NCS000578_MONITORING INFO_20190411

M*W
STORMWATER DIVISION CODING SHEET
NCS PERMITS
PERMIT NO.
nI(�7 ouV 5� "
DOC TYPE
El FINAL PERMIT
Lv�MONITORING REPORTS
❑ APPLICATION
❑ COMPLIANCE
❑ OTHER
DOC DATE
❑ � OI � V 7 o
WYYMMDD

(� DUKE
ENERGY
April 4, 2019
NC Department of Environmental Quality
Attention: Central Files
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Duke Energy Carolinas, LLC
NPDES Storm Water Discharge Monitoring Report for:
Buck Stearn Station — NCS000578 — Rowan County
Duke Energy
Buck Combined Cycle
1385 Dukeville Road
Salisbury, NC 28146
In accordance with Part 111, E(2) of the above referenced NPDES Storm Water permit, the
original and one copy of the monthly monitoring reports are attached. The period for sampling
ended March 31, 2019.
Enclosed is the DMR for outfalls SW001, SW002, SW003, SW073, SW075, SW077, SW078
and SW079. There were no samples collected from these outfalls and are listed as "No Flow"
for the sampling period. This was due to either nighttime rainfall events, inclement weather or
lack of qualifying rainfall events.
Please direct any correspondence or questions concerning the Buck Steam Station NPDES
Storm Water Program to Elizabeth Glenn at [phone].
REC F NE
Yours truly,
�. APR 1 2019
Ct=N 'R/-\L FILE3
DWR SECT€ON
Henry A. Botkins, 4Jr.,General Mana er II
Buck Combined Cycle
Attachments
bc: w/attachment
Elizabeth Glenn
Tina Woodward
Steve Hodges
Mailed by USPS: 7018 0040 0000 0302 4566
Return Receipt USPS: 9590 9402 3857 8060 1485 32

STORII�IWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS000578
FACILITY NAME Buck Steam Station
PERSON COLLECTING SAMPLE(S) N/A
CERTIFIED LABORATORY(S) Duke Energy of the Carolinas, LLC Lab #248
Shealv Environmental Services, NC_Lah #329
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2019
(This monitoring report shall he received by the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY Rowan
PHONE NO. [phone]
SIGNATURE OF PERM ITTEE OR DESIGNEE
REQUIRED ON PAGE 3.
Outfall
No.
Date
Sample
Collected
50050
00400
01077
01002
01022
01012
01027
Total
Flow (if app.)
Total
Rainfall
pH
Silver, Total (as
Ag)
Arsenic,
Total (as As)
Boron, Total
(as B)
Beryllium,
Total (as Be)
Cadmium,
Total (as Cd)
mo/dd/ yr
MG
inches
m
m L
m L
m
m L
SW001
NIA
NIA
NO QUALIFYING
FLOW FOR THE MONTH
OF MARCH 2O19
SWO02
NIA
NIA
NO QUALIFYING FLOW FOR THE MONTH OF MARCH 2O19
SWO03
N/A
NIA
NO QUALIFYING FLOW FOR THE MONTH OF MARCH 2O19
SW073
N/A
NIA
NO QUALIFYING FLOW FOR THE MONTH OF MARCH 2O19
SW075
NIA
NIA
NO QUALIFYING FLOW FOR THE ,'MONTH OF MARCH 2019
SW077
NIA
NIA
NO QUALIFYING FLOW FOR THE ,MONTH OF MARCH 2O19
SW078
NIA
NIA
NO QUALIFYING FLOW FOR THE MONTH OF MARCH 2019
SW079
NIA
NIA
NO QUALIFYING FLOW FOR THE MONTH OF MARCH 2O19
Outfall
Date
01034
01042
01067
01051
01097
01147
01059
01092
No.
Sample
Collected
Chromium,
Total (as Cr)
Copper, Total
(as Cu)
Nickel, Total
(as Ni)
Lead, Total
(as Ph)
Antimony,
Total (as Sb)
Selenium,
Total (as Se)
Thallium,
Total (As Tl)
Zinc, Total (as
Zn)
mo/ddl r
m
m
m L
m L
mg1L
m
m L
m
SW001
NIA
NO QUALIFYING
FLOW FOR THE MONTH OF MARCH 2019
SWO02
NIA
NO QUALIFYING FLOW FOR THE 'MONTH OF MARCH 2O19
SWO03
NIA
NO QUALIFYING FLOW FOR THE ,MONTH OF MARCH 2O19
SW073
N/A
NO QUALIFYING FLOW FOR THE MONTH OF MARCH 2O19
SW075
N/A
NO QUALIFYING FLOW FOR THE ,I�iONTH OF MARCH 2O19
SW077
N/A
NO QUALIFYING FLOW FOR THE MONTH OF MARCH 2O19
SW078
N/A
NO QUALIFYING FLOW FOR THE MONTH OF MARCH 2O19
SW079
N/A
NO QUALIFYING FLOW FOR THE ,MONTH OF MARCH 2O19
Permit Number NCS000578
Form SWU-247, last revised 21212012
Page I of 3

