Quarterly Routine Stormwater Inspection Report
This procedure is important to determine effectiveness of Pollution Prevention Measures and Controls.
Jake's Finer Foods
04/30/2024
Quarterly Routine Stormwater Inspection Report
This procedure is important to determine effectiveness of Pollution Prevention Measures and Controls.
1. General Information:
Note: Inspection must include at least one member of the Stormwater Pollution Prevention Team to determine effectiveness of Pollution Prevention Measures and Controls. Inspections must be conducted at least once per quarter. At least one (1) of these inspections must be conducted during a period when stormwater discharge is occurring.
Date of Inspection
Time of Inspection
Name of Inspector(s)
2. Weather and Discharge Information
Weather at time of inspection
Temperature
Rainfall Data (inches)
Are there any discharges occurring at the time of inspection?
Describe any discharges occurring
Have any previously unidentified discharges of pollutants occurred since the last inspection?
Describe any previously unidentified discharges
3. Observations Related to Stormwater Outfalls
Outfall ID: Describe your observations of any evidence of potential for pollutants entering the drainage system, physical condition of and around each outfall, flow dissipation devices, etc. Identify if any corrective action is needed.
Outfall ID #001 Observations
Outfall ID #002 Observations
4. Observations Related to Areas of Industrial Materials/Activities Exposed to Stormwater
Diesel aboveground storage tank (AST) and refueling areas inspected and controls effective?
Diesel Exhaust Fluid (DEF) AST and dispensing area inspected and controls effective?
Disinfectant (CLEANSANHQ) polyethylene drums inspected and controls effective?
Industrial vehicle traffic, cleaning, maintenance, and parking areas inspected and controls effective?
Trash compactor inspected and controls effective?
Wooden pallets, bailed cardboard, and plastic inspected and controls effective?
Back-up diesel generator inspected and controls effective?
Refrigeration system condensers inspected and controls effective?
5. Observations Related to Implementation of Structural Control Measures
Concrete pavement and vegetated areas operating effectively?
Wash bay canopy and wash water collection area operating effectively?
Vegetated stormwater detention basin operating effectively?
Sediment filter in storm drain next to trash compactor operating effectively?
Building gutters/downspout discharge areas operating effectively?
Concrete bollards around diesel AST and generator operating effectively?
Double-walled tanks monitored for leaks in the interstitial space operating effectively?
6. Spill Kit Inventory - An inventory of spill cleanup materials and equipment is required to be maintained and updated as needed. Below is the facility’s inventory: inspect and update the materials/equipment, quantity of each item and storage location. Add new materials/equipment as needed.
Quantity of Spill Kit Pads
Storage Location of Spill Kit Pads
Quantity of Spill Kit Socks
Storage Location of Spill Kit Socks
Quantity of Spill Kit Pillows
Storage Location of Spill Kit Pillows
Quantity of Bags of Solid Absorbent Powder
Storage Location of Solid Absorbent Powder
7. Facility Recordkeeping Review - Review listed requirements of the general permit. If a requirement has not been completed, explain why and when it will be completed under the Corrective Action / Notes column.
Quarterly Routine Facility Inspection Reports completed/documented?
Quarterly Visual Stormwater Monitoring Reports completed/documented?
Weekly Qualifying Storm Event (Rain Gauge) Monitoring Reports completed/documented?
Annual Employee Training completed/documented?
Notes on Annual Employee Training
Annual Comprehensive Site Compliance Inspection Report completed/documented?
Notes on Annual Comprehensive Site Compliance Inspection Report
8. Incidents of Non-Compliance or additional control measures needed
Describe any incidents of non-compliance or deficiencies observed
Certification Statement
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 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 s
This report must be maintained on-site for three (3) years from the date of the record
Name of certifying individual
Title of certifying individual
Signature of certifying individual
Click here to sign
Date of certification
Source: Jake's Finer Foods (Community Member)