PMI Concrete Environmental Site Evaluation Form (V1)

• Conducted on

  Date
• Location
  Address

• Inspected by

• Attendees

• How is the weather today?

  Select Rainy Cloudy Sunny Overcast Windy

  • Rainy
  • Cloudy
  • Sunny
  • Overcast
  • Windy

• Take a picture of the plant entrace

  Media

PERMITS & DOCUMENTATION

• Air Permits current?

  Y

  N

  N/A

• VE test current? (make sure 3 year onsite)

  Yes

  No

  N/A

• Stormwater/Wastewater Permit current?

  Y

  N

  N/A

• Fuel Permit current?

  Y

  N

  N/A

• Storage Tank Certificate of Insurance (COI) and CFR current and completed? (explain how to look up tank in policy)

  Y

  N

  N/A

• Environmental Board/Book/Files updated and organized?

  Y

  N

  N/A

• Emergency Reporting Procedures posted?

  Y

  N

  N/A

• Environmental Green Alerts and Tool Box Talks on file?

  Y

  N

  N/A

BEST MANAGEMENT PRACTICES (SPCC-SWPPP PLANS)

• Does location have a SWPPP in place?

  Y

  N

  N/A

• SWPPP Contact List Updated?

  Y

  N

  N/A

• SWPPP plan and pits match what is on site? (review with manager and update if no engineering is required)

  Y

  N

  N/A

• SWPPP Inspection Records Available?

  Y

  N

  N/A

• SWPPP training records available? (look at last 3 years)

  Y

  N

  N/A

• Does location have an SPCC in place?

  Y

  N

  N/A

• SPCC Contact list updated?

  Y

  N

  N/A

• SPCC Tank list matches what is on site? (review with manager and update if no engineering is required)

  Y

  N

  N/A

• SPCC Inspection Records Available?

  Y

  N

  N/A

• SPCC training records available (annual) (look at last 3 years)

  Y

  N

  N/A

GENERAL HOUSEKEEPING

• Rate Work/Breakroom/Bathroom cleanliness

  Good

  Fair

  Poor

  N/A

• Dumpster lids closed and surrounding areas clean?

  Y

  N

  N/A

• Exits/Entrances/Electrical Room unobstructed?

  Y

  N

  N/A

• Are parking areas and yard free of vehicle leaks/stains?

  Y

  N

  N/A

APPEARANCE-IMPRESSION

• How well is property landscaped, grass is mowed and maintained?

  Good

  Fair

  Poor

  N/A

• Rate footprint of operation in neighborhood (trackout-noise-outside perimeter)

  Good

  Fair

  Poor

  N/A

• Rate Perimeter Fencing/Gate

  Good

  Fair

  Poor

  N/A

AIR QUALITY

• Rate overall air quality in yard (swept, curbs clear of build up, no visible dust cloud, track out)

  Good

  Fair

  Poor

  N/A

• Rate effectiveness of BMP's followed to minimize dusting? (Sweeping/sprinkling/water truck)

  Good

  Fair

  Poor

  N/A

• Dust/Sweeping Log kept on site?

  Y

  N

  N/A

• Baghouse/Dust Collector exterior in good shape and functioning at time of observation

  Good

  Fair

  Poor

  N/A

• Emission Unit Maintenance Log kept on site?

  Y

  N

  N/A

PLANT (EQUIPMENT-BINS-SLUMP RACKS-ADMIX)

• Rate how Dust Collector is performing at load point? (if possible)

  Good

  Fair

  Poor

  N/A

• Is there little to no dusting when tanker unloads?

  Y

  N

  N/A

• Rate the integrity of all silos? (visual inspection of integrity, paint)

  Good

  Fair

  Poor

  N/A

• Are pinch-valves and corresponding hoses in good condition? (visual only)

  Y

  N

  N/A

• Slump racks look clear of slime/build up?

  Y

  N

  N/A

• Rate integrity of Aggregate bin walls

  Good

  Fair

  Poor

  N/A

• Proper signage on aggregate storage?

  Y

  N

  N/A

• Are admixture tanks in containment area?

