090146_Waiver of Right_20220804

STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL
QUALITY
COUNTY OF BLADEN
IN THE MATTER OF ASSESSMENT
OF CIVIL PENALTIES AGAINST
CHAD WAYNE HAZELWOOD
PERMIT NO. AWS090146
WAIVER OF RIGHT TO AN
ADMINISTRATIVE HEARING AND
STIPULATION OF FACTS
FILE NO. DV-2022-0013
Having been assessed civil penalties totaling $25,736.91 for violation(s) as set forth in the
assessment document of the Division of Water Resources dated June 1, 2022, 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 thirty (30) days from the receipt of the notice of assessment.
This the _ day of _ , 2022
Signature
ADDRESS
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