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~ ,.+ <br />V: Sediment Removal <br />Total amount of accumulated sediment removed from the stormwater treatment measure(s) during the <br />reporting period: cubic yards. <br />The sediment was removed and disposed as follows: <br />VI. inspector Information: <br />The inspections documented in the attached inspection checklists were conducted by the following <br />inspector(s): /~~ ~ <br />Inspection Dade J~ispec~or Name and Title ~ Inspector's Em~loyc~ and Address ~ <br />VII. Sta. el~t6f ah~e t on ' on ~J <br />Based on the ' pection oc en in ed kli , is( )the m ore(s) entified <br />in this report p coon d b ain ce PI eck yes or <br />no.) <br />YES NO <br />If "NO", describe problem, proposed solution and schedule rrection: <br />VIII. Certification: <br />I hereby certify, under penalty of perjury, that the information presented in this report and attachments is <br />true and complete: <br />Signature of Property Owner or Other Responsible Party Date <br />Type or Fruit Name <br />Company Name <br />Address <br />Phone number: Email: <br />Attach Inspection Checklists <br />C:11)oaxnanb and 3attlrgalDa~d.carAairoLL.oe~ S~nys\Temporary Internet Ftles\Content.0utbok\QROVMUKCIO M /1pro~nt to teat m~s.doc H <br />