NCS000289 DMR SW (9)

STORM EVENT CRARACTERISTICS:
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see perait.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (bouts): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Qualuy
Attn: Central Files
1617 Mail Service Center
Raleigh, North Carolina 27699-1617
"I certify, under penalty of law, that this docament and all attachments were prepared under my direction or supervision in accordance with a
system designed to assam that qualified personnel properly gather and evaluate the information submitted. Based on my ingairy 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."
( ignature of Permittee) (Tat )