NCS000289 DMR SW (6)

STORM EVENT CRARACTERISTICS:
Date
Total Event Precipitatiou (inches):
Event Duration (hours): (only if applicable — see permit.)
(if more than one storm event was sampled)
Date
Total Event Precipitation (inches):
Event Duration (hours): (only if applicable — see permit.)
Mail Original and one copy to:
Division of Water Quality
Attn: Central Files
1617 Flail Service Center
Raleigh, North Carolina 27699-1617
"I certify, ander 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 property 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. F am aware that there are significant penalties for submitting false information,
including the possibility of fines and imprisewwrit for knowing vialations."
(s4 -nature of Permittee)
Fon SWU 12608