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Construction Stormwater rite Inspection For i <br />F. Elements checked "Action Required" (section D) describe cor active action to be taken. List t. 2 element number; <br />be specific on location and work needed. Document, initial, anc date when the corrective action has been completed <br />and inspected. <br />Element Description and Location Action Required Completion Initials <br /># Date <br />Attach additional page if needed <br />Sien 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) (Signature) Date: <br />Title/Qualification of Inspector: <br />Page 5 <br />