Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Industrial User:

  • Document Revision/Date:

  • Date Received:

  • Reviewer:

  • Date of Review:

  • Purpose of review:

  • Has Slug/Spill Discharge Control Plan Submittal Approval letter been sent by the City?

  • Date when approval letter was sent:

  • Is the Approval Letter filed in the IU's binder?

  • Final Result of Review:

  • Linko updated with result of review?

Plan Review

  • Description of discharge practices (routine and non-routine, including batch discharges)

  • Please describe the required revision:

  • Please describe the required additional information.

  • Description of stored chemicals

  • Please describe the required revision:

  • Please describe the required additional information.

  • Procedures for immediately notifying City of slug discharges (including any discharge that would violate a prohibition stated in the Salt Lake City Wastewater Control Ordinance).

  • Please describe the required revision:

  • Please describe the required additional information.

  • Notification provisions include each of the following: location of discharge, type of waste, concentration, volume, corrective actions.

  • Please describe the required revision:

  • Please describe the required additional information.

  • Procedures for follow-up written notification within five days.

  • Please describe the required revision:

  • Please describe the required additional information.

  • Procedures to prevent adverse impact from accidental spills.

  • Please describe the required revision:

  • Please describe the required additional information.

  • Procedures for inspection and maintenance of storage areas

  • Please describe the required revision:

  • Please describe the required additional information.

  • Procedures for handling and transfer of materials

  • Please describe the required revision:

  • Please describe the required additional information.

  • Procedures for loading and unloading operations

  • Please describe the required revision:

  • Please describe the required additional information.

  • Procedures for Control of toxic organic pollutants (including solvents)

  • Please describe the required revision:

  • Please describe the required additional information.

  • Description of equipment for emergency response

  • Please describe the required revision:

  • Please describe the required additional information.

  • Provisions to permanently post on user's bulletin board or other prominent place notice advising employees who to call in the event of a dangerous discharge

  • Please describe the required revision:

  • Please describe the required additional information.

  • Certification statement signed by duly authorized representative

  • Please describe the required revision:

  • Please describe the required additional information.

  • Additional comments:

  • Corrected actions required:

  • Due date for corrective actions:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.