Visual Assessment Monitoring

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Outfall 001

• No discharge occurred during monitoring period.

• Sample Collection Date & Time

  Date

• Signature of Personel Collecting Sample:

  Sign

• Was the sample collected within the first 30 minutes of the measurable storm event? If no, provide explanation as to why sample was collected after the first 30 minutes.

  Yes

  No

  N/A

• Nature of Discharge (i.e. runoff, snowmelt):

  Select Runoff Snowmelt

  • Runoff
  • Snowmelt

• Magnitude of Event:

  Select 0-5' 5-10' >10'

  • 0-5'
  • 5-10'
  • >10'

• Start of Discharge:

  Date

• Duration of Event:

  Date

• Was previous storm event that resulted in a discharge more than 72 hrs. before this event?

  Yes

  No

  N/A

• Visual Assessment Date & Time

  Date

• Signature of Personnel Performing Visual Assessment:

  Sign

• Visually inspect the sample for the following characteristics; If the characteristic is present in the sample, write "Present" in the results column, and provide a description of the characteristic and it's probable source. If the characteristic is absent from the sample, indicate with "Not Present" in the Results Column.
  Note that the sample must be collected in a clean, clear glass or plastic container and examined in a well-lit area.

Color

• Unusual color, such as reddish, brown, or yellow hue?

  Corrective Action(s)

  Stormwater Maintenance Task

  NA

Odor

• Noticeable odor (smells like gas fumes, rotten eggs, sour, etc.?

  Corrective Action(s)

  Stormwater Maintenance Task

  NA

Clarity

• Not clear-cloudy or opaque?

  Corrective Action(s)

  Stormwater Maintenance Task

  NA

Floating Solids

• Floating material at or near top of sample?

  Corrective Action(s)

  Stormwater Maintenance Task

  NA

Settled Solids

• Material settled at the bottom after approx. 30 minutes?

  Corrective Action(s)

  Stormwater Maintenance Task

  NA

Suspended Solids

• Particles suspended in the water will affect clarity and color?

  Corrective Action(s)

  Stormwater Maintenance Task

  NA

Foam

• After gently shaking the bottle, foam is present?

  Corrective Action(s)

  Stormwater Maintenance Task

  NA

Oil Sheen

• Rainbow color or sheen on surface of the water?

  Corrective Action(s)

  Stormwater Maintenance Task

  NA

Obvious Indicators of Stormwater Pollution?

• Other Indicators?

  Corrective Action(s)

  Stormwater Maintenance Task

  NA

Corrective actions

• Describe any Corrective Actin(s) or Stormwater Maintenance Tasks Necessary (include ID number):

  Not Present

  Present

Comments / Additional Notes:

• Notes: