OR FLAP DOT 126(1) OR_CompiledESCP_8.12.24.pdf

Plan

S P

For:

Federal Highway Administration Western Federal Lands Highway Division

OR FLAP DOT 126(1)

Blue Pool Safety and Access Enhancement Project

Linn County, Oregon

Project Engineer General Contractor

Table of Contents

ESCP TABS

TAB 1:

TAB 2: Permit ( )

TAB 3: NOI , Correspondence

TAB 4: Delegation of Authority

TAB 5: Maps

TAB 6: Erosion/Sediment Control Plan Sheets ( lan et and BMP ypical etails)

TAB 7: Revegetation Plan (if applicable)

TAB 8: Amendment Log

TAB 9: Inspection Reports

TAB 10: Corrective Action Log

TAB 11: Water Quality Monitoring, Reporting Requirements, and Reports

TAB 12: Training/Certification Log

TAB 13: Government-Selected Waste, Borrow, Staging Sites

TAB 14: Grading and Stabilization Log

TAB 15: Hazardous Spill Plan or Spill Prevention, Control, and Countermeasures (SPCC)

TAB 1 : Quality Assurance Checklist

Tab 1

Tab 2

Tab 3

Tab 4

FEDERAL HIGHWAY ADMINISTRATION

WESTERN FEDERAL LANDS

HIGHWAY DIVISION

DELEGATION OF AUTHORITY

I, , hereby designate the person or specifically described position below to be a duly authorized representative for the purpose of overseeing compliance with environmental requirements, including the Construction General Permit, at the construction site.

The designee is authorized to sign any reports, stormwater pollution prevention plans and all other documents required by the permit.

Name or Position:

Company:

Address:

City, State, Zip:

Phone:

Company:

Title:

Signature:

FHWA, Western Federal Lands Highway Division

610 East Fifth Street

Vancouver, WA 98661-3801

360-619-7700

By signing this authorization, I confirm that I meet the requirements to make such a designation as set forth in and that the designee above meets the definition of a “duly authorized representative” as set forth in

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 significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.

Name:

WFLHD, Western Federal Lands Highway Division

Environmental Manager

Jennifer Chariarse

OR FLAP DOT 126(1) - Blue Pool

Project Engineer

1200-CA

Jennifer Chariarse

JENNIFER A CHARIARSE Digitally signed by JENNIFER A CHARIARSE Date: 2024.08.21 06:37:49 -07'00'

Tab 5

Tab 6

Tab 7

Tab 8

WESTERN FEDERAL LANDS HIGHWAY DIVISION

AMENDMENT LOG

Project Name: Page:

Amendment Number Description of Amendment/BMP

Location of Amendment/BMP, Page/Sheet Number

Date of Amendment

Amendment Approved by:

(Name, Title)

WFLHD 157-4 (5/2011)

Blue Pool Safety and Access Enhancement Project

Tab 9 Inspection Reports

WESTERN FEDERAL LANDS

HIGHWAY DIVISION

CONSTRUCTION SITE INSPECTION REPORT

General Information Project Name:

Date of Inspection: Start/End Times:

Project Name:

Inspector’s Names: Inspectors Title:

Inspector’s Company:

Inspector’s Contact Information:

Inspector’s Qualifications (CESCL or other certification number): Inspector’s Qualifications expiration date:

Describe present phase of construction

Type of Inspection:

Regular Post-storm event Reduced inspection frequency period

Weather Information Has there been a storm event since the last inspection? Yes No If yes, provide:

Estimated Storm Start Date & Time:

Estimated Storm Duration (hrs):

Approximate Amount of Precipitation (in):

Weather at time of this inspection?

Clear Cloudy Rain Sleet Fog Snowing High Winds Other:

Temperature:

WFLHD 157-2 (5/2011)

OR FLAP DOT 126(1): Blue Pool Safety and Access Enhancement Project

Page 2 Project Name:

Inspection Date:

Site-specific BMPs BMP - Describe and give the location of the structural and non-structural BMPs identified in your SWPPP in the BMP column below (add as many BMPs as necessary on the continuation sheets. Include areas that are required to be inspected by the CGP, such as material storage areas that are exposed to precipitation.

