WQCS00055_DV-2023-0031_20230301

ROY COOPER
Governo+
ELIZABETH S. BISER
Secretary
RICHARD E. ROGERS, JR.
Direcinr
Certified Mail # 7020 3160 0000 4115 6167
Return Receipt Requested
Terrell Blackmon, City Engineer
City of Henderson
PO Box 1434
Henderson, NC 27536-1434
NORPH CAROLINA
Environmental Quality
March 01, 2023
SUBJECT: Notice of Violation and Assessment of Civil Penalty
for Violations of North Carolina General Statute (G.S.) 143-215.1(a)(1)
and Collection System Permit No. WQCS00055
City of Henderson
Henderson Collection System
Case No. DV-2023-0031
Vance County
Dear Mr. Blackmon:
This letter transmits a Notice of Violation and assessment of civil penalty in the amount of $1,345.72 ($1,250.00 civil penalty
+ $95.72 enforcement costs) against City of Henderson.
This assessment is based upon the following facts: a review has been conducted of the Sanitary Sewer Overflow (SSO)
5-Day Report submitted by City of Henderson. This review has shown the subject facility to be in violation of the
requirements found in Collection System Permit No. WQCS00055 and G.S. 143-215.1(a)(1). The violation(s) that occurred
are summarized in Attachment A to this letter.
Based upon the above facts, I conclude as a matter of law that City of Henderson violated the terms, conditions or
requirements of Collection System Permit No. WQCS00055 and G.S. 143-215.1(a)(1) in the manner and extent shown in
Attachment A. In accordance with the maximums established by G.S. 143-215.6A(a)(2), a civil penalty may be assessed
against any person who violates the terms, conditions or requirements of a permit required by G.S. 143-215,1(a).
North[amnaa Deparimem of Environmental Quality l Division of Waler Rr 00rces
Wflgl-Recr—1 Offi,e .1800 Carmir Delve l Weigh. Noah CawTina 27n119
419-7914200

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Based upon the above findings of fact and conclusions of law, and in accordance with authority provided by the
Secretary of the Department of Environmental Quality and the Director of the Division of Water Resources, 1, Scott
Vinson, Regional Supervisor, Raleigh Regional Office hereby make the following civil penalty assessment against City of
Henderson:
1 250.00 For 1 of the 1 violations of Collection System Permit No. WQCS00055 and G.S. 143-215.1(a)(1) for
Sanitary Sewer Overflow(s) resulting in a discharge without a valid permit.
1 250.00 TOTAL CIVIL PENALTY
95.72 Enforcement Costs
1 345.72 TOTAL AMOUNT DUE
Pursuant to G.S. 143-215.6A(c), in determining the amount of the penalty I have taken into account the Findings of Fact and
Conclusions of Law and the factors set forth at G.S. 143B-282.1(b), which are:
(1) The degree and extent of harm to the natural resources of the State, to the public health, or to private property
resulting from the violation;
(2) The duration and gravity of the violation;
(3) The effect on ground or surface water quantity or quality or on air quality;
(4) The cost of rectifying the damage;
(5) The amount of money saved by noncompliance;
(6) Whether the violation was committed willfully or intentionally;
(7) The prior record of the violator in complying or failing to comply with programs over which the Environmental
Management Commission has regulatory authority; and
(8) The cost to the State of the enforcement procedures.
Within thirty (30) days of receipt of this notice, you must do one of the following:
(1) Submit payment of the penalty, OR
(2) Submit a written request for remission, OR
(3) Submit a written request for an administrative hearing
Option 1: Submit payment of the penalty:
Payment should be made directly to the order of the Department of Environmental Quality (do not include waiver
form). Payment of the penalty will not foreclose further enforcement action for any continuing or new violation(s).
Please submit payment to the attention of:
Attn: PERCS Branch
Division of Water Resources
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

