Environmental Site Visit - R1.7 - duplicate

• Company Name

• Location

• Document No.

• Conducted on

  Date

• Is this a follow-up site visit?

  Yes

  No

• Follow-up Site Visit conducted on:

  Date

• ESH Team member(s) completing inspection:

• Facility Personnel accompanying ESH Team:

• Facility Description:

• Photographs, Maps, etc.

  Media

Air (Point Source, Fugitive Sources, Emissions Inventory, VOC/HAPs)

• Were any Air (Point Source, Fugitive Sources, Emissions Inventory, VOC/HAPs) items observed:

  Yes

  No

• No Air (Point Source, Fugitive Sources, Emissions Inventory, VOC/HAPs) related items were observed during this site visit.

• Air observation items:

Air Observed Item

• Location:

• Describe the item?

• Photographs:

  Media

• Is this a repeat item?

  Yes

  No

• Date of Previous Inspection

  Date

• Is this an action item?

  Yes

  No

• Describe Corrective Action:

• Date Corrective Action is to be completed?

  Date

• Is the Corrective Action Completed?

  Yes

  No

• Date Corrective Action Completed?

  Date

• Corrective Action Photo:

  Media

Water (Drinking Water, Potable Water, Sanitary Sewer/Septic, Wells & Surface Water)

• Were any Water (Drinking Water, Potable Water, Sanitary Sewer/Septic, Wells & Surface Water) items observed?

  Yes

  No

• No Water (Drinking Water, Potable Water, Sanitary Sewer/Septic, Wells & Surface Water) related items were observed during this site visit.

• Water observations:

Water Observed Item

• Location:

• Describe the item?

• Photographs:

  Media

• Is this a repeat item?

  Yes

  No

• Date of Previous inspection

  Date

• Is this an action item?

  Yes

  No

• Describe Corrective Action:

• Date Corrective Action is to be completed?

  Date

• Is the Corrective Action Completed?

  Yes

  No

• Date Corrective Action Completed?

  Date

• Corrective Action Photo:

  Media

Land (Mining, Dredging, Wetlands, Reclamation, Zoning)

• Were any Land (Mining, Dredging, Reclamation, Zoning) items observed?

  Yes

  No

• No Land (Mining, Dredging, Wetlands, Reclamation, Zoning) related items were observed during this site visit.

• Land observations:

Land Observed Item

• Location:

• Describe the item?

• Photographs:

  Media

• Is this a repeat item?

  Yes

  No

• Date of Previous inspection

  Date

• Is this an action item?

  Yes

  No

• Describe Corrective Action:

• Date Corrective Action is to be completed?

  Date

• Is the Corrective Action Completed?

  Yes

  No

• Date Corrective Action Completed?

  Date

• Corrective Action Photo:

  Media

SPCC (Petroleum Tanks, Equipment and Operations)

• Has annual training been completed for current year?

  Yes

  No

  N/A

• Date of training?

  Date

• Date of last training?

  Date

• Were any SPCC items observed:

  Yes

  No

• No SPCC related items were observed during this site visit.

• SPCC Observed items:

SPCC Observed Item

• Location:

• Describe the item?

• Photographs:

  Media

• Is this a repeat item?

  Yes

  No

• Date of Previous inspection

  Date

• Is this an action item?

  Yes

  No

• Describe Corrective Action:

• Date Corrective Action is to be completed?

  Date

• Is the Corrective Action Completed?

  Yes

  No

• Date Corrective Action Completed?

  Date

• Corrective Action Photo:

  Media

SWPPP (Stormwater, Process Water, and Erosion & Sediment Control)

• Has annual training been completed for current year?

  Yes

  No

  N/A

• Date of training?

  Date

• Date of last training?

  Date

• Were any SWPPP items observed

  Yes

  No

• No SWPP related items were observed during this site visit.

• SWPPP Observed Items:

SWPPP Observed Item

• Location:

• Describe the item?

• Photographs:

  Media

• Is this a repeat item?

  Yes

  No

• Date of Previous inspection

  Date

• Is this an action item?

  Yes

  No

• Describe Corrective Action:

• Date Corrective Action is to be completed?

  Date

• Is the Corrective Action Completed?

  Yes

  No

• Date Corrective Action Completed?

  Date

• Corrective Action Photo:

  Media

Waste (Solid, Liquid, Non-hazardous, Hazardous, etc.)

• We're any Waste (Solid, Liquid, Non-hazardous, Hazardous, etc.) observed during this site visit:

  Yes

  No

• No Waste (Solid, Liquid, Non-hazardous, Hazardous, etc.) related items were observed during this site visit.

• Waste Inspection items:

Waste Inspection Item

• Location:

• Describe the item?

• Photographs:

  Media

• Is this a repeat item?

  Yes

  No

• Date of Previous inspection

  Date

• Is this an action item?

  Yes

  No

• Describe Corrective Action:

• Date Corrective Action is to be completed?

  Date

• Is the Corrective Action Completed?

  Yes

  No

• Date Corrective Action Completed?

  Date

• Corrective Action Photo:

  Media

Permitting, documentation, EnviroLIS, Testing, and other.

• Select Region for EnviroLIS compliance.

  South

  Building Products

  No Active Tasks in EnviroLIS

• EnviroLIS Overall Site YTD Score:

• This EnviroLIS Overall Site YTD score falls below the annual goal.

• The EnviroLIS task completion rate is compliant.

• EnviroLIS Overall Site YTD Score:

• This EnviroLIS Overall Site YTD score falls below the annual goal.

• The EnviroLIS task completion rate is compliant.

• Permitting, documentation, EnviroLIS, Testing, and other items:

Permitting, documentation and other Item

• Permits or Documentation:

  Select Air Permit Stormwater Permit Process Water Permit Form R Tier II Waste Mining Permit Universal Waste SPCC SWPPP EnviroLIS Zoning Multimedia General Permit Permit by Rule Other Testing

  • Air Permit
  • Stormwater Permit
  • Process Water Permit
  • Form R
  • Tier II
  • Waste
  • Mining Permit
  • Universal Waste
  • SPCC
  • SWPPP
  • EnviroLIS
  • Zoning
  • Multimedia
  • General Permit
  • Permit by Rule
  • Other
  • Testing

• Describe the item?

• Photographs:

  Media

• Is this a repeat item?

  Yes

  No

• Date of Previous inspection

  Date

• Is this an action item?

  Yes

  No

• Describe Corrective Action:

• Is the Corrective Action Completed?

  Yes

  No

• Date Corrective Action Completed?

  Date

• Corrective Action Photo:

  Media

Best Management Practices

• Best Management Practices in use:

BMP item

• Location:

• Describe the item?

• Photographs:

  Media

Closeout

• Are there any additional comments:

  Yes

  No

• Additional Comments:

• Was this Site Visit and Action Items reviewed with the Plant Manager (or designee) prior to leaving the Facility?

  Yes

  No

  N/A

• Please sign as receipt of the attached Site Visit:

  Sign

• Cut and Paste E-mail return receipt if forwarded after leaving the facility.