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Inst 2017120097
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Inst 2017120097
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Last modified
7/17/2017 2:46:30 PM
Creation date
7/17/2017 2:46:16 PM
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CM City Clerk-City Council
Document Date (6)
6/2/2017
Recorded Document Type
Agreement to Conditions
Retention
PERM
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I <br /> IV: 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 /> I <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 /> I <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 /> IIf"NO",describe problem,proposed solution and schedule of correction: <br /> VIII. Certification: <br /> I hereby certify, .er pe :lty of perjury,that the information presented in this report and attachments is <br /> tru d compl: - <br /> 11-)(cLf t 5, 44). <br /> gig re of P 'i: y Own•r or Other Responsible Party Date <br /> � vt'mA � <br /> Type or Print Name <br /> C 11-1 Imo I Hi'1-m. S\..1 l;lL:— <br /> Company Name <br /> (f2,41,30L 4Ottet q <br /> Address <br /> Phone number Email: C�C�Lv�S1 ' a Gb+M►i'at-l�'c'c fl 0-06 Glion_ <br /> I <br /> Attach Inspection Checklists <br /> W:\2008W08609-7\Documents\KW Reports and Calcs\SWQCP\O&M Agreement\O&M- <br /> Narrative.docx 11 <br /> I <br />
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