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Option 2: Submit a written request for remission or mitigation including a detailed justification for such
request:
Please be aware that a request for remission is limited to consideration of the five factors listed below as they may
relate to the reasonableness of the amount of the civil penalty assessed. Requesting remission is not the proper
procedure for contesting whether the violation(s) occurred or the accuracy of any of the factual statements contained in
the civil penalty assessment document. Because a remission request forecloses the option of an administrative hearing,
such a request must be accompanied by a waiver of your right to an administrative hearing and a stipulation and
agreement that no factual or legal issues are in dispute. Please prepare a detailed statement that establishes why you
believe the civil penalty should be remitted, and submit it to the Division of Water Resources at the address listed below.
In determining whether a remission request will be approved, the following factors shall be considered:
(1) whether one or more of the civil penalty assessment factors in NCGS 14313-282.1(b) was wrongfully
applied to the detriment of the petitioner;
(2) whether the violator promptly abated continuing environmental damage resulting from the violation;
(3) whether the violation was inadvertent or a result of an accident;
(4) whether the violator had been assessed civil penalties for any previous violations; or
(5) whether payment of the civil penalty will prevent payment for the remaining necessary remedial actions.
Please note that all evidence presented in support of your request for remission must be submitted in writing. The
Director of the Division of Water Resources will review your evidence and inform you of his decision in the matter of
your remission request. The response will provide details regarding the case status, directions for payment, and
provision for further appeal of the penalty to the Environmental Management Commission's Committee on Civil Penalty
Remissions (Committee). Please be advised that the Committee cannot consider information that was not part of the
original remission request considered by the Director. Therefore, it is very important that you prepare a complete and
thorough statement in support of your request for remission.
In order to request remission, you must complete and submit the enclosed "Request for Remission of Civil Penalties,
Waiver of Right to an Administrative Hearing_ and Stiflulation of Facts" form within thirty (30) days of receipt of this
notice. The Division of Water Resources also requests that you complete and submit the enclosed "Justification for
Remission Request."
Both forms should be submitted to the following address:
Attn: PERCS Branch
Division of Water Resources
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
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Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
1628 Mail Service Center, Raleigh
Raleigh, NC 27699-1628

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Option 3: File a petition for an administrative hearing with the Office of Administrative Hearings:
If you wish to contest any statement in the attached assessment document you must file a petition for an administrative
hearing. You may obtain the petition form from the Office of Administrative Hearings. You must file the petition with
the Office of Administrative Hearings within thirty (30) days of receipt of this notice. A petition is considered filed
when it is received in the Office of Administrative Hearings during normal office hours. The Office of Administrative
Hearings accepts filings Monday through Friday between the hours of 8:00 a.m. and 5.00 p.m., except for official state
holidays. The petition may be filed by facsimile (fax) or electronic mail by an attached file (with restrictions) - provided
the signed original, one (1) copy and a filing fee (if a filing fee is required by NCGS § l 5013-23.2) is received in the
Office of Administrative Hearings within seven (?) business days following the faxed or electronic transmission. You
should, contact_ the Office of Administrative Hearings with all questions regarding the filing fee and/or the details of the
filing process.
The mailing address and telephone and fax numbers for the Office of Administrative Hearings are as follows:
6714 Mail Service Center
Raleigh, NC 27699 6714
Tel: [phone]
Fax: [phone]
One (1) copy of the petition must also be served on DEQ as follows:
Mr. William F. Lane, General Counsel
Department of Environmental Quality
1601 Mail Service Center
Raleigh, North Carolina 27699-1601
Please indicate the case number (as found on page one of this letter) on the petition.
Failure to exercise one of the options above within thirty (30) days of receipt of this letter, as evidenced by an internal
date.:time received stamp (not a postmark), will result in this matter being referred to the Attorney General's Office for
collection of the penalty through a civil action. Please be advised that additional penalties may be assessed for violations
that occur after the review period of this assessment.
If you have any questions, please contact Mitchell Hayes with the Division of Water Resources staff of the Raleigh
Regional Office at [phone] or via email at mitch.hayes(a.,mcdenr.gov.
Sincerely,
Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
ATTACHMENTS
Cc: WQS Raleigh Regional Office - Enforcement File
PERCS ComplianceiEnforcement Unit - Enforcement File

