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STORMWATER ANNUAL REPORT-METAL MINING(& COAL) <br /> Permit Cert.No. COR-04 <br /> Second Inspection-Date / / Findings,and action taken: <br /> Other Inspections-Date /a/io/a Findings,and action taken: <br /> SIl eā€” A-frl;-e 4z <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 the <br /> Division. However,the results of any stormwater monitoring that you performed on your own should be reported <br /> 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 evaluate the <br /> information submitted. Based on my inquiry of the person or persons who manage the system, or those persons <br /> directly responsible for gathering the information,the information submitted is,to the best of my knowledge and <br /> belief,true,accurate,and complete. I am aware that there are significant penalties for submitting false information, <br /> including the possibility of fine and imprisonment for knowing violations." <br /> Signature of Permittee(legally r sponsible person) Date Signed - <br /> Lo āœ“e-4Q n e do- <br /> Name(printed) Title <br /> Use additional pages as needed. Page 2 of 2 ar&961t <br />