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STORMWATER AN T - METAL MINING (& COAL) <br />Permit Cert. No. COR -34 1 1 4 1 4 s <br />Second Inspection — Date <br />NA <br />Other Inspections - Date <br />Findings, and action taken: <br />Findings, and action taken: <br />Regular, monthly or after a storm event. General maintenance only. No site changes requiring SWMP change. <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 <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? El No C] 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, 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 />Rick Barth <br />Digitally signed by Rick Barth <br />DN: cn =Rick Barth, o =City of Rifle, <br />ou= Engineering, <br />email= rbarth @rifleco.org, c =US <br />Date: 2013.02.06 14:25:15 - 07'00' <br />Signature of Permittee (legally responsible person) <br />Rick L Barth <br />Name (printed) <br />07 -12 -2013 <br />Date Signed <br />City Engineer <br />Title <br />Use additional pages as needed. Page 2 of 2 ar6 /06mm <br />