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Case Number: DV-2023-0031
JUSTIFICATION FOR REMISSION REQUEST
County: Vance
Assessed Party: City of Henderson
Permit No.: WQCS00055 Amount Assessed: $1,345.72
Please use this form when requesting remission of this civil penalty. You must also complete the "Request For Remission,
Waiver of Right to an Administrative Hearing, and Stipulation of Facts" form to request remission of this civil penalty.
You should attach any documents that you believe support your request and are necessary for the Director to consider in
evaluating your request for remission. Please be aware that a request for remission is limited to consideration of the five
factors listed below as they may relate to the reasonableness of the amount of the civil penalty assessed. Requesting
remission is not the proper procedure for contesting whether the violation(s) occurred or the accuracy of any of the factual
statements contained in the civil penalty assessment document. Pursuant to N.C.G.S. § 14313-282.1(c), remission of a civil
penalty maybe granted only when one or more of the following five factors apply. Please check each factor that you
believe applies to your case and provide a detailed explanation, including copies of supporting documents, as to why the
factor applies (attach additional pages as needed).
(a) one or more of the civil penalty assessment factors in N.C.G.S. 143B-282.1(b) were wrongfully applied to the
detriment of the petitioner (the assessment./actors are listed in the civil penalty assessment document);
(b) the violator promptly abated continuing environmental damage resulting from the violation (i.e., explain the
steps that you took to correct the violation and prevent f tare occurrences);
(c) the violation was inadvertent or a result of an accident (i.e., explain why the violation was unavoidable or
something you could not prevent or prepare, for);
(d) the violator had not been assessed civil penalties for any previous violations;
(e) payment of the civil penalty will prevent payment for the remaining necessary remedial actions (i.e., explain
how payment of the civil penalty will prevent you from performing the activities necessary to achieve
compliance).
EXPLANATION:

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STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENTAL QUALITY
COUNTY OF VANCE
IN THE MATTER OF ASSESSMENT ) WAIVER OF RIGHT TO AN
OF CIVIL PENALTIES AGAINST ) ADMINISTRATIVE HEARING AND
STIPULATION OF FACTS
City of Henderson )
Henderson Collection System )
PERMIT NO. WQCS00055 ) CASE NO. DV-2023-0031
Having been assessed civil penalties totaling $1,345.72 for violation(s) as set forth in the assessment document of the
Division of Water Resources dated March 01, 2023, 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.
This the day of , 20_
SIGNATURE
ADDRESS
TELEPHONE

Ell

ATTACHMENT A
City of Henderson
CASE NUMBER: DV-2023-0031
PERMIT NO: WQCS00055
FACILITY: Henderson Collection System
Other Violations
INCIDENT VIOLATION
NUMBER DATE VIOLATION TYPE VIOLATION DESCRIPTION
202201223 8I112022 CSOISSO(Sewer Overflow) Discharge without valid permit
REGION: Raleigh
COUNTY: Vance
TOTAL VOLUME
(GALLONS)
PENALTY
AMOUNT
31,500
$1,250.00

DIVISION OF WATER RESOURCES - CIVIL PENALTY ASSESSMENT
Violator: City of Henderson
Facility Name: Henderson Collection System
Permit Number: WOCS00055
County: Vance
Case Number: DV-2023-0031
ASSESSMENT FACTORS
1) The degree and extent of harm to the natural resources of the State, to the public health, or to private
property resulting from the violation;
A total volume of 31,500 gallons overflowed from various manholes along 214 798 Rock Mill Road in Henderson due to
I/I. 28,000 gallons reached Sandy Creek, classified as C; NSW+ in the Tar -Pam River Basin. Nutrients and pathogens to
surface waters.
2) The duration and gravity of the violation;
The SSO's started on 08.01,2022 at 1:00 am and ended the same day at 6:15 am.
3) The effect on ground or surface water quantity or quality or on air quality;
The effect of water quality include nutrients and pathogens to surface waters and water quality standard violations.
4) The cost of rectifying the damage;
The cost of rectifying the damage is not given.
5) The amount of money saved by noncompliance;
It is believed that no money was saved by the noncompliance.
6) Whether the violation was committed willfully or intentionally;
It does not appear that the violation was committed willfully or intentionally.
7) The prior record of the violator in complying or failing to comply with programs over which the
Environmental Management Commission has regulatory authority;
There have been six enforcement cases within the past 12 months.
S) The cost to the State of the enforcement procedures.
$95.72
Date AO —Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ

