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Exhibit C <br />INSPECTION & MAINTENANCE CHECKLIST <br />Facility Number: <br />Subdivision Name: <br />Date of Last Rainfall: Amount: Inches Streets: <br />Mapbook Location: GPS Coordinates: <br />Property Classification: Residential • • Government • • Commercial • • Other: <br />Type of Practice: Trench • • Basin • - <br />Confined • • Unconfined • • Barrel Size As -built Plan Available? Yes • • No <br />Is Facility Inspectable? Yes • • No • - <br />Comments Specific <br />Scoring Breakdown: <br />N/A = Not Applicable 1 = Monitor (potential for future problem exists) Use open space in each section to <br />N/I = Not Investigated 2 = Routine Maintenance Required further explain scoring as needed <br />0 = Not a Problem 3 = Immediate Repair Necessary <br />1. Bubbler/Pop-Up Outfall and Area/Trench Drains <br />Woody growth within 5' of outfall/drail <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />Outfall/Drain channel functioning <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />Inlets, frames and covers <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />Released water undercutting outlet <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />Erosion <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />Displaced rip rap <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />Excessive sediment deposits <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />Other: <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />2. Pervious Pavement <br />Surface Cracking or Gaps <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />Surface Ponding During Rain Events <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />Accumulation of Sediment, Debris or Littler <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />Erosion and pavement undercutting <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />Evidence of Leaked or Spilled Fluids (oils, etc.) <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />Other: <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />3. Subsurface conveyance Lines <br />Broken <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />Daylighted or Exposed <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />Clogging <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />Evidence of Leaks (damp/wet surface above) <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />Erosion <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />Other: <br />N/A <br />N/I <br />0 <br />1 <br />2 <br />3 <br />N/A = Not Applicable 1 = Monitor for Future Repairs <br />N/I = Not Investigated 2 = Routine Repairs Needed <br />0 = Not a Problem 3 = Immediate Repair Needed <br />ATTY/AGR.2024.085/David-Kim T. Nguyen (533 Vera Ave) (Page 14 of 16) <br />Pagel of 3 <br />