NCC213520_Annual Fee Invoice_20220601

North Carolina Department of Environmental Quality
Division of Energy, Mineral, and Land Resources
F Stormwater Program
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NPDES Construction Stormwater Permit
mlmM a �• '� INVOICE
Annual Permit Fee
This Construction Stormwater annual fee is required by the North Carolina Administrative Code 143-
215.D(a). The fee covers the administrative costs associated with your permit. The fee is required of
any person holding a permit for any time during the annual fee period, regardless of the facility's
operating status. Failure to pay the fee by the due date will subject the permit to revocation.
Operating without a valid permit is a violation and is subject to a $10,000 per day fine. If the permit is
revoked and you later decide a permit is needed, you must reapply, with the understanding the permit
request may be denied due to changes in environmental, regulatory, or modeling conditions.
Invoice No: NCC213520-2022
Certificate of Coverage No.: NCC213520
Effective Date: 6/14/2021
Project Name: Han -Dee Hugo's #1
Legally Responsible Person:
Haddon Clark
Sampson-Bladen Oil Company, Inc.
O Box 469
Tinton, NC
8328
Invoice Date: 6/1/2022
Due Date: 7/1/2022
nual Fee Period: Jun 2022 to Jun 2023
nual Fee: $100
E-mail: [e-mail]
Telephone: [phone]
Site Contact: Bob Brantley
Contact E-mail: [e-mail]
actronic payment option is preferred. Type https://deg.nc.gov/SW-epayments into your browser. If
u select eCheck, there is no convenience fee. The convenience fee for a credit card is 2.65% and
nvenience fee for debit card is $3.95.
If you must pay with paper check, please make your check payable to "DEMLR Stormwater Program"
and include the Certificate of Coverage No. in the memo field along with a copy of this invoice.
$25.00 processing fee will be charged for returned check in accordance with North Carolina General
atute 25-3-512. Contact Aziza Selkane at [e-mail] or [phone] with questions.
Remit to: NCDEQ— Division of Energy, Mineral, and Land Resources
Stormwater Program
1612 Mail Service Center
Raleigh NC 27699-1612
If this project has been closed out, you must submit a Notice of Termination (NOT) request here:
httos://edocs.dea.nc.2ov/Forms/NCG01-Termination