Laserfiche WebLink
~„ . STORMWATER ANNUAL REPORT -METAL MINING f& cOAL> <br />Permit Cert. No. COR-04 O ~ o ~ <br />Second Inspection -Date _/_/_. Findings, and action taken: <br /> <br />Other Inspections -Date _/_/_. Findings, and action taken: <br /> <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 <br />by the Division. However, the results of any stormwater monitoring that you performed on your own <br />should be reported here.) ~' <br />Monitoring Results Attached? IJ 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 <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 awaze that there aze <br />significant penalties for submitting false information, including the possibility of fine and imprisonment for <br />knowing violations." <br />~~ / ~- <br />Signarure of Permittee (legally responsible person) Date Signed <br />~!}uE 4Jc-~e(t,~+A+-t ~~ckax ~PE.2J7~-off <br />Name (printed) Title <br />Use additional pages as needed. Page 2 of 2 uv/96m;~, <br />