WQCSD0267_DV-2020-0039 Remission Green Card_20211027

■ Complete items 1, 2, and 3.
A. Signature
■ Print your name and address on the reverse
X 0 Agent
so that we can return the card to you.
❑ Addressee
■ Attach this card to the back of the mailpiece,
B. Received by (Printed Name)
C. Date of Delivery
or on the front if space permits.
D. Is deliveryaddress differentfrom item 17 ❑ Yes
a North Carolina, Inc.
If YES, enter delivery address below: ❑ No
I Amanda Berger
Mackenan Ct
Ca& NC 27511
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eRestncted D0 Registered elivery ❑ Reggistemd MlilResfidei
❑ Cedi ied Mal® Delivery
9590 9402 3950 8060 9852 25 ❑ Certified Mail Restricted Delivery ❑ Return Receipt for
❑ Collect on Delivery Merchandise
n Delivery Restricted Delivery ❑ Signature Confirmation^^
7018 1830 0001 8037 1868 Rail ❑ Signature Confirraidan
al Restricted Delivery Restricted Delivery
(over $500)
PS Form 3811, July 2015 PSN 7530-02-000-9053 Domestic Return Receipt
Postal
CERTIFIED o
RECEIPT
Co
-0
•.
U Relur Receipt(nardcopy) $
❑ Retum Receipt (elecVonk) $
❑C difi d Mail Restricted Delivery $
0MO Signature Required $
Postmark
Here
Aqua North Carolina, Inc.
Attn: Amanda Berger
------------------
202 Mackenan Ct
Cary, NC 27511 ... ` `------
,

LISPS TRACKING #
First -Class Mail
Postage & Feep, Paid
USPS
Permit No. G
9590 9402 1950 8060 9852 25
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Sender: Please print your name, addres
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NCDEQiDWR/NPDES
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Thedford
1617 Mail Service Center
Raleigh, NC 27699-1617
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