Waste Connections Weekly Site Evaluation Form

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Storage Drums of Maintenance Fluids: in good condition with covers and plugs intact?

  Yes

  No

  N/A

• Fuel Storage Tank: in good condition, no rust or damage; vent pipe intact; refilling pipe capped?

  Yes

  No

  N/A

• Fueling Station: hoses in good connections? no drips from fuel pump or hose connections

  Yes

  No

  N/A

• Storm Water Pond: sediment is not above the cleanout level; no erosion around inlet or outlet pipes?

  Yes

  No

  N/A

• Storm Water Channels: is sediment building up in the channels? Are the sides of channels eroding?

  Yes

  No

  N/A

• Material Storage and Handling Areas: evidence or potential of pollutants entering the drainage system? Are materials stored neatly with no trash lying around?

  Yes

  No

  N/A

• Vehicle and Equipment Maintenance, Cleaning; Processing Areas: evidence of spills? Are good housekeeping practices maintained?

  Yes

  No

  N/A

• Landscaping: are landscaped areas bare or eroding? Grass cut and landscaping maintained.

  Yes

  No

  N/A

• Spill Response Equipment: Oil-dry and absorbent boom available on-site? Are there any potential pollutants on-site that are not currently listed in the SWPPP? (examples include a new storage tank, a changed location for storing equipment, etc.)

  Yes

  No

  N/A

• Other Indicators of Contamination Access Roads: are roads in good repair? Dirt & mud tracked onto pavement and Centerville Turnpike?

  Yes

  No

  N/A

• Truck staging area @ working face

  Yes

  No

  N/A

• All weather access @ working face

  Yes

  No

  N/A

• Waste covered as required

  Yes

  No

  N/A

• Liter controlled and removed from working face and site

  Yes

  No

  N/A

• Leachate Tank: Check tank, test pumps & level reading.

  Yes

  No

  N/A

• Leachate Extraction Pumps: Test pumps and flow reading.

  Yes

  No

  N/A

• Leachate Extraction Pumps: Level readings

  Yes

  No

  N/A
Leachate Witness Zone

• Cell

  Yes

  No

  N/A

• Fire extinguishers checked and in working order

  Yes

  No

  N/A

• Exits marked and lights in working order

  Yes

  No

  N/A

• First aid kits checked and refilled as needed

  Yes

  No

  N/A

• Signs and posters placed as required and needed

  Yes

  No

  N/A

• Employee PPE in use and maintained in good repair

  Yes

  No

  N/A

• Equipment maintained and in good repair

  Yes

  No

  N/A

• Gas System checked and in working order

  Yes

  No

  N/A

• Odor control plan system weekly check

  Yes

  No

  N/A

• Gas monitoring completed for quarter

  Yes

  No

  N/A

• Storm water monitoring completed for quarter

  Yes

  No

  N/A

• Leachate monitoring completed for month

  Yes

  No

  N/A

• HRSD reports completed and submitted for month

  Yes

  No

  N/A

SIGN OFF

• Schedule for repair of work items noted above

• Prepared by

  Sign