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2. Date*
   Date
6. STORAGE
8. 1. NONHAZARDOUS MATERIALS & RECYCLABLES ARE PROPERLY STORED & NOT EXPOSED TO WEATHER.*

   1. Yes
   2. No
   3. N/A
9. 1. If answer is no - describe issue.
11. 2. HAZARDOUS MATERIALS & WASTES, SUCH AS JANITORIALOR POOL PRODUCTS, ARE STORED PROPERLY AND NOT EXPOSED TO THE WEATHER.*

    1. Yes
    2. No
    3. N/A
12. 2. If answer is no - describe issue.
14. 3. ALL COMPATIBLE MATERIALS OR WASTES ARE PHYSICALLY STORED SEPARATE FROM INCOMPATIBLE MATERIALS OR WASTES.*

    1. Yes
    2. No
    3. N/A
15. 3. If answer is no - describe issue.
17. 4. ALL CONTAINERS & DRUMS ARE PROPERLY STORED & COVERED; MARKED/LABELED WITH THE CONTENTS IDENTIFIED; TIGHTLY CLOSED WITH LIDS; ON PALLETS OR SECONDARY CONTAINMENT, & NO LEAKS, STAINS, DENTS OR CORROSION PRESENT.*

    1. Yes
    2. No
    3. N/A
18. 4. If answer is no - describe issue.
20. 5. ALL GARBAGE CANS, WASTE BINS, & DUMPSTERS ARE PROPERLY COVERED WITH DRAIN PLUGS IN PLACE, AS APPLICABLE.*

    1. Yes
    2. No
    3. N/A
21. 5. If answer is no - describe issue.
25. VEHICLES AND EQUIPMENT
27. 6. VEHICLES IN PARKING AREAS ARE NOT DRIPPING OR LEAKING LIQUIDS OR FLUIDS.*

    1. Yes
    2. No
    3. N/A
28. 6. If answer is no - describe issue.
30. 7. LEAKING VEHICLES ARE EQUIPPED WITH DRIP PANS, PADS, OR CONTAINMENT UNTIL THE VEHICLE IS MOVED.*

    1. Yes
    2. No
    3. N/A
31. 7. If answer is no - describe issue.
33. 8. ALL STORM WATER/SANITARY SEWER DRAINS ARE PROPERLY MAINTAINED; DRAINS DO NOT CONTAIN TRASH, DEBRIS, SOIL, SAND, OIL OR CHEMICALS.*

    1. Yes
    2. No
    3. N/A
34. 8. If answer is no - describe issue.
36. 9. STORM WATER DRAINAGE PATHS ARE CLEAR AND UNOBSTRUCTED.*

    1. Yes
    2. No
    3. N/A
37. 9. If answer is no - describe issue.
39. 10. SEDIMENT AND SOIL EROSION IS PREVENTED FROM ENTERING THE STORM DRAIN.*

    1. Yes
    2. No
    3. N/A
40. 10. If answer is no - describe issue.
42. 11. GROUND SURFACE IS NOT STAINED WITH OIL OR CHEMICALS (NEW STAINS ONLY). *

    1. Yes
    2. No
    3. N/A
43. 11. If answer is no - describe issue.
45. 12. ANY STAINS OR SPILLS WERE CONTAINED, CLEANED UP & DISPOSED OF PROPERLY.*

    1. Yes
    2. No
    3. N/A
46. 12. If answer is no - describe issue.
48. IDENTIFY MANAGEMENT PRACTICES EMPLOYED TO REDUCE POLLUTANTS IN STORM WATER DISCHARGES (Check All That Apply)

    1. GOOD HOUSE KEEPING
    2. CONTAINMENT
    3. BERMS
    4. SILT FENCE
    5. HAY BALES
    6. BOOMS
    7. OIL/WATER SEPARATOR
    8. OTHER
49. IF OTHER - PLEASE SPECIFY
51. SPILL RESPONSE EQUIPMENT PROPERLY STORED ONSITE: (Check All That Apply) *

    1. SPILL KIT
    2. SAND
    3. ABSORBENT
    4. BLANKETS
    5. DRIP PANS
    6. BOOMS
    7. DRUMS
    8. PILLOWS
    9. BROOMS
    10. SHOVELS
    11. OTHER
52. IF OTHER - PLEASE SPECIFY
54. ACTIONS TAKEN TO REMEDY THE SOURCE OF POLLUTION (Include date; time; employee’s name).
    REQUIRED FOR “NO” ANSWER(S) FOR LINES 1-12
56. Upload any photos related to this inspection below (if needed).
58. Review and carefully answer the following Consent Agreement. If you consent, fill in the “I Agree” button. 1) I represent and warrant that the answers I have given are full and true to the best of my knowledge and belief. 2) I acknowledge that I have read and understood the questions and that I answered all questions truthfully. 3) I understand that failure to answer all questions fully and truthfully may result in disciplinary action.*

    1. I AGREE
60. Conducted By:*
    Employee Signature
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64. Submit

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