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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% as removed and disposed as follows: <br /> V1. inspector Information: <br /> The inspections documented in the attached inspection checklists were conducted by the following <br /> inspector(s): <br /> Inspection Dae "eco ame an T tle Ins eetor E pl ve and A ess <br /> VIL 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 /> Type or Print Name <br /> Company Mame <br /> Address <br /> Phone number: Email: <br /> Attach Inspection Checklists <br /> 11 <br /> !Users/amccoy/Desktop12062 West 140th-0 M Agreement for treat measures.docx <br />