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SAMPLE ANNUAL REPORT <br />Treatment Measure Operation and Maintenance <br />Inspection Report to the <br />Public Works Director <br />City of San Leandro <br />14200 Chapman Road <br />San Leandro, CA 94578 <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 />Property Information: <br />Property Address or APN: <br />Property Owner: <br />Contact Information: <br />Name of person to contact regarding this <br />Phone number of contact aerson: Email: <br />Address to which correspondence regarding this report should be directed: <br />III. 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 I 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 <br />Number of <br />Treatment <br />Measure <br />Type of Treatment Measure <br />Location of Treatment Measure on the <br />Property <br />8 <br />PA2700 - 2799\2719-000\Engineering\S WMP\O&M\3rd Submittal\O & M Agreement for treat meas 04252019_parrotl.doc <br />