ESCP_OR_BLM_ERFO_-151-3203_Medford_District_Roads.pdf

TABS

TAB 1: SWPPP/ESCP Narrative

TAB 2: NPDES Permit (Construction General Permit or Corresponding State Permit)

TAB 3: NOi, EPA/State Acknowledgement, Other Applicable EPA/State Correspondence

TAB 4: Delegation of Authority

TAB 5: Maps

TAB 6: Erosion/Sediment Control Plan Sheets (plan set and BMP typical details)

TAB 7: Permanent Stabilization and Revegetation Plan (plan sets and details)

TAB 8: SWPPP Amendment Log

TAB 9: Erosion/Sediment Control Inspection Reports and Requirements

TAB 10: Corrective Action Log

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

TAB 12: Training Log

TAB 13: Waste and/or Borrow Site Information

TAB 14: Grading and Stabilization ;Log

TAB 15: Hazardous Spill Plan

TAB 16: Other Applicable Permits(§ 404, § 401, Oregon Remove-Fill Permit)

TAB 17: NPDES Quality Assurance Checklist

TAB 18: NPDES Notice of Termination (NOT)

Tab 1

CONTRACTOR:

Complete SWPPP narrative in accordance with contract 107.0lA(b).

Revise SWPPP narrative as needed throughout construction in accordance with contract 107.0lA(f)

ALASKA, IDAHO AND WASHINGTON PROJECTS ONLY:

SWPPP narrative must be signed by General Contractor's responsible corporate officer as defined in CGP I.11.2.

File approved SWPPP narrative i~ Tab 1.

GENERAL PERMIT

NAT!O:\At ANT EUi\HNATJON SYSTE\l

STOR'.\i WATER DISCHARGE PER\UT

Note: This permit has been administratively extended until the general permit is renewed, and remains in effect at this time.

SOURCES COVERED BY THIS PER~HT:

Thi:> Division of State Land:s. US

PERMrTTED ACTlVlTlES Until this facilities. and m storm \\if!h:r lo limita1inns. and condilion:s st:! forth

Scfa~duic t\ B

Schcduk C S1.:hcdule D Schedule F

- Limitmions und Contmls . !vlinlmum nn1rnEu·w·• Schedule

Conditions

- General Condi1ion:s

WPCF

to ware rs of the

Dale dismrbm1'>2 if pan

Penna !\umber: 1200-CA "'! l5

SCHEDtLEA U\UTAT!ONS A.ND CONTROLS FOR STORM WATER DlSC!-L\RGES

Performance Limitations An Ern,ion and Sediment Control Plan shall he and prevem the amoums of scdimem w surface wa1er.s. The amounts d scdink'nt and shall he from wan:r;;.

b. Evidence of conet•n!rah~d flows'" of water causin.i.: erosion \Vhen such !low' are nol filtered or settled !\J remove scdiment to !he constrnction site and an.: Lo surfac.c waters. Evid:.:nce includes tht: presence of rivulets or channds.

c. Turbid nows''' of water that an:· nor filtered or senkd the con;;m1ction site and an:

d. sediment ;tt thi.'. o.,ns1mction }iJk in ar:;~a;; that drain to ,.,,.,~"""'·"''""'d storm water inlet:> catch basins that ro surface water<.. rnkts and c;1tch basins wi1h sedim::m comrnh due lack of maintenanct: or will h1.~ cnnsitkn:d

e. ;.cdiment from the C;1lbtruc!i(lfl silt' on streets the con:'truction thar are discharge ,~urfi.lct-~ \•~;,ncr~.

f. sediment from the constmction :;it;:.• on any property m1bick: fif ch<:

cmi:-,trnniun that are likely surfa,;c "'aters.

Flow to storm water inlets catch basin<. locmed on the site will l:P..: considered ihc siic" if there arc sediment .:ontrol strn.:mre.~ for con . .;tmction n,,,.,., dov.n-;1n.:am of th~~ inlets r>r catch b::1sins rhat are undr:r the r"erminee · s control.

1 Erosion and Sediment Control Phrn Preparation and Submittal ESCP is and fur the crnbrrnction hy this permit.

a. A copy of the F.SCP shali be retained on-site and made available to tbt.'.

inaz.:tive of gr.:ater !han ;;even (7; consecuti\·e calendar retained b.

