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Use additional pages as needed. Page 2 of 3 ar6/961t <br />CF 21.6.4 <br />STORMWATER ANNUAL REPORT -METAL MINING (& COAL) <br />Permit Cert. No. COR-040209 <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 penalfies for <br />submitting false information, including the possibility of fine and imprisonment for knowing violations." <br />z -/y- <br />Signature of Permittee (legally responsible person) Date Signed <br />KEITH HALEY MINE MANAGER <br />Name (printed) Title <br />