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443 <br /> <br /> ATTACHMENT Il <br /> <br /> MITIGATION MONITORING PLAN <br />SAMPLE COMPLIANCE VERIFICATION FORM <br /> <br />Mitigation Measure: # <br /> <br />__ Impact Issue: <br /> <br />(Earth, Water, Traffic, etc.) <br /> <br />Location: Onsite Offsite <br /> <br />Administrative <br /> <br />Project Phase: Design <br /> <br />Construction <br /> <br />Operation <br /> <br />Description of Activity/Method of Implementation: <br /> <br />Disposition: <br /> <br />Mitigation measure for the above-noted project phase implemented. <br />No further action is required. <br /> <br />Mitigation measure for the above-noted project phase is not fully <br />implemented. Further action required. (Please explain below) <br /> <br />The mitigation measure for the above-noted project phase is not <br />in compliance. Further action required. (Please explain below) <br /> <br />Comments/Revisions: <br /> <br />Completed by: <br /> <br />Title: <br /> <br />Date: <br /> <br />Approved by: Name: <br /> Title: <br /> Date: <br /> <br />JB 1/08850001 B-1 <br /> <br /> <br />