BMP Installed – If a BMP should be installed at the current phase of the project and you marked “No” in the “BMP Installed” column, then you must check “Yes” in the “BMP Action Required?” column BMP Action Required? - .If a BMP needs repair, modification, replacement, maintenance or a new BMP is needed or a SWPPP amendment is needed, then a BMP Action is required.

BMP Action Required, Complete by Date - Before certifying the report, fill in the date when the BMP Action can reasonably be expected to be completed. When a BMP Action is NOT required, leave the “Complete by Date” blank.

Describe BMP Action, if Needed – Anytime you check “Yes” for “BMP Action Required”, then you must also fill in the “Describe BMP Action” column.

Delayed Action Item Report - When a BMP Action is required and the Complete by Date is not met, you must then fill out the Delayed Action Item Report to explain why the date was not met Keep the Delayed Action Item Report in the SWPPP.

Corrective Action Log - When a BMP Action is required as noted in this report, you must also enter all the information for this action in the Corrective Action Log.

BMP & Location BMP Installed?

BMP Action Required?

Describe BMP Action, if Needed

Yes No Yes No

Complete by Date:

Page 3 Project Name:

BMP & Location BMP Installed?

BMP Action Required?

Please use continuation sheets if there are additional BMPs to list.

Page 4 Project Name:

Overall Site Issues BMP or Activity -- These are some general site issues that must be assessed during inspections.

Implemented? – If a BMP or activity should be implemented at the current phase of the project and you check “No”, then you must mark “Yes” in the “Corrective Action Required?” column.

Corrective Action Required? - When maintenance or some other corrective action is required, check “Yes” in this column.

Corrective Action Required, Complete by Date - When a corrective action is required, before certifying the report, fill in the date when the corrective action can reasonably be expected to be completed. When a corrective action is NOT required, leave the “Complete by Date” blank.

Describe Corrective Action, if Needed – Anytime you check “Yes” in the “Corrective Action Required?”

column, you must fill in the “Describe Corrective Action” column as well.

Delayed Action Item Report – When a Corrective Action is required and the Complete by Date is not met, you must then fill out the Delayed Action Item Report to explain why the date was not met. Keep the Delayed Action Item Report in the SWPPP.

Corrective Action Log - When a Corrective Action is required as noted in this report, you must also enter all the information for this action in the Corrective Action Log.

BMP or Activity Implemented? Corrective Action Required?

Describe Corrective Action and Location, if Needed

1 Have stabilization measures been initiated on slopes and disturbed areas not actively being worked?

Yes No Yes No

2 Are natural resource areas (e.g., streams, wetlands, mature trees, etc.) required by the SWPPP to be delineated in the field, identified with barriers or markings?

Yes No Yes No

Complete by Date:

3 Are perimeter controls and sediment barriers adequately installed (keyed into substrate) and maintained?

Yes No Yes No

4 Are storm drain inlets properly protected?

Yes No Yes No

5 Are the construction exits preventing sediment from being tracked into the street?

Yes No Yes No

6 Is trash/litter from work areas collected and placed in covered dumpsters?

Yes No Yes No

7 Are washout facilities (e.g., paint, concrete) available, clearly marked, and maintained?

Yes No Yes No

Page 5 Project Name:

BMP or Activity Implemented? Corrective Action Required?

Describe Corrective Action and Location, if Needed

8 Are vehicle and equipment fueling, cleaning, and maintenance areas free of spills, leaks, or any other deleterious material?

Yes No Yes No

Complete by Date:

9 Are materials that are potential stormwater contaminants stored inside or under cover?

Yes No Yes No Complete by Date:

10 Are non-stormwater discharges (e.g., wash water, dewatering) properly controlled?

Yes No Yes No Complete by Date:

Overall Site Issue Answer to Question

Corrective Action Required?

