Monthly Storm Water Inspection

• Facility

  Select
• Add location
  Address

• Conducted on

  Date

• Weather Conditions

• Prepared by

Non-Storm Water Discharges

• Non-Storm Water Discharges (Examples of authorized NSWDs: Landscape watering, natural springs, ground water, potable water, foundation/footing drainage, condensates (from air conditioners, air compressors, and refrigeration units), fire system flushing)

  Yes

  No

• Were any unauthorized NSWDs observed? (Examples of unauthorized NSWDs: Wash water (from vehicles, buildings, and pavement), spilled industrial materials)

  Yes

  No

• If yes to either, identify the source, quantity observed, and frequency of occurrence:

Drainage Area Observations

• List of Storm Water Drainage Areas:

• Describe any abnormal conditions, BMP deficiencies, or industrial pollutants observed:

• Describe corrective actions taken with implementation date(s):

Best Management Practice Inspection Checklist

• Instructions: Perform a monthly facility-wide inspection and address each item below. If necessary, initiate corrective actions as soon as possible. Document corrective actions and implementation dates on this form. If a specified area is not present at your facility, write “Not Applicable or N/A” in the Comments column.

  Drawing

General Facility Checklist

• Access Areas: Inspect access areas to identify potential track out of dirt, gravel, or industrial materials.

  Compliant

  Non-Compliant

  N/A

• Parking Lots: Inspect employee and fleet parking areas to identify potential spills, leaks, debris, or trash.

  Compliant

  Non-Compliant

  N/A

• Curb Lines: Inspect curb lines to identify potential debris, sediment, or trash accumulation.

  Compliant

  Non-Compliant

  N/A

• Drains & Outfalls: Inspect storm water drain inlets and outfalls to identify potential debris or trash accumulation. Assess associated filter devices for performance and installation.

  Compliant

  Non-Compliant

  N/A

• Spill Response Kits: Inspect spill kits to verify adequate supplies are maintained.

  Compliant

  Non-Compliant

  N/A

Loading & Unloading Areas

• Dock Aprons: Inspect the dock apron to identify potential trash or debris accumulation.

  Compliant

  Non-Compliant

  N/A

• Material Handling Areas: Inspect material handling areas to identify potential spills, leaks, or debris.

  Compliant

  Non-Compliant

  N/A

Industrial Material Storage Areas

• Industrial Storage Areas: Inspect industrial material and waste storage areas to identify potential spills, leaks, or debris.

  Compliant

  Non-Compliant

  N/A

• Secondary Containment: Inspect secondary containment structures or devices to verify the interiors are free of accumulated materials, liquids, or storm water.

  Compliant

  Non-Compliant

  N/A

• Stockpiles: Inspect stockpiles, if present, to verify adequate BMPs are in place to prevent migration of materials by wind or rainfall.

  Compliant

  Non-Compliant

  N/A

Maintenance Areas

• Fuel Stations: Inspect fueling areas (fixed station or mobile) to identify potential spills, leaks, or track out.

  Compliant

  Non-Compliant

  N/A

• Repair Areas & Shops: Inspect vehicle or equipment repair areas to identify potential spills, leaks, or track out.

  Compliant

  Non-Compliant

  N/A

• Washing Areas: Inspect washing areas (fixed or mobile) to identify potential wash water discharges, staining, residues, or debris.

  Compliant

  Non-Compliant

  N/A

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• Name of Inspector

  Sign

• Date and time

  Date