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j <br />Exhibit D -Annual Report Form & Maintenance Inspection <br />Checklist <br />ANNUAL REPORT <br />Treatment Measure Operation and Maintenance <br />Inspection Report to the <br />City Engineer <br />City of San Leandro <br />835 East 14"' Street <br />San Leandro, CA 94577 <br />This report and attached inspection checklists document the inspection and maintenance conducted for the <br />identified stormwater treatment measure(s) subject to the Maintenance Agreement between the City and the <br />property owner during the annual reporting period indicated below. <br />Property Information: <br />Property Address or APN: 2013 Farallon Dr. San Leandro. CA 94577 <br />Property Owner: The A~~ a v '~ a~ Gilbert Foundation <br />II. Contact Information: ~on% ~ ~.oSpt.f~+DF A-~'~ ~~~``~" <br />Name of person to contact regarding this report: ~- Herb Cervantes, Padilla Landscaping <br />Phone number of contact person: 510-715-9384 Email: herb ,padillalandscape.com <br />Address to which correspondence regarding this report should be directed: <br />] 8 ] Sand Creek Road. Suite B Brentwood CA 94513 <br />III. Reporting Period: <br />This report, with the attached completed inspection checklists, documents the inspections and maintenance <br />of the identified treatment measures during the time period from January 1 to December 31 , <br />IV. Treatment Measure Information: <br />The following stormwater treatment measures (identified treatment measures) are located on the property <br />identified above and are subject to the Maintenance Agreement: <br />Identifying <br />Number of <br />Treatment <br />Measure Type of Treatment Measure Location of Treatment Measure on the <br />Property <br />1 Vegetated Swale Along NW boundary, edge of parking lot <br /> <br /> <br />