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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 pect r Name and Title Inspector's Emp •ye and Address <br /> • <br /> a 1 I <br /> VII. Stay melt <br /> Based on the r spectio d• umen d ' - • c • , e: t ;easure( . identified <br /> in this report pr- ctio .', .-• _ - • -- -• - a' - ce • heck yes or <br /> no.) <br /> YES NO <br /> If"NO",describe problem,proposed solution and schedu orrection: <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 Print Name <br /> Company Name <br /> Address <br /> Phone number: Email: <br /> Attach Inspection Checklists • <br /> CA User s4demondlAppDatalLocanNGaosatlUKuidows 1Temporary Internet Fles1CortenLOutlooMuUL63J%J1O M Agreement for treat mess(2).doc <br />