SWPPP Inspection Form Century Companies

• Wibaux Anderson Hot Plant Site MT NOI Number MTR105569 Primary SWPPP Administrator: Tim Barth Secondary SWPPP Administrator: Aaron Golik

• Theodore National Park ND NOI Number NDR Primary SWPPP Administrator: Tim Barth Secondary SWPPP Administrator: David Drga

• Axness Farms Pit ND NOI Number NDR32-0000 Primary SWPPP Administrator: Garrett Workman

• Century Sidney Facility MT NOI Number MTR105530 Primary SWPPP Administrator: Tim Barth Secondary SWPPP Administrator: Garrett Workman

• New Bighorn County AIrport - Phase II MT NOI Number MTR105006 Primary SWPPP Administrator: Tim Barth Secondary SWPPP Administrator: Tyler Hulbert

• Lower Two Calf Road Reroute Upper Missouri River Breaks, Bureau of. Land Management MT NOI MTR105688 Primary SWPPP Administrator: Tim Barth Secondary SWPPP Administrator: Carl Patton

• Site Name

• Conducted on

  Date

• Prepared by

• Personnel

General Information

• Type of inspection?

  Biweekly Routine

  Post-Storm Event

  Monthly for Inactive Site

  Completed Construction

• Date of previous inspection

  Date

• Weather Conditions

• Temperature

• Sky Conditions

  Select Clear Partly Cloudy Overcast Windy Raining Thunderstorm Snowing

  • Clear
  • Partly Cloudy
  • Overcast
  • Windy
  • Raining
  • Thunderstorm
  • Snowing

• Ground Conditions

  Select Dry Wet Saturated Frozen Snow Cover

  • Dry
  • Wet
  • Saturated
  • Frozen
  • Snow Cover

• Has it Rained since the last inspection?

  Yes

  No

  N/A

• Date of Storm Event:

  Date

• Amount of Precipitation:

• Storm water runoff occurring?

  Yes

  No

  N/A

• Location(s) and description- of discharges of sediment or other potential pollutants from the site:

Site Assessment

• Present phase of construction?

• Are there any discharges that have occurred since the last inspection?

  Yes

  No

  N/A

• Was discharge in compliance?

  Yes

  No

  N/A

• Describe the non-compliant discharge

• Description of corrective action taken for items identified, date for the corrective action(s) taken for each, measures taken to prevent future recurrences.

  Yes

  No

  N/A

• Has the non-compliant been reported?

  Yes

  No

  N/A

• Have changes to the SWPPP been made to reflect the measures taken?

  Yes

  No

  N/A

• Site perimeter contained?

  Yes

  No

  N/A

• Disturbed areas contained?

  Yes

  No

  N/A

• Estimated disturbed area at time of inspection (acres):

• Are dust control measures being used as needed?

  Yes

  No

  N/A

• Material storage areas contained?

  Yes

  No

  N/A

• Material stockpiles contained?

  Yes

  No

  N/A

• Vehicle/equipment areas contained?

  Yes

  No

  N/A

• Is a spill containment kit on site?

  Yes

  No

  N/A

• Have there been any spills, leaks or hose breaks that have occurred since the last inspection?

  Yes

  No

  N/A
Spill

• Location

• Size (gallons)

• Was it reportable?

  Yes

  No

  N/A

• Was it reported?

  Yes

  No

  N/A

• Debris containers available

  Yes

  No

  N/A

• Offsite tracking minimized?

  Yes

  No

  N/A

• Identify potential pollutants present

  Select Petroleum products Sanitation chemicals Concrete washout Form oil/curing compound Saw-cutting Trash/waste debris

  • Petroleum products
  • Sanitation chemicals
  • Concrete washout
  • Form oil/curing compound
  • Saw-cutting
  • Trash/waste debris

• Potential Pollutants

Pollutant

• Pollutant

• Properly contained/contingency

• Have all erosion and sediment controls and BMP's identified in the plan been installed or implemented?

  Yes

  No

  N/A
Explanation

• Reason for discrepancy

Site Debri

• Are all construction materials kept within the project limits?

  Yes

  No

  N/A
Location

• Materials not kept within project limits

• Anticipated date of addressing issue

  Date

BMP Inspection

• Is there evidence of sediment depositing off-site other than in surface waters, drainage ditches and stormwater conveyance systems?

  Yes

  No

  N/A

• Sediment must be recovered in a manner and frequency sufficient to minimize off-site impacts – for example, sediment could wash away during the next precipitation event. Date to be repaired/Stabilized.

  Date

• Is stormwater flow distributed evenly over vegetative buffers?

  Yes

  No

  N/A

• If vegetative buffers are silted covered, contain rills or are otherwise rendered ineffective, other erosion and sediment controls must be implemented. Eroded areas must be repaired and stabilized. Date to be repaired/Stabilized.

  Date

• Is sediment accumulating in vegetative buffers?

  Yes

  No

  N/A

• If vegetative buffers are silted covered, contain rills or are otherwise rendered ineffective, other erosion and sediment controls must be implemented. Eroded areas must be repaired and stabilized. Date to be repaired/Stabilized.

  Date

• Are rills forming within vegetative buffers?

  Yes

  No

  N/A

• If vegetative buffers are silted covered, contain rills or are otherwise rendered ineffective, other erosion and sediment controls must be implemented. Eroded areas must be repaired and stabilized. Date to be repaired/Stabilized.

  Date

• Are Erosion and sediment controls operating consistently and effectively?

  Yes

  No

  N/A
Location

• Description

• Are there any devices similar to silt fence or fiber rolls where sediment has reached more than 1/3 the height of the device?

  Yes

  No

  N/A
Area

• Description

• Date to be fixed by; Removal and repairs must be made within 24 hours

  Date

• Are there any sediment basins where collected sediment has reduced the storage capacity by 1/2?

  Yes

  No

  N/A
Area

• Description

• Date to be fixed by; Removal and stabilization must be completed within 7 days unless prohibited by legal, regulatory or physical access constrains. All reasonable efforts must be made to obtain access. Once permission is granted, removal must take place within 7 days

  Date

• Are there additional BMPs are needed that were not in place at the time of inspection

  Yes

  No

  N/A
Area

• Location and description:

• Description of corrective action taken for items identified and measures taken to prevent future recurrences.

• Date for the corrective action to be taken

  Date

Inlet Protection

• Are inlets that are or will be functional during construction protected?

  Yes

  No

  N/A
Location

• Inlet that needs to be protected

• Anticipated date of addressing issues

  Date

• Are inlet protections being maintained?

  Yes

  No

  N/A
Location

• Inlet that needs to be maintained

• Anticipated date of addressing issues

  Date

• Are inlets that are or will be functional during construction protected?

  Yes

  No

  N/A
Location

• Inlet that needs to be protected

• Anticipated date of addressing issues

  Date

Concrete Waste

• Are there concrete activities present?

  Yes

  No

  N/A

• Are washouts adequate for the amount of material being discharged?

  Yes

  No

  N/A

• Are liners free from tips and tears?

  Yes

  No

  N/A

• Are washouts located in a location that will not effect water inlets?

  Yes

  No

  N/A

• Has the SWPPP Plan been updated as a result of this inspection?

  Yes

  No

  N/A

• Has the Site Map been updated as a result of this inspection?

  Yes

  No

  N/A

• 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 gather and evaluate the information submitted. Based on my inquiry of the 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

  Sign

• SWPPP Administrator

  Sign