L.

d. ff irn::fftxtive at amoun1s t>f Sl'.dim..::1n and 1urbidi1y tn surf;1ce \Valcrs.

m:ccssary to mt:ct local erosion and :;cdirni:nt comrol cunstrnction actiYities should avoid or If 1.he chooses comimie bnd additi(Jnal wei Wt'ather requiremems ! refer to are if construction occurs the winter season and the have medium to erosion

3. Erosion ;md Sediment Control Phm I<cquircmcnts Th::; at a minimum. include the from concrete tmcks.

d. shall are lL

Iii. A implernt•nlatio11.

'."itorrn

\'1 uf c~rosinn and sediment l.'llllHol ftOlll ht:COIHing a SOlll'C(' uf CW~inn.

but still under tlW CO!l!rlll of the located aw;1y from ilw shall abo b•.l protee!(:d !ti

:\t l~ml dcani11i! and maintenance fluid. and b.

it and

(c\) activitil'.S; Approval cO(•rdinared by and Wild Ilk under ~:onditions may ''"'""'·r1r,., or w prow~:t

Permil Nurnix:r: 1200-CA 6 pf 15 with the uf Fish

Constmction or other Legitimate Activities: Permit or cenificninn amhoriZ~'.d under terms Sct:lion 40 l or 404 Permits and License.s. Feder a.I Water Polhnion Control J or OAR 141-085-0100 seq. !Removal and Fill Division of St;ite with limitations and condiiion::. the set forth in 1lw or certificak.

OAR .J.lfl-04 I -(

Lirnitt:d Strenms:

may establish additional con1rols on wnstrnction activities that storm water stlcams if Tuia! ;..i:n:imum Load::. ar,_• csiahlished arn.J constrnc<ion ;.;cnvities arc determined to be a fi~:tml contributor to th<:sc loack The appl k:ation for in di vidmd or a ·watershed-based

All Sites

L in construction

Active

J. inactive of

Prior to activities at the site, any Stabilizatim1 may occur by ::.etc.) or calendar' area shall be swbi!ized erosion control

5. \Vhen a site is inaccessible due msp1:'('!ions shall not be SIH:'d Adverse

Prior an ina,;1i vc siie or of site in:te1:1~ssibi st:dimenr comrol measures shall be to ensun:~ that ;m:

mainrenanc.: or 1>hall he the site.

\Vdttcn Rt~cords

.1 t\11 visual must do~:umem. I.he following s n::mw, wt:athcr

h. erosion nmJ locmhm::. where vehicles cmer and exit rhc siw. status. of an:as that stockpik~ arna, :md mmstormwater controls.

from the construction site conduct sU"eam, observe dmvnstream wichin 30 feet of rhe could be noted as spill and/or fr{1m vehicles or would describe any apparent color and the with rile stream.

shall only be:

and Any m:cessary

Pl:rmii ~~urnb.::r: .'.Oll-C\ tL ff ican!. amoums of futun:

rdcases The ESCP shall

L'.. If a silt: is HK1cccssibll.' due to mdcment \Veather the mspection shal! indude nb.serva1ions al a relevant or dc,wnstrcam location. if

x. All n:cords for an active site shall he kept on-site or be rnait11ained with !he and shall nude available to the Department, its or local upon request.

9. A wriiIC'.rl rcc11rd of inspections and mwJ;:;

availabk 10 !ht: ii:.. or local

I 0. R.::tention of ail inspection records shall be f'or a period of one year from project completion.

irnhk tremment to

b. wit.bin lhklj' ohtaim::d.

4. Perm!!

SCHEDLLEO

SPECIAL CONDITIONS

relieve the frorn ai I other will n:rnam in cffl:'c! after Hie date until anoitu::r all fee:,; and has filed a ren.:wal applica1icn1.

that does not w~rnt to an individual NPDES

Defini!ions:

limik:d this ill accordance with the l\·rirnl ?\umber: 1200-C.\ w tif 15 may make in OAR l'n1ctiffs { Bivf f's} Schedules of activiti:.:s, ::;!ructurnl and/or of prac11cl:s. mainlcnam:e !.O prevcm or n::dth:<: the trcatn1t;?ni -systern;-;. .. erosion and st:dirnent i:on1ruL and prne11cc;; 10 control: site rnnofL or kab. ;ind WdSte

