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EXHIBIT "C" - Inspection and Maintenance Checklist <br />Stormwater Treatment Measure Operation and Maintenance <br />Inspection Report to the [San Mateo County Mosquito Abatement District], <br />California <br />This report and attached Inspection and Maintenance Checklists document the inspection <br />and maintenance conducted for the identified stormwater treatment measure(s) subject to <br />the Maintenance Agreement between the City and the property owner during the annual <br />reporting period indicated below. <br />Property Information: <br />Property Address or APN: 052-296-180 <br />Property Owner: Sara Seyedin <br />Contact Information: <br />Name of person to contact regarding this report: Sara Seyedin <br />Phone number of contact person: 408-656-2207 Email: DrSeyedin ,gmail.com <br />Address to which correspondence regarding this report should be directed: <br />17110 Scott Drive Monte Sereno CA 95030 <br />Ill. Reporting Period: <br />This report, with the attached completed inspection checklists, documents the inspections <br />and maintenance of the identified treatment measures during the time period from <br />November of each year to March of each vear. <br />IV. Stormwater Treatment Measure Information: <br />The following stormwater treatment measures (identified treatment measures) are located <br />on the nronertv 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 />I <br />Bioretention planter <br />Left front <br />2 <br />Bioretention planter <br />Right front <br />Page 1 O&M Inspection Report <br />ATTY/AGR.2023.001 /Sara Seyedin (437 Iris Street) (Page 10 of 15) <br />