Program for Residents



ANNUAL REPORT DATA SUMMARY SHEET

Program for Illicit Discharges/Illegal Connections

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Co-permittee:

(City Name)

|Incident Response |

|Illicit Discharges | | |

| |Total number of reports of illicit discharges | |

| | | |

| |Number of reports that were responded to* | |

| | | |

| |Number of these reports that were identified as actual illicit discharges | |

| | | |

| |Number of actual illicit discharges where the incident was cleaned up/referred to another agency**/ followed up/education | |

| | | |

|Illicit Connections | | |

| |Total number of illicit connections identified | |

| | | |

| |Total number of illicit connections eliminated | |

* SMP Performance Criteria: Co-permittees will investigate 90% of reported illicit discharge/dumping incidents.

** SMP Performance Criteria: When appropriate or necessary, Co-permittees will refer documented non-stormwater discharges/connections or dumping to the appropriate agency for investigation, containment, and cleanup.

|Definitions/Reporting Criteria |

|Report |Includes all complaints, referred complaints and/or reports received by telephone, email, fax or website, etc. |

|Illicit Discharge |Shall mean any discharge to the storm drain system or an upstream flow, which is a tributary to the storm drain system that is not |

| |composed entirely of stormwater except discharges pursuant to a NPDES permit and discharges that are exempt or conditionally exempt in |

| |accordance with any applicable order of the RWQCB-LA. For more information, please see pages 7-2 through 7-4 of the SMP. |

|Illicit Connection |Shall mean any man-made conveyance or drainage system pipeline, graded channel, conduit, inlet or outlet, or condition of property |

| |whether on the surface or subsurface through which the discharge of any pollutant to the storm drain system occurs or may occur. The |

| |term illicit connection shall not include connections to the storm drain system that are authorized by a Co-permittee with jurisdiction|

| |over the system at the location at which the connection is made. |

Completed by: Date: Phone:

ANNUAL REPORT DATA SUMMARY SHEET

Program for Illicit Discharges/Illegal Connections

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Co-permittee:

(City Name)

|Source Determination |

|Probable Cause | | |

| |Total number of actual illicit discharges/dumping that resulted from an accident | |

| | | |

| |Total number of actual illicit discharges/dumping that resulted from cleaning activities | |

| | | |

| |Total number of actual illicit discharges/dumping that resulted from a spill/overflow | |

| | | |

| |Total number of actual illicit discharges/dumping that resulted from unknown cause | |

| | | |

| |Total number of actual illicit discharges/dumping that resulted from other | |

| | | |

| |Sum of above | |

| |(should match number of actual illicit discharges on page 1) | |

|Please briefly describe actions taken to prevent similar discharges from occurring: |

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|Probable Cause Definitions |

|Accident |An unpreventable or chance happening that occurs unexpectedly, without deliberate plan or cause. |

|Cleaning Activities |Any activity intended to wash, tidy up, or make clean. |

|Spill/Overflow |A preventable release of material; may be the result of poor maintenance or negligence. |

|Unknown |Cause is unidentified; unable to determine origin. |

|Other |Any remaining incidents that do not fit into the above mentioned categories. |

Completed by: Date: Phone:

ANNUAL REPORT DATA SUMMARY SHEET

Program for Illicit Discharges/Illegal Connections

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Co-permittee:

(City Name)

|Source Determination con’t. |

|Type of | | |

|Material |Number of actual illicit discharges/dumping that involved hazardous material | |

| | | |

| |Number of actual illicit discharges/dumping that involved sewage | |

| | | |

| |Number of actual illicit discharges/dumping that involved wastewater | |

| | | |

| |Number of actual illicit discharges/dumping that were building materials | |

| | | |

| |Number of actual illicit discharges/dumping that were landscape debris | |

| | | |

| |Number of actual illicit discharges/dumping that were animal wastes | |

| | | |

| |Number of actual illicit discharges/dumping that were litter/trash | |

| | | |

| |Number of actual illicit discharges/dumping that were other | |

| | | |

| | | |

| |Sum of above | |

| |(should match number of actual illicit discharges on page 1) | |

|Type of Material Definitions |

|Hazardous Material |By-products of society that can pose a substantial or potential hazard to human health or environment when improperly managed. |

| |Posses at least one of the four following characteristics (ignitability, corrosivity, reactivity, or toxicity), or identified as a |

