
Initial Invoice No. NCC223496-2022
Initial Fee $ 100.00
Invoice Due Date 11/9/2022
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 10/11/2022
Received * (Or, if not received, date rejected for no payment)
Method of Payment* electronic
check
Other
ePayment 657026752
Transaction Number*
NOI Tracking No. 108730
Tracking ID referenced upon submittal
This is an Express No
Review Project Yes
Project Tracking ID NCC-MCDOW-2022-C&B Toothland of Marion