Describe Corrective Action and Location, if Needed

1 At the time of inspection, are the discharge points and receiving waters free of pollutant discharges (sediment deposits, sediment plume or oil sheen)? (See continuation page for list of discharge points)

Yes No Yes No

2 Since the last inspection, are the discharge points and receiving waters free of evidence that pollutants had left the project site (for example, sediment deposits, oily residue)? (See continuation page for list of discharge points)

Yes No Yes No

3 Has Spill Response kit been used since the last inspection? If yes, has stock been maintained?

Yes No Yes No Complete by Date:

4 Are any additional BMPs needed?

Yes No Yes No Complete by

5 (Other)

Page 6 Project Name:

Scope of Inspection

Did you inspect all areas of the project that are required to be inspected by the CGP (areas disturbed by construction activity, areas used for storage of materials that are exposed to precipitation, discharge locations and locations where vehicles enter or exit the site)?

Yes No If you did not inspect any required areas, list those locations here and explain why they weren’t inspected.

Check the box below if the project is in compliance with the CGP and the SWPPP:

I certify that on the date of this inspection, this project was found to be in compliance with the terms of its Storm Water Pollution Prevention Plan and the current Construction General Permit.

If there are incidences of non-compliance, then do not check the box above.

When you don’t check the box above, then you must describe each incident of non-compliance and the actions that are needed to bring the project into compliance.

If there is an Action Item described in the non-compliance box that does not already have a “Complete by Date” assigned elsewhere in this report, then add a completion date within the box.

Non-Compliance

Incidence of Non-compliance:

Action Item and Complete by Date:

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 significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.”

Contractor’s Duly Authorized Representative FHWA’s Duly Authorized Representative

Print name: Print Name:

Title: Superintendent Title: Project Engineer Signature: Signature:

CONSTR CTION SITE INSPECTION REPORT

Continuation Sheets

Pro ect Name and Number

BMP & Location BMP Installed

BMP Action Required

Describe BMP Action, if Needed

Yes No Yes No

Complete by Date:

Yes No Yes No

Complete by Date:

Yes No Yes No

Complete by Date:

Yes No Yes No

Complete by Date:

Yes No Yes No

Complete by Date:

Yes No Yes No

Complete by Date:

Yes No Yes No

Complete by Date:

Yes No Yes No

Complete by Date:

Yes No Yes No

Complete by Date:

Yes No Yes No

Complete by Date:

Yes No Yes No

Complete by Date:

BMP & Location BMP Installed

BMP Action Required

Tab 10

CORRECTIVE ACTION LOG

Project Name: Page:

Inspection Date

Inspector Name Description of BMP Deficiency Location of BMP Deficiency Date Corrective Action Taken/

Responsible Person

WFLHD 157-5 (5/2011)

Tab 11

Construction Stormwater Discharge Permit Monitoring Oregon Department of Environmental Quality

DEQ21-LAB-0007-QAG 02/12/21

Version 1.0 Page 13 of 15

Appendix C Example Continuing Calibration Verification (CCV) Field Sheet

Sampling Agency: Date:

Sample

Collector:

Permit

Number:

pH

Meter S/N ID#1:

Accuracy Criterion: +/- 0.2 SU Meter Make:

Meter Model:

Pre time2: Post time3:

Std Temp (°C)

Theo

(SU)

Read

(SU)

Diff

(SU)

Pass4 (Y/N) Std

Temp (°C)

Theo

(SU)

Read

(SU)

Diff

(SU)

Pass4 (Y/N)

Turbidity

Meter S/N ID#1:

Accuracy Criterion: +/-

10%

Meter Make:

Meter Model:

Pre time2: Post time3:

Std Read

(NTU)

Diff

Pass4 (Y/N)

Read

(NTU)

Diff

Pass4 (Y/N)

Standards QA information5 pH

Std Value 7 10 4 Lot # Exp.

