APPENDIX E SWPPP FORM.pdf
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- Attached to
- Blocks 1, 6, 8, & Van Vliet Streetscapes
- Solicitation number
- 145410
- Issued by
- Riverside County, California
About this file
This is a Storm Water Pollution Prevention Plan (SWPPP) Inspection Report form utilized by California jurisdictions for construction site environmental compliance monitoring. The form documents comprehensive site inspections to ensure adherence to stormwater pollution prevention requirements during construction activities. The inspection report captures critical project information including job site location, weather conditions, rainfall data, construction stage, and the date of the last inspection and predicted rain events. The document is structured to systematically evaluate compliance across multiple categories: outfall protection, street and entrance conditions, perimeter controls, erosion and sediment management, stockpile maintenance, non-stormwater discharge controls, concrete and paint washout facilities, solid waste management, hazardous waste containment, equipment storage practices, and documentation requirements for the SWPPP plan itself.
The inspection form requires authorized personnel from the Storm Water Pollution Prevention Team to document observations through yes-or-no responses for each compliance item, with designated sections for corrective action items identified during previous inspections and their current status. The report must be signed by both the on-site Stratham Inspector and a qualified Stormwater Professional (QSP), with provisions for a designated representative of the discharger to sign if an external consultant conducts the inspection. The form includes certification language requiring inspectors to attest under penalty of law to the accuracy and completeness of submitted information. This SWPPP inspection report template is applicable to the Blocks 1, 6, 8, & Van Vliet Streetscapes project in California, which involves underground irrigation and landscape improvements located between Chino Corona Road and Legacy Park on Market Street south of Pine Avenue.
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Text version
APPENDIX E
SWPPP INSPECTION REPORT
SWPPP Inspection Report Inspection Date
Company: Inspection #
Job Site: Job Site Address:
WDID #:
Inspector: Current Weather:
Phone #: Date of Last Rain:
Last Inspection Date: Duration of Event:
Rainfall Amount:
Current Inspection Type
Date Rain Predicted to Occur: Chance of Rain:
Site Information
Stage of Construction
Recent Activities Completed:
Approximate area of site exposed:
Observation of Outfalls, Streets, Entrances, Perimeter Control and all other BMP's Yes or No
1 Outfalls: Are outfalls and discharge locations protected from pollutents/sediment leaving the site?
2 Streets: Are perimeter and interior streets free of sediment and debris?
3 Entrances: Is the constructin entrances installed/maintained and free of track out?
4 Perimeter: Are perimeter bmp's installed and maintained?
5 Erosion and Sediment Controls: Installed and maintained in accordance with active construction?
6 Stock Piles Properly maintained and covered?
Non Storm Water Observation Yes or No
7 Concrete/Stucco/Paint Washouts: Installed and maintained per SWPPP?
8 Solid Waste: Trash and debris properly managed and stored?
9 Hazardous Wastes: Waste is properly contained and identified?
10 Equipment Storage: Bmp's in place to prevent leaking or contamination?
SWPPP Yes or No
11 EC Plan: Is EC Plan acurate and updated to activies in the field?
12 SWPPP: Is SWPPP and NOI on site or accessible?
13 SWPPT: Is the Storm Water Pollution Prevention Team contact info available?
14 Corrective Actions: Have Corrective actions from the last report been timely addressed?
Corrective Action Items
Action # Date of Inspection
Signatures from Authroized Storm Water Pollution Prevention Team
Name and Title of Stratham Inspector Date
Date
If a Designee (e.g. Storm Water Consultant) conducts the inspection, A designated Representative of the discharger must sign the completed Site Inspection Form
Signature
SignatureName and Title of QSP
I certify under the 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 gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons diretly 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 aer significant penalties for submitting false information, including the possibliity of fine and imprisonment for knowing violations.
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