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STORMWATER AN E T - METAL MINING (& COAL) <br />Permit Cert. No. COR -04 0 1 7 2 <br />Second Inspection — Date <br />See attached (B) <br />Other Inspections - Date <br />See attached (B) <br />Findings, and action taken: <br />Findings, and action taken: <br />C. Results and interpretation of any stormwater monitoring performed. Attach a separate sheet with the lab <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? 9 No ® Yes <br />D. Certiflcation <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 />February 11, 2015 <br />Signature of Permittee (legally responsible person) Date Signed <br />Dw' t Blackwell Mine Manager <br />Name (printed) Title <br />Use additional pages as needed. Page 2 of 2 ar6/06mm <br />