Certificate of Coverage No. CERTIFICATION "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." [Required by 40 CFR §122.22] Signature __________________________________________________ Date _______________ Mail Benchmark Exceedance/Tier 2 DMR to Your DEMLR Regional Office Land Quality Section: REGIONAL OFFICE REGIONAL OFFICE MOORESVILLE REGIONAL OFFICE 70 610 East Center Avenue/Suite 301 (828) 296-4500 (704) 663-1699 (910) 433-3300 RALEIGH REGIONAL OFFICE REGIONAL OFFICE REGIONAL OFFICE Mall Extension (919) 791-4200 (252) 946-6481 (910) 796-7215 WINSTON-SALEM REGIONAL CENTRAL OFFICE OFFICE Questions for The Central Office 450 Hanes Mill Road, Suite 300 Stormwater Permitting Program? Winston-Salem, NC 27103 (919) 707-9220 (336) 776-9800
Certificate of Coverage No. CERTIFICATION "I certify, under penalty of law, that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fines and imprisonment for knowing violations." [Required by 40 CFR §122.22] Signature __________________________________________________ Date _______________ Mail Benchmark Exceedance/Tier 2 DMR to Your DEMLR Regional Office Land Quality Section: REGIONAL OFFICE 70 (828) 296-4500 REGIONAL OFFICE (910) 433-3300 MOORESVILLE REGIONAL OFFICE 610 East Center Avenue/Suite 301 (704) 663-1699 RALEIGH REGIONAL OFFICE (919) 791-4200 REGIONAL OFFICE Mall (252) 946-6481 REGIONAL OFFICE Extension (910) 796-7215 WINSTON-SALEM REGIONAL OFFICE 450 Hanes Mill Road, Suite 300 Winston-Salem, NC 27103 (336) 776-9800 CENTRAL OFFICE Questions for The Central Office Stormwater Permitting Program? (919) 707-9220
NCG14-DMR-SWTier2-20170822-DEMLR-SW.docx