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166 <br /> <br />Home Place Shopping Center Mitigation Monitoring Program <br /> Sample Compliance Verification Form <br /> <br />Impact Issue (e.g., aesthetics, air quality): <br /> <br />Location: Onsite <br />Project Phase: Design <br /> <br /> Mitigation Measure #: <br /> <br />Offsite Administrative <br /> <br />Grading/Construction .Operation <br /> <br />Description of Activity/Method of Implementation: <br /> <br />Disposition <br /> <br />Comments/Revisions: <br /> <br />Mitigation measure for the above-noted project phase has been <br />implemented. No future action is required. <br /> <br />Mitigation measure for the above-noted project phase is not fully <br />implemented. Further action is required. (Please explain below). <br /> <br />The mitigation measure for the above-noted project phase is not in <br />compliance. Further action is required. (Please explain below). <br /> <br />Completed by: Name: <br /> Title: <br /> Date: <br /> <br />Approved by: Name: <br /> Title: <br /> Date: <br /> <br /> <br />