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STO,MWATER ANNUAL REPORT-METAL MINING (& COAL) <br /> Permit Cert.No. COR-04 <br /> Second Inspection - Date_/ / Findings, and action taken: <br /> Pe ti 1,/ c 10 S , R-- o s' <br /> / c. A—T-T/�- 4t P — <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 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? 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 responsible person) Date Signed <br /> Name(printed) Title <br /> Use additional pages as needed. Page 2 of 2 a,6/961t <br />