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COLORADO DEPAR7'!•T1T OF HEALTH • <br />Water Quality Control Division <br />WQCD-PE-B2 <br />4300 Cherry Creek Drive South <br />Denver, CO 80222-1530 <br />SAND AND GRAVEL MINIIVG AND PROCESSIIVG <br />GENERAL PERMIT <br />CERTIFICATION OF COMPLETION AND IMPLEMENTATION OF <br />STORMWATER MANAGEMENT PLAN <br />Permittee Facility Number: COG - S 0 _ _ _ <br />Company/Permittce Name: <br />Facility Name: <br />'I certify under penalty of law that a complete Stormwater Management Plan, in <br />compliance with Part I.C.2 of the Sand and Grave] Mining and Processing general <br />permit, has been prepared and implemented for my facility. Based on my inquiry <br />of the person or persons who manage the system, or those persons directly <br />responsible for gathering the information, the Stormwater Management Plan is, to <br />the best of my knowledge and belief, true, accurate, and complete, and <br />implemented as written. 1 am aware that there are significant penalties for falsely <br />certifying the completion and implementation of said SWMP, including the <br />possibility of fine and imprisonment for knowing violations.' <br />S <br />Signature of Applicant Date Signed <br />s-' <br /> <br />Name (printed) Title <br />