NC0021644_Remission (Justification for Request)_20191211 (2)

4
STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT�A(kQUALITY
COUNTY OF LENOIR D••
e
IN THE MATTER OF ASSESSMENT ) WAIVER OF RIGHT TO sh0rafQ�j,. ��J9
O,y Di0S d j;
ADMINISTRATIVEOF CIVIL PENALTIES AGAINST ) HEARING` l ' a,.
) STIPULATION OF FACTS „di�� df
Town of La Grange ) /00
La Grange WWTP )
)
PERMIT NO.NC0021644 ) CASE NO. LV-2019-0303
Having been assessed civil penalties totaling$600.00 for violation(s)as set forth in the assessment document of the Division
of Water Resources dated November 07, 2019,the undersigned, desiring to seek remission of the civil penalty,does hereby
waive the right to an administrative hearing in the above-stated matter and does stipulate that the facts are as alleged in the
assessment document. The undersigned further understands that all evidence presented in support of remission of this civil
penalty must be submitted to the Director of the Division of Water Resources within thirty(30)days of receipt of the notice
of assessment. No new evidence in support of a remission request will be allowed after(30)days from the receipt of the
notice of assessment. {'1
This the /? ` day of C ' i4/ , 20 J!f
SI A RE
ADDRESS
RECEIVEDiff 47/Ttfetor
DEC 17 2019
?VC 3t
NCDEQIDWRINPD 4$ 6, , 2:53-1
TELEPHONE
(2-5-2Z-)