NCG550086_Other Agency Documents_19970415

Letter to DON FLOCKHART April 15, 1997
NCG550086
INVOICE FOR RENEWAL OF j y
NPDES PERMIT
Check here if you do NOT wish to renew this permit.
Please return this page along with a letter documenting your reasons
for not requesting renewal to:
Mr. Charles H. Weaver, Jr.
Division of Water Quality/WQ Section
NPDES Group Jrn
Post Office Box 29535 Z 3
1141
MP
Raleigh, North Carolina 27626-0535 -4 NM7.
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711
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❑ Check here if you wish to renew this permit. -0 x3rn
Please verify that the following information is documented accurately: _..CO
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Mailing Address 7:4.
DON FLOCKHART El No revision required.
FLOCKHART, DON- RESIDENCE
1142 PINE KNOLLS DRIVE 111 Revision required. (Please specify below.)
KERNERSVILLE , NC 27284
Phone number: [phone]
Fax number:
e-mail address:
Facility Location
DON FLOCKHART No revision required.
FLOCKHART, DON - RESIDENCE
1142 PINE KNOLLS DR Revision required. (Please specify below.)
KERNERSVILLE, NC 27284
I
Please retdrn this page with your letter requesting renewal, and $240 fee (payable to NCDEHNR) to:
Mr. Charles H. Weaver, Jr.
Division of Water Quality/WQ Section
NPDES Group
Post Office Box 29535
Raleigh, North Carolina 27626-0535 /
Signature of applicant or authorized representative -17971 'L
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Date 17/ 3 Op 7

w SENDER:
■Complete items 1 and/or 2 for additional services. I also wish to receive the
r• ■Complete items 3,4a,and 4b. following services(for an
(IN •Printor name and address on the reverse of this form so that we can return this extra fee):
card6. to you.
.■Attach this form to the front of the mailpiece,or on the back if space does not 1. ❑ Addressee's Address 5
m permit. ,-
y •Write'Return Receipt Requested'on the mailpiece below the article number. 2. ❑ Restricted Delivery rn
■The Return Receipt will show to whom the article was delivered and the date ..
c delivered. Consult postmaster for fee. .�
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PS Form 3811, December 1994 Domestic Return Receipt

First-Class Mail. •
UNITED STATES POSTAL SERVICE
oft iRl46 Postage&Fees Paid
'O. USPS ..
Permit No.G-10
• Print your name, address, and ZIP Code in this box •
1690-6901
North Carolina Department of
Environment, Health & Natural Resources
Division of Environmental Management
PO Box 29535
Raleigh, NC 27626-0535
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1142 Pk.Knolls Rd.
rsviNe,NC 27284-8231