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STORMWATER ANNUAL REPORT - - SAND AND GRAVEL <br />Permit Cert. No. COG-34 - <br />Second Inspection - Date Findings, and action taken: <br />Otltar Inspections - Date Findings, and action taken: <br />C. Results and interpretation of any stonnwater 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 i <br />reported here.) <br />Monitoring Results Attached? -X- No - 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, <br />or those persons directly responsible for gathering the information, the information submitted is, to the befit-` <br />of my knowledge belief, true, accurate, and complete. I am aware that there are significant pena_...s for <br />submitting-4L-f,s' nation, including the possibility of fine and imprisonment for knov g- ?_tations. <br />y <br />SiLnature of Permittee (legall responsible person) Date Signed <br />r')I,J,r.-Iv -0; 11E <br />Name (printed) <br />&-- awNEI? <br />Title <br />Pa e 2 of 2 09/07di <br />Use additional pages as needed. g