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Second Inspection -Date _/_/_. Findings, and action taken: <br />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 fah <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 <br />reported here.) <br />Monitoring Results Attached? ~ N ^' 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 <br />the information submitted. Based on my inquiry of the person or persons who manage the system, or those <br />persons directly responsible for gathering the information, the information submitted is, to the best of my <br />knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting <br />fajs~,information, including the po~sipility of fine and imprisonment for_knowing s~olations." <br />Signature of Pernrittee (legally <br />`~~L~,Pf <br />Name (printed) <br />person)Date Signed <br />Title <br /> <br />Use additional pages as needed. Page 2 of 2 eArozss <br />