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5TORMWATER ANNUAL REPORT -METAL MINING (& COAL) <br />Permit Cert. No: COR-04 .'` <br />' Second Inspection -Date : /_/ .Findings, and-action taken: <br />.- - <br />~eRr.~drz , .S.,rrrrw2~ ~-uu 4' <br />Other Inspections -'Date _/ : /_ Findings, and action taken: <br />C. Results and inferpretritlon of any,siormwkter ittoniforing performed. Attach a separate sheet with the dab <br />results: (Monitorng is not a requirement under the pemmit, unless you were specifically directed to do so bythe <br />. Division. however, the results of any.stormwater monitoring that you performed on your own should be reported <br />here.) <br />Monitoring Results Attached? ~ o ' ~ Yes - <br />D: Certification <br />"I certify under penalty of law that tins document and al] attachments were piepared 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 />dti'ectly responsible for gathering the information, the information submitted is, to the best of my knowledge and . <br />belief,lrue, accurate, aimd complete. I am aware that there are significant penalties for submitting false information, <br />including the po of fine and imprisonment-for knowing violations." <br />'~,-.- ~/ <br />Signature of Permittee (legally responsible person)ll, Date Signed., /J" <br />h~Aa.2~:2 ~. C~t.~zra.~y ~;y~s.•c.~ ~:,g~a7`or` <br />Name (printed) Tide <br />Use addifional pages as needed... Page 2 of 2 osvm <br />:~». <br />