Outfall
Date
71900
C0530
00556
Mercury, Total,
Solids, Total
Oil & Grease
No.
Sample
Collected
Method_ 16.31E
Suspended.- .-
-
Concentration
mo/dd/ r
ngIL
m L
mg1L
SW001
NIA
NO QUALIFYING FLOW FOR THE MONTH OF
MARCH 2O19
SWO02
NIA
NO QUALIFYING FLOW FOR THE MONTH OF
MARCH 2O19
SW003
N/A
NO QUALIFYING FLOW FOR THE MONTH OF
MARCH 2O19
SW073
N/A
NO QUALIFYING FLOW FOR THE MONTH OF
MARCH 2O19
SW075
NIA
NO QUALIFYING FLOW FOR THE MONTH OF
MARCH 2O19
SW077
NIA
NO QUALIFYING FLOW FOR THE MONTH OF
MARCH 2O19
SW078
N/A
NO QUALIFYING FLOW FOR THE MONTH OF
MARCH 2O19
SW079
N/A
NO QUALIFYING FLOW FOR THE MONTH OF
MARCH 2019
Outfall
No.
Date
Sample
Collected
Aroclor 1016
Aroclor 122E
Aroclor 1232
Aroclor 1242
Aroclor 1248
Aroclor 1254
Aroclor 1260
mo/dd/ r
ugfL
u
u L
u L
ugIL
u
u
SW001
N/A
NO QUALIFYING FLOW FOR THE MONTH OF MARCH 2O19
SWO02
NIA
NO QUALIFYING FLOW FOR THE MONTH OF MARCH 2O19
SWO03
NIA
NO QUALIFYING FLOW FOR THE MONTH OF MARCH 2O19
SW078
NIA
NO QUALIFYING FLOW FOR THE MONTH OF MARCH 2O19
SW079
NIA
NO QUALIFYING FLOW FOR THE MONTH OF MARCH 2O19
NOTE: March 2019 samples not collected due to unqualified rain events or adverse weather conditions.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes X no
(if yes, complete Part B)
Permit Number NCS000578 Form SWU-247, last revised 21212012
Pa-e 2 of 3

Part B: Vehicle Maintenance Activity Monitoring Requirements
Out€all
Date
50050
00556
00530
00400
Total Flow _ .
Total
-Oil & Grease
Non -polar
Total
pH
New Motor
No.
Sample
Collected
(if applicable)
Rainfall
(if appl.)
O&G/TPH
Suspended
Oil Usage
(Method 1664
Solids
SGT-HEM), if
a 1.
mo/dd/ r
MG
inches
m
m
unit
gallmo
STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Water Quality
Date N/A Attn: Central Files
Total Event Precipitation (inches): N/A 1617 Mail Service Center
Event Duration (hours): (only if applicable — see permit.) Raleigh, North Carolina 27699-1617
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
"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 an 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
hest of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information,
including1he possibility of fit}e�s and imprisonr„pent for knowing violations." I ,
(Signature of Permittee) (Date)
Permit [slumber NCS000578. Form SWU-247, last revised 21212012
Page 3 of 3