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EN City of Henderson
g4� Public Works Department
�o a Post Office Box 1434.900 S. Beckford Drive
Henderson, NC 27536-1434
Phone: [phone] / Fax: [phone]
November 4, 2022
Mr. Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Office
Division of Water Resources, NCDEQ
1628 Mail Service Center
Raleigh, NC 27699-1628
Re: Response to Notice of Violation & Intent to Issue Civil Penalty
Tracking No. — NOV-2022-DV-0269
Sanitary Sewer Overflows — August 2022
Henderson Collection System
Permit No. — WQCS00055
Dear Mr. Vinson:
I am writing in response to the above -mentioned violation that we received on October 3, 2022. The
overflow in this incident was due to inflow and infiltration during extended periods of heavy rainfall.
Once the rain event ended, the overflow subsided. Following the overflow, we cleaned debris and
placed lime as needed.
Henderson has hired a consultant, WK Dickson, to assist our efforts in reducing 1/1. With their help the
City of Henderson received and accepted a loan in the amount of $2.5 million from the Clean Water
State Revolving Fund for sewer rehabilitation. On July 14th we were notified that Henderson will receive
an additional $5 million ARP grant from the Clean Water State Revolving Fund for sewer rehabilitation.
We are using every resource available to stop sewer overflows in our system.
We take our responsibility to maintain compliance for our collection system very seriously. I trust that
you find the City's actions for compliance are satisfactory. Thank you very much for the opportunity to
respond. Please feel free to contact our staff or myself should you need any further information.
Sincerely,
Lee Owen
Assistant Public Works Director
Cc.. Edward Terrell Blackmon, City Manager
Andy Perkinson, Public Works Director
Joey Long, Distribution & Collection System Supervisor —Collection System ORC
Christy Lipscomb, Water Resources Director/ORC
File

