NC0028827_LV20170201_20170707

ROY COOPER
G at1,N no,
MICHAEL S. REGAN
$trcfct;
Water Resources S JAY ZEMMERMAN
ENVIRONMENTAL QUALITY NwfG,'
Certified Mail # 7013 2630 0002 1133 8413
Return Receipt Requested
July 07, 2017
F Patrick Ausband
Snug Harbor Management LLC RECEIVEMCDEWWR
PO Box 150
Sealevel, NC 28577-0150 JUL 17 2017
Water Quality
SUBJECT Notice of Violation and Assessment of Civil Penalty Permitting Section
for Violations of North Carolina General Statute (G S) 143-215 1(a)(6)
and NPDES WW Permit No NCO028827
Snug Harbor Management LLC
Snug Harbor on Nelson Bay WWTP
Case No LV -2017-0201
Carteret County
Dear Permittee
This letter transmits a Notice of Violation and assessment of civil penalty in the amount of $567 25 ($450 00 civil penalty +
$117 25 enforcement costs) against Snug Harbor Management LLC
This assessment is based upon the following facts a review has been conducted of the Discharge Monitoring Report
(DMR) submitted by Snug Harbor Management LLC for the month of January 2017 This review has shown the subject
facility to be in violation of the discharge limitations and/or monitoring requirements found in NPDES WW Permit No
NCO028827 The violations, which occurred in January 2017, are summarized in Attachment A to this letter
Based upon the above facts, I conclude as a matter of law that Snug Harbor Management LLC violated the terms,
conditions or requirements of NPDES WW Permit No NCO028827 and G S 143-215 1(a)(6) 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 maybe
assessed against any person who violates the terms, conditions or requirements of a permit required by G S 143-2151(a)
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, I, James H Gregson,
Regional Supervisor, Wilmington Regional Office hereby make the following civil penalty assessment against Snug Harbor
Management LLC
State of North Carolina I Environmental Quality I Water Resources
127 Cardinal Drive Extension, Wilmington, North Carolina 28405
910-796-7215

$100 00 1 of the I violations of 143-215 1(a)(6) and Pen -nit No NC0028827, by discharging waste water into
T
the waters of the State in violation of the Permit Daily Maxiinum for BOD - Cone
5100 00 1 of the 1 violations of 143-215 1(a)(6) and Permit No NCO028827, by discharging waste water into
the waters of the State in violation of the'Permit Daily Maximum for TSS - Cone
S000 0 of the 1 violations of 143-215 1(a)(6) and Permit No NC0028827, by discharging waste water into
the waters of the State in violation of the Permit Monthly Average for BOD - Cone
$250 00 1 of the 1 violations of 143-215 1(a)(6) and Permit No NC0028827, by discharging waste water into
the waters of the State in violation of the Permit Monthly Average for TSS - Cone
$45000 TOTAL CPaL PENALTY
$117 25 Enforcement Costs
$56725 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
Wastewater Branch
Division of Water Resources
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

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 143B-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 Stipulation of Facts" form within thu-ty 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
Wastewater Branch
Division of Water Resources
1617 Mail Service Center
Raleigh, North Carolina 27699-1617

Option 3: File a petition for an administrative hearing with the Office of Administrative Hearings:
If you wish to contest any statement in the attachzd 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 in and 5 00 p in, 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 § 15OB-23 2) is received in the
Office of Administrative Hearings within seven (7) 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
Office of Administrative Hearings
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 resulr_ 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 Dean Hunkele with the Division of Water Resources staff of the Wilmington
Regional Office at [phone] or via email at dean hunkele@ncdenr gov
Sincerely,
krFr-s H Gregson, Regional Supervisor
Water Quality Regional Operations Section
Wilmington Regional Office
Div_sion of Water Resources, NCDEQ
ATTACHMENTS
Cc WQS Wilmington Regional Office - Enforcement File
NPDES Compliance/Enforcement Unit - Enforcement File