(� DUKE
�2 ENERGY
March 15, 2019
NC Department of Environmental Quality
Attention: Central Files
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Duke Energy Carolinas, LLC
NPDES Storm Water Discharge Monitoring Report for:
Buck Stearn Station — NCS000578 — Rowan County
MAR 2B nig
?R SECTION
Duke Energy
Buck Combined Cycle
1385 Dukeville Road
Salisbury, NC 28146
In accordance with Part III, E(2) of the above referenced NPDES Storm Water permit, the
original and one copy of the monthly monitoring reports are attached. The period for sampling
ended February 28, 2019.
Enclosed is the DMR for outfalls SW001, SW002, SW003, SW073, SW075, SW077, SW078,
SW079. There were no samples collected from these outfalls and are listed as "No Flow" for the
sampling period. This was due to either nighttime rainfall events, inclement weather or lack of
qualifying rainfall events.
Please direct any correspondence or questions concerning the Buck Steam Station NPDES
Storm Water Program to Elizabeth Glenn at [phone].
Yours trul
Henry A�ns, Jr., General Manager II
Buck Combined Cycle
Attachments
bc: w/attachment
Elizabeth Glenn
Tina Woodward
Steve Hodges
Mailed by USPS: 7018 0040 0000 0302 4535
Return Receipt USPS: 9590 9402 3857 8060 1485 63

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS000578
FACILITY NAME Buck Steam Station
PERSON COLLECTING SAMPLE(S) NIA
CERTIFIED LABORATORY(S) Duke Energv of the Carolinas, LLC Lab #248
Shealy Environmental Services, NC Lab #329
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2019
(This monitoring report shall be received by the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY Rowan
PHONE NO. [phone]
SIGNATURE OF PERMITTEE OR DESIGNEE
REQUIRED ON PAGE 3.
Outfall
No.
Date
Sample
Collected
50050
00400
01077
01002
01022
01012
01027
Total
Flow (if app.)
Total
Rainfall
pH
Silver, Total (as
Ag)
Arsenic,
Total (as As)
Boron, Total
(as B)
Beryllium,
Total (as Be)
Cadmium,
Total (as Cd)
mo/dd/ r
MG
inches
m
m L
m
mgtL
m L
SW001
N/A
N/A
NO QUALIFYING
FLOW FOR THE MONTH
OF FEBRUARY
2019
SWO02
N/A
N/A
NO QUALIFYING FLOW FOR THE MONTH OF FEBRUARY 2019
SWO03
N/A
N/A
NO QUALIFYING FLOW FOR THE MONTH OF FEBRUARY 2019
SW073
N/A
N/A
NO QUALIFYING FLOW FOR THE MONTH OF FEBRUARY 2019
SW075
N/A
N/A
NO QUALIFYING FLOW FOR THE MONTH OF FEBRUARY 2019
SW077
NIA
NIA
NO QUALIFYING FLOW FOR THE MONTH OF FEBRUARY 2019
SW078
NIA
NIA
NO QUALIFYING FLOW FOR THE MONTH OF FEBRUARY 2019
SW079
NIA
NIA
NO QUALIFYING FLOW FOR THE MONTH OF FEBRUARY 2019
Outfall
Date
01034
01042
01067
01051
01097
01147
01059
01092
No.
Sample
Collected
Chromium,
Total (as Cr)
Copper, Total
(as Cu)
Nickel, Total
(as NO
Lead, Total
(as Ph)
Antimony,
Total (as Sb)
Selenium,
Total (as Se)
Thallium,
Total (As Tl)
Zinc, Total (as
Zn)
mo/dd/ r
m L
m L
m L
m L
m L
m L
MgE
m L
SW001
N/A
NO QUALIFVING FLOW FOR THE MONTH OF FEBRUARY 2019
SWO02
N/A
NO QUALIFYING FLOW FOR THE MONTH OF FEBRUARY 2019
SWO03
N/A
NO QUALIFYING FLOW FOR THE MONTH OF FEBRUARY 2019
SW073
N/A
NO QUALIFYING FLOW FOR THE MONTH OF FEBRUARY 2019
SW075
N/A
NO QUALIFYING FLOW FOR THE MONTH OF FEBRUARY 2019
SW077
N/A
NO QUALIFYING FLOW FOR THE MONTH OF FEBRUARY 2019
SW078
N/A
NO QUALIFYING FLOW FOR THE MONTH OF FEBRUARY 2019
SW079
N/A
NO QUALIFYING FLOW FOR THE MONTH OF FEBRUARY 2019
Permit Number NCS000578 Form SWU-247, last revised 2/2/2012
Page 1 of 3

