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STORIVIWATER ANNUAL REPORT -SAND AND GRAVEL <br />Per;r~iit Cert. No. COG-50 <br />Second Inspection -Date `?CJ'~~~~Findings, and action taken: ~~`~-vY- ~~~~- `"`-~"` N ° <br />GY~~nr, n ~~- ~~<t ~ ;T'. `~ ~s i~~r~1c~n 5~~.,~5 rf ~ tiY ~ 1n~ ti~~ <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 />x <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; and complete. I am aware that there are significant penalties for submitting false information, <br />including the possibility of fine and imprisonment for knowing violations." <br />,® <br />Signature of Pernuttee (legal~sponsib erson) Date <br />~2~d2~c <br />Name (printed) <br />Use additional pages as needed. <br />! ~~~~ <br />.,.z : „ <br /> <br />Title <br />Page 2 of 2 <br />arG/lGlr <br />a <br />