JUSTIFICATION FOR REMISSION REQUEST
Case Number: LV -2017-0201 County: Carteret
Assessed Party- Snug Harbor Management LLC
Permit No.: NC0028827 Amount Assessed: $567 25
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 i equest 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 § 143B-282 1(c), remission of a civil
penalty may be 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 1438-282 1(b) were wrongfully applied to the
detriment of the petitioner (the assessment factors 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 future 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 (z e, explain
how payment of the civil penalty will prevent you from performing the activities necessary to achieve
compliance)
EXPLANATION:

STATE OF NORTH CAROLINA
COUNTY OF CARTERET
IN THE MATTER OF ASSESSMENT
OF CIVIL PENALTIES AGAINST
Snug Harbor Management LLC
Snug harbor on Nelson Bay WWTP
PERMIT NO NCO028827
DEPARTMENT OF ENVIRONMENTAL QUALITY
WAIVER OF RIGHT TO AN
ADMINISTRATIVE HEARING AND
STIPULATION OF .PACTS
CASE NO. LV -2017-0201
Having been assessed civil penalties totaling 5567 25 for violation(s) as set forth in the assessment document of the Division
of Water Resources dated July 07, 2017; 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 (3 0) days of receipt of the notice
of assessment No new evidence in support of a rerr-ission request will be allowed after (30) days from the receipt of the
notice of assessment
This the
day of
TELEPHONE
SIGNATURE
20

ATTACHMENT A
Snug Harbor Management LLC
CASE NUMBER. LV -2017-0201
PERMIT:
NCO028827
REGION
Wilmington
FACILITY.
Snug Harbor
on Nelson Bay WWTP
COUNTY
Carteret
LIMIT VIOLATION(S)
SAMPLE LOCATION
Outfall 001 - Effluent
Violation
Report
Unit of
Limit
Calculated % Over
Violation
Penalty
Date
Month/Yr
Parameter
Frequency
Measure
Value
Value Limit
Type
Amount
1/19/2017
1-2017
BOD, 5 -Day (20 Deg
Weekly
mg/I
45
84 867
Daily
$10000
C) - Concentration
Maximum
Exceeded
1/31/2017
1-2017
BOD, 5 -Day (20 Deg
Weekly
mg/I
30
3230 78
Monthly
$000
C) - Concentration
Average
Exceeded
1/26/2017
1-2017
Solids, Total
Weekly
mg/1
45
1680 3,6333
Daily
$10000
Suspended-
Maximum
Concentration
Exceeded
1/31/2017
1-2017
Solids, Total
Weekly
mg/I
30
431 40 1 3379
Monthly
$25000
Suspended-
Average
Concentration
Exceeded

DMSION OF WATER RESOURCES - CIVIL PENALTY ASSESSMENT
Violator: Snug Harbor Management LLC
Facility Name: Snug Harbor on Nelson Bay WWTP
Permit Number: NC0028827
County: Carteret
Case Number: LV -2017-0201
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;
ev)
c_1. -r rte. �,��.-G2.l.,:i t.�c.�-."--''4...�d ' �� .,��..�;�"-r,..r,F"^ �.�%i/'- r��i� e -,J' �l'`''•..''._.=-'e`.E.��'-/�-�Ii"'�����-D,��
�✓'`�.�'j�ir'' �!Y/�•-"'�/ `
2) The duration and gravi of the viol/a/.tio(n;� �. ✓ �`-7`,,` y _��� ��� �� ij
,6 J—
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;
IJ -
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
L'�.�s�19 C' ll�j7 G���...� ��/LLS:�� �`3 ��l�i!�%�•i��✓� � .%�AG''? —� ...�'--s-� r_'i--L.-�,��-�..Lv�'?.e.r"
8) The cost to the State of the enforcement procedures.
$117.25
'Date Jamb H. regson, Regi na upervisor
Water`Q� ahty Regional perations Section
Wilmington Regional Office
Division of Water Resources, NCDEQ

