Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Section 1 - General Information
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Inspector Name(s):
- Andra Ahrens
- David Koltz
- Karl Hartman
- Lindsay France
- Elizabeth Hatton
- Jennifer Green
- Talena Walton
- Adam Butterfield
- Constance Modrow
- Alex Christensen
- Tracey Bryson
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Reason for inspection
- Pre-permit
- Scheduled
- Unscheduled
- Demand
- IU Problem
- POTW Emergency
- Compliance Follow-up
- Other
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Permit #:
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Permit Signatory:
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Present at inspection?
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Were any other individuals present besides the Inspector?
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Individual:
Individual
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Name:
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Title:
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Contact Information:
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Last inspected by:
- Andra Ahrens
- David Koltz
- Karl Hartman
- Lindsay France
- Elizabeth Hatton
- Jennifer Green
- Talena Walton
- Adam Butterfield
- Constance Modrow
- Alex Christensen
- Tracey Bryson
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Were any recommendations or deficiencies noted in previous inspection?
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Recommendations/Deficiencies noted:
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Corrective actions taken by IU:
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Date of last inspection:
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Date Facility went into operation?
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Date of initial discharge to POTW:
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Date of last application/BMR
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Is this a new CIU (i.e. less than 6 months)?
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Date of 90 day, if new CIU.
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Plant Layout/Schematic on file at POTW?
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Request Plant Layout / Schematic from Permittee.
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When was the file received?
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Schematic depicts each of the following items:
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Location and fate of process discharges (sewer laterals, holding tanks, outfalls, leach fields)
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All internal and external drains (floor drains, plumbing drains, overflow pipes)
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Permit monitoring locations
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All tanks and vessels (day tanks, liquid storage, dry chemicals, fuels, waste holding)
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Secondary containment tanks, walls and other systems
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Comments:
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SIU Permit Signatory:
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Present at Inspection?
Section 2 - Product or Service Information
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Brief description of manufacturing or service activity at this facility:
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SIC Codes:
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NAIC Codes:
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Has production rate been affected since the last inspection?
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How has production rate been affected?
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Decrease in production.
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By what percent?
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Increase in production.
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By what percent?
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Industrial Category:
- CIU
- SIU
- IU
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Applicable Standards:
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List products manufactured, indicating the appropriate production units. (Skip if not applicable):
Product
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Product
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Units
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List type and amount of raw materials utilized, indicating the appropriate units:
Raw Material
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Material
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Units
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Are there any by-products?
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Please describe:
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Comments:
Section 3 - Production Information
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Total hours per day of operation
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Employees / Schedule:
Shift
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Number of full-time employees:
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Number of part-time employees:
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Hours of operation
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Days of operation:
- Monday-Friday
- Monday-Saturday
- Seven days a week
- Other
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Describe schedule.
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Is production seasonal?
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Indicate periods of maximum and minimum production.
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Do scheduled shutdowns occur?
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List time period(s):
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Total days of production for the latest calendar year:
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Are expansion plans scheduled within the next three (3) years?
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Which changes are anticipated?
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New products
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Same products, additional capacity
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New facility
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Expansion of current facility
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Relocation of facility
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Relocating within SLC sewer district?
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Proposed new facility address:
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Comments:
Section 4 - Water Use Information
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Water supply information:
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Public Source
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Enter SLCDPU Billing Account Number:
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Surface Water
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What is the source?
- Stream
- Creek
- River
- Canal
- Pond
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What is the flow in GPD?
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Well Water
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What is the flow in GPD?
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Other
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Specify:
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What is the flow in GPD?
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List total average daily plant water use (Gallons):
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Does usage vary widely during the production day?
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List maximum periods:
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Is a boiler in use at the facility?
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What is the blowdown frequency and quantity?
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Are corrosion or biological inhibiting chemicals added to facility water systems which are discharged to the sewer?
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Are raw water treatment processes employed?
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Water softener
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Reverse Osmosis (RO)
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Deionizing System (DI)
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Other
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Describe:
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Is any residue/regenerant disposed to sewer (e.g., reverse osmosis reject)?
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List type and quantity:
Section 5 - Wastewater Discharge Information
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Is facility connected to the SLC sanitary sewer system?
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Sewer Account and/or Service ID Number:
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What type of system is utilized for wastewater discharge?