Erosion 'fhe mtivt•ment of sr•il wind.

resulting from the flow or preSSllrC from siOnn Wal.er or

Grade Cun.stmciion activity 1hat ~:tm:'es the di:;wrbance of the ,,;arth. This shall include bm not be iimitcd to any di'.Sturbam:c, ll!nm/0111 Materials As defiued in 40 CFR .~02 A\m!abk \1!11hc wt:b at "-'P·l-1,'(1\.

root mat or

Quanti!l\.:s. and Notifirnlion a pf land in distinct phases, with the stabilizalitin of t.:adi includin!! soil of ail soil distmbaw.:e activi1ics at !IK: sik~ and !he establishmt>ll! of a cover. or equivalent permanent stabilization mcas1m~s /such us riprap, '""r"""'~

!hai will prt~vem .;·rosion.

The first lund-disturhing activi!y associated with a and of sm:ers and t'n:ction of icmporary forms: and in~tallation of accessory

Storm ~Viiler Storm water nmoff. snow melt runoff. am! surfoce runoff assoriaied with a storm event.

t\n nfthe absorbed rather than 1rnnsrni!led in a h is caused by the pn:sence of matter a liquid.

lO

4.

wmt:rs Class

SCHEl}lJLE F

Pcnmt . 1200-CA for violatilm wasti;:

state, is in advance !:Jui later than

5 ..

but nm of the or a notification of or does 1101 conv(:y any of any sort, or any

SECTION H. OPERATION Al'ID MAINTENANCE OF POLLUTION CONTROLS

1. enam:e T'h".::~~::~:;::tf;:;'.';'':~h';;1··~,1';t' ·-s-propcrly o. per·ate appurtenances) which or permit Pmp<~r r.n.,~·,,,,,.," and maintenance quality assurance This provision requires l l cL s\ stems which an.: installed with the ·,.:onditions

Permit Nnrnber: 1200-C.-\ ol' 15 apnlies.

It -;!1:'11! no!

hnl! or reduce the' knows in ad,ance the w.:,xi for a shall suhmi! pnor bypass as n:quired in

Burden of upset has hL·fon: 1 hr: 1..bte ,,f the submit no!ke

Event \Vhich viola1ion. /\ unknowing who \Vtshes to establish the affirmative or other

Gcnt~ral Condition D.5, hereof {24-hour to establish the ocn1m.:nct: of an lo simultaneous violations of operational event is an vi'""'"'·"''..,, result of a act or c.

l3 of the ww;te'-Va!er or s1mi.:lU1\~.

Permit Number: 1200-CA Pag<! 1-l of 1.5

The pcrmittce advance to the Director of anv planned changes in the permitted facilitv or uc1ivity 1.vhich may resuh in noncompliance with permit reqltirements. ~ · permit may be u.~msfr:rred co a nc:w pt:'.~rpiiWl? prnvid~t! lh~'. tmnsferee acquin:s _aprope!1Y inten::sy in ihe pcm11tt?d acL1vity ano agree:<; m wnung ti:: tmly complY wnn Ll}lH1e terrns <_md cond_11ions _ol the permit •1}1d the r.ule~: ~)I tht: C~1:rnrnssio1,i. ::\o penrn1 ~lmll be_ transferred to a Umd party \vHhom pno_r wrmen approval from me U1rector. I he perrn1ttee slmll not!ly the Uepartmem \vhen a 1r~1n.;fer of propcrcy rntcrest takes place.

:l Compliw1ce Schedule l{(:p(1rts ;_;·i~ciin1pITiiT1ce i?r nonc~mplianc~ . or any progress reports on interim and final n:~1uircn_K:nts contamed m anv compliance scnedule of rhis pt:nmr shall tx? no lmer than l.:i davs iol!owmg each sd1,~duk daw. }\ny reports of noncompliarn:e sha!i include cause of noncompliance, ar1v n::mediaf';u.:tions taken, and rhe probability of meeting the next scheduled •

5. Twt:ntv-Fcmr Hour Reponing The perrnittee shall renort any noncompliance which may endanger health or the enviromnenL Anv i,nfonnmh:m shall !:~ pi-~widc<l orally (by telep~one) _within 24 hottr~, u~1less otherwise_ specified in t11is permit, trom che time the perm11tec becomes a\1.·are ot the cm:umsmnces. Durmg normal bus111ess nours, the Department's Regwn~tl q.flke shall he called. Outside of non:ial business hours, the Department shall bi:

6.

contacted i1L l-:5(X)-4::il-05 ! l Emergency Response Sy.skmJ.