| |listed waste (e.g. oil, used anti-freeze, hydraulic fluid). |

|Sewage |The waste and wastewater produced by residential and commercial sources and discharged into sewers, includes the sludge produced by |

| |Publicly Owned Treatment Works. |

|Wastewater |The spent or used water from a home, community, farm or industry that contains dissolved or suspended matter. |

|Building Materials |Any debris associated with construction activities used to construct a building and/or stand/alone facility, such as plaster, |

| |dry-wall, nails, wood, etc. |

|Landscape Debris |Excessive eroded soils, sediment and/or organic materials |

|Animal wastes |Discharge from confinement facilities, kennels, pens, recreational facilities, stables, show facilities, and residential yards. |

|Litter/Trash |Synthetic consumer by-products |

|Other |Any remaining materials that do not fit into the above mentioned categories. |

Completed by: Date: Phone:

ANNUAL REPORT DATA SUMMARY SHEET

Program for Illicit Discharges/Illegal Connections

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Co-permittee:

(City Name)

|Source Type | | |

| |Number of actual illicit discharges/dumping that originated from a residential source | |

| | | |

| |Number of actual illicit discharges/dumping that originated from an industrial/commercial source | |

| | | |

| |Number of actual illicit discharges/dumping that came originated a Co-permittee facility | |

| | | |

| |Number of actual illicit discharges/dumping that originated from construction activities | |

| | | |

| |Number of actual illicit discharges/dumping that originated from an unknown source | |

| | | |

| |Sum of above | |

| |(should match number of actual illicit discharges on page 1) | |

| Source Type Definitions |

|Residential |Discharge generated from residential activities; can include solid waste (trash, discarded appliances), automotive |

| |maintenance/cleaning by-products (oil, transmission fluid), home repair/remodel waste (paint, plaster) and yard trimmings. |

|Industrial/Commercial |Discharge of all solid and unwanted materials emanating from a business or industrial facility/operation; may be liquid, sludge, |

| |solid or hazardous. |

|Co-permittee Facility |Discharge of effluent or waste from a Co-permittee owned facility (includes corporate yards, and waste water treatment plants); |

| |may be composed of domestic wastewaters and/or industrial discharges. |

|Construction Activities |Discharge of building materials, dredging materials (including sediment), tree stumps, and rubble from construction and |

| |demolition of homes, commercial buildings and other structures and pavements. May contain lead, asbestos, or other hazardous |

| |material. |

|Unknown |Any discharge from city streets and adjacent domestic or commercial properties that could carry pollutants of various kinds into |

| |the storm drains and receiving waters that cannot be traced to source or does not fit into the above mentioned categories. |

Completed by: Date: Phone:

ANNUAL REPORT DATA SUMMARY SHEET

Program for Illicit Discharges/Illegal Connections

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Co-permittee:

(City Name)

|Enforcement Program |

|Enforcement Actions |Total number of enforcement actions taken | |

| | | |

| |Total number of warnings issued | |

| | | |

| |Total number of Notice of Violations issued | |

| | | |

| |Total number of Legal Actions taken | |

|Stormwater Quality Staff Training |

|Number of staff targeted for stormwater training |

| |

|Percentage of Targeted Staff Trained* |

* SMP Performance Criteria: Co-permittees will train 90% of targeted employees by January 27, 2001 and annually thereafter. Training will include education in illicit discharge/dumping and illegal connections identification, investigation, reporting and/or cleanup.

|Definitions/Reporting Criteria |

|Warning |This is the first level of enforcement. This enforcement is generally limited to problems that are relatively minor and will be |

| |resolved immediately and cooperatively upon notification. This notification can be either verbal or written. |

|Notice of Violation |This is the second level of enforcement. This enforcement is used when a warning fail to achieve compliance for minor problems that are|

| |repeated, and for moderate level problems that will be resolved cooperatively but may require an extended period of time to achieve |

| |desired compliance. The NOV will identify the objectives that are not being met and/or the local requirements that have not been |

| |achieved and will indicate that continued noncompliance may result in additional enforcement actions. The NPV will provide a compliance|

| |date. |

|Legal Action |This is the third level of enforcement. This enforcement is used when prior efforts have failed to achieve compliance for major |

| |problems that are repeated, for any violation that may pose an immediate and/or significant threat to the public or the environment, or|

| |when problems are the result of deliberate, intentional, and/or criminal acts or failures to act. Legal actions usually involve the |

| |judicial system. |

Completed by: Date: Phone:

