NCC232932_Annual Fee Invoice_20241001

North Carolina Department of Environmental Quality
Division of Energy, Mineral,and Land Resources
t� "�� Stormwater Program
o;� ��:� ;"„� NPDES Construction Stormwater Permit
INVOICE
Annual Permit Fee—PLEASE N�TE FEE IN��EASE� T� $120 �t�E T� LE�ISLATI�N
This Construction Stormwater annua) 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: NCC232932-2024 Invoice Date: 10/1/2024
Certificate of Coverage No.: NCC232932 Due Date: 1111J2024
Effective Date: 4/1/2024 Original Issued Date: 10/17/2023
Permit Term Expiration*: 3/31/2029 11:59 PM Annual Fee Period: Oct 2024 to Oct 2025
Project Name: Circle K- Expansion 2723205
Old US HWY 52 & Hickory Tree Rd
Annual Fee: $120
Legally Responsible Person: E-mail: [e-mail]
Meredith Rice
Telephone: 919'7746'700
Circle K Stores, Inc. Site Contact: Dennis Patterson
1100 Situs Court Site Contact E-mail: dpatters@circiel�.com
Raleigh, NC
27606-5446
Electronic payment preferred. Go to https:JJd�q.r�c.�ovJ5W-epa�rr�er�ts. If you select eCheck,there is no
convenience fee.The convenience fee for a credit card is 2.65%, and the conv. 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 Covera�e No. in the memo field along with a copy of this invoice.
A$25.00 processing fee will be charged for returned check, in accordance with North Carolina General Statute
25-3-512. Contact Tev Holloman at teu.hallocr�an�deq.r�c.�ov or(919) 707-3649 with any questions.
Remit to: NCDEQ—Division of Energy, Mineral, and �and Resources
Stormwater Program
1612 Mail Service Center
Raleigh NC 27699-1612
If this project has been closed out or sold,you must submit a Notice of Termination (NOT) request here:
https:jJedocs.deq.r�c.�ouJFormsJR1��01-Terrr�ir�atior� (New owners must obtain a new COC}
*If the Permit Term Expiration date has passed,this COC was not renewed under the new General Permit on
4/1/2024 because of overdue fees. Please be sure to pay all outstanding fees so coverage can be renewed.