nu larbor
Sl ��f$9E f1 T Y
10 May 2017
James'l I Gregson. Rogionat Supervisor
Water Quality Regional Operations Scetion
127 Cardinal Dove.I'�xtonsion
Wilt-nngtoi, NC 2,8405 Re Your .Lotter of 02 May 2013
Subleet, Notice of Violation & Iu ent
to Assess CPtvil Penalty
T,rackUig No NOV-2017-1`.V-4307
Permit No 'NC0028827
Snug Harbor' onN'elson Bay W W I,P
Carteret County
Mr Cly egson:
Your above xeforonced letter addresses Limit Exceedance Violations reported on the
January 2017 Discharge Monitoring Report The, specifiioviolations are -BOD and TSS
As you know, the 1 SS tikas 43 on 19 January 2017, and although not above the Daily
Maximum; did cause. concern and J invostigated, the potential cause as soon as I
xeectved notification from the Lab, E'nvi onment 1, ou 24 January When looking for
the culprit, everything appeared normat and the cause was not identified On 26
January, T received notification from the Lab that BOD, from the sample taken on 19
January, was >84 00 I investigated the, potential source of the inalfunetton again oil 26
January and could not locate the source
In the evening boars of the 26th and morning fours of the 27th 1 continued to
investigate the cause of the high values Knowing the problem was most likely tertnar)
falter related, I started digging deeper into the filter media and discovered debris in the
Filter media was causing a ,short circuit Numerous hours were spent on the 27th
removing portions of the „media., removal of the debris. washing; and replacing At the,
same bine on the 27th I was ,locating sources for the media, P&A. and contacting
outside contractors to Jme up the labor force needed to rebuild the f Iters.
Ovex the next several days, we spent numerous manhours removing portions of the
media, cleaning and replacing to attempt to stay in compliance while the media and
labor force was getting lined up and on site. The results of the offlue,nt aualy sis Crom 02
February samples proved that our time spent on cleaning the filters was not in vetn
On 3 I January,, the order, with prepaid freight to Snug Harbor, was placed for the
anthracite and the anticipated delivery was scheduled NLT 06 February, but did not
arrive. On 06 February the sand for the filters was picked 'up in SC by Snug Harbor, and
xeady to begin work. however without the antbraeite, we had to reschedule the crew,
We ended up having to pick up the, anthracite in Greenville. on 08 February due to a
transfex of fre7,ght from the original carrier, to a subcontracted carrier
f (0 `R1 -15c dS� �0v*/<`,C,-? (� j<< X0,52l

S
_nup r arbor
on 9Uson 'Bay
\J:� •
The crew began work on the East Filter on 08 February, however we discovered the
specifications had been altered sometime in the past and on 09 February, I contacted
Dean Hunkele and Tom Tharrington for advice which was very helpful and most
appreciated. We continued our daily media cleaning process on the West Filter,
prepped the East Filter under drain and tank interior, and began the search for the
balance of media gravel needed to rebuild the filters in accordance with the advice of
your staff.
On 14 February, the gravel media was picked up in Hoffman, NC by Snug Harbor
and delivered to the site. The crew began immediately placing the media in the East
Filter. The newly placed media was saturated and the West Filter media cleaned while
still on line. After almost 40 hours of total saturation, the East filter was placed on line,
observed through several backwash cycles and after confirmation of proper operation,
the West Filter was taken off line and rebuilt in kind.
The debris which caused the filters was not visible on the surface and was only
discovered after hours of looking and then only by digging down to the sand layer
under the anthracite.
In summary, I began investigating the situation as soon as I received knowledge of
the problem and spent numerous hours cleaning the old media with the filters in service
to curtail the Parameter Values of BOD and TSS exceeding our NPDES Permit.
It is requested that consideration be given for the enormous expense and effort by
Snug Harbor in resolution of the matter giving rise to your NOTICE OF VIOLATION
& INTENT TO ASSESS CIVIL PENALTY when you evaluate the civil penalty
associated with the Limit Exceedance Violations.
If you have any questions, please do not hesitate to contact me.
Sincerely,
Paul Tully, Director of Engineering
Snug Harbor on Nelson Bay
272 Hwy. 70 E
Sea Level, NC 28577
o: 252-225-4411 x223
c: 910-389-1295
e: [e-mail]
cc: F Patrick Ausband
Penny Sproul
Joe Behan
(PC 90x 150 CSea'Gael, 9YC 96577 252-225-4411

