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STORMWATER ANNUAL REPORT -METAL MINING (& COAL) <br />Permit Cert. No. COR-04 <br />Second Inspection -Date _/_/_ Findings, and action taken: <br />%~entad r c ~/Iv~G-4 Swyrrc2 r Div ~ <br />` ~I t9- Sc Sec A~T~+-{ L.c.1~ <br />Other Inspections -Date _/_/ .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 pemut, unless you were specifically directed to do so by the <br />Division. However, the results of any stormwater monitoring that you performed on your own should be reported <br />here.) <br />Monitoring Results Attached? ~ Yes <br />D. Cerfificatioo <br />"I certify under penalty of law that this document and all attachments were prepazed 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 awaze that there aze significant penalties for submitting false information, <br />including the possibility of fine and imprisonment for knowing violations." <br />~~ a~3~o6 <br />Signature of Permittee (legally responsible person) Date Signed <br />L o re ~a. ~ ~n~~4. 7'/D i~ Am J <br />Name (printed) Title <br />Use additional pages as needed. Page 2 oft =rt.-vain <br />