Annual Pretreatment Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Section 1 - General Information

• Inspector Name(s):

  Select Andra Ahrens Jennifer Green Karl Hartman Elizabeth Green David Koltz

  • Andra Ahrens
  • Jennifer Green
  • Karl Hartman
  • Elizabeth Green
  • David Koltz

• Reason for inspection

  Select Pre-permit Scheduled Unscheduled Demand IU Problem POTW Emergency Compliance Follow-up Other

  • Pre-permit
  • Scheduled
  • Unscheduled
  • Demand
  • IU Problem
  • POTW Emergency
  • Compliance Follow-up
  • Other

• Permit #:

• SIU Permit Signatory:

• Present at Inspection?

  Yes

  No

  N/A

• Emergency Contact Phone:

• Date Facility went into operation?

  Date

• Persons present during current inspection

• Last inspected by:

  Select Andra Ahrens Adam Butterfield Jennifer Green Karl Hartman Elizabeth Green David Koltz Constance Modrow Talena Walton

  • Andra Ahrens
  • Adam Butterfield
  • Jennifer Green
  • Karl Hartman
  • Elizabeth Green
  • David Koltz
  • Constance Modrow
  • Talena Walton

• Date of discharge to POTW:

  Date

• Date of last application/BMR

  Date

• Is this a new CIU (i.e. less than 6 months)?

  Yes

  No

• Date of 90 day, if new CIU.

  Date

• Plant Layout/Schematic on file at POTW?

  Yes

  No

• Request Plant Layout / Schematic from Permittee.

• When was the file received?

  Date

• Schematic depicts each of the following items:
  

• Location and fate of process discharges (sewer laterals, holding tanks, outfalls, leach fields)

• All internal and external drains (floor drains, plumbing drains, overflow pipes)

• Permit monitoring locations

• All tanks and vessels (day tanks, liquid storage, dry chemicals, fuels, waste holding)

• Secondary containment tanks, walls and other systems

• Comments:

Section 2 - Product or Service Information

• Brief description of manufacturing or service activity at this facility:

• SIC Codes:

• NAIC Codes:

• Industrial Category:

  CIU

  SIU

  IU

• Applicable Standards:

• How has production rate been affected since the last inspection?

  Yes

  No

• By what percent?

• By what percent?

• List products manufactured, indicating the appropriate production units. (Skip if not applicable):

Product

• Product

• Units

• List type and amount of raw materials utilized, indicating the appropriate units:

Raw Material

• Material

• Units

• Are there any by-products?

  Yes

  No

• Please describe:

• Comments:

Section 3 - Production Information

• Total hours per day of operation

• Employees / Schedule:

Shift

• Number of full-time employees:

• Number of part-time employees:

• Hours of operation

• Days of operation:

  Select Monday Tuesday Wednesday Thursday Friday Saturday Sunday

  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday
  • Saturday
  • Sunday

• Is production seasonal?

  Yes

  No

• Indicate periods of maximum and minimum production.

• Do scheduled shutdowns occur?

  Yes

  No

• List time period(s):

• Total days of production for the latest calendar year:

• Are expansion plans scheduled within the next three (3) years?

  Yes

  No

• Which changes are anticipated?

  Select New Products Same Products - Additional Capacity New Facility Expansion of Current Facility Relocation

  • New Products
  • Same Products - Additional Capacity
  • New Facility
  • Expansion of Current Facility
  • Relocation

• Relocating within, or outside existing district?

  Within District

  Outside District

• Comments:

Section 4 - Water Use Information

• Water supply information:

  Select Public Surface Well Other

  • Public
  • Surface
  • Well
  • Other

• Enter SLCDPU Billing Account Number:

• What is the source?

  Stream

  Creek

  River

  Canal

  Pond

• What is the flow in GPD?

• What is the flow in GPD?

• Specify:

• What is the flow in GPD?

• List average daily total plant water use (Gallons):

• Does usage vary widely during the production day?

  Yes

  No

• List maximum periods:

• List sources and volumes of industrial wastewater discharged to the City sewer collection system:

• Is a boiler in use at the facility?

  Yes

  No

• What is the blowdown frequency and quantity?

• Are corrosion or biological inhibiting chemicals added to facility water systems which are discharged to the sewer?

  Yes

  No

• Are raw water treatment processes employed?

  Yes

  No

• List process(es):

• Is any residue/regenerant disposed to sewer (e.g., reverse osmosis reject)?

