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North Carolina Department of Labor <br />Occupational Safety and Health Division <br />4964 University Parkway, Suite 202 <br />Winston-Salem, NC 27106 <br />Phone: 336-776-4420 FAX: 336-767-3989 <br />INVOICE/ <br />DEBT COLLECTION NOTICE <br />Company Name: Proshot Concrete, Inc. <br />Inspection Site: Near 1430 Sherman Court, High Point, NC 27260 <br />Issuance Date: 12/14/2018 <br />Summary of Penalties for Inspection Number: 318141884 <br />Citation 1, Serious <br />TOTAL PENALTIES <br />r $24,5.00.00 <br />524,500.00 <br />Please remit payment promptly to Attn: Financial Services Division - Collections, NC Department of <br />Labor at 1101 Mail Service Center, Raleigh, NC 27699-110I, for the total amount of the uncontested <br />penalties summarized above. Make your check or money order payable to: NC Department of Labor, <br />OSHA Division. For payment by credit card, complete the form provided. Please indicate OSHA' Inspection Number (indicated above) on the remittance. Pay online at www.nclabor.com. We accept <br />VISA, MasterCard, and E -Checks. You may also fax your payment to (919) 715-9094, or mail to: N.C. <br />Department of Labor, Financial Services Division, 1101 Mail Service Center, Raleigh, NC 27699-110 1. <br />OSHA does not agree to any restrictions or conditions or endorsements put on any check or money <br />order for less than full amount due, and will cash the check or money order as if these restrictions, <br />conditions, or endorsements do not exist. <br />Citation and Notification of Penalty Page 25 of 23 OSI IA -2 (Rev 1/14) <br />