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STORMWATER ANNUAL. + T - METAL MINING (& COAL) <br />I q15 <br />Permit Cert. No. COR 34 <br />Second Inspection - Date Findings, and action taken: <br />l B U?- y?l (p f l ;?-0 0 ETo -M e td A-4v-c- 4?,, n o zJ `rity <br />L ,d AG ?e70bv-e ?- , TA -w i? <br />a 4L.- T>11-T <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 <br />the Division. However, the results of any stormwater monitoring that you performed on your own should be <br />reported here.) <br />Monitoring Results Attached? WNo El 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 <br />evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or <br />those 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 <br />submitting false information, including the possibility of fine and imprisonment for knowing violations." <br />Signature of Permittee (legally responsible person) <br />4-1- ?< 01 6?L a L) <br />//- o5.. <br />Date Signed <br />Title <br />Name (printed) <br />Use additional pages as needed. Page 2 of 2 ar6106mm