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ROY COOPER
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EUZABETH S. BISER
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WHIARD E. ROGERS, JR.
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Terrell Blackmon, City Engineer
City of Henderson
PO Box 1434
Henderson, NC 27536-1434
AROLINA
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September 16, 2022
SUBJECT: NOTICE OF VIOLATION & INTENT TO ISSUE CIVIL PENALTY
Tracking No.: NOV-2022-DV-0269
Sanitary Sewer Overflows - August 2022
Collection System Permit No. WQCS00055
Henderson Collection System
Vance County
Dear Mr. Blackmon:
A review has been conducted of the self -reported Sanitary Sewer Overflows (SSO's) S-Day Reports submitted by
City of Henderson. The Division's Raleigh Regional Office concludes that the City of Henderson violated Permit
Condition I (2) of Permit No. WQCS00055 by failing to effectively manage, maintain, and operate their collection
system so that there Is no SSO (Sanitary Sewer Overflow) to the land or surface waters and the SSO constituted
making an outlet to waters of the State for purposes of G.S. 143-215.1(a)(1), for which a permit is required by
G.S. 143-215.1.
The Raleigh Regional Office is providing the City of Henderson an opportunity to provide evidence and justification
as to why the City of Henderson should not be assessed a civil penalty for the violation(s) that are summarized
below:
Total Vol
Total surface
Incident Start Duration Vol Water
Number Date (Miss) Location Caws (Gals) (Gals) DWR Action
202201223 8/1/2022 315 214-798 Rods Mill Rd, Inflow and Infiltration 31,500 28,000 Notice of violation -
Henderson, NC, 27537 Notice of Intent
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This Notice of Violation / Notice of Intent to Enforoe (NOV/NOI) is being Issued for the noted violation. Pursuant
to G.S. 143-215.6A, a civil penalty of not more than twenty-five thousand dollars ($2S,000.00) may be assessed
against any person who violates or fails to act in accordance with the terns, conditions, or requirements of any
permit issued pursuant Ito G.S. 143-215.1.
This otfiaa requests that you respond to this Notiaey in writing, within 10 business days of its
receipt. In your response, you should address the causes of non-compliance, remedial actions, and all other
actions taken to prevent the recurrence of similar situations. The response to this correspondence will be
considered in this process. Enforcement decisions will also be based on volume spilled, volume reaching surface
waters, duration and gravity, impacts to public health, fish kills or recreational area closures. Other factors
considered in determining the amount of the civil penalty are the violator's history of non-compliance, the cost of
rectifying the damage, whether the spill was intentional and whether money was saved by non-compliance.
N you have any questions, please do not hesitate to contact Mitchell Hayes with the Water Quality Section in
the Raleigh Regional Office at 919-791-4200 or via email at mitch.hayes6ncdenr.gov.
Sincerely,
Scott Vinson, Regional Supervisor
Water Quality Regional Operations Section
Raleigh Regional Ofitce
Division of Water Resources, NCDEQ
Cc: Raleigh Regional Office - WQS File
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ROY COOPER
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ELIZABM S. IHSER
Secowy
RICHAW E. ROGERS, JR.
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Terrell Blackmon, City Engineer
City. of Henderson
PO Box 1434
Henderson, NC 27536-1434
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SUBIECT: NOTICE OF VIOLATION & INTENT TO ISSUE CIVIL PENALTY
Tracking No.: NOV-2022-DV 0269
Sanitary Sewer Overflows - August 2022
Collection System Permit No. WQCS00055
Henderson Collection System
Vance County
Dear Mr. Blackmon:
A review has been conducted of the self -reported Sanitary Sewer Overflows (SSO's) 5-Day Reports submitted by
City of Henderson. The Division's Raleigh Regional Office concludes that the City of Henderson violated Permit
Condition I (2) of Permit No. WQCS00055 by failing to effectively manage, maintain, and operate their collection
system so that there is no SSO (Sanitary Sewer Overflow) to .the land or surface waters and the SSO constituted
making an outlet to waters of the State for purposes of G.S. 143-215.1(a)(1), for which a permit Is required by
G.S. 143-215.1.
The Raleigh Regional Office is providinq the City of Henderson an_onnnl#uniti to orovidm—eWdence and iustification
as to why the City of Henderson shot
below: I SENDER: COMPLETE THIS SFCTION
incident Start Duration
Number Date (Mina) Locat
202201223 OW2022 315 214-7
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Dhidon of Water Resources
PART I:
State of North Carolina
Department of Environment and Natural Resources
Division of Water Resources
Collection System Sanitary Sewer Overflow Reporting Form
Form CS-SSO
This form shall be submitted to the appropriate DWQ Regional Office within five business days of the first knowledge of the
sanitary sewer overflow (SSO).
Permit Number: WQCS00055
(WQCS# if active, otherwise use WQCSD#)
Facility: Henderson Collection System incident #: 202201223
Owner: City of Henderson
City: Henderson
Source of SSO (check applicable):
County: Vance
Region: Raleigh
❑ Sanitary Sewer Q Pump Station 1 Lift Station
SPECIFIC location of the SSO (be consistent in description from past reports or documentation - i.e. Pump Station 6,
Manhole at Westall & Bragg Street, etc): 214-798 Rock Mill Rd, Henderson, NC, 27537
Manhole #:
Latitude (Decimal Degrees):
Incident Started Dt: 08/01/2022 Time:
(mm-dd-yyyy)
Estimated Volume of the SSO: 31,500
Longitude (Decimal Degrees):
1:00 am
(hh:mm AM/PM)
Incident End Dt: 08/01/2022 Time:
mm-dd-yyyy
06:15 am
(hh:mm AM/PM)
gallons Estimated Duration (Round to nearest hour): 5:15 hours
Describe how the volume was determined: visual estimation
Weather conditions during the SSO event:
Rain Event
Did SSO reach surface waters? d Yes ❑ No ❑ Unknown Volume reaching surface waters (gals): 28000
Surface water name: Sandy Creek (Fox Reservoir, Roland Pond, Club Pond, Weldons Mill Pond, Southerlands Pond)
Did the SSO result in a fish kill? ❑ Yes [ANo ❑ Unknown If Yes, what is the estimated number of fish killed? 0
SPECIFIC cause(s) of the SSO:
0 Inflow and Infiltration
24 hour verbal notification (name of person contacted ): Joshua S Brigham
0 DWR ❑ Emergency Mgmt Date (mm-dd-yyy): 08/02/2022 Time (hh:mm AM/PM): 02:18:00 pm
If an SSO is ongoing, please notify the appropriate Regional Office on a daily basis until SSO can be stopped.
Per G.S. 143-215.1 C(b), the responsible party of a discharge of 1,000 or more of untreated wastewater to surface waters
shall issue a press release within 24-hours of first knowledge to all print and electronic news media providing general
coverage in the county where the discharge occurred. When 15,000 gallons or more of untreated wastewater enters surface
waters, a public notice shall be published within 10 days and proof of publication shall be provided to the Division within 30
days. Refer to the reference statute for further detail.
The Director. Division of Water Resources, may take enforcement action for SSOs that are required to be reported to
Division unless it is demonstrated that:
1) the discharge was cause by sever natural conditions and there were no feasible alternative to the discharge; or
2) the discharge was exceptional, unintentional, temporary and caused by factors beyond the reasonable control of the
Permittee and/or owner, and the discharge could not have been prevented by the exercise of reasonable control.
Part II must be completed to provide a justification claim for either of the above situations. This information will be the basis
WHETHER OR NOT PART III IS COMPLETED, A SIGNATURE IS REQUIRED AT THE END OF THIS FORM
CS-SSO Form Page: 1

