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RESOLUTION 95-062 <br /> <br />ATTACItMENT A <br /> <br />SEVENTEENTH STREET WIDENING <br />MITIGATION MONITORING PROGRAM <br />SAMPLE COMPLIANCE VERIFICATION FORM <br /> <br />Mitigation Measure: # Impact Issue: <br /> <br />Location: Onsite <br />Project Phase: Design <br /> <br />Description of Activity/Method of Implementation: <br /> <br />(F. arth, Water, Traffic, Etc.) <br /> <br />Offsite Administrative <br /> Construction Operation <br /> <br />Disposition: .... Mitigation measure for the above-noted project phase implemented. No <br /> 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 />Mitigation measure for the above-noted project phase is not in compliance. <br />Further action required. (Please explain below) <br /> <br />Comments/Revisions: <br /> <br />Completed by: <br /> <br />Approved by: <br /> <br />, Name: <br /> <br /> Title: <br /> Date: <br /> <br />Name: <br /> <br />Tit/e: <br /> <br />Date: <br /> <br />A-1 <br /> <br /> <br />