NC0085952_NOV20150002_20150113 (3)

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STATE OF NORTH CAROLINA DEPARTMENT OF ENVIRONMENT
AND NATURAL RESOURCES
COUNTY OF BUNCOMBE
IN THE MATTER OF ASSESSMENT ) WAIVER OF RIGHT TO AN
OF CIVIL PENALTIES AGAINST ) ADMINISTRATIVE HEARING AND
STIPULATION OF FACTS
T A Operating LLC
Candler Travel Center ) '
PERMIT NO.NC0085952 ) CASE NO. LV-2015-0002 " i:� `.�i
Having been assessed civil penalties totaling $409.26 for violation(s) as set forth in the assessment document of the
Division of Water Resources dated January 13, 2015, 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.
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This the day of $20
SIGNATURE
ADDRESS ,�, .• . t
TELEPHONE
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