Semi- Annual Inspection Form

• Conducted on

  Date

• Plant Inspected

  Select Danbury Groton Hamden Manchester New Britain Newington Newtown North Branford Old Saybrook Portland Wallingford Waterbury

  • Danbury
  • Groton
  • Hamden
  • Manchester
  • New Britain
  • Newington
  • Newtown
  • North Branford
  • Old Saybrook
  • Portland
  • Wallingford
  • Waterbury

• Employees Performing Inspection

• The Semi-Annual Inspection should be completed semi-annually (at a minimum) by qualified personnel in accordance with the requirements of the General Permit for the Discharge of Storm-Water Associated with Industrial Activity, effective October 1, 2011. Such evaluations should include the following:

1) Visual Inspection

• Inspect the following for evidence of, or potential for, pollutants entering the storm-water drainage system.

• Petroleum Storage Tanks

  No Evidence

  Potential/Apparent Evidence of Pollution

• Drums

  No Evidence

  Potential/Apparent Evidence of Pollution

• Diesel/Gasoline Fuel Dispensing Stations

  No Evidence

  Potential/Apparent Evidence of Pollution

• Vehicle Traffic

  No Evidence

  Potential/Apparent Evidence of Pollution

• Roof Drains

  No Evidence

  Potential/Apparent Evidence of Pollution

• Transformer

  No Evidence

  Potential/Apparent Evidence of Pollution

• Dumpsters

  No Evidence

  Potential/Apparent Evidence of Pollution

• Inspect the following storm-water pollution control features for effectiveness.

• Spill Response Equipment (fully stocked?)

  Yes

  No

• Storm-Water Drainage Structures (operating correctly?)

  Yes

  No

• Were oil, floating solids, etc. present?

  No

  Yes

• Dumpster/Secondary Containment Drain Plugs (closed?)

  Yes

  No

• Inspection completed during a rain event?

  Yes

  No

2) Inspection Report

• Major Observations Relating to the SWP3 Plan (i.e., new operations, material inventory)

• Actions Taken?

  Yes

  No

• If yes, please describe:

• SWP3 Plan Updates Required?

  Yes

  No

• If yes, please describe:

• Permittee Signature:

  Sign