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Certification of Completed Work <br />Corps bile Nwnher: <br />Mime of PormiucC: <br />Date of Jssuance: <br />]expiration Date: <br />Upon coil ipIction ofthe activity authorized by this hermit and any III Iti alioII required by <br />the perillit, sign this certification and return it to the followillu address: <br />U. S. Army Corps of'lsngineer,� <br />1_)CIIVCr RCgutatory Offilec <br />9307 South Wadsworth I31vcl. <br />Littleton, Colorado 80128 -0901 <br />Phone (3 03) 979-1120 <br />lax (303) 979 -0002 <br />I'lcasC note that your permitted activity is subject to , mhnipiby a l Sa e . <br />Army Corps of' l;ngincers rCpresen tali ve. ICyou fail to comply with tills hcrnlit you ave <br />subjccl to permit suspCllsion, Modification, or revocation. <br />1 Hereby certify that the work authorized by the above referenced hermit hrts hccn <br />completed in accordance with the terms and conditions of said permit, and reguircd <br />mitigation was Conlp1CtCd in accordance with the perinit conditions.' <br />Signature of' Permitice <br />lfyour hcrnlit included wetlands monitoring and annual reports, these activities will continuo afler <br />submittal ohthis form until you are notified by the Denver Regulatory 0111ce that yotu- niitit,ation is <br />successful and monitoring; reports are no longer required. <br />