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STORMWATER ANNUAL REPORT -SAND AND GRAVEL <br />Permit Cert. No. COG50 <br />Second Inspection -Date LZ/~/ ob Findings, and action taken: `-TZ~ti~~ ~~,K...- ,04~-. N o <br />Other Inspections -Date _/_/_. Findings, and action taken: <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 Results Attached? ~ No ~ Yes <br />D. CertiFication <br />"I certify under penalty of law that this document and all attachments were prepared 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 />directly responsible for gathering the information, the information submitted is, to the best of my knowledge and <br />belief, true, accurate aRd complete. I am aware that there aze significant penalties for submitting false information, <br />including the possibility o , e and imprisonment for knowing violations." <br />t\`~~' <br />Signature of P~}mit#~ (legally responsible person) Date Signed <br />~' r.aCCA. S Wace,4tz_, -Clv..s~~ <br />Name (printed) Title <br />Use additional pages as needed. - Page 2 of 2 a~u~ie¢ <br />