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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 />Other Inspections -Date iu/ ro/ o ~ Findings, and action taken: <br />- S-~ L ~4~r7~-e l.~ ~ /'mot ^~ o - <br />C. Results and interpretation of any stormwarer monitoring performed. Attach a separate sheet with the lab <br />results. (Monitoring is not a requiremem under the pemrit, unless you were specifically duected to do so by the <br />Division However, the results of any stormwater monitoring that you perfornted on your own should be reported <br />here.) <br />Monitoring Results Attached? ~ No ~ 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 />infomuttion submitted. Based on my ingtury of the person or persons who manage the system, or those persons <br />directly responsible for gathering the infomiation, the information submitted is, to the best of my knowledge and <br />belief, tme, accurate, and complete. I am awaze that there aze significant penalties for submitting false information, <br />including the possibihty of fine and imprisonment for knowing violations" <br />. ~~~/s <br />Signature of Pemuttee (legally r sponsible person) Date Signed - <br />D /e~Q ~ ~i n e ~~ ~m -P ~ra~r~ ~JcJ~e~'/l~sa~ <br />Name (printed) Tide <br />Use additional pages as needed. Page 2 of 2 ~ wvmi <br />