Storm Water Management Report for: ____________ to _



__________ __________ Storm Water Management Report for: ____________ to ____________

Month Year (MM / DD / YYYYY) (MM / DD / YYYYY)

|Inspection and Monitoring Requirements |Risk Level |Were all required inspections and |

|Refer to the projects SWPPP for details, |Visual Inspections |sampling conducted? |

|such as: |Sample Collection |Yes1 ( No( NA ( |

|Inspection frequencies, | |1 Attach copies of inspections and |

|Testing parameters, etc. | |sampling reports as applicable |

| |Quarterly Non-storm Water Discharge | |

| |Pre-storm Event | |

| |Daily Storm BMP | |

| |Post Storm | |

| | | |

| | | |

| | | |

| | | |

| |Baseline | |

| |REAP | |

| | | |

| | | |

| |Storm Water Discharge | |

| |Receiving Water | |

| | | |

| |1 | |

| |X | |

| |X | |

| | | |

| |X | |

| |X | |

| | | |

| | | |

| | | |

| |2 | |

| |X | |

| |X | |

| |X | |

| |X | |

| |X | |

| |X | |

| | | |

| | | |

| |3 | |

| |X | |

| |X | |

| |X | |

| |X | |

| |X | |

| |X | |

| |X | |

| | | |

|Where there any Storm Water or authorized non-storm water discharges? |Yes ( No( |

|List the dates of the events: _________________________________________________________________ | |

|Are there loose stockpiled construction materials that are currently not actively being used (i.e. soil, spoils, aggregate, fly-ash, stucco, hydrated lime, etc.) covered and |Yes ( No ( NA( |

|bermed? | |

|Are the site management (i.e., "housekeeping") measures for construction materials that could potentially be a threat to water quality if discharged implemented and effective? |Yes ( No( |

|Are the site management (i.e., “ housekeeping“housekeeping”) measures) measures for waste management, implemented and effective? |Yes ( No( |

|Are good housekeeping measures for vehicle storage and maintenance implemented and effective? |Yes ( No ( NA( |

|Are good housekeeping for landscape materials implemented and effective? |Yes ( No( |

|Are good housekeeping measures in place on the construction site to control the air diseposition of site materials and from site operations? |Yes ( No( |

|Are there any areas of the site where additional BMPs are necessary to reduce or prevent pollutants in storm water discharges and authorized non-storm water discharges? |Yes ( No( |

|Are measures in place to control all non- storm water discharges during construction and were they effective? |Yes ( No( |

|Were any vehicles washed done in such a manner as to prevent non-storm water discharges to surface waters or MS4 drainage systems? |Yes ( No ( NA( |

|Are effective wind erosion control measures in place? |Yes ( No ( NA( |

|Are effective soil covers in place for inactive areas and all finished slopes, open space, utility backfill, and completed lots? |Yes ( No ( NA( |

|Are effective perimeter controls in place that stabilize all construction entrances and exits to sufficiently control erosion and sediment discharges from the site? |Yes ( No ( NA( |

|Was all run-on, all runoff within the site and all runoff that discharges off the site effectively managed in accordance with the SWPPP? |Yes ( No ( NA( |

|Were all inspection, maintenance repair and sampling activities at the project location performed or supervised by a Qualified SWPPP Practitioner (QSP) representing the |Yes1 ( No ( NA( |

|discharger? |1 Attach copies of inspections and |

| |sampling reports as applicable |

|Were weekly inspections and observations conducted, including at least one during each 24-hour period during extended storm events? NOTE: Inspectors shall be the QSP or be |Yes1 ( No ( NA( |

|trained by the QSP. |1 Attach copies of inspections and |

| |sampling reports as applicable |

I, ____________________ ____________________, QSP No. ______ the Qualified Stormwater Practitioner for_____________________________

Print first name Print last name project description

certifyCertify the project is in compliance with the Storm Water Pollution Prevention Plan (SWPPP) for this project and the current General Permit For Storm Water Discharges Associated With Construction And Land Disturbance Activities (Activities NPDES(NPDES NO. CAS000002 )CAS000002).

____________________________ _______________

Signature date

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