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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 Date Inspector Name and Title Inspector's Employer and Address <br /> VII. Statement of Treatment Measure Condition <br /> Based on the inspections documented in the attached checklists, is(are) the treatment measure(s) identified <br /> in this report present, functional and being maintained as required by the Maintenance Plan? (Check yes or <br /> no.) <br /> YES NO <br /> If "NO ", describe problem, proposed solution and schedule of correction: <br /> VIII. Certification: <br /> 1 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 Print Name <br /> Company Name <br /> Address <br /> - <br /> Phone number: Email: - - - <br /> Attach Inspection Checklists <br /> Ge_ LOWCCWP PERMmEngtneermg and re"evAO B M Agreement Mr treat rreas.doc 8 <br />