A wriuen submission ~hali also provided within 5 days of the the permitlc<~ b;.:com.:s aware of the circt!mstan~~s. !~ th~J1ermitte~ es.t<~blishin_g an affjn?1ative . _ ofupset or bypass .to any offen~e ORS 468.922 w -+68.946. and m wh1cn case if tht: om~rnal n::porllllf: notH:e w;1-; oral, delivered written .n:u,;t b~ made ~o the Depmtment or other agency w·ith'rcguiatory j1lr1"d1Ction within 4 { calendar days.

l he wnucn subm1,swn ~hall conmm:

<L A descrip1ion of the noncompliance and its i:..:ause;

b. The period or r1oncornplianct:, including exacl date.~ and time.-;:

c The estimated time noncompliance lS cxpc~:!Ctl tO contiilU\.' if ii has no! been C(l!TCC!ed;

d. Step? rnken_or 11lanne<l ro reduce. eliminate,~md prev~nt r~~1ccurrence of the noncompliance: and c.. Pubhc notdicatmn taken, to (1i::neral Condition B.7.

The follmving shall be included as inform1tion which must lx~ n.:pont:d within 24 hours umk~r this para1m1ph:

a. Anv unaiiik:ipmed which exceed.;;; any eftluent limitation in this permit '

b. An~· upset which any dflm:nl limirntinn in rhis permit.

c, Violatwn of maximum dai!v llmitation for anv of the Doi lutanls listed the Director in this permit. . · ' , The !)e~)amm::nt may wai Ve' the wriuen report on a w1th111 .A hours.

Other Nom:o1111Jlia11ce basi:.; if the oral report has been received

Thepenn!ite~ sh~1!1 report instances of t1Sl!1tompliancc not repom:d under General Condition DA or D.5. at tne t1m,;: monttormg rcp1.irts are submmed. 1 he reports shall comam:

n. :~description_ of the noncompl~~m~t: and its c;;mse; .

b. I he pe~1od ot n~:irn.:omphance._ mciU~mg ~'xact dates ar~d tm.1".~:.

c. The estimated time nonct•mpl!anc1~ is expected w contmue 1t n has not been corrected: and

d. Steps or planm.:d to reduce. eliminate, and prevent reoccurn;nce of the noncompliam:t:.

Dutv to Prov! formation The pei=i1iltf(;~. I funil~!1fo the Department, within a reasonabh: time. any information which the Department may request to det~m1i~!'~ coniplianct:: v. ilh this The permiltet! shall also furnish to th<:

Department. upon request, copies or recorus reqmred to be this permit.

Oth~r . ~Vhe111he permiHee hecomt;s aware tJrnl it 1:ailcd to submit any releyant facL'i in a p~rmit , appllcahon, or submmt7d mcory-ect _ ma permit appltcm1on or any report to tne Department, it shml promptly suhirnt s.uch !acts or mfom111tn)1L

S ~t<J.Q' R~'quirement~ applicmmns, reports or accordance with 40 CFR 122.22.

submitted to the Department shall be signed and certified in

9. Falsificati ons UnderT.H{ 3, any person \Vl!o knmvingl~1 makes any ~·als~ statement, r~presen!:it~on: or.certific~tioii in any record or other docun~nt subrmued or re{1mred ,to be !11Rmtamt~d am~r. this penn~t. rncludmg 1~1on1tormg repo11s 9r rep?r.ts co_mph.<mce or nonco1nphanl?e, IS, sub.iect to a Class C felony punishable a hne not to exceed S !00,UOO per vmlauon and up to ) years m pnson.

a.

discrete owned m::.umem

S'WM-JEC-00101

TAB 3: NOi, EPA/State Acknowle:l'll""B,.., EPA/State does not apply to Oregon

Adc:litional Constructi():n Site Requirements:

A sign or other notice will be posted conspicuously near the mam entrance of the construction site. For linear projects, the sign or other notice will be posted at a publicly accessible location near the active part of the construction project.