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Does the facility have more than one sanitary sewer connection to the public sewer?
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How many connections?
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Is sanitary waste discharged separately to the POTW from process waste?
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Does IU discharge industrial/process wastewater to the POTW?
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List sources of industrial/process wastewater discharged to the POTW:
source
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Source:
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Volume currently discharged:
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Batch or continuous?
- Batch
- Continuous
- Both
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Treated prior to discharge?
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Authorized in Permit?
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Are any of the process discharges regulated by Federal Categorical Standards?
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List processes and standards:
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Does IU conduct process or equipment washes?
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What days and times do washes normally occur?
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Describe:
Section 5 (a) - Waste Streams
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Are waste streams separated at the facility?
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Is a piping diagram available on site?
Section 5 (b) - Pretreatment
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Pretreatment System(s) in use?
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Indicate system(s) used:
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Dissolved Air floatation (DAF)
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Chlorination
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Flow Equalization
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Grease, Oil, & Sand Interceptor
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Ion Exchange
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Flocculation / Precipitation
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Air Stripping
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Chemical Precipitation
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Filtration
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Grease/Oil Separation
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Grit Removal
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Reverse Osmosis
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Centrifuge
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Cyanide Destruction
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Neutralization, pH Control
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Screening
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Solvent Separation
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Sedimentation
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Evaporation
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Cyclone
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Ozonation
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Other
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Describe:
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Comments:
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Describe the process flow. (Be specific):
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Does the City have a copy of the Process Flow Diagram (PFD)?
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Draw, or have the Permitee draw a basic sketch of the process flow.
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Does the pretreatment system provide "continuous" or "batch" treatment?
- continuous
- batch
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How many batches are treated per week?
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Average quantity per batch:
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Is there a full-time wastewater treatment operator(s)?
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Provide name, title, and training received:
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Are all wastewater treatment units in service?
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Is there a wastewater treatment operations & maintenance manual?
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Is there a spare parts inventory of critical parts?
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Which parts?
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Are there any bypasses?
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Describe bypass:
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Potential pollutants:
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List existing and proposed engineering and operational controls:
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Are air pollution control devices employed?
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Describe location:
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Is a wastewater stream generated?
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Potential pollutants:
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Discharge or disposal method:
Section 5 (c) - Pollutants
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Could pollutants potentially be contained in the wastewater?
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Check all potential pollutants:
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Acids and Acidic Waste
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Alkali and Caustic Wastes
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Pickling Wastes
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Metal Cleaning and Preparation Wastes
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Metal Finishing Wastes
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Electroplating Wastes
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Photographic Wastes
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Latex Wastes
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Paints and Pigments
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Glues
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Inks and Printing Wastes
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Dyes, Coloring Agents
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Waxes
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Soaps, Surfactants, Detergents
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Oils
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Fats and Grease
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Aldehydes, Ketones
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Ethers
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Organic Acids
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Pesticides, Herbicides, Rodenticide
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Phenol Containing Wastes
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Benzene and Benzene Derivatives
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Organic Solvents, Thinners
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Halogenated Organic Compounds
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Hot Wastes
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Radioactive Wastes
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Other
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Specify:
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Which of the above-noted pollutants come into direct contact with water that is discharged to the POTW?
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Is Permittee subject to any Best Management Practices (BMPs)?
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Are BMP Requirements implemented appropriately?
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Comments:
Section 6 - Stored Chemical & Waste Production
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Are liquid chemicals used/stored in quantities of 55 gallons or more and/or dry chemicals in quantities of 500 pounds or more?
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List each chemical and amount stored/used:
Chemical
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Chemical name:
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Amount currently stored:
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Quantity used:
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Time frame for quantity used:
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Does the City have a copy of the chemical inventory?
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Obtain a copy of the chemical inventory.
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Comments:
Section 6 (a) - Spill Control
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Does facility have a written Spill/Slug Discharge Control Plan?
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Is the Plan Adequate?
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List Plan deficiencies:
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Is a copy of the Plan on file at POTW?<br>
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When was the Plan submitted?
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Are notification procedures posted in the plant?
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Describe any spill control methods or facilities:
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Are employees trained in spill response procedures?
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Are employees properly trained to handle hazardous waste and other chemicals?
