NCG050360_RTN Inv_2020012

NORTH CAROLINA DEPARTMENT OF
ENVIRONMENTAL QUALITY 11111111 0 III II
INVOICE * 2 0 2 0 P R 0 0 0 8 6 6 *
Stormwater Annual Permit Fee Open
This Stormwater annual fee is required by the North Carolina Administrative Code 143-215.D(a). It covers the administrative
costs associated with your permit. It is required of any person holding a permit for any time during the annual fee period,
regardless of the facility's operating status. Failure to pay the fee by the due date will subject the permit to revocation.
Operating without a valid permit is a violation and is subject to a$10,000 per day fine. If the permit is revoked and you later
decide a permit is needed,you must reapply,with the understanding the permit request may be denied due to changes in
environmental, regulatory,or modeling conditions. (�
Invoice Number: 2020PR000866 R6 ]�� l rl Annual Fee Period: 2020-03-01 to 2021-02-28
Permit Number: NCG050360 (/ l II oice Date: 02/04/2020
Edgecombe County R1\3-iria ',(�{�-I((J/,,(J// Y/
General Foam Plastics ex le Date: 03,05/2020
Larry Mattern Annual Fee: $100.00
General Foam Plastics Corporation 501 Daniel St XIE 276 FE 1 ; /12/2
Tarboro,NC 27886
RETU CN TO SENDER
NOT DELZVERASLE AS ADDRESSED
UNABLE TO FORWARD t Payment Options:
a 1. Electronic payment is convenient and quick. To pE x 'Fx 'i" 3- 129 t $ 6 $2 _
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browser. If you select eCheck,there will be no convi �a �� $ � �� s vi$vi ass tag `" 8 8 ' € i t s
convenience fee for a debit card is$3.95.
2. To pay by mail,please make your check payable to"DEMLR Stormwater Program"and include the invoice number on the check.
Then,detach the invoice below and write the check number on the invoice. A$25.00 processing fee will be charged
for returned checks in accordance with N.C.General Statute 25-3-512.
Remit payments by mail to:
NCDEQ-Division of Energy,Mineral and Land Resources
Attn: Stormwater Billing
512 N.Salisbury Street
1612 Mail Service Center
Raleigh,NC 27699-1612
3. Non-payment of this fee by the payment due date will initiate the permit revocation process.
4. Please include your permit number in all correspondence.
5. Should you have any questions,please contact the Fee Coordinator at(919)707-9220.
(Return This Portion With Check)
lIFFI:IFII I' "Ill
* 2 0 2 0 P R 0 0 0 8 6 6 *
ANNUAL PERMIT INVOICE
Open
Invoice Number: 2020PR000866 Annual Fee Period: 2020-03-01 to 2021-02-28
Permit Number: NCG050360
Edgecombe County Invoice Date: 2/4/2020
General Foam Plastics Due Date: 3/5/2020
Annual Fee: $100.00
Larry Mattern
General Foam Plastics Corporation
501 Daniel St Check Number:
Tarboro,NC 27886