PART II:
ANSWER THE FOLLOWING QUESTIONS FOR EACH RELATED CAUSE CHECKED IN PART I OF THIS FORM AND
INCLUDE THE APPROPRIATE DOCUMENTATION AS REQUIRED OR DESIRED
COMPLETE ONLY THOSE SECTONS PERTAINING TO THE CAUSE OF THE SSO AS CHECKED IN PART I
(In the check boxes below, NA = Not Applicable and NE = Not Evaluated)
A HARDCOPY OF THIS FORM SHOULD BE SUBMITTED TO THE APPROPRIATE DWR REGIONAL OFFICE UNLESS IS
Inflow and Infiltration
Are you under an SOC (Special Order by Consent) or do you have a schedule in any ❑ Yes W No ❑ NA ❑ NE
permit that addresses III?
Explain if Yes:
What corrective actions have been taken to reduce or eliminate I & I related overflow
at this spill location within the last year?
Has there been any flow studies to determine III problems in the collection system at ❑ Yes [7 No ❑ NA ❑ NE
the SSO location?
If Yes, when was the study completed and what actions did it recommend?
Has the line been smoke tested or videoed within the past year? ❑ Yes fo No ❑ NA ❑ NE
If Yes, when and indicate what actions are necessary and the status of such actions:
Are there III related projects in your Capital Improvement Plan? L7 Yes ❑ No ❑ NA ❑ NE
If Yes, explain:
Have there been any grant or loan applications for Ill reduction projects? [7 Yes ❑ No ❑ NA ❑ NE
If Yes, explain:
Do you suspect any major sources of inflow or cross connections with storm sewers' ❑ Yes ❑ No ❑ NA NE
If Yes, explain:
Have all lines contacting surface waters in the SSO location and upstream been ❑ Yes W No ❑ NA ❑ NE
inspected recently?
If Yes, explain:
CS-SSO Form Page: 2

What other corrective actions are planned to prevent future III related SSOs at this
location?
Comments:
System Visitation
ORC ❑ Yes
Backup W Yes
Name:
Christy Lipscomb
Cert#
1001657
Date visited:
08/02/2022
Time visited:
09:OOAM
How was the SSO remediated (i.e. Stopped and cleaned up)?
rain stopped and debris cleaned up and lime broadcasted
As a representative for the responsible party, I certify that the information contained in this report is true and accurate to the
best of my knowledge.
Person submitting claim: Clarissa M Lipscomb Date: 08/10/22 06:47 pm
Signature:
Telephone Number:
Title:
Any addition information desired to be submitted should be sent to the appropriate Division Regional Office within five days of t
knowledge of the SSO with reference to the incident number (the incident number is only generated when electronic entry of th
form is completed, if used).
CS-SSO Form Page: 3

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nit Type: Collection s,,stem management and operation
ification: Individual Primary Related Permit:
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Owner; City of Henderson Details
-- Dates —
Issued: 04117/2018 Orig Issued:.0512W2005
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Expire: 0413012026 Inactive:
SOC: S07-005 Details...
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City of Henderson Details... Protect Tope: Renewal
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