Outfall
Date
71900
C0530
00556
Mercury, Total,
Solids, Total
Oil & Grease
No.
Sample
_
Collected
_Method 1631E
-Suspended-
Concentration
mo/dd/ yr
n
m
m L
SW001
N/A
NO QUALIFYING FLOW FOR THE MONTH OF
FEBRUARY 2019
SWO02
N/A
NO QUALIFYING FLOW FOR THE MONTH OF
FEBRUARY 2019
SWO03
N/A
NO QUALIFYING FLOW FOR THE MONTH OF
FEBRUARY 2019
SW073
NIA
NO QUALIFYING FLOW FOR THE MONTH OF
FEBRUARY 2019
SW075
N/A
NO QUALIFYING FLOW FOR THE MONTH OF
FEBRUARY 2019
SW077
N/A
NO QUALIFYING FLOW FOR THE MONTH OF
FEBRUARY 2019
SW078
N/A
NO QUALIFYING FLOW FOR THE MONTH OF
FEBRUARY 2019
SW079
N/A
NO QUALIFYING FLOW FOR THE MONTH OF
FEBRUARY 2019
Outfall
No.
Date
Sample
Collected
Aroclor 1016
Aroclor 1221
Aroclor 1232
Aroclor 1242
Aroclor 1248
Aroclor 1254
Aroclor 1260
mo/dd/ r
u L
u
u L
u
u
u
u L
SW1N11
NIA
NO QUALIFYING FLOW FOR THE MONTH OF FEBRUARY 2019
NOTE: February 2019 samples not collected due to unqualified rain events or adverse weather conditions.
Does this facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? _yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
Date
50050
00556
00530
60400
No.
Sample
Total Flow
Total
Oil & Grease
Non -polar
Total
pH
New Motor
Collected
(if applicahle)
Rainfall
(if appl.)
O&G/TPH
Suspended
Oil Usage
(Method 1664
Solids
SGT-HEM), if
appl.
mo/ddl r
MG
inches
m
m
unit
gaumo
Permit Number NCS000578 Form SWU-247, last remised 2212012
Page 2 of 3

STORM EVENT CHARACTERISTICS: Mail Original and one copy to:
Division of Water Quality
Date NIA Attn: Central Files
Total Event Precipitation (inches): NIA 1617 Mail Service Center
Event Duration (hours): (only if applicable —see permit.) Raleigh. North Carolina 27699-1617
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
"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 theApossibility of /nes a dAt d✓nment for knowing violations."
(Signature of Permittee) (Date)
Permit Number NCS000578 Form SWU-247, lust remised 21212012
Page 3 of 3

