Exhibit H Mitigation Verification Form

Project Name: ___________________________________________________________


LAFCO Number: _________________________________________________________


  1. Mitigation Measure: (Needs to be exactly as adopted by the Commission)

    2.  

  2. Required Implementation Actions by LAFCO:

    3.  

  3. Required Implementation Actions by Other Public Agency:

    4.  

  4. Required Implementation Actions by Project Applicant:

    5.  

  5. Required LAFCO Verification Actions:

    6.  

  6. Mitigation Completed On: ____________________________________________

    7.  

  7. Verified By:_______________________________________________________

    8.