  Yes

  No

  N/A

• List type and quantity:

• Are any of the process discharges regulated by Federal Categorical Standards?

  Yes

  No

• List processes and standards:

Section 4 (a) - Waste Streams

• Are waste streams separated at the facility?

  Yes

  No

  N/A

• Is a piping diagram available on site?

  Yes

  No

Section 5 - Pretreatment

• Pretreatment System(s) in use?

  Yes

  No

• Indicate system(s) used:

• Dissolved Air floatation (DAF)

• Chlorination

• Flow Equalization

• Grease, Oil, & Sand Interceptor

• Ion Exchange

• Flocculation / Precipitation

• Air Stripping

• Chemical Precipitation

• Filtration

• Grease/Oil Separation

• Grit Removal

• Reverse Osmosis

• Centrifuge

• Cyanide Destruction

• Neutralization, pH Control

• Screening

• Solvent Separation

• Sedimentation

• Evaporation

• Cyclone

• Ozonation

• Comments:

• Describe the process flow. (Be specific):

• Does the City have a copy of the Process Flow Diagram (PFD)?

  Yes

  No

  N/A

• Draw, or have the Permitee draw a basic sketch of the process flow.

  Drawing

• Does the pretreatment system provide "continuous" or "batch" treatment?

  continuous

  batch

• How many batches are treated per week?

• Average quantity per batch:

• Is there a full-time wastewater treatment operator(s)?

  Yes

  No

• Provide name, title, and training received:

• Are all wastewater treatment units in service?

  Yes

  No

  N/A

• Is there a wastewater treatment operations & maintenance manual?

  Yes

  No

  N/A

• Is there a spare parts inventory of critical parts?

  Yes

  No

  N/A

• Are there any bypasses?

  Yes

  No

  N/A

• Are air pollution control devices employed?

  Yes

  No

  N/A

• Describe location:

• Is a waste stream generated?

  Yes

  No

• Potential pollutants:

• Discharge or disposal method:

Section 5 (a) - Pollutants

• Could pollutants potentially be contained in the wastewater?

  Yes

  No

  N/A

• Check all potential pollutants:

• Acids and Acidic Waste

• Alkali and Caustic Wastes

• Pickling Wastes

• Photographic Wastes

• Latex Wastes

• Paints and Pigments

• Glues

• Inks and Printing Wastes

• Dyes, Coloring Agents

• Waxes

• Soaps, Surfactants, Detergents

• Oils

• Fats and Grease

• Aldehydes, Ketones

• Ethers

• Organic Acids

• Pesticides, Herbicides, Rodenticide

• Phenol Containing Wastes

• Benzene and Benzene Derivatives

• Organic Solvents, Thinners

• Halogenated Organic Compounds

• Hot Wastes

• Radioactive Wastes

• Other

• Specify:

• Which of the above-noted pollutants come into direct contact with water that is discharged to the POTW?

• Comments:

Section 6 - Stored Chemical & Waste Production

• Are liquid chemicals used/stored in quantities of 55 gallons or more and/or dry chemicals in quantities of 500 pounds or more?

  Yes

  No

• List each chemical and amount stored/used:

Chemical

• Chemical name:

• Amount currently stored:

• Quantity used:

• Time frame for quantity used:

• Does the City have a copy of the chemical inventory?

  Yes

  No

  N/A

• Obtain a copy of the chemical inventory.

• Comments:

Section 6 (a) - Spill Control

• Does facility have a written Spill/Slug Discharge Control Plan?

  Yes

  No

  N/A

• Is the Plan Adequate?

  Yes

  No

• List Plan deficiencies:

• Is a copy of the Plan on file at POTW?<br>

  Yes

  No

• When was the Plan submitted?

  Date

• Are notification procedures posted in the plant?

  Yes

  No

• Describe any spill control methods or facilities:

• Are employes trained in spill response procedures?

  Yes

  No

• Are employees properly trained to handle hazardous waste and other chemicals?

  Yes

  No

• Name and title of person responsible for chemicals:

• Is heavy equipment serviced or cleaned on your property (forklifts, cranes, trucks, etc.)?

  Yes

  No

• What provisions are made for disposal of oil, steam cleaning wastes or other wastes?

• Comments:

Section 6 (b) - Offsite Disposal

• Are any solid wastes, sludges or other residues generated which require offsite disposal?

  Yes

  No

• Provide information for each waste type (Type, Amount Generated, Waste Hauler)

Waste type

• Waste:

• Amount generated per month GPM:

• Waste hauler:

• Disposal location:

• Hazardous waste?