  Yes

  No

  N/A

• Rate integrity of admixture tank farm (visual)

  Good

  Fair

  Poor

  N/A

• Is there a check valve to open or close admix containment area drainage?

  Y

  N

  N/A

• Is there water in admix containment area?

  Yes

  No

  N/A

• If there is water in admix containment area, does it look clear of chemicals/debris?

  Y

  N

  N/A

STORMWATER (PONDS AND SEDIMENT PITS)

• All pond slopes sodded and mowed? (Look for erosion)

  Y

  N

  N/A

• Is pond water being recycled for batching/yard wash down or aggregate sprinkling? (Standpipe at pond for loader)

  Yes

  No

  N/A

• Pond vegetation maintained? (No cattails or vegetation should be present in excess)

  Y

  N

  N/A

• Pond discharge outfall(s) clean and free of vegetation/builup?

  Y

  N

  N/A

• Stormwater flowing properly?

  Y

  N

  N/A

• Does pond water look clean and free of sheen, sediment or fines?

  Y

  N

  N/A

• At time of evaluation there is no water or sludge leaving property?

  Y

  N

  N/A

• Rate sediment trap maintenance (no vegetation or cloudiness)

  Good

  Fair

  Poor

  N/A

WASTEWATER (CELLS AND RECYCLING BIN)

• Is there at least a foot of free-board at type II system?

  Y

  N

  N/A

• Drum washout stand pipe working?

  Y

  N

  N/A

• Pump(s) within Type II working properly?

  Y

  N

  N/A

• Does Type II have the ability to pump cleanest water into aggregate when wastewater levels are high?

  Y

  N

  N/A

• Check pit bottoms for build up (visual)

  Good

  Fair

  Poor

  N/A

• Rate water color/clarity and maintenance of Type II pits.

  Good

  Fair

  Poor

  N/A

• Slurry and waste concrete is contained within designated area?

  Y

  N

  N/A

• Is there a designated truck pressure wash area on site?

  Yes

  No

  N/A

• If so, does the wash water get pumped from sump to a holding tank?

  Y

  N

  N/A

• Is the truck wash permit available and current?

  Y

  N

  N/A

STORAGE TANKS (PETROLEUM PRODUCTS)

• 55 Gallon drums properly kept?

  Y

  N

  N/A

• 55 Gallon drums properly labeled?

  Y

  N

  N/A

• Are all containers over 55gal in containment?

  Y

  N

  N/A

• Are tanks bodies in good condition?(Specify if Discolor- Blistering- Corrosion- Cracks -Damage seen on tanks)

  Y

  N

  N/A

• No Smoking/Diesel/NFPA Signs posted and visible?

  Y

  N

  N/A

• Fire extinguishers inspected?

  Y

  N

  N/A

• Are fueling and oil storage areas clean and covered?

  Y

  N

  N/A

• Piping and hoses in good condition?

  Y

  N

  N/A

• Spill kits full & located near tank(s)

  Y

  N

  N/A

• Are pumping and fueling areas free of visible leaks or stains?

  Y

  N

  N/A

• Is there a break-away hose at fuel tank(s)?

  Y

  N

  N/A

• Tank port in good condition and within containment?

  Y

  N

  N/A

• Are petroleum product containment areas clean and covered?

  Y

  N

  N/A

• Are drainage check valves at petroleum containment areas closed?

  Y

  N

  N/A

• If there is water in petroleum containment areas is it clear of sheen?

  Y

  N

  N/A

• Is there a petroleum containment area water drainage log? Or does water get removed by Authorized vendor?

  Y

  N

  N/A

• Are recyclable oil transport manifests kept on site (cradle to grave), including truck wash holding tank water if applicable

  Y

  N

  N/A

• Yearly Operability Test done on registered storage tanks? (last 3 years should be available on site)

  Y

  N

  N/A

• 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.

• Overall Impression of Site

  Lacking

  Implementing

  Practicing

  Excelling

• Name of Authorized Representative conducting Inspection

• Signature of Authorized Representative

  Sign

• Name of Location Representative

• Signature of Location Representative

  Sign