If displaying near the main entrance is infeas~ble, th~ notice can be posted in a local public building such as the town hall or public library. ·

The sign or other notice will contajn the fol.lowing information:

1. A copy of the completed Notice of Intent (NOD as submitted to the EPA Stormwater Notice Processing Center or State Authorization; and

2. The current location of the SWPPP and the name and telephone number of the contact person for scheduling SWPPP viewing .

• ~ r' -, . ~ ', ... - ~."· ..

,,..,,T ."" r;"'I'

ALASKA PROJECTS ONLY:

File electronic or hard ... copy NOI with Alaska, Department of Environmental Conservation (ADEC) following instructions at http://dec.alaska.gov/water/wnpspc/stormwater/APDESeNOI.html

If you do not have an existing my Alaska account, follow ADEC instructions to register.

When filling out your NOI, use the same information as the FHW A NOi in tab 3 AND the following:

ti} ·SeCtion I. Single/Multiple NOi Project. Fee has been paid by FHWA

• Section II. Operator Information. Complete this section using information for

YOURCOMPANY~ .

Afte~ your NOi has been signed or paid, you will receive an email certifying that your applicatim;1 was signed or paid and another after being both signed and paid that your application was successfully submitted.

If you submitted a hard-copy signature page, it may take a few days to process.

Provide a copy of this acknowledgement email to the CO.

File copy of Contractor's NOI and ADEC Acknowledgement e-mail in Tab 3.

WASHINGTON AND IDAHO PROJECTS ONLY:

File electronic NOI with EPA at http://cfpub.epa.gov/npdes/stormwater/cgpenoi.cfm

If you do not have an existing CDX account with EPA, follow EPA instructions to register.

When filling out your NOi, use the same information as the FHW A NOi in tab 3 AND the following:

• Section III. Operator Information. Complete this section using information for

YOUR COMP ANY.

• Section IV. Project/Site Information. Question. Are you requesting coverage under this NOI as a "federal operator" as defined in Appendix A? ANSWER

YES.

• · Section IV. Project/Site Information. Question. Have stormwater discharges from your project/site been covered previously under an NPDES permit? ANSWER YES. Provide the FHW A Permit Tracking Number in the EPA acknowledgement email in Tab 3.

• Section VII. Sto·rmwater Pollution Prevention Plan (SWPPP) Information. Use contact information for YOUR COMP ANY

• Section X. Certification Information. NOi must .be certified by YOUR responsible corporate officer as defined in CGP I.11.1. If your Certifying Official is a different person than the one preparing the NOi, then the Certifying Official must also have an EPA CDX account.

When the NOi has been completed, it will be electronically delivered to the email address of your Certifying Official. Follow the instructions in the email to complete the Certification of the NOI.

When you have successfully completed and certified your NOI, the preparer and Certifying Official will receive an email from EPA acknowledging that your CGP NOi Certification is complete. Provide a copy of this acknowledgement email to the CO.

File copy of Contractor's NOi and EPA Acknowledgement e-mail in Tab 3.

TAB 4: Delegation. of Au.th.orlty

Tab4 .

. CONTRACTOR:·

ALL STATES:

J>urllig projef!t ~onstru¢tiol!, tbe CQP reqµir~: ~hat all .cbauges fo tlie proje~t SwPf P of re¢ord~ inspe~tio.ns, n~po~, ~ne,'biny otber c().11\pliance docu1U¢lltidio11 musflit signed by y9U:r Co:mpa,tl1Y's Certifying Offici~l (signer olNOI. an~· SwPPP·n~rrative) or. by:a duly auth~rized t~presentative oftb.at person as tl~t'W~ in th~ CGP.

if the Certifying Official-will ·not be ijvers~ing day-to-day opetati~11s at tbe constructi~11 site, tbat person may delegate C~P compliance a,uthorityto ~n on~site · representative using form WFLHDlS7-7.

File Contr~ctor's Delega.tion of A.µtho:rlty Form WFLHD 157 ... 7111 Tab 4. ·

TABS: Maps

Vicinity a:nd Location Maps

Location of the con~truction site and waters of the United States within one mile of the site.

Tab5

CONTRACT-OR:

ALL STATES

Add the locations of all Government-selected staging areas, borrow sites, waste sites, and other dedicated ancillary areas.

TAB 6: ESCP Sheets

Erosion/Sediment Control Plan Sheets including major structural and non ·structural BMPs and typical details.

