Title Page

  • Site conducted

  • Facility

  • Conducted on

  • Inspector Name and Title

  • Current weather condition

  • Photos taken

  • Location

Non-Storm Water Discharge (NSWD) Observations

  • AUTHORIZED -
    Fire Hydrant Flushing
    Potable Water Source
    Condensation (refrigeration, air conditioners, etc.)
    Ground Water
    Landscape Watering

    UNAUTHORIZED*
    Wash Water
    Cooling Tower Water
    Blowdown Water (compressors, boilers. etc.)
    Leaks / Spills of Materials
    All Other Types of Discharges

  • Are there any unauthorized NSWDs occurring at any of the drainage outfall(s), or indications of prior unauthorized NSWDs?

  • Drainage
  • Specify Drainage Ara

  • Source of Discharge / Characteristics / Source of Pollutant(s) (if applicable)

  • Are there any authorized NSWDs occurring at any of the drainage?

  • Drainage
  • Specify Drainage Ara

  • Source of Discharge / Characteristics / Source of Pollutant(s) (if applicable)

Observation Tips and Instructions

  • CHARACTERISTICS
    Clear
    Discoiored
    Turbid / Cloudy
    Odorous (Smelly)
    Oily Sheen
    Floating Materials

    • Observe the water and look for evidence of pollutants (oily sheen, odor, etc.)
    • Document the source of the observed pollutant(s) (ex: If there is an oil sheen, you should be able to follow that sheen back to a particular source on the ground, such as an oil spot in a parking area)
    • Write down the additional BMP(s) necessary to eliminate pollutant(s) from future discharges

Industrial Activities:

  • Check all applicable

MINIMUM BMP OBSERVATIONS

Good Housekeeping

  • 1. Are the observed outdoor areas associated with industrial activity free of pollutants at time of inspection?

  • 2. Is material tracking minimized or prevented effectively?

  • 3. Is dust generated from industrial materials or activities minimized?

  • 4. Are all facility areas impacted with rinse/wash waters cleaned promptly?

  • 5. Is all stored industrial material that can be readily mobilized with storm water covered?

  • 6. Are stored non-solid industrial materials or wastes properly contained from wind/rain?

  • 7. Is disposal of rinse/wash waters or other materials prevented from conveyance systems?

  • 8. Have SW discharges from non-industrial areas that contact industrial areas been minimized?

  • 9. Are non-industrial area authorized NSWDs minimized from contacting industrial areas?

Preventive Maintenance

  • 1. Have equipment & systems used outdoors that may spill/leak pollutants been identified?

  • 2. Have identified equipment, systems, or other conditions been observed to detect for leaks?

  • 3. Is the established schedule for maintenance appropriate?

  • 4. Are the prompt maintenance & repair procedures effectively preventing spills or leaks?

Spill and Leak Prevention and Response (SLPR)

  • 1. Are the procedures and/or controls to minimize spills & leaks established?

  • 2. Are spill/leak procedures preventing discharge to storm water convenience stem?

  • 3. Are there any response equipment or maintenance procedures identified or described?

  • 4. Are all response personnel identified & trained in spill/leak response?

Material Handling and Waste Management

  • 1. Is industrial material/wastes readily mobilized with storm water prevented/minimized?

  • 2. Are stored non-solid industrial materials or wastes properly contained from wind/rain?

  • 3. Are all industrial waste containers and material storage containers covered when not in use?

  • 4. Is run-on and storm water generated from the facility diverted from all stockpiled material?

  • 5. Are all spills of industrial materials/wastes cleaned in accordance with the SLPR procedures?

  • 6. Is outdoor material, waste handling equipment, & containers observed/cleaned as needed?

Erosion and Sediment Controls

  • 1. Are the implemented wind erosion controls effective?

  • 2. Are inactive areas, finished slopes & other erodible areas stabilized prior to rain events?

  • 3. Are perimeter controls & entrances/exits controlling erodible discharges & tracking off site?

  • 4. Is run-on and storm water generated from the facility diverted from all erodible material?

  • 5. Are sediment basins compliant to design storm standards of the Industrial General Permit?

ADVANCED BEST MANAGEMENT PRACTICES

  • 1. Exposure Minimization BMPs

  • 2. Storm Water Containment and Discharge Reduction BMPs

  • 3. Treatment Control BMPs

  • 4. Other Advanced BMPs

ADDITIONAL CORRECTIVE ACTIONS REQUIRED

  • (Identify additional corrective actions not included with BMP deficiencies above. Identify BMPs that need more frequent inspections. Note if SWPPP changes will be required.)

  • Required Action
  • Details

  • Imp Date

  • SWPPP Update

Exception Documentation

  • Explanation required if inspection could nor be conducted

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The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.