NCC223789_NOI 112177 Payment Verification_20221118

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 11/8/2022 11:20:15 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 11/9/2022 6:16:35 AM (Review - NOI 112177 Eastern Pines Dental)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 11/8/2022 11:20 AM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: November 11, 2022 5:00
PM. The priority is: High 11/8/2022 11:20 AM
by Workflow 11/9/2022 6:16:46 AM (Workflow Start Event)
Submit by Georgoulias, Bethany A 11 /18/2022 8:04:27 AM (Payment Verification for NCC223789)
P Kelli Gill, the transaction from 11/4/2022 was moved from NCC223750 to this permit; NCC223750 had
the incorrect county and has been rescinded. Original payment being applied to new COC (mistake
was identified within 60 days of issuance).
• Georgoulias, Bethany A reassigned the task to Georgoulias, Bethany A 11/18/2022 7:59 AM
• Holloman, Tevye L assigned the task to Holloman, Tevye L 11/17/2022 2:48 PM
• The task was assigned to DEMLR NCG01 Payment Team. The due date is: December 21, 2022 5:00 PM.
The priority is: High 11/9/2022 6:16 AM

STA—
NORTH CAROLINA
Environmental Quallty
Project Name Eastern Pines Dental
Lot Numbers (If listed on the eNOI)
NC Reference No.* NCG01-2022-3789
Certificate of NCC223789
Coverage (COC) No.*
Invoice Date 11/9/2022
Initial Invoice No. NCC223789-2022
Initial Fee $ 100.00
Invoice Due Date 12/9/2022
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 11/17/2022
Received * (Or, if not received, date rejected for no payment)
Method of Payment* electronic
check
Other
ePayment 660882169
Transaction Number*
NOI Tracking No. 112177
Tracking ID referenced upon submittal
This is an Express No
Review Project Yes
Project Tracking ID NCC-CRAVE-2022-Eastern Pines Dental