Tab6

ALL STATES

Add the locations of all stockpiles (soil or other erodible material) and Government selected staging areas, borrow sites, waste sites, and other dedicated ancillary areas.

TAB 7: Perm~nent Stabiliza~on and Revegetation Plan

Tab7·

FHWA:

Insert Revegetation Plan (FS, NPS, Consultant) IF APPLICABLE.

If revegetation is being pe:rfo:rmed by others, inform the Contractor here

CONTRACTOR:

ALL STATES

This revegefation phm is for SWPPP documentation only.

The Contractor's :responsibility for revegetation is specified in the Contract.

TAB 8: SWPPP Amendment Log

Tab8

ALL STATES

Note in the SWPPP Amendment_ Log any changes that occur to the SWPPP of record, including the SWPPP narrative (Tab 1) and plan sheets (Tab 6).

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TAB 9: Inspedion Reports

Inspection Requir~ments for NPDES Compliance

EPA Construction General Permit Part 4 inspection requirements for NPDES compliance:

Inspection Frequency: You must conduct inspections in accordance with one of the iwo schedules listed below.

You must specify in your SWPPP which sche<fule you will be following.

1. At least once every 7 calendar days, OR

2. At least once every 14 calendar days and within 24 hours of the end of a storm event of O .5 inches or greater. (If this option is chosen, a rain gauge is required to be on-site: The SWPPP should also include a daily rainfall log.)

Case-by-Case Reductions irz Inspection Frequency: You may reduce your inspection frequency to at least once every month if: · ·

1. The entire site is temporarily stabilized, 2~ Runoff is unlikely due to winter_conditions (e.g., site is covered with snow, ice, or the ground is frozen), or

3. Constructionkoccurring during seasonal arid periods in arid areas and semi-arid areas.

I11spection Waiver for Frozen Conditions: A waiver of the inspection requirements is av~ilable until one month before thawing conditions are e.xpected to result in a discharge if all of the following requirements are met:

· 1. The project is located in an area where frozen conditions are anticipated to continue for extended periods of time (i.e., more than one month);

2. Land disturbance activities have been suspended; and

3. The beginning and ending dates of the waiver period are documented in the SW.PPP.

Qualified Persormel: Inspections must be .conducted by qualified personnel (provided by the operator or cooperatively by multiple operators). "Qualified personnel" means a person knowledgeable in the principles and practice of erosion and sediment controls who possesses the skills to assess conditions at the construction site that could impact stormwater quality and tc;> assess the effectiveness of any sediment and erosion control measures · selected to control the quality of stormwater disch~rges from the construction activity. ·

Scope of lnspectio11s: Inspections must include all areas of the site disturbed by construction activity and areas used for storage of~terials that are exposed to precipitation. Inspectors must look fc;>r evidence of, or the potential for, pollutants entering the stormwater conveyance system. Sedimentation and erosion control measu·res must be observed to ensure proper operation. Discharge .locations must be inspected to .ascertain whether erosion control measures are effective in preventing significant impacts to waters of the United States, where accessible. Where discharge locations are inaccessible, nearby downstream lqcations must be inspected to the extent that such inspections .are practicable. Locations where vehicles enter or exit the site must be inspected for evidence of off-site sediment tracking.

A// .reports required by this permit, iitcluding tlie SWPPP, S.WPPP a11te11dttie11ts, and inspection reports must be signed by a person described in Appendix G, Subsection 11.A (below) or by a duly authorized representative of that person.

1. For a corporation: By a responsible corporate officer. For the purpose of this Part, a responsible corporate officer ineans: (i) a president, secretary, treasurer, or vice-president of the corporation in charge .of a principal business function, or any other person who performs similar policy- or: decision-making functions for the corporation, or (ii) the manager of one or more manufacturing, production, or operating facilities, provided, the manager is authorized to make management decisions which govern the operation of th~ regulated facility including having the explicit or implicit duty of makirig major capital investment recommendations, and initiating and directing other comprehensive measures to assure long term environmental compliance with environmental laws and regulations; the manager can ensure that the necessary systems are established or actions taken to gather complete and accurate information for permit application requirements; and where authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures.

