WQ0004823_NOV-2021-PC-0259 GC_20210510

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9590 9402 6321 0296 8940 79
United States
Postal Service
First -Class Mail
Postage & Fees Paid
USPS
Permit No. G-10
• Sender: Please print your name, address, and ZIP+4® in this box'
NCDEQ
DIVISION OF WATER RESOURCES
WATER QUALITY OPERATIONS SECTION
943 WASHINGTON SQUARE MALL
WASHINGTON, NC 27889
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SENDER: COMPLET7 THIS SECTION
COMPLETE THIS SECTION ON DELIVERY
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or on the front if space permits. -:Fr PlyPni
1. Article Addressed to:
A. Signature
❑ Agent
❑ Addressee
eived by (Printed Name)
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C. D e of D%(Ive
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address different from item 1? 0 Yes
If YES, enter delivery address below: ❑ No
Rolf Blizzard, Manager MAY J
Pine Island-Currituck LLC
4400 Silas Creek Pkwy-Ste 302 ✓vater()kJRif
Winston Salem, NC 27104-32/Iglona, Operatgnm ccctft:z,
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9590 9402 6321 0296 8940 79
9. Article Niimhar (Transfer from servira lahall
7020 1810 0001 5981...0610
PS Form 3811, July 2020 PSN 7530-02-000-9053
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❑ Certified Mail Restricted Delivery
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}_4.Jer $5001 ;
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Delivery
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