DUKE
ENERGY
March 4, 2019
NC Department of Environmental Quality
Attention: Central Files
Division of Water Quality
1617 Mail Service Center
Raleigh, NC 27699-1617
Subject: Duke Energy Carolinas, LLC
NPDES Storm Water Discharge Monitoring Report for:
Buck Steam Station — NCS000578 — Rowan County
Duke Energy
Buck Combined Cycle
1385 Dukeville Road
Salisbury, NC 28146
In accordance with Part III, E(2) of the above referenced NPDES Storm Water permit, the
original and one copy of the monthly monitoring reports are attached. The samples collected are
required monthly due to Tier two Status. The period for sampling ended January 31, 2019.
Samples were collected from outfalls on January 29, 2019. Samples for the following outfalls
were collected: SWO01 and SW073. The laboratory results were received on February 19,
2019. Analytes sampled above the benchmark values for analytical monitoring are as follows,
Parameter
Benchmark
SWO01
Zinc
0.126mg/L
0.181
m g/i
Hg ***
12.0 ng/L
31.8 ng/1
MAR 14 21319
D'aY-A;' is AON
** Hg is not a benchmark exceedance, however North Carolina requires valises-abloveNll2 ng/L
to be documented on the DMR.
Duke Energy has performed the steps required by the Tier Three status for these outfalls. All
values reported on the attached reports are dependent on the accuracy of approved analytical
methods used to measure parameters.
Please direct any correspondence or questions concerning the Buck Steam Station NPDES
Storm Water Program to Elizabeth Glenn at [phone].
Yours truly,
Henry A. Botkins, Jr., General Manager II
Buck Combined Cycle
7015 1660 0000 7244 8292 — Mailed by USPS to Raleigh
9590 9402 2894 7094 8954 85 — Return USPS receipt from Raleigh

STORMWATER DISCHARGE OUTFALL (SDO)
MONITORING REPORT
Permit Number NCS000518
FACILITY NAME Buck Steam Station
PERSON COLLECTING, SAMPLE(S) Myron Amick/Dan Diffenbach/CARDNO
CERTIFIED LABORATORY(S) Duke Energy of the Carolinas, LLC Lab #248
Shealv Environmental Services, NC Lab #329
Part A: Specific Monitoring Requirements
SAMPLES COLLECTED DURING CALENDAR YEAR: 2019
(This monitoring report shall he received by the Division no later than 30 days from
the date the facility receives the sampling results from the laboratory.)
COUNTY Rowan
PHONE NO. [phone]
SIGNATURE OF PERyMITTEE OR DESIGNEE
REQUIRED ON PAGE 3.
Outfall
No.
Date
Sample
Collected
50050
00400
01077
01002
01022
01012
01027
Total
Flow (if app.)
Total
Rainfall
pH
Silver, Total (as
Ag)
Arsenic,
Total (as As)
Boron, Total
(as B)
Beryllium,
Total (as Be)
Cadmium,
Total (as Cd)
mo/dd/vr
MG
inches
mgfL
m L
m
m L
m L
SW001
1/29/19
NIA
0.18
7.6
SWO02
1/29/19
N/A
NO FLOW FOR THIS OUTFALL FOR THE
MONTH OF JANUARY 2019
SW003
1/29/19
N/A
NO FLOW FOR THIS OUTFALL FOR THE MONTH OF JANUARY 2019
SW073
1/29/19
NIA
0.18 17.0 1 <0.0002 1 <0.001 1 <0.05
<0.001
<O.00I
SW075
1/29/19
NIA
NO FLOW FOR THIS OUTFALL FOR THE MONTH OF JANUARY 2019
SW077
1/29/19
NIA
NO FLOW FOR THIS OUTFALL FOR THE MONTH OF JANUARY 2019
SW078
1/29/19
N/A
NO FLOW FOR THIS OUTFALL FOR THE MONTH OF JANUARY 2019
SW079
1/29/19
N/A
NO FLOW FOR THIS OUTFALL FOR THE MONTH OF JANUARY 2019
Outfall
Date
01034
01042
01067
01051
01097
01147
01059
01092
No.
Sample
Collected
Chromium,
Total (as Cr)
Copper, Total
(as Cu)
Nickel, Total
(as Ni)
Lead, Total
(as Ph)
Antimony,
Total (as Sb)
Selenium,
Total (as Se)
Thallium,
Total (As Tl)
Zinc, Total (as
Zn)
mo/dd/ r
m L
m L
m
mgfL
m L
m
m L
mg1L
SW001
1/29/19
0.00540
0.00266
0.180
SWO02
1/29/19
NO FLOW FOR THIS OUTFALL FOR THE MONTH OF JANUARY 2019
SWO03
1/29/19
NO FLOW FOR THIS OUTFALL FOR THE MONTH OF JANUARY 2019
SW073
1/29/19
<0.001 <O.001 0.00104 1 <0.001 I <0.001
I <11.Of11 1
<0.0002
10.022
SW075
1/29/19
NO FLOW FOR THIS OUTFALL FOR THE MONTH OF JANUARY 2019
SW077
1/29119
NO FLOW FOR THIS OUTFALL FOR THE MONTH OF JANUARY 2019
SW078
1/29/19
NO FLOW FOR THIS OUTFALL FOR THE MONTH OF JANUARY 2019
SW079
1/29/19
NO FLOW FOR THIS OUTFALL FOR THE MONTH OF JANUARY 2019
Permit Number NCS000578
Form SWU-247, last revised 21212012
Page 1 of' 3

