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STORMWATER ANNUAL REPORT - -SAND AND GRAVEL <br />Permit Cert. No. COG-34 M `?' ?J w <br />. it <br />Second Inspection - Date LZ/?/ b Findings, and action taken: A o ?iA^ tN6--f \ (. tS c +?- ?` <br /> <br /> <br /> <br />Other Inspections - Date Findings, a <br />\90 !,C--1 tVi W .L tLIntC ?F'"4 nd action taken: <br />C. Results and interpretation of any stormwater may <br />results. (Monitoring is not a requirement under <br />the Division. However, the results of any storm <br />reported here.) <br />Monitoring Results Attached? No <br />D. Certification <br />"I certify under penalty of law that this documen <br />supervision in accordance with a system designer <br />evaluate the information submitted. Based on m: <br />or those persons directly responsible for gatherin <br />of my knowledge and belief, true, accurate, and <br />submitting false information, including the possit <br />41- <br />Signature dkPermittee (legally <br />t? <br />Name (printed) <br />ring performed. Attach a separate sheet with the lab <br />permit, unless you were specifically directed to do so by <br />er monitoring that you performed on your own should be <br />Yes <br />and all attachments were prepared under my direction or <br />to assure that qualified personnel properly gather and <br />inquiry of the person or persons who manage the system, <br />the information, the information submitted is, to the best <br />:omplete. I am aware that there are significant penalties for <br />dity of fine and imprisonment for knowing violations. " <br />g-q-opt <br />Date Signed <br />Title <br />Use additional pages as needed. Page ?. of'?.