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STORMWATER ANNUAL REPORT - - SAND AND GRAVEL <br />Permit Cert. No. COG -34 1)1 C) 5 S <br />Second Inspection - Date 6 / 0/ / 1. Findings, and action taken: <br />CVO kalif i t - d - e <br />Other Inspections - Date 9 /2a/ H. Findings, and action taken: <br />C. Results and interpretation of any stormwater monitoring perfonned. 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? )( 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 best <br />of my 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 />'�f <br />Signature of Permittee (legall y tesponsible person) <br />We /eiii t n r e,r <br />Name (printed) <br />Use additional pages as needed. Page 2 of 2 <br />• ait i(A,?n ( 44-- <br />l / / /l <br />Date Signed <br />Title <br />09/07dj <br />