Dominion Energy BMP Inspection Report

• Document No.

• Job Name / Job Number

• Conducted on

  Date

• Prepared by

• Location
  Address

• Date and Time of Inspection:

  Date

Part I. General Information

• Site Information

• Feeder Line / WO#:

• Photos Taken:

  Yes

  No

Weather

• Estimate Storm Beginning: (Date and Time)

  Date

• Estimate Storm Duration: (Hours)

• Estimate Time Since Last Storm: (Days or Hours)

Inspection Information

• Inspector Name and Title:

  Sign

Good Housekeeping for Construction Materials

• Stockpiled construction materials not actively in use are covered and bermed

• Failure or Other Short Comings?

  Yes

  No

  N/A

• Action Required?

  Yes

  No

  N/A

• Action Implementation Date:

  Date

• All chemicals are stored in watertight containers with appropriate secondary containment, or in completely enclosed storage shed.

• Failure or Other Short Comings?

  Yes

  No

  N/A

• Action Required?

  Yes

  No

• Action Implementation Date:

  Date

Good Housekeeping for Waste Management

• Portable toilets are contained to prevent discharges of waste

• Failures or Other Short Comings?

  Yes

  No

  N/A

• Action Required?

  Yes

  No

• Action Implemented Date:

  Date

• Stockpiled waste material is securely protected from wind and rain if not actively in use

• Failures or Other Short Comings?

  Yes

  No

  N/A

• Action Required?

  Yes

  No

• Action Implementation Date:

  Date

• Procedures are in place for addressing hazardous and non-hazardous spills

• Failures or Other Short Comings?

  Yes

  No

  N/A

• Action Required?

  Yes

  No

• Action Implementation Date:

  Date

• Equipment and materials for cleanup of spills is available onsite

• Failures or Other Short Comings?

  Yes

  No

  N/A

• Action Required?

  Yes

  No

• Action Implementation Date:

  Date

• Washout areas (e.g., concrete) are contained appropriately to prevent discharge or infiltration into the underlying soil

• Failures or Other Short Comings?

  Yes

  No

  N/A

• Action Required?

  Yes

  No

• Action Implementation Date:

  Date

Good Housekeeping for Vehicle Storage and Maintenance

• Measures are in place to prevent oil, grease, or fuel from leaking into ground, storm drains, or surface waters

• Failures or Other Short Comings?

  Yes

  No

  N/A

• Action Required?

  Yes

  No

• Action Implementation Date:

  Date

• All equipment or vehicles are fueled, maintained, and stored in a designated area with appropriate BMP's

• Failures or Other Short Comings?

  Yes

  No

  N/A

• Action Required?

  Yes

  No

• Action Implementation Date:

  Date

Sediment Controls

• Entrances and exits are stabilized to control erosion and sediment discharges from the site

• Adequately Designed, Implemented and Effective?

  Yes

  No

  N/A

• Action Required?

  Yes

  No

• Action Implementation Date:

  Date

• Linear sediment control along toe of slope, face of slope and at grade breaks.

• Adequately Designed, Implemented and Effective?

  Yes

  No

  N/A

• Action Required?

  Yes

  No

• Action Implementation Date:

  Date

Descriptions of BMP Deficiencies

• Repairs Implemented:
  Note: Repairs must be within 72 hours of identification and complete repairs as soon as possible.

• Deficiency:

• Photo(s):

  Media

• Start Date:

  Date

• Action:

• Deficiency:

• Photo(s):

  Media

• Start Date:

  Date

• Action:

• Deficiency:

• Photo(s):

  Media

• Start Date:

  Date

• Action:

• Deficiency:

• Photo(s):

  Media