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EXHIBIT D <br />SAMPLE ANNUAL REPORT <br />Treatment Measure Operation and Maintenance <br />Inspection Report to the <br />City Engineer <br />City of San Leandm <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 />I. Property Information: <br />Property Address or APN: ~ ~77~ " ~~~ - d~~ " O Z, <br />Property Owner: ~ rse~ .Zr~vedfi~rn~l, LLG <br />11. Contact Information: j~ ~+ <br />Name of person to contact regarding this report: +'~ r C7Cl/''C! 4 -~' ~GC1~11? <br />Phone number of contact person:J~,~~- 7~• •3~ Email: ~/?~Q/'~t~ ~!"i ;' (~ <br />Address to which correspondence regarding this report should be directed: <br />V Q~ ~aha~rD , C~4~ 9tiC5"77 <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 ~ to member 31 , <br />N. 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 Type of Treatment Measure Location of Treatment Measure on the <br />Number of Property <br />Treatment <br />Measure <br />~ <br />~ f - ~~~l~'~6~~ <br />/ <br />P~ `' y r ~' <br />3 ~ ti ~. ~. <br />C:1Doarn~nta imd S~inpslbemard.cordeirolloal 8egirgqslT~mpwary Mbmst FpeslCoMenl.OutlooklQRO'VMUKCW M Aprwrt»nt Por UMN msw.doc <br />