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Exhibit C <br /> 1061 Douglas Ave <br /> ❑ other location on-site as described in and allowed by the maintenance <br /> plan <br /> ❑ other, explain <br /> VII. Inspector Information: <br /> The inspections documented in the attached Inspection and Maintenance Checklists were <br /> conducted by the following inspector(s): <br /> Inspector Name and Title Inspector's Employer and Address <br /> VIII. Certification : <br /> I hereby certify, under penalty of perjury, that the information presented in this report and <br /> attachments is true and complete: <br /> Signature of Property Owner or Other Responsible Party Date <br /> Type or Print Name <br /> Company Name <br /> Address <br /> Phone number: Email: <br /> Page 3 O&M Inspection Report <br /> ATTY/AGR.2015.209/1061 Douglas Ave <br />