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t <br /> � y <br /> t, <br /> 525 Middlefield Rd <br /> VII. Inspector Information: <br /> Tlie inspections documented in the attached Inspection vid Maintenance Checklists were <br /> conducted by the following inspector(s): <br /> Inspector Name and Title Inspector's Employer nnd Address <br /> VIII. Certification: <br /> I hereby certify,under penalty of perjwy,that the infonnation presentad in this report and <br /> attachments is true And complete: <br /> Signature of Property(hvner or Other ResponsiUle Party Date <br /> Type or Print Name <br /> Company Name <br /> Address <br /> Phone number: Email: <br /> Page 3 O&M lnspection Report <br /> REV:03-21-14 VR <br /> Page 16 of 16 <br /> ATTY/AGR.2014.039/Indigo 525 Middlefield-Stormwater Agreement <br />