2. For a partnership or sole proprietorship: By a general partner or the proprietor, respectivyly; or

· 3. For a municipality, state, federal, or other public agencY: By either a principal executivt? officer or ranking elected official. For purposes of this Part, a principal executive officer of a federal agency includes (i) the chief executive officer of the agency, or (ii) a senior executive officer having responsibility for the overall operations of a principal geographic unit ~fthe agency (e.g., Regional Administrator of EPA). · ·

A person is a duly authorized representative only if:

The authorization is made ~n writing by a.person described in Appendix G, Subsection 11.A;

The authorization specifies either an individual or a position having responsibility for the overall operation of the regulated facility or activity such as the position of plant manager, operator of a well or a well field, superintendent, position of equivalent responsibility, or an individual or position having overall responsibility for environmental matters for the company. (A duly authorized representative may thus be either a named individual or any individual occupying a named position); and ·

The signed and dated written authorization is included in the SWPPP. A copy must be submitted to EPA, if requested. · i

BMP & Location BMP BMPActj.on Describe BMP Action, if Needed Installed? Required?

9 LJYes 0No UYes 0No

Complete by Date:

·10 0Yes QNo LJYes 0No

Complete by Date:

11 0Yes 0No 0Yes 0No

Complete by Date;

12 0Yes 0No 0Yes 0No

Complete by "

Date:

13 0Yes 0No 0Yes LJNo

Complete by.

Date:

14 0Yes 0No LJYes 0No

Complete by· Date:

15 0Yes 0No 0Yes 0No

Complete by Date:

16 0Yes 0No 0Yes 0No

Complete by Date:

17 0Yes LJNo 0Yes 0No

Gomplete by Date:

18 0Yes 0No LJYes 0No

Complete by Date:

19 0Yes 0No 0Yes 0No

Complete by Date:

20 0Yes 0No 0Yes lJNo

Complete by Date:

21 0Yes 0No 0Yes 0No

Complete by Date:

• Please use continuation sheets if there are additional B¥Ps to list.

Page 3 Project Name:

Inspection Date:

Overall Site Issues

• BMP or Activity · -- These are some general ~ite 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? - Wlum maintenance or some other corrective action is required, ~heck

"Yes" in this column.

• Corrective Action Required, Complete by Date - When a corrective actidn. 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 th~ "Complete by Date" blank.

• Describe Corrective Action, if Needed - Anytime you check "Yes" in the "Corrective Action Required?"

column, you must fill in the ".Qescribe 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 Itein 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 Co~rective Action Log.

BMP or Activity Implemented? Corrective Describe Coi:r~ctive Action and Location, if Needed Action Reauired?

Have stabilization 0Yes LJNo 0Yes UNo measures been initiated on slopes and disturbed Complete 'by areas not actively being Date:

worked?

Are natural resource 0Yes 0No 0Yes 0No areas (e.g., streams, wetlands, mature trees, Complete by etc.) required by the Date:

SWPPP to be delineated .

in the field, identified with barriers or markin~s?

Are perimeter controls LJYes 0No 0Yes 0No and sediment barriers . adequately installed Complete by (keyed into substrate) .Date:

and maintained?

Are ~torm drain inlets 0Yes 0No 0Yes 0No pr~perly protected? Complete by

Date:

Are the construction LJYes LJNo OY~s UNo ' exits preventing sediment from being Complete by tracked. into the street? Date:

Is trash/litter from work LJYes LJNo UYes 0No areas collected and placed in covered Complete by dumpsters? Date:

Are washout faciliti~ 0Yes LJNo LJYes 0No (e.g., paint, concrete) available, clearly Complete by marked, and maintained? Date:

Page4 Project Name:

BMP or Activity Implemented? Corrective Describe Corrective Action and Location, if Needed '

Action Required?

8 Ar.e vehicle and 0Yes 0No 0Yes 0No equipment fueling, cleaning, and Complete by maintenance areas free Date:

of spills, leaks, or any other deleterious material?

9 Ar.e materials that are 0Yes 0No UYes O·No potential stormwater Complete by contaminants stored Date:

inside or under cover?

10 Are non-stormwater 0Yes 0No 0Yes 0No discharges (e.g., wash Complete by water, dewatering) Date:

properly controlled?