NPDES PERMIT NO NCO028827 ' OISCHAR&- SIO 103 MONTH January YEAR 2017
FACILITY NAME Snug Harbor on Nelson Bay CLASS II COUNTY Carteret
CERTIFIED LABORATORY (1) Environment 1, atc �, P",-* `, CERTIFICATION NO 10
(list additional laboratories on the backside/page 2 of this f'orkrs) o ;
OPERATOR IN RESPONSIBLE CHARGE (ORC) VI/11 ' '',ton Paii�-T60-;cc- Grade 1 CERTIFICATION NO 1003977
PERSON(S) COLLECTING SAMPLI J Futcher P Tully e� i r ORC PHONE [phone] eat 223
CHECK ]BOX E1F' ORC HAS CHANGED ® NO FLOW/ DISCHARGE FROM SITE
Mail ORIGINAL and ONE COPY to _
ATTN CENTRAL FILES x 3 / t" C- "
DIVISION OF WATER QUALITY (SIGNATURE OF OPERAT OR IN RESPONSIBLE CHARGE) DATE
1617 MAIL SERVICE CENTER BV THIS SIGNATURE, I CERTIFY THAI TMS REPORT 1S
RALEIGH NC 27699-1617 ACCURATE AND COMPLETE TO THE BEST Of MI KNOWLEDGE
MR -1 (11-04)
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noon
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16 700 8 B
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19 1400l 7 1 B
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23 700 8 - B
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24 445 8 B
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26 13 ool 7 B
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29 N
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cCerttiffied Maid # 7013 2630 0002 1133 7843
Return Reeeilpt Reguested
May 2, 2017
F Patrick Ausband
Snug Harbor Management LLC
PO Box 150
Sealevel, NC 28577-0150
RO)" COOPER
• p �I q r �ry
1\41CHAEL S. REGAN
Sowt,so'- t`
S JAY ZINIMERINIAN
i I(PCiti 1.
SUBJECT' NOTXCE OF VI OLATHON & HNTENT TO ASSESS CXVHL PENALTY
Tracking Number- NOV-2017-LV-0307
Permit No. NCO028827
Snug Harbor on Nelson Bay WWTP
Carteret County
Dear Permittee
A review of the January 2017 Discharge Monitoring Report (DMR) for the subject facility revealed the violation(s)
indicated below:
Limit Exceedance Violation(s):
Sample
c _
Reported
Location
Parameter
Date
Value
Water Resources
EN'NiRONRENTALDUA!
ITY
cCerttiffied Maid # 7013 2630 0002 1133 7843
Return Reeeilpt Reguested
May 2, 2017
F Patrick Ausband
Snug Harbor Management LLC
PO Box 150
Sealevel, NC 28577-0150
RO)" COOPER
• p �I q r �ry
1\41CHAEL S. REGAN
Sowt,so'- t`
S JAY ZINIMERINIAN
i I(PCiti 1.
SUBJECT' NOTXCE OF VI OLATHON & HNTENT TO ASSESS CXVHL PENALTY
Tracking Number- NOV-2017-LV-0307
Permit No. NCO028827
Snug Harbor on Nelson Bay WWTP
Carteret County
Dear Permittee
A review of the January 2017 Discharge Monitoring Report (DMR) for the subject facility revealed the violation(s)
indicated below:
Limit Exceedance Violation(s):
Sample
Limit
Reported
Location
Parameter
Date
Value
Value
Tyre of Violation
001 Effluent
BOD, 5 -Day (20 Deg, C) -
1/19/2017
45
84
Daily Maximum Exceeded
Concentration (C0310)
001 Effluent
Solids, Total Suspended -
1/26/2017
45
1,680
Daily Maximum Exceeded
Concentration (CO530)
001 Effluent
BOD, 5 -Day (20 Deg C) -
1/31/2017
30
32 33
Monthly Average Exceeded
Concentration (C0310)
001 Effluent
Solids, Total Suspended -
1/31/2017
30
43138
Monthly Average Exceeded
Concentration (C0530)
A Notice of Violation/Intent to Issue Civil Penalty is being issued for the noted violation of North Carolina General
Statute (G S ) 143-215 1 and the facility's NPDES Permit. Pursuant to G S. 143-215 6A, a civil penalty of not
more than twenty-five thousand dollars ($25,000.00) may be assessed against any person who violates or fails
to act in accordance with the terms, conditions, or requirements of any permit issued pursuant to G.S.
143-2x15 1
State of North Carolina I Environmental Quality I Water Resources
127 Cardinal Drive Extension, Wilmington, North Carolina 28405
910-796-7215

