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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 p,�.pect'=r Name and Title Inspector's Emp s - and Address <br /> iF EF = <br /> = <br /> VII. Stai-me' of Fri:at ;? .sure'1 on it on <br /> Based on the f spectio dorumen d i it e a c ped klf s fs( e)th re �g`t •easure(;'identified <br /> port • ="r • t. -= a -==-=i d • of .`nce ' • heck yes or <br /> no.) <br /> YES NO <br /> If"NO",describe problem,proposed solution and schedul•`i 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 /> C:\Users\EspWS1\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\YKOOX43W\O MAgreement for treat meas.doc 8 <br />