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STORMWATER ANNUAL REPORT- -SAND AND GRAVEL <br /> Permit Cert.No. COR34/COG-50 1720 <br /> Second Inspection-Date -21/1241 q Findings,and action taken: <br /> Second and final visit to this dig site for the 2016 season. Repaired silt fence below dig site and <br /> reset lower silt fence deeper into scree slope to lessen future wind damage. <br /> Other Inspections-Date / / . Findings,and action taken: <br /> C. Results and interpretation of any stormwater monitoringperformed. 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? 17 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 /> y a- ,3- ,2- <br /> Signatu o Permittee(legally responsible person) Date Signed <br /> Name(printed) Title <br /> Use additional pages as needed. Page 2 of 2 arl/i lsg <br />