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CerUf kale of Core;age Naber: NCG -(This moubmft report aban be rec&M.by the Ditd*n no la than M dada tram
• � the date, tie fae3lit� =ecdres the �11ng iesotb ttro�o the talortt .) = -:
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CBRft'�IRD LABORATORY(S) t;
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By this dzmhwej Y certify that this report baw mante.
mart �A: Monttorhsg•Ydb
camp= m the best K mykaos►letiga
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Does dus facility perform Vehicle IMainkmace Activities using more than 55 gaHmn of new motor oil per gxmthl _,
drys compida-part B). yea __Do
_. Form SWU:.24& .iM
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STORM EVENT CBABAC'> S14MC Mad Otlgiwf* Or* ft
Division ofWater Q=Iity -
Date Atter Cci* tFbes
Tota! ETWt Ptedpftadon On6u):._ 1617 fllail•Suvkc demi
Ev6st Darafton (hours): `_ (o* if appBcable — see p).. ltafeigb, North Canofina 27699-1617
(if more than one atoim event • aams�led) _
Date
Total Evedt Predpwan (Biehrsr - -
Erent Dorafbp (boi!ra): (�► 4 applicable -set permit)
"I arfit , finder penalty of bw, that this d0clMmut and aII stbchnknb were prepared under my d uflon or soper0don tut ww' rdance with a
system designed to assureUat goaGf3ed persomnd properly gather and evahrate the information sabmithd. Based on my h q*.y of the pump
or persons; who mansgge the system, or thosa persons directly responAk for
. oI my foeowledge• and beef, true, aecara and comp*., � � information, the information submitted b. to the best
k, mp* .I am aware that th=e are
W17 the pomibfiEty_of f1m and Imprkemmmt for imowft vlobt�" dPffk=t penalties for aabffittiug Labe information,
(ipatere.of Permittee) V (Date) : .