Annual Comprehensive Site Inspection (ACSI) - Stormwater

• Inspection started on

  Date

• Inspected by

• Temperature (in degrees F)

• Precipitation

  None

  Rain

  Sleet

  Snow

  Hail

Paperwork Verification

• Is the previous years's inspection verified complete?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• Are all actions from previous year's inspection assigned?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

General Exterior

• Pavement or concrete (including parking areas) - Are there large cracks or potholes?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• Grass in place with no signs of visible disturbance or staining?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No containers stored outside (product or waste)?

  Yes

  No

• Do liquid containers have secondary containment?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No empty containers stored outside?

  Yes

  No

• Are they marked to indicate empty?<br>

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No racking stored outside?

  Yes

  No

• Is it free of contaminants? (Grease, dirt, etc)

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No abnormal materials outside?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• Site

  Decostar

  DSC

  GSC & GMC

• Identify all potential sources of Stormwater Contamination

  Select Resin Silos RIM Bulk Storage Purge Solvent Storage Paint Loading Dock Emergency Generator Paint Sludge Roll Off Trash Roll Offs Paint Racks and Carriers Cooling Towers Air Pollution Control Devices ( Stacks & RTO) Other Spills or Leaks

  • Resin Silos
  • RIM Bulk Storage
  • Purge Solvent Storage
  • Paint Loading Dock
  • Emergency Generator
  • Paint Sludge Roll Off
  • Trash Roll Offs
  • Paint Racks and Carriers
  • Cooling Towers
  • Air Pollution Control Devices ( Stacks & RTO)
  • Other
  • Spills or Leaks

• Is "other" selected on previous question?

  Yes

  No

• Describe other source

Storm water Discharges : Inspect each potential source listed above to determine whether the following conditions exist:

• No evidence of pollutants discharging to receiving waters at any facility outfalls ?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No previously unidentified pollutants in existing discharges?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No evidence of or potential for pollutants to enter the drainage system?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No offsite tracking of pollutants by vehicles entering and exiting facility?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No offsite tracking of sediment by vehicles entering or exiting the facility?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No tracking or blowing of pollutants from exposed areas to areas of no exposure?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• Is spill response equipment in proper working condition?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• Is pollution prevention equipment in good condition?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No additional control measures needed to comply with stormwater permit requirements?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• Is sedimentation pond in good condition?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• Describe any discharges occurring at time of inspection

• No revisions required to SWPPP as a result of inspection?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• Have all outfalls been visually evaluated for the presence of non-stormwater discharges?

  Yes

  No

• Go and visually evaluate the outfall at this time. If that is not possible, schedule a time to evaluate the outfall. The outfall must be visually evaluated every year.

• Please enter the date of the visual evaluation

  Date

• Which outfall(s) were evaluated?

• Any potential significant sources of non-stormwater on site?

  Yes

  No

• List the sources. Create a corrective action to eliminate the non-stormwater discharge(s).

• Are there any new areas needing sediment control measures?

  Yes

  No

• Create a follow up action item to address the issue(s).

• Has the most recent list of EPD's 305(b)/303(d) impaired stream segment list and list of TMDLs been reviewed?

  Yes

  No

• Any new TMDLs associated with the discharge from the site?

  Yes

  No

• Any applicable TMDLs to the site's discharge?

  Yes

  No

• Identify all potential sources of Stormwater Contamination

  Select Wooden pallets Packaging material Metal rack storage Compactor/scrap metal roll-off Chillers Forklift traffic Other

  • Wooden pallets
  • Packaging material
  • Metal rack storage
  • Compactor/scrap metal roll-off
  • Chillers
  • Forklift traffic
  • Other

• Is "other" selected on previous question?

  Yes

  No

• Describe other source

Storm water Discharges : Inspect each potential source listed above to determine whether the following conditions exist:

• No evidence of pollutants discharging to receiving waters at any facility outfalls ?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No previously unidentified pollutants in existing discharges?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No evidence of or potential for pollutants to enter the drainage system?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No offsite tracking of pollutants by vehicles entering and exiting facility?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No tracking or blowing of pollutants from exposed areas to areas of no exposure?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• Is spill response equipment in proper working condition?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• Is pollution prevention equipment in good condition?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No additional control measures needed to comply with stormwater permit requirements?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• Is sedimentation pond in good condition?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• Describe any discharges occurring at time of inspection

• No revisions required to SWPPP as a result of inspection?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• Have all outfalls been visually evaluated for the presence of non-stormwater discharges?

  Yes

  No

• Go and visually evaluate the outfall at this time. If that is not possible, schedule a time to evaluate the outfall. The outfall must be visually evaluated every year.

• Please enter the date of the visual evaluation

  Date

• Which outfall(s) were evaluated?

• Any potential significant sources of non-stormwater on site?

  Yes

  No

• List the sources. Create a corrective action to eliminate the non-stormwater discharge(s).

Certification statement

• "I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted.

• Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge, true, accurate, and complete.

• I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.

• Identify all potential sources of Stormwater Contamination

  Select Wooden Pallets Staging Area Trash Compactors Metal Rack Staging Area Trash Roll-Off Diesel Generator & Transformer Area Cardboard Compactor Truck/AGV Loading & Unloading Activities Forklift Activities

  • Wooden Pallets Staging Area
  • Trash Compactors
  • Metal Rack Staging Area
  • Trash Roll-Off
  • Diesel Generator & Transformer Area
  • Cardboard Compactor
  • Truck/AGV Loading & Unloading Activities
  • Forklift Activities

• Is "other" selected on previous question?

  Yes

  No

• Describe other source

Storm water Discharges : Inspect each potential source listed above to determine whether the following conditions exist:

• No evidence of pollutants discharging to receiving waters at any facility outfalls ?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No previously unidentified pollutants in existing discharges?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No evidence of or potential for pollutants to enter the drainage system?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No offsite tracking of pollutants by vehicles entering and exiting facility?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No offsite tracking of sediment by vehicles entering or exiting the facility?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No tracking or blowing of pollutants from exposed areas to areas of no exposure?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• Is spill response equipment in proper working condition?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• Is pollution prevention equipment in good condition?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• No additional control measures needed to comply with stormwater permit requirements?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• Is sedimentation pond in good condition?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• Describe any discharges occurring at time of inspection

• No revisions required to SWPPP as a result of inspection?

  Yes

  No

• Corrective Action Required: Add follow-up item for this question if the issue cannot be immediately resolved.

• Have all outfalls been visually evaluated for the presence of non-stormwater discharges?

  Yes

  No

• Go and visually evaluate the outfall at this time. If that is not possible, schedule a time to evaluate the outfall. The outfall must be visually evaluated every year.

• Please enter the date of the visual evaluation

  Date

• Which outfall(s) were evaluated?

• Any potential significant sources of non-stormwater on site?

  Yes

  No

• List the sources. Create a corrective action to eliminate the non-stormwater discharge(s).

• Are there any new areas needing sediment control measures?

  Yes

  No

• Create a follow up action item to address the issue(s).

Additional Comments

• Comments

Signature(s) of Staff Completing Inspection

• Environmental Representative

  Sign

• I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.

• Responsible Official

  Sign

• Were there additional Staff that Attended the Inspection?

  Yes

  No

• Additional Inspector

Inspector

• Inspector

  Sign