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Name and title of person responsible for chemicals:
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Is heavy equipment serviced or cleaned on your property (forklifts, cranes, trucks, etc.)?
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What provisions are made for disposal of oil, steam cleaning wastes or other wastes?
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Comments:
Section 6 (b) - Offsite Disposal
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Are any solid wastes, sludges or other residues generated which require offsite disposal?
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Provide information for each waste type (Type, Amount Generated, Waste Hauler)
Waste type
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Waste:
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Amount generated per month GPM:
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Waste hauler:
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Disposal location:
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Hazardous waste?
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Are all applicable waste manifests and/or shipping records available for review?
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Comments:
Section 6 (c) - Management of Toxic Organics
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Is the facility subject to 40 CFR 413 or 433?
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Has a Toxic Organic Management Plan (TOMP) been submitted and reviewed by the POTW?
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Is the TTO certification statement being submitted as required?
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Is the TOMP being implemented and followed as described?
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How is the TOMP being implemented?
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Explain: Note deficiencies in TOMP implementation.
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Are TTOs being monitored?
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By whom and how often?
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Which of the required TTOs are being monitored (624, 625, 608, 1613B)?
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Has a request to utilize alternative TTO monitoring been submitted and reviewed by the POTW?
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Are the parameters specified by the POTW being monitored?
Section 7 - Self-Monitoring Sampling & Testing
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Does Industrial User (Permittee) perform all monitoring?
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Person responsible for sampling:
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Date IU last sampled wastewater discharge:
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Type of sample:
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Composite
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How many aliquots are being taken?
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Grab
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Grab samples are being collected for which of the following?
- pH
- Cyanide
- Oil & Grease
- Phenols
- TTO (Volatiles)
- Other
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Specify:
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Are samples properly preserved?
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Deficiencies observed:
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Are samples iced or refrigerated as needed?
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Is pH measured immediately after collection?
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Measured with a pH meter?
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How often is the pH meter calibrated?
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Which buffers are used for calibration?
- 4
- 7
- 10
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Are calibration logs being kept.
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Is a continuous recording pH meter used?
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Are pH records being submitted?
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Which type of records are being submitted?
- Recording charts
- Summary reports
- Other
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Is the sampling point identified in the permit being used?
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Deficiencies observed:
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Add media
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Does the IU have written sampling procedures?
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Do the sampling procedures reference 40 CFR 136?
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Have the sampling procedures been submitted to the City for approval?
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Have the procedures been approved?
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Deficiencies:
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Are samples being tested by a certified lab?
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Name of lab:
- Enviropro
- Chemtech Ford
- AWAL
- Unified State Laboratories
- Other
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Specify name of lab, and evidence of certification:
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Contact person:
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Phone number:
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Are samples delivered to the lab within holding times?
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Are 40 CFR 136 procedures being followed?
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Are self-monitoring reports being submitted according to the permit requirements?
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Reporting frequency:
- Weekly
- Monthly
- Quarterly
- Semi-annually
- Annually
- Other
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Are they consistent with results?
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Sampling frequency:
- Weekly
- Monthly
- Quarterly
- Semi-annually
- Annually
- Other
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Specify:
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Did IU monitor for all Permit parameters since the last inspection?
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Which parameters were not sampled?
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Has the IU violated any pollutant limits or reporting requirements since the last inspection?
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Explain:
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Was the City notified within 24 hours?
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Was corrective action documented?
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Was sampling increased in the last reporting period?
Section 8 - Record Keeping
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Does the Permit require any other reports, such as Zero Discharge Periodic Compliance Reports or TTO certification statements?
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Have the reports been complete and on time?
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Has the IU notified the POTW of all sampling (including any non-routine sampling) conducted at the permitted monitoring point?
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Is the current wastewater discharge control permit on file?
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Are on-site records maintained and available for review for at least a minimum of five (5) years?
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Are all reports signed by an authorized representative?
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Are spill and/or upset/bypass reports being submitted?
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Comments:
Section 9 - Enforcement
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Is the IU presently under an informal/formal enforcement action by Salt Lake City?
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Describe status:
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Is the IU under a compliance schedule?
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Are compliance schedule progress reports being submitted?
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Comments:
Section 10 - Walk Through
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If visible, are pipes labeled or color coded?
