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1 (, <br />STORMWATER ANNUAL REPORT - - SAND AND GRAVEL <br />Permit Cert. No. COG-50 <br />Second Inspection - Date 11)/,24 0 <br />1 Findings, and action taken: <br />1 <br />f IC) int WC/'e 416011 <br /> <br />I Fr/,e1' <br />C <br />D. <br />Other Inspections - Date Findings, and action taken: <br />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? CNo _ Yes <br />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 />/`/ 5-i/v <br />(legally responsible <br />E ), II Name (printed) <br />Use additional pages as needed. Page 2 of 2 <br />L- G-uJr-en Ce- <br />Date Signed <br />LC l?r es t'd>°l,-IL <br />Title <br />ar6/06sg