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STORMWATER ANNUAL REPORT -METAL MINING (& COAL) <br />Permit Cent. No: COR-04 <br />Second Inspection -Date _/_/_ Findings, and action taken: <br />Other Inspections - Date ~ /o Z Findings, and action taken: <br />- ~~~.~ ~ /.11r~1.ar ~. D 2 ~~2 T - <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 permit, 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 Resul[s Attached? ~ / Nd ~ Yes <br />D. Certification <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 />drecdyresponsible forgathering the information, the infomration submitted is, to the best of my knowledge and' <br />belief, ave, accurate, and complete. I am awaze that there aze significant penalties for submitting false infomtation, <br />including the possibility of fine and imprisonmeht for knowing violations." <br />~~ce- ~3 <br />Signature of Permittee (legally responsible person) Date Signed <br />~,~+t' 3k~k~f~ti ~(4'a ~~,Fia'l ~,~.~'µ-C/t S-oR -- <br />Name (printed) Tide <br />Use additional pages as needed. Page 2 of 2 - .,dvm~ <br /> <br />