  Yes

  No

• Are all applicable waste manifests available for review?

  Yes

  No

  N/A

• Comments:

Section 7 - Record Keeping

• Does the Permit require any other reports, such as Zero Discharge Periodic Compliance Reports or TTO certification statements?

  Yes

  No

• Have the reports been complete and on time?

  Yes

  No

• Has the IU notified the POTW of any non-routine sampling conducted at the permitted monitoring point?

  Yes

  No

  N/A

• Is the current wastewater discharge control permit on file?

  Yes

  No

  N/A

• Are on-site records maintained and available for review for at least a minimum of three (3) years?

  Yes

  No

  N/A

• Are all reports signed by an authorized representative?

  Yes

  No

• Are spill and/or upset/bypass reports being submitted?

  Yes

  No

  N/A

• Comments:

Section 8 - Enforcement

• Is the IU presently under an informal/formal enforcement action by Salt Lake City?

  Yes

  No

• Describe status:

• Is the IU under a compliance schedule?

  Yes

  No

• Are compliance schedule progress reports being submitted?

  Yes

  No

• Comments:

Section 9 - Walk Through

• If visible, are pipes labeled or color coded?

  Yes

  No

  N/A

• Are system alarms or shut off valves in place?

  Yes

  No

  N/A

Section 9 (a) - Exterior Inspection

• Perimeter of Building

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Storm Drains

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Outside Chemical Storage Areas - Containment

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Outside Chemical Storage Areas - Covered

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Grease removal devices

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Describe each grease removal device:

Device

• Type

• Number of chambers:

• Size:

• Location:

• Date of most recent cleaning

  Date

• By whom?

• Cleaning frequency schedule:

• Comments:

Section 9 (b) - Interior Inspection

• Chemicals/Raw Materials - Storage and Use

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Chemicals/Raw Materials - Labeling

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Waste Storage - Containment

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Waste Disposal

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Floor Drains - Location

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Floor Drains - Protected from Pollutants

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Mop Water - Proper Disposal

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Spill Containment Equipment / Spill Kits

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Maintenance shop, storage, garages, etc.

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Pretreatment Equipment - Maintenance

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Pretreatment Equipment - Operation

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Pretreatment Equipment - Authorized

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• MSDS - Complete

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• MSDS - Available

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Slug/Spill/Emergency Notification Procedures - Posted

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Lab - Plumbing

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Lab - Procedures

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• pH meters/ORP Meters - Provided

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• pH meters/ORP Meters - Properly Calibrated / Complete Records

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• pH meters/ORP Meters - Operation & Maintenance

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Incompatible chemicals - Properly Separated

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Chemical Containment - Adequate

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Flammable Cabinet

  Yes

  No

  N/A

• Deficiencies observed:

• Add media

  Media

• Sampling Points

  Yes

  No

  N/A

• Add media

  Media

• Deficiencies observed:

• Comments:

Section 10 - Visit Summary

• Narrative: Describe the pretreatment system at this facility:

• If needed, draw a sketch of the pretreatment system:

  Drawing

• Pretreatment system sketch #2:

  Drawing

• Pretreatment system sketch #3:

  Drawing

• Wastewater is free from potential of prohibited pollutant discharges listed in 40 CFR 403.5(b)

  Yes

  No

  N/A

• Wastewater is free from potential of pollutant discharges not previously noted.

  Yes

  No

  N/A

• Wastewater effluent is not being diluted as a substitute for adequate treatment.

  Yes

  No

  N/A

• There is no evidence of spill, upset or bypass.

  Yes

  No

  N/A

• Note any action items (facility or POTW) and summarize overall observations of the facility:

• Information/handouts given to industry (titles: RCRA, Local Limits, etc):

• Inspection result:

  No Deficiencies Observed

  Deficiencies Observed

  Non-Compliance

  Significant Non-Compliance

• Summary of all deficiencies:

• Follow-up date

  Date

• Summary of actions to be taken:

• Summary of actions to be taken:

• Reclassification required?

  Yes

  No

• Additional photo

  Media

• Additional photo

  Media

• Additional photo

  Media

• Additional photo

  Media

• Additional photo

  Media

Section 11 - Signature Block

• Inspector Signature:

  Sign

• Permitee Signature (or authorized representative):

  Sign

• Copy of inspection report to be sent to IU?

  Yes

  No