Information
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Document No.
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Project Name:
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Conducted on
Section 1 - General Information:
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Project Name:
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Address:
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Owner:
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Operator:
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Site Contact:
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Contact Phone:
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Contact Email::
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Type of Inspection:
- Scheduled Inspection
- Complaint / Tip
- Random
- Drive-by
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Inspector Name(s):
- Greg Archuleta
- Jason Draper
- Anthony Garcia
- Other
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Date of last inspection:
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Last inspected by:
- Greg Archuleta
- Jason Draper
- Anthony Garcia
- Other
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Were any recommendations or deficiencies noted in previous inspection?
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Recommendations/Deficiencies noted:
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Corrective actions taken by Opertor:
Section 2 - Additional Information:
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Permit Number:
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UTR Number:
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Permit Expiration Date:
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Receiving Waters:
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Weather:
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Date of Last Rainfall:
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Duration:
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Other individuals present besides the Inspector?
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Individual:
Individual
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Name:
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Title:
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Contact Information:
Section 3 - Documentation
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SWPPP Reviewed?
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SWPPP Document Onsite?
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City and State NOI in the SWPPP?
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SWPPP site plan / Erosion Control Plan Onsite?
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Has the SWPPP been updated to reflect the current site conditions (modifications dated & initialed on the site map, new BMPs, details and specifications, etc.)
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Last updated?
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Operator to update the Erosion Control Plan.
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Site plan depicts each of the following items:
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Location of Site BMPs
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Location of Potential Discharges (fueling areas, trash containers, port-a-potty, concrete washout, etc)
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Amendment Log
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Other
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Require ECP from Operator.
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SWPPP Document not reviewed.
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Comments:
Section 4 - Site Inspection Check if BMP is installed, maintained, and compliant. Include Photos and Description of any Deficiencies.
Erosion Controls
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Perimeter Control - Silt Fence, Vegetative Buffer, Curb
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Comments
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Add media
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Site Stabilization
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Comments
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Add media
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Dust Control
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Comments
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Add media
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Erosion Control Comments
Sediment Controls
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Inlet Protection
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Comments
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Add media
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Sediment Basin
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Comments
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Add media
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Construction Entrance
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Comments
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Add media
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Other
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Comments
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Add media
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Sediment Control Comments
Housekeeping
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Trash Control
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Comments
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Add media
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Port a Potty
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Comments
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Add media
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Chemicals Storage and Leak Controls
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Comments
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Add media
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Concrete Washout
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Comments
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Add media
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Other
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Comments
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Add media
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Housekeeping Comments
Section 5 - Enforcement
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Is the Operator presently under an informal/formal enforcement action by Salt Lake City?
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Describe status:
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Comments:
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Additional Comments:
Section 6 - Inspection Summary
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Inspection result:
- No Deficiencies Observed
- Deficiencies Observed
- Non-Compliance
- Significant Non-Compliance
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Summary of all deficiencies:
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Follow-up date
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Summary of actions to be taken:
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Additional photo
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Additional photo
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Additional photo
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Additional photo
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Additional photo
Signature
Certification:
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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 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.
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Inspector Signature -
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Date:
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Operator Signature -
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Date:
