Quarterly Inspection

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• QUARTER

  1ST

  2ND

  3RD

  4TH

• SIC

  Select 5015 5093 3441 2851 4581 3715 3999 3799 3446

  • 5015
  • 5093
  • 3441
  • 2851
  • 4581
  • 3715
  • 3999
  • 3799
  • 3446

• INDUSTRY SECTOR

  Select M N F U C S AA AB

  • M
  • N
  • F
  • U
  • C
  • S
  • AA
  • AB

• WEATHER

  Select Sunny Partly Sunny Cloudy Partly Cloudy Rain Snow

  • Sunny
  • Partly Sunny
  • Cloudy
  • Partly Cloudy
  • Rain
  • Snow

• (g) Periodic Inspections-Qualified personnel, who are familiar with industrial activities performed at the facility, shall conduct periodic inspections to determine the effectiveness of the Good Housekeeping, Spill Prevention and Response Measures, Erosion Control Measures, Maintenance Programs for Structural Controls, Best Management Practices, and Employee Training Program. Periodic inspections must be conducted on a frequency of once per quarter or monthly, unless otherwise specified in Part V of this permit, relating to Specific Requirements for industrial activities. The inspection must be documented through the use of a checklist that is developed to include each of the controls and measures that are evaluated. When revisions or additions to the SWP3 are recommended as result of inspections, a summary description of these proposed changes must be attached to the checklist. The summary must identify any necessary time frames required to the proposed changes. The periodic inspections checklists must be made readily available for inspection and review by authorized TCEQ personnel upon request.

• AREAS NEEDING ATTENTION FOR NEXT PERIOD

• Add media

  Media

GOOD HOUSEKEEPING MEASURES

• Are areas clean and organized?

  Yes

  No

  N/A

• Are areas clean and orderly? (ie. Trash containers, storage areas, outdoor processing, and loading docks)

  Yes

  No

  N/A

• Are there any trash, debris, or staining present at the outfall?

  Yes

  No

  N/A

• Are there any other areas that need attention?

  Yes

  No

  N/A

SPILL PREVENTION & RESPONSE MEASURES

• Waste containers provided and used?

  Yes

  No

  N/A

• Are all drums, tanks or containers clearly labeled?

  Yes

  No

  N/A

• Are there any hazardous materials present? If so, are they clearly labeled?

  Yes

  No

  N/A

• Is the spill response posted?

  Yes

  No

  N/A

• Are materials and equipment available for spill cleanup?

  Yes

  No

  N/A

• Are leaks and spills noted?

  Yes

  No

  N/A

• Has there been any significant spills or leaks? If so, has appendix 7 been updated?

  Yes

  No

  N/A

• Is secondary containment provided around liquid storage areas?

  Yes

  No

  N/A

• Is equipment monitored for leaks and spills? If so, is there a log available?

  Yes

  No

  N/A

EROSION CONTROL MEASURES

• Is vegetation in good condition?

  Yes

  No

  N/A

• Is paving adequate?

  Yes

  No

  N/A

• Are there any other structural controls needed or in need of attention?

  Yes

  No

  N/A

• Was any other erosion noted?

  Yes

  No

  N/A

• Are there any other signs of erosion noted at the outfalls?

  Yes

  No

  N/A

MAINTENANCE PROGRAMS FOR STRUCTURAL CONTROLS

• Are oil/water separators use? If so, are they maintained?

  Yes

  No

  N/A

• Are catch basins used? If so are they maintained?

  Yes

  No

  N/A

• Are sediment ponds used? If so, are they maintained?

  Yes

  No

  N/A

• Are grass swales used? If so, are they maintained?

  Yes

  No

  N/A

• Are berms used? If so, are they maintained?

  Yes

  No

  N/A

• Are fluid storage areas covered?

  Yes

  No

  N/A

• Any other structural controls used? If so, are they maintained?

  Yes

  No

  N/A

BEST MANAGEMENT PRACTICES

• Are all BMP's required by the SWP3 being implemented?

  Yes

  No

  N/A

• Are additional BMP's needed?

  Yes

  No

  N/A

• Have there been any changes in operation that require changes to the SWP3?

  Yes

  No

  N/A

• Is the SWP3 up to date?

  Yes

  No

  N/A

• Are the maps current?

  Yes

  No

  N/A

• Was Visual sample collected this quarter? If so, are the results available in the SWP3?

  Yes

  No

  N/A

• Was the Benchmark sample collected? If so, are the results available in the SWP3?

  Yes

  No

  N/A

• Was the annual twelve metals collected? If so, are they results available in the SWP3?

  Yes

  No

  N/A

• Is the NOI/permit available in the SWP3?

  Yes

  No

  N/A

• Is the Pollution Prevention Team correct in the plan?

  Yes

  No

  N/A

• Are there any non-storm water discharges? If so, has the SWP3 been updated?

  Yes

  No

  N/A

• Is the certification page signed by the proper signatory and available in the SWP3?

  Yes

  No

  N/A

EMPLOYEE TRAINING

• Has employee training been conducted? If not, when is it scheduled? If so, is the content of the training in the SWP3?

  Yes

  No

  N/A

• REPORT CERTIFICATION

• This certification is that the information in this report is correct.

• "I certify under penalty of law this document and all attachments were prepared under my direction and supervision under accordance with a system designed to ensure that qualified personnel properly gathered and evaluated the information submitted? Based on my inquiry of the person or person 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"

• SWP3 Inspector

  Sign

• Do not sign this certification if there is any noncompliance or corrective action issues identified within this Periodic Site Evaluation

• "I certify under penalty of law this document and all attachments were prepared under my direction and supervision under accordance with a system designed to ensure that qualified personnel properly gathered and evaluated the information submitted? Based on my inquiry of the person or person 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"

• SWP3 Inspector

  Sign