SWPPP Compliance Inspection Form

• Document No.

• Project Name:

• Conducted on

  Date

Section 1 - General Information:

• Project Name:

• Address:
  Address

• Site Contact:

• Contact Phone:

• Type of Inspection:

  Select Scheduled Inspection Complaint / Tip Random Drive-by

  • Scheduled Inspection
  • Complaint / Tip
  • Random
  • Drive-by

• Inspector Name(s):

  Select Greg Archuleta Jason Draper Anthony Garcia Other

  • Greg Archuleta
  • Jason Draper
  • Anthony Garcia
  • Other

Section 2 - Additional Information:

• Permit Number:

• Weather:

  Sunny

  Cloudy

  Rain

  Snow

• Date of Last Rainfall:

  Date

• Duration

• Approximate Rainfall

• Other individuals present besides the Inspector?

  Yes

  No

  N/A

• Individual:

Individual

• Name:

• Title:

• Contact Information:

Section 3 - Documentation

• SWPPP Reviewed?

  Yes

  No

• SWPPP Document Onsite?

  Yes

  No

• City NOI in the SWPPP?

  Yes

  No

• State NOI in the SWPPP?

  Yes

  No

• SWPPP site plan / Erosion Control Plan Onsite?

  Yes

  No

• Has the SWPPP been updated to reflect the current site conditions (modifications dated & initialed on the site map, new BMPs, details and specifications, etc.)

  Yes

  No

• Last updated?

  Date

• Operator to update the Erosion Control Plan.

• Site plan depicts each of the following items:
  

• Location of Site BMPs

• Location of Potential Discharges (fueling areas, trash containers, port-a-potty, concrete washout, etc)

• Amendment Log

• Other

• Require ECP from Operator.

• SWPPP Document not reviewed.

• Comments:

Section 4 - Site Inspection Check if there are any Deficiences. Include Photos and Description of any Deficiencies.

Erosion Controls

• Perimeter Control - Silt Fence, Vegetative Buffer, Cut Back Curb, Etc.

• Comments

• Add media

  Media

• Site Stabilization

• Comments

• Add media

  Media

• Dust Control

• Comments

• Add media

  Media

• Other

• Comments

• Add media

  Media

• Erosion Control Comments

Sediment Controls

• Inlet Protection

• Comments

• Add media

  Media

• Sediment Basin

• Comments

• Add media

  Media

• Construction Entrance

• Comments

• Add media

  Media

• Other

• Comments

• Add media

  Media

• Sediment Control Comments

Housekeeping

• Trash Control

• Comments

• Add media

  Media

• Port a Potty

• Comments

• Add media

  Media

• Chemicals Storage and Leak Controls

• Comments

• Add media

  Media

• Concrete Washout

• Comments

• Add media

  Media

• Other

• Comments

• Add media

  Media

• Housekeeping Comments

Section 6 - Inspection Summary

• Inspection result:

  No Deficiencies Observed

  Deficiencies Observed

• Summary of actions to be taken:

• Follow-up date

  Date

• Additional photo

  Media

• 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.

• Inspector Signature -

  Sign

• Date:

  Date

• Operator Signature -

  Sign

• Date:

  Date