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"1'UKMWA'1'LK ANNUAL KL~'YUK'1 <br />Permit Cert. No. COG50 <br />Second Inspection -Date _/_/_. Findings, and action taken: <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 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'? l~^' "' 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 designefl 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 awaze that there aze significant penalties for submitting <br />fare information, inc~ytding the,Rossibility of fine and imprisonment for knowing violations." <br />-ii-[7~ <br /> <br />Use additional pages as needed. Page 2 of 2 eA/02sg <br />Signature of Permittee (legally res(onsible person) Date Signed <br />