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STORMWATER ANNUAL REPORT - - SAND AND GRAVEL <br />Permit Cert. No. COR34 /COG -50 1646 <br />Second Inspection - Date 012114 Findings, and action taken: <br />No repairs or maintenance required. <br />Other Inspections - Date 190111A Findings, and action taken: <br />No repairs or maintenance required. <br />C. Results and interpretation of any stormwater monitoring performed Attach a separate sheet with the lah <br />results. (Monitoring is not a requirement under the permit, unless you were specifically directed to do so by <br />the Division. However, the results of any stormwater monitoring that you performed on your own should be <br />reported here.) <br />Monitoring Results Attached? V✓ No ,❑Yes <br />D. Certification <br />"I certify under penalty of law that this document and all attachments were prepared under my direction or <br />supervision in accordance with a system designed to assure that qualified personnel properly gather and <br />evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or <br />those persons directly responsible for gathering the information, the information submitted is, to the best of my <br />knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for <br />submitting false information, including the possibility of fine and imprisonment for knowing violations." <br />01/14/2015 <br />Signature of Permittee (legally responsible person) Date Signed <br />Thomas E. Brubaker President <br />Name (printed) Title <br />Use additional pages as needed. Page 2 of 2 az1 /1 lsg <br />