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Construction Stormwater Site Inspection Form <br />W. Elements checked "Action Required" (section D) describe corrective action to be taken. List the element number; <br />be specific on location and work needed. Document, initial, and date when the corrective action has been completed <br />and inspected. <br />Element <br /># <br />Description and Location <br />Action Required <br />Completion <br />Date <br />Initials <br />Attach additional page if needed <br />Sign the following certification: <br />"I certify that this report is true, accurate, and complete, to the best of my knowledge and belief" <br />Inspected by: (print) <br />Title/Qualification of Inspector: <br />• <br />• <br />(Signature) <br />Date: <br />Page 5 <br />