OPTIONAL GUIDANCE MATERIAL FOR CO-PERMITTEE DOCUMENTATION PURPOSES (for your files only)

Program for Illicit Discharges/Illegal Connections

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Co-permittee:

(City Name)

|Incident Report* |

|Incident Date |Source Name |Source Address |

| | | |

| | | |

| | | |

|( Incident was an illicit discharge/dumping |

|Date of Initial Inspection |Date of Follow-up/Education |

| | |

| | |

| | |

|Type of Material |Source Type |Probable Cause |

| | | |

|( Hazardous ( Building Materials |( Residential |( Accident |

|( Sewage ( Landscape Debris |( Industrial/Commercial |( Cleaning Activities |

|( Wastewater ( Animal Wastes |( Co-permittee Facility |( Spill/Overflow |

|( Litter/Trash ( Other |( Construction |( Unknown |

| |( Unknown |( Other |

|Actions taken to prevent similar discharges from occurring |

| |

| |

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| |

|Date of Conclusion |Date of Cleanup/Removal |

| | |

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|( Incident was referred to other agency |Type of Enforcement Action taken (if appropriate) |

| | |

|( Incident was cleaned up/terminated |( Warning |

| |( Notice of violation |

|( Follow-up/education conducted |( Legal Action |

| | |

|( Enforcement action taken | |

* SMP Performance Criteria: Co-permittees will investigate 90% of reported illicit discharge/dumping incidents.

Completed by: Date: Phone:

OPTIONAL GUIDANCE MATERIAL FOR CO-PERMITTEE DOCUMENTATION PURPOSES (for your files only)

Program for Illicit Discharges/Illegal Connections (cont.)

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Co-permittee:

(City Name)

Co-permittee Illicit Discharge/Dumping Database*

Co-permittee Type of Material Source Type

Insert Co-permittee Name Choice of: Choice of:

Hazardous Material Residential

Sewage Industrial/Commercial

Wastewater Co-permittee Facility

Building Materials Construction

Landscape Debris Unknown

Animal Wastes

Litter/Trash

Other

Date of Initial Inspection Date of Follow-up Inspection Date of Conclusion/Clean

DATE DATE up/Removal/Follow

up/Education

DATE

Probable Cause Enforcement Action Taken

Choice of: Choice of:

Accident Not applicable

Cleaning Activities Warning Issued

Spill/Overflow Notice of Violation Issued

Unknown Legal Action Taken

Other

* SMP Performance Criteria: Co-permittees will provide a summary of records on illicit discharges and connections, which includes type of material, type of source, date of initial inspections, enforcement action taken, date of follow-up inspection, date of conclusion/clean up/removal/ follow up/education, annually as part of the Annual Storm Water Report and Assessment.

Completed by: Date: Phone:

OPTIONAL GUIDANCE MATERIAL FOR CO-PERMITTEE DOCUMENTATION PURPOSES (for your files only)

Program for Illicit Discharges/Illegal Connections (cont.)

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Co-permittee:

(City Name)

|Stormwater Quality Staff Training |

|Number of staff targeted for stormwater training |

| |

|Total Trained* |

| | |

|Staff Training Sessions |

|Date |Number Trained |Topics Covered |

| | |( General Stormwater |

| | |( Inspections |

| | |( Illicit Discharge Response |

| | |( General Stormwater |

| | |( Inspections |

| | |( Illicit Discharge Response |

| | |( General Stormwater |

| | |( Inspections |

| | |( Illicit Discharge Response |

| | |( General Stormwater |

| | |( Inspections |

| | |( Illicit Discharge Response |

| | |( General Stormwater |

| | |( Inspections |

| | |( Illicit Discharge Response |

| | |( General Stormwater |

| | |( Inspections |

| | |( Illicit Discharge Response |

| | |( General Stormwater |

| | |( Inspections |

| | |( Illicit Discharge Response |

| | |( General Stormwater |

| | |( Inspections |

| | |( Illicit Discharge Response |

* SMP Performance Criteria: Co-permittees will train 90% of targeted employees by January 27, 2001 and annually thereafter. Training will include education in illicit discharge/dumping and illegal connections identification, investigation, reporting and/or clean up.

Completed by: Date: Phone:

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