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Are system alarms or shut off valves in place?
Section 10 (a) - Interior Inspection
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Chemicals/Raw Materials - Storage and Use
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Deficiencies observed:
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Add media
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Describe chemical storage and containment:
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Chemicals/Raw Materials - Labeling
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Deficiencies observed:
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Add media
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Waste Storage - Containment
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Deficiencies observed:
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Add media
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Describe waste storage and containment:
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Waste Disposal
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Deficiencies observed:
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Add media
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Floor Drains - Location
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Deficiencies observed:
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Add media
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Describe floor drain location and pollution potential, where applicable:
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Floor Drains - Protected from Pollutants
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Deficiencies observed:
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Add media
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Mop Water - Proper Disposal
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Deficiencies observed:
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Add media
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Spill Containment Equipment / Spill Kits
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Deficiencies observed:
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Add media
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Describe spill containment equipment:
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Maintenance shop, storage, garages, etc.
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Deficiencies observed:
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Add media
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Pretreatment Equipment - Maintenance
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Deficiencies observed:
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Add media
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Pretreatment Equipment - Operation
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Deficiencies observed:
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Add media
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Pretreatment Equipment - Authorized
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Deficiencies observed:
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Add media
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MSDS - Complete
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Deficiencies observed:
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Add media
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MSDS - Available
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Deficiencies observed:
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Add media
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Slug/Spill/Emergency Notification Procedures - Posted
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Deficiencies observed:
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Add media
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Lab - Plumbing
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Deficiencies observed:
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Add media
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How does Permittee dispose of lab waste?
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Lab - Procedures
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Deficiencies observed:
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Add media
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pH meters/ORP Meters - Provided
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Deficiencies observed:
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Add media
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pH meters/ORP Meters - Properly Calibrated / Complete Records
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Deficiencies observed:
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Add media
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pH meters/ORP Meters - Operation & Maintenance
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Deficiencies observed:
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Add media
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Incompatible chemicals - Properly Separated
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Deficiencies observed:
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Add media
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Chemical Containment - Adequate
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Deficiencies observed:
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Add media
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Flammable Cabinet
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Deficiencies observed:
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Add media
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Sampling Points
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Add media
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Deficiencies observed:
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What manufacturing processes were observed/identified?
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Additional Comments:
Section 10 (b) - Exterior Inspection
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Perimeter of Building
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Deficiencies observed:
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Add media
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Storm Drains
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Deficiencies observed:
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Add media
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Location of all storm drains:
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Outside Chemical Storage Areas - Containment
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Deficiencies observed:
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Add media
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Outside Chemical Storage Areas - Covered
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Deficiencies observed:
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Add media
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Grease removal devices
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Deficiencies observed:
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Add media
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Describe each grease removal device:
Device
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Type
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Number of chambers:
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Size:
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Location:
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Date of most recent cleaning
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By whom?
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Cleaning frequency schedule:
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Monitoring Points
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Add media
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Deficiencies observed:
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Comments:
Section 11 - Inspection Summary
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Narrative: Describe the pretreatment system at this facility:
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If needed, draw a sketch of the pretreatment system:
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Pretreatment system sketch #2:
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Pretreatment system sketch #3:
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Wastewater is free from potential of prohibited pollutant discharges listed in 40 CFR 403.5(b)
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Describe deficiency:
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Wastewater is free from potential of pollutant discharges not previously noted.
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Describe deficiency:
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Wastewater effluent is not being diluted as a substitute for adequate treatment.
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Describe deficiency:
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There is no evidence of spill, upset or bypass.
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Describe deficiency:
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There is no evidence of unreported violations.
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Describe deficiency:
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Note any action items (facility or POTW) and summarize overall observations of the facility:
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Information/handouts given to industry (titles: RCRA, Local Limits, etc):
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Inspection result:
- No Deficiencies Observed
- Deficiencies Observed
- Non-Compliance
- Significant Non-Compliance
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Summary of all deficiencies:
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Follow-up date
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Summary of actions to be taken:
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Summary of actions to be taken:
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Reclassification required?
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Additional photo
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Additional photo
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Additional photo
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Additional photo
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Additional photo
Section 12 - Signature Block
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Inspector Signature:
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Permitee Signature (or authorized representative):
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Copy of inspection report to be sent to IU?