If you wish to provide additional information regarding the noted violation, request technical assistance, or
discuss overall compliance please respond in writing within ten (10) business days after receipt of this Notice -.A
review of your response will be considered along witn any information provided on the submitted Discharge
Monitoring Report(s) You will then be notified of any civil, penalties that may be assessed regarding the
violations If no response is received in this Office within the ILO -day period, a oaviB {penalltty
assessment may he prepared.
Remedial actions should have already been taken to correct this problem and prevent further occurrences in the
future The Division of Water Resources may pursue enforcement action for this and any additional violations of
State law If the violations are of a continuing nature, not related to operation and/or maintenance problems,
and you anticipate remedial construction activities, then you may wish to consider applying for a Special Order by
Consent
Reminder. Pursuant to Permit Condition 6 in Section E, the Permittee is required to verbally notify the Regional
Office as soon as possible, not to exceed 24 hours, from first knowledge of any non-compliance at
the facility including limit violations, bypasses of, or failure of a treatment unit. A written report may
be required within 5 days if directed :)y Division staff Prior notice should be given for anticipated or
potential problems due to planned maintenance activities, taking units off-line, etc
If you have any questions concerning this matter or to apply for an SOC, please contact Dean Hunkele of the
Wilmington Regional Office at 910-796-7215.
Sincerely,—),
j '
Jams i'sgC n, Regional Supervisor
eY Q
Watuality Regional Operations Section
J Wilmington Regional Office
Divis on of Water Resources, NCDEQ
Cc WQS Wilmington Regional Office - Enforcement File
Central Files, WQS
State of North Carolina I Environmental Quality I Water Resources
127 Cardinal Drive E)dension, Wilmington, North Carolina 28405
910-796-7215

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® Attach this card to the back of the mailpiece,
or on the front if space permits
1 Article Add sed to
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❑ Addressee
C Date of Delivery
D Is delivery address different from item 19 ❑ Yes
If YES, enter delivery address below ❑ No
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3 Service Type
❑ Priority Mad Express@
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❑ Registerreed Mail Restncted
9590 9402 1772 6074 8659 39
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Delivery
❑ Return Receipt for
❑ Collect on Delivery
Merchandise
2 Article Number (Transfer from service label)
❑ Collect on Delivery Restricted Delivery
❑ Signature ConfirmationT
❑ Signature Confirmation
701,3 2630 0002 1,1,33 7843
❑ Insured Mail
7 Insured Mail Restricted Delivery
(over$500)
Restricted Delivery
` PS Go m3811, July 2015 PSN 7530-02-000-9053
Domestic Return Receipt
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