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Stormwater Management Plan <br />Spill Report Form <br />May Day Idaho Mine Complex <br />Spill Reported by: <br />Date/Time Spill: <br />Date/Time Spill reported to George M.L. Robinson/Storm Water Administrator: <br />Date/Time Spill Report Form faxed to Robinson/Storm Water Administrator: <br />Describe spill location and events leading to <br />Material spilled: <br />Source of spill: <br />Amount spilled: <br />Containment or clean up <br />Approximate depth of soil excavation: <br />List Injuries or Personal Contamination: <br />Action to be taken to prevent future spills: <br />Amount spilled to waterway: <br />Modifications to the SWPPP, including required sampling, necessary due to this spill: <br />Agencies notified of the spill: <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 evaluate the <br />information submitted. Based on my inquiry of the person or persons who manage the system, or those persons <br />directly responsible for gathering the information, the information submitted is, to the best of my knowledge and <br />belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, <br />including the possibility of fine and imprisonment for knowing violations. <br />Sunrise Mining, LLC <br />Revised August 9, 2017 <br />Page 17 of 30 <br />