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STORMWATER ANNUAL REPORT - - SAND AND GRAVEL <br />Permit Cert. No. COR34/COG-50 1646 <br />Second Inspection - Date 6/f1127°1! Findings, and action taken: <br />No action necessary <br />Other Inspections - Date _/ I . 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 />MOOtating R Atm'? D'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 diteotlyvearnsible for gethering the intennation, Abe inforaation iced is, to the best of my <br />knowkklge arid bel: f trace, accurate, mai complete. I am aware that there are significant Tenalties for <br />submitting false information, including the possibility of fine and imprisonment for knowing violations." <br />-4-t40‘0 1/28/2015 <br />Signature of Permit= (legally responsible person). Date Signed <br />Thomas E Brubaker President <br />Name (printed) Title <br />flee acl iteral paps' as aecaerl. <br />?age 2 01'2 seri/1 h g <br />