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347 <br /> <br />ATTACIIMENT A <br /> <br /> DYER ROAD WIDENING <br /> MITIGATION MONITORING PROGRAM <br />SAMPLE COMPLIANCE VERIFICATION FORM <br /> <br />Mitigation Measnre: # <br /> <br />Location: Onsite <br />Project Phase: Design <br /> <br />Description of Activity/Method of hnplementation: <br /> <br />hnpact Issue: <br /> (Earth, Water, Traffic, Etc.) <br /> <br /> Offsite Administrative <br /> Construction Operation <br /> <br />Disposition: <br /> <br />Mitigatiou measure for the above-noted project phase implemented. No <br />fi~rther action is required. <br /> <br />Mitigation measure for tile above-noted project pbase is not fully <br />implemented. Further action required. (Please explain below) <br /> <br />Mitigation measure for tile above-noted project phase is not in compliance. <br />Fnrther action required. (Please explain below) <br /> <br />Comments/Revisions: <br /> <br />Completed by: <br /> <br />Name: <br /> <br />Title: <br /> <br />Date: <br /> <br />Approved by: <br /> <br />Name: <br /> <br />Title: <br /> <br />Date: <br /> <br />A-I <br /> <br /> <br />