Date

Version 1.0 Page 14 of 15

Instructions for completing CCV:

1 Meter ID, please record the meter number used for each parameter

2 Pre-time, please record the time each meter was checked with standards prior to sample analysis

3 Post-time, please record the time each meter was checked with standards after sample analysis

4 Pass, please indicate whether the meter passed the pre-check according to the accuracy criteria for the meter by indicating Y or N

5 Standards QA Information, please record the lot numbers and expiration dates for pH standards being used in the field

Version 1.0 Page 15 of 15

Appendix D Example Data Field Sheet Monitoring

Agency: Monitoring Observation Date1:

Monitoring Personnel2: Permit Number:

Monitoring Information Field Data

Notes5 pH

(SU)

Conductivity

(NTU)

Result

Monitoring Site

Description3 Time4

Instructions for completing Data Field Sheet:

1 Observation Date, please record the date once at the top of the data field sheet

2 For Monitoring Personnel, please list all personnel that were present during sampling. Initials are not sufficient for this field

3 The Monitoring Site Description should describe the exact location from which the sample was collected

4 Please record the Time the field measurement was observed

For Notes, please identify any pertinent information, including but not limited to whether initial test failed acceptance criteria, any treatment performed, and whether result is a re-test after treatment

Tab 12

TRAINING LOG

Sediment and Erosion Control/NPDES Training

Project Name:

Course Title:

Instructor’s Name(s)/Title(s):

Course Location:

Course Date: Course Length (hours):

Training Topics:

Erosion Control BMPs Good Housekeeping BMPs Other (Specify)

Sediment Control BMPs SWPPP Provisions

Non-Storm Water BMPs Conducting Inspections

Emergency Procedures Turbidity Monitoring

(attach additional pages as necessary)

Name of Attendee Company/Agency

WFLHD 157-3 (5/2011)

FEDERAL HIGHWAY ADMINISTRATION

WESTERN FEDERAL LANDS

HIGHWAY DIVISION

Tab 13

Tab 14

GRADING AND STABILIZATION LOG

Project Name: Page:

Date Grading Activity Initiated

Description of Grading Activity and Location

Date Grading Activity Ceased

(Indicate Temporarily or Permanently)

Date When Stabilization Measures Initiated

Description of Stabilization Measures

WFLHD 157-6 (5/2011)

Tab 15

Tab 1

Quality Assurance Checklist

General Information Project Name:

Date of Inspection:

Project Reviewed by:

Contact Information:

Describe present phase of construction:

Information Date of Original SWPPP: Date of Most Recent

Amendment or Modification:

Is the SWPPP signage properly and conspicuously posted? Yes No (Signage should include where the SWPPP is located, who to contact for viewing the SWPPP, and a copy of the NOI(s) if applicable)

Are the SWPPP narrative and plan sheets being updated to accurately reflect the progress of the project?

Yes No

If the answer is No to any of the above questions, the following corrective action is recommended:

Inspections (Review SWPPP documentation to assure required inspections are being performed as required)

Inspection Frequency Required by SWPPP:

At least once every 7 calendar days

At least once every 14 calendar days and within 24 hours of the end of a storm event of 0.5 inches or greater.

Are inspections being performed and documented at the above stated frequency? Yes No

Are inspection reports included in the SWPPP? Yes No Are borrow and/or waste sites dedicated to the project inspected as part of the SWPPP construction site inspection? Yes No

Are stormwater pollution controls effectively in place at borrow and/or waste sites? Yes No Are inspections and SWPPP documentation signed by the Signatory Official? Yes No (Ensure all SWPPP documentation is signed by the Signatory Official designated in Tab 4 of the SWPPP)

Stormwater Pollution Controls

Are perimeter controls installed before any ground disturbing activities take place? Yes No Are temporary and permanent erosion control practices properly installed and effectively maintained within the required timeframe? Yes No Are temporary and permanent sediment control practices properly installed and effectively maintained?

Yes No

If the answer is No to any of the above questions, the following corrective action is recommended:

Are BMPs being selected, installed, implemented, and maintained as stated in the SWPPP? Yes No

Is the SWPPP being updated and revised as needed to address problems and reflect changes in the contractor’s operations? Yes No (SWPPP must be updated within 7 days of revisions, amendments, and modifications)

Are the BMPs adequate to minimize pollutants in stormwater discharge necessary to meet water quality standards as stated by the State Water Quality Certification and/or NPDES? Yes No (State Water Quality Certification found in Tab 16 of the SWPPP; NPDES permit found in Tab 2 of the SWPPP)

WFLHD 157-1 (2/2011)