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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 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 /> 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 /> Dennis Bock,Compliance Manager <br /> Type or Print Name <br /> Costco Wholesale Corporation <br /> Company Name <br /> P.O.Box 35005,Seattle, WA 98124 <br /> Address <br /> Phone number: (425)313-8100 Email: dbockacostco.com <br /> Attach Inspection Checklists <br /> 2 6214.010-D1.doc <br />