PMI Annual Storm Water Comprehensive Site Evaluation V.2

• Conducted on

  Date

• Prepared by

• Location
  Address

SWPPP and Record Review

• 1. Is a copy of the storm water permit located on-site?

  Compliant

  Non-Compliant

  N/A

• 2. Is a copy of the Storm Water Pollution Prevention Plan (SWPPP) located on-site?

  Compliant

  Non-Compliant

  N/A

• 3. Is the SWPPP up-to-date? (Note areas which need to be updated.)

  Compliant

  Non-Compliant

  N/A

• 4. Has annual employee training been conducted and documented?

  Compliant

  Non-Compliant

  N/A

• 5. Are inspections before performed and documented according to SWPPP frequency?

  Compliant

  Non-Compliant

  N/A

• 6. Does the site comply with storm water discharge permit?

  Compliant

  Non-Compliant

  N/A

• 7. Have appropriate storm water samples been collected? (CYD terminals -

  Compliant

  Non-Compliant

  N/A

Field Inspection Findings

• 8. Are Best Management Practices (BMP's) / erosion and sediment controls noted in the SWPPP being followed?

  Compliant

  Non-Compliant

  N/A

• 9. Is the site maintenance in an orderly manner to prevent storm water pollution?

  Compliant

  Non-Compliant

  N/A

• 10. Fuel/Oil Storage Area: Is the area free of leaks and spills?

  Compliant

  Non-Compliant

  N/A

• 11. Are buckets used to catch oil or other containers covered and/or not exposed to the weather?

  Compliant

  Non-Compliant

  N/A

• 12. Are storm water discharge locations (outfalls) free of visible silt or other contaminants?

  Compliant

  Non-Compliant

  N/A

• 13. Was there a storm water discharge the day of the inspection? If yes, was there evidence of turbidity, sediment or oil in the discharge?

  Compliant

  Non-Compliant

  N/A

• 14. Is there non-storm water discharges (water pumped off-site)

  Compliant

  Non-Compliant

  N/A

• 15. Is there visible trackout from the facility?

  Compliant

  Non-Compliant

  N/A

• 16. Is the property and surrounding ditches free of trash and litter?

  Compliant

  Non-Compliant

  N/A

• 17. Is the property perimeter in good condition? (No erosion off site. No stock piled material off site. Storm water runoff only leaving property at permitted outfall.)

  Compliant

  Non-Compliant

  N/A

• 18. Photos and other comments.

  Compliant

  Non-Compliant

  N/A

Notes/Comments:

• Overall Impression of the Site

  Developing

  Implementing

  Practicing

  Excelling

• I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible, for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.

• Authorized Representative Printed Name:

• Title:

• Annual Report Certification

  Sign