Stormwater Industrial Routine Facility Inspection Report General Information Insert Name Facility Name NPDES Tracking No. Insert Tracking No. Insert Date Insert Start/End Time Date of Inspection Start/End Time Inspector’s Name(s) Insert Name Insert Title Inspector’s Title(s) Inspector’s Contact Information Insert Contact Info Inspector’s Qualifications Insert qualifications or add reference to the Weather Information Weather at time of this inspection? Clear Cloudy Rain Sleet Fog Snow High Winds Other: Temperature: Have any previously unidentified discharges of pollutants occurred since the last inspection? Yes No If yes, describe: Describe Are there any discharges occurring at the time of inspection? Yes No If yes, describe: Describe Control Measures Number the structural stormwater control measures identified in your SWPPP on your site map and list them below (add as many control measures as are implemented on-site). Carry a copy of the numbered site map with you during your inspections. This list will ensure that you are inspecting all required control measures at your facility. Identify if maintenance or corrective action is needed. If maintenance is needed, fill out section B of this template If corrective action is needed, fill out section G of this template Structural Control Control If No, In Need of Maintenance or Corrective Action Needed and Measure Measure is Maintenance, Notes Operating Repair, or Effectively? Replacement? 1 Insert Control Measure Yes No Maintenance Describe Maintenance and/or Corrective Actions Needed Name Repair Replacement 2 Insert Control Measure Yes No Maintenance Describe Maintenance and/or Corrective Actions Needed Name Repair Replacement 3 Insert Control Measure Yes No Maintenance Describe Maintenance and/or Corrective Actions Needed Name Repair Replacement 4 Insert Control Measure Yes No Maintenance Describe Maintenance and/or Corrective Actions Needed Name Repair Replacement Insert Control Measure Describe Maintenance and/or Corrective Actions Needed 5 Yes No Maintenance Name Repair Replacement Insert Control Measure Describe Maintenance and/or Corrective Actions Needed 6 Yes No Maintenance Name Repair Replacement 7 Insert Control Measure Yes No Maintenance Describe Maintenance and/or Corrective Actions Needed Name Repair Replacement 8 Insert Control Measure Yes No Maintenance Describe Maintenance and/or Corrective Actions Needed Name Repair Replacement
Stormwater Industrial Routine Facility Inspection Report General Information Facility Name Insert Name NPDES Tracking No. Insert Tracking No. Date of Inspection Insert Date Start/End Time Insert Start/End Time Inspector’s Name(s) Insert Name Inspector’s Title(s) Insert Title Inspector’s Contact Information Insert Contact Info Inspector’s Qualifications Insert qualifications or add reference to the Weather Information Weather at time of this inspection? Clear Cloudy Rain Sleet Fog Snow High Winds Other: Temperature: Have any previously unidentified discharges of pollutants occurred since the last inspection? Yes No If yes, describe: Describe Are there any discharges occurring at the time of inspection? Yes No If yes, describe: Describe Control Measures Number the structural stormwater control measures identified in your SWPPP on your site map and list them below (add as many control measures as are implemented on-site). Carry a copy of the numbered site map with you during your inspections. This list will ensure that you are inspecting all required control measures at your facility. Identify if maintenance or corrective action is needed. If maintenance is needed, fill out section B of this template If corrective action is needed, fill out section G of this template Structural Control Measure Control Measure is Operating Effectively? If No, In Need of Maintenance, Repair, or Replacement? Maintenance or Corrective Action Needed and Notes 1 Insert Control Measure Name Yes No Maintenance Repair Replacement Describe Maintenance and/or Corrective Actions Needed 2 Insert Control Measure Name Yes No Maintenance Repair Replacement Describe Maintenance and/or Corrective Actions Needed 3 Insert Control Measure Name Yes No Maintenance Repair Replacement Describe Maintenance and/or Corrective Actions Needed 4 Insert Control Measure Name Yes No Maintenance Repair Replacement Describe Maintenance and/or Corrective Actions Needed 5 Insert Control Measure Name Yes No Maintenance Repair Replacement Describe Maintenance and/or Corrective Actions Needed 6 Insert Control Measure Name Yes No Maintenance Repair Replacement Describe Maintenance and/or Corrective Actions Needed 7 Insert Control Measure Name Yes No Maintenance Repair Replacement Describe Maintenance and/or Corrective Actions Needed 8 Insert Control Measure Name Yes No Maintenance Repair Replacement Describe Maintenance and/or Corrective Actions Needed
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