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r <br /> `l .STORMWATER ANNU&REPORT - SAND AND GRAvi <br /> 'Permit Cert. No. COG-500 _ (� <br /> Second Inspection - Date //O/'Z? Findings, and action taken: 1W 57AWbi4-)G' 6OX7EP- <br /> T!J ?jT 3bf?T7o^J Doc PIT. <br /> A/o 2uiv0,FF <br /> Other Inspections - Dateq/AI/-22. Findings, and action taken: A/D 1n7A7M Off- RUtyClFF <br /> ) NO ACTION 72q ec7✓- <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 stormwater section of the permit, unless you were <br /> specifically directed to do so by the Division. However, the results of any stormwater monitoring that <br /> you performed on your own should be reported here. Any monitoring you performed under the process <br /> water section of the permit is reported separately, on DMR forms, and should not be included here.) <br /> Monitoring Results Attached? © 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 <br /> system, or those persons directly responsible for gathering the information, the information submitted is, <br /> to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are <br /> significant penalties for submitting false information, including the possibility of fine and imprisonment for <br /> knowing violations." <br /> Signature'of Permittee (1 ally responsible person) Date Signed <br /> M I C I-I P E L T. PkESi D E7Ul <br /> Name (printed) Title <br /> Use additional pages as needed. Page 2 of 2 art 1/94sg <br />