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Certification Of Completed Work <br />Corps File Numher: <br />Name ofPermittee: <br />Date of Issuance: <br />Expiration Date: <br />Upon completion ol' the activity autborired by this permit and any mitigation required by <br />the permit, sign this certification and return it to the following address: <br />U. S. Army Corps of l.ngineers <br />Denver Regulatory Office <br />9307 South Wadsworth Blvd. <br />Littleton, Colorado 80128-6901 <br />Phone (303) 979 -4120 <br />Fax (303) 979 -0602 <br />Please; note that your permitted activity is subject to a compliance inspection by a U. S. <br />Army Corps of Engineers representative. Ifyou fail to comply with this permit you are <br />subject to permit suspension, modification, or revocation. <br />I hereby certify that the work authorized by the above referenced permit has heeen <br />completed in accordance with the tennis and conditions ofsaid permit, and required <br />mitigation was completed in accordance with the permit conditions.1 <br />Signature of I'ermittce <br />1 ll'your permit included wetlands monitoring and annual reports, these activities will continae after <br />submittal of this form until you are notified by the Denver Regulatory Office that your mitig;moii is <br />successful and monitoring reports are no longer required, <br />