HVPS Inspection Form

• Facility Name:

• Facility ID #:

• Facility Address:
  Address

• Facility Phone Number:

• Correspondent(s) during inspection:

• Inspection Date/Time:

  Date

• Inspection Type:

  Select Routine Monitoring Enforcement Follow-up

  • Routine
  • Monitoring
  • Enforcement
  • Follow-up

Site Inspection

• Are outside areas kept, neat, clean and orderly?

  Yes

  No

  N/A

• Are trash receptacles and grease bins covered and leak resistant (plugs in place)?

  Yes

  No

  N/A

• Are trash and grease bin lids kept closed?

  Yes

  No

  N/A

• Has the stormwater conveyance system been recently altered?

  Yes

  No

  N/A

• If yes, does the alteration maintain compliance SWPPP compliance

  Yes

  No

  N/A

• Are stormwater drainage paths clear? Grates clean?

  Yes

  No

  N/A

• Are vehicles or equipment cleaned at this facility?

  Yes

  No

  N/A

• If yes, is wash water being collected and disposed of properly?

  Yes

  No

  N/A

• Are vehicle fuel at this location?

  Yes

  No

  N/A

• If yes, are fuel tanks locked and/or properly secured?

  Yes

  No

  N/A

• Are measures taken to prevent storm drains from spills?

  Yes

  No

  N/A

• Do above ground tanks have secondary containment?

  Yes

  No

  N/A

• Are containment structures or surface slabs liquid tight?

  Yes

  No

  N/A

• Does this site store hazardous materials such as solvents, pesticides, or acids?

  Yes

  No

  N/A

• If yes, are containers weather tight or covered?

  Yes

  No

  N/A

• Has the facility had a hazardous spill since the last inspection?

  Yes

  No

  N/A

• If yes, was the problem resulting in the spill corrected?

  Yes

  No

  N/A

• Are wast materials kept on site in closed leak tight containers?

  Yes

  No

  N/A

• Are leaking vehicles or equipment equipped with drip pans?

  Yes

  No

  N/A

• Is the ground surface stained by oil or significant materials?

  Yes

  No

  N/A

• If yes, has the source been found and contained?

  Yes

  No

  N/A

• Does the facility have waste products, salvaged materials, and recyclable stored?

  Yes

  No

  N/A

• Has the facility received a complaint regarding stormwater discharge?

  Yes

  No

  N/A

• Have the personnel received training on Stormwater Pollution Prevention?

  Yes

  No

  N/A

• Are janitorial liquids and wash water disposed of/in the sanitary sewer?

  Yes

  No

  N/A

• Are floor mats reinstate and other wash water directed away from the stormwater system?

  Yes

  No

  N/A

• Are spill response materials available?

  Select Sand Rice Hulls Sorbent Booms/Pillows/Blankets Kitty Litter Neutralizer Drip Pans

  • Sand
  • Rice Hulls
  • Sorbent Booms/Pillows/Blankets
  • Kitty Litter
  • Neutralizer
  • Drip Pans

• Other

• Were outreach materials distributed?

  Yes

  No

  N/A

Required Actions/Notice of Violation

• N.O.V. Issued?

  Yes

  No

  N/A

• Required Actions/Comments

• Violation to be corrected by

  Date

Sign Off

• Inspector Name

• Inspector Signature

  Sign

• Title

• Agency

• Name of Facility Representative

• Facility Representative Signature

  Sign

• Title