Outfall
Date
71900
C0530
00556
Mercury, Total,
Solids, Total
Oil & Grease
No.
Sample
Collected_
Method. 1631 E
Suspended --
Concentration
mo/dd/ •r
n
m L
mg1L
SW001
1/29/19
18.0 avg
l9
<5.0
SWO02
1/29/19
NO FLOW FOR THIS OUTFALL FOR THE MONTH
OF JANUARY 2019
SWO03
1/29/19
NO FLOW FOR THIS OUTFALL FOR THE MONTH
OF ,JANUARY 2019
SW073
1/29/19
7.03 15.0
SW075
1/29119
NO FLOW FOR THIS OUTFALL FOR THE MONTH
OF JANUARY 2019
SW077
1129/19
NO FLOW FOR THIS OUTFALL FOR THE MONTH
OF JANUARY 2019
SW078
1129/19
NO FLOW FOR THIS OUTFALL FOR THE MONTH
OF JANUARY 2019
SW079
1129/19
NO FLOW FOR THIS OUTFALL FOR THE MONTH
OF JANUARY 2019
Outfall
No.
Date
Sample
Collected
Aroclor 1016
Aroclor 1221
Aroclor 1232
Aroclor 1242
Aroclor 1248
Aroclor 1254
Aroclor 1260
moldd/ r
u L
ugfL
u L
u
u
u L
u L
SW001
1/29/19
<0.40
<0.40
<0.40
<0.40
<0.40
<0.40
<0.40
Benchmark exceedances include Zinc at SW001.
Avg - Average of primary and duplicate mercury samples (31.8 ng/L and 4.1 ng/L = 18.0 ng/L).
Does this Facility perform Vehicle Maintenance Activities using more than 55 gallons of new motor oil per month? — yes X no
(if yes, complete Part B)
Part B: Vehicle Maintenance Activity Monitoring Requirements
Outfall
Date
50050
00556
00530
410400
Total Flow
Total
Oil & Grease
Non -polar
Total
pH
New Motor
No.
Sample
Collected
(if applicable)
Rainfall
(if appl.)
O&G/TPH
Suspended
Oil Usage
(Method 1664
Solids
SGT-HEM), if
appl.
mo/dd/ r
MG
inches
MgA
m
unit
gaUrno
Permit Number NCS000578 Form SWU-247, last revised 21212012
Page 2 of 3

STORM EVENT- CHARACTERISTICS: Mail Original and one copy to:
Division of Water Quality
Date 1/29/19 Attn: Central Files
Total Event Precipitation (inches): 0.18 1617 Mail Service Center
. Event Duration (hours): (only if applicable — see permit.) Raleigh. North Carolina 27699-1617
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
"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 aT aware that there are significant penalties for submitting false information,
including the po si. 'lity of fines d impr' ment.for knowing olations."
( gnature of Permitt {Date)
Permit Number NCS000578 Form SWU-247, last revised 21212012
Pave 3of3