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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 Leandro <br /> 835 East 14th 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 /> 1. Property Information: <br /> Property Address or APN: <br /> Property Owner: <br /> II. Contact Information: <br /> Name of person to contact regarding this report: <br /> Phone number of contact person: Email: <br /> Address to which correspondence regarding this report should be directed: <br /> 111. 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 Type of Treatment Measure Location of Treatment Measure on the <br /> Number of Property <br /> Treatment <br /> Measure <br /> Aurora Cottage 7 13533-13547 Aurora Dr. <br />