Attachment 0002_ESCP.pdf

Plan

S P

For:

Federal Highway Administration Western Federal Lands Highway Division

Tab 1

Tab 2

Tab 3

FEDERAL HIGHWAY ADMINISTRATION

WESTERN FEDERAL LANDS

HIGHWAY DIVISION

DELEGATION OF AUTHORITY

Name or Position:

Company:

Address:

City, State, Zip:

Phone:

Company:

Title:

Signature:

Name:

Tab 5

Tab 7

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)

Tab 9 Inspection Reports

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:

Weather Information

Has there been a storm event since the last inspection?

If yes, provide:

Weather at time of this inspection?

WFLHD 157-2 (5/2011)

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

BMP & Location BMP Installed?

BMP Action Required?

Describe BMP Action, if Needed

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

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

Describe Corrective Action and Location, if Needed

BMP or Activity Implemented? Corrective Action Required?

Describe Corrective Action and Location, if Needed

Overall Site Issue Answer to Question

Corrective Action

Describe Corrective Action and Location, if Needed

Scope of Inspection

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.

Incidence of Non-compliance:

Action Item and Complete by Date:

CERTIFICATION STATEMENT

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

Print name: Print Name:

Title: Title:

Signature: Signature:

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

Sampling Agency: Date:

Sample Collector:

Permit Number:

pH

Meter S/N ID#1:

Accuracy Criterion: +/- 0.2 SUMeter 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

Instructions for completing CCV:

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

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

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

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

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

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

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

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

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

HIGHWAY DIVISION

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)

DateWhen Stabilization Measures Initiated

Description of Stabilization Measures

WFLHD 157-6 (5/2011)

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?

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

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

Inspections

Inspection Frequency Required by SWPPP:

Are inspections being performed and documented at the above stated frequency?

Are inspection reports included in the SWPPP?

Are borrow and/or waste sites dedicated to the project inspected as part of the SWPPP construction site inspection?

Are stormwater pollution controls effectively in place at borrow and/or waste sites?

Are inspections and SWPPP documentation signed by the Signatory Official?

Stormwater Pollution Controls

Are perimeter controls installed before any ground disturbing activities take place?

Are temporary and permanent erosion control practices properly installed and effectively maintained within the required timeframe?

Are temporary and permanent sediment control practices properly installed and effectively maintained?

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?

Is the SWPPP being updated and revised as needed to address problems and reflect changes in the contractor’s operations?

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?