Overall Site Issue AnsWer to Corrective Question Action Describe Corrective Action and Location, if Needed

Required?

l· At the time of LJYes 0No 0Yes LJNo inspection, ate the Complete by discharge points and Date:

receiving waters free of pollutant discharges (sediment deposits, sediment plume or oil sheen)? (See continuation page for list of discharge points)

2 Since the last inspection; LJYes 0No 0Yes 0No are the discharge points · Complete by and receiving waters free Date:

of evidence that pollutants had left the project site (for example, sediment deposits, oily residue)?. (S~ continuation page for list . of discharge points)

3 Has Spill Response kit 0Yes QNo 0Yes 0No been used since the last Complete by inspection? If yes, has Date:

stock been maintained?

4 . Aie any additional 0Yes 0No OYes 0No BMPs needed? Complete by

Date:

5 (Other) lJYes QNo 0Yes 0No

0 Complete by Date:

Pages Project Name:

Scope of Inspection

Did you inspect all areas of the project that are UYes UNo If you did not inspect any required. areas, list those required to be inspected by the COP (areas locations here and explain why they weren't inspected.

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)?

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

DI certify that on the date of this inspection, this project was found to be in compliance with the terms ofits Storm Water·Pollution Prevention Plan and the curn~nt 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-c:Ompliance and tlie · 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 desigtied 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 infonnation, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there· are signifieant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations."

Contractor's Duly Authorized Representative FHW A's Duly Authoriied Representative

Print name: Print Namei ·

Title: Superintendent Title: Project Engineer

Signature: Signature:

Page6 Project Name:

TAB 10: Corrective Action Log

Tab 10

ALL STATES

Record in the SWPPP Corrective Action Log the completion of BMP maintenance that was noted in the. "Describe BMP Action, If Needed" section of the SWPPP Inspection Report (f ab 9)

P ro ie ct

N am e:

In sp ec ti on

D at e In sp ec to r N am e

W F

L H

D

-5

5/

.j

FE

D

E R

A L m G

H W

A Y

A D

JM

lN

IS

TR

A

TI

ST

E R

N F

E D

E R

A L

L A

N D

S H

IG

H

W A

Y D

IV

IS

C

R R

E C

T

IV

E A

C T

IO

N

L l?

ae

:e e C ru ie et lv e D es cr ip t:

)o no f'B ,M

P D ef id en cy

L o ca ti o n of

:B l\ ~l

? D ef ic ie nc y

I .A

~o n, Ta li

:e n/

R

.e S

P on si bl eP er so n

L H

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F E

D E

R A

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W A

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IS

T R

A T

S T

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N F

E D

E R

A L

L A

N D

S H

IG

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W A

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IV

IS

R R

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IV

E A

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N

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D E

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D M

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A T

S T

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N F

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A L

L A

N D

S H

IG

H

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IV

IS

R R

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T

IV

E A

C T

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N

L

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F E

D E

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L H

IG

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W A

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D M

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IS

T R

A T

S T

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N F

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E R

A L

L A

N D

S H

IG

H

W A

Y D

IV

IS

R R

E C

T

IV

E A

C T

IO

N

L

D E

R A

L H

IG

H

W A

Y A

D M

IN

IS

T R

A T

IO

N

W E

S T

E R

N F

E D

E R

A L

L A

N D

S

ID

G H

W A

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IV

IS

R R

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T

IV

E .A

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N

L

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TAB 11: .

Water Qualify Monitorlllg, Repoftlng Requirements, and Reports

Sa,mpl~s and measurements .taken for the purpose of monitoring will be representative of the monitored activity. Records of all monitoring fufonnatioli will be retained, including a11 calibration and maintenance n~cords and all .original strip chart rec01:dings for cQntinuous monitoring instrumentation, copies of all reports required by this permit, and records of all data used to complete the application for this permit, for a period of at least 3 years from the date of the sample, measurement, report or application.

Records of mon,itori:ng i:nfon.natiQn will juclude:

1. Th~ date, exact place, and time of sampling or measurements;

2. The indi,vidual(s) who performed the sampling or measurements;

3. The date(s) analyses were performed .

4. The individual(s) who performed the analyses;

· 5. The analytical techniques .or methods used; and

6. The results of such analyses. ·

Tab 11

Insert water quality monitoring :requirements IF APPLICABLE.

If not applicable, insert the following statement:

Water quality monitoring is not required for this project.

TAB 12: Training Log

Tab 12

ALL STATES

Insert Erosion Control Supervisor certification in accordance with contract 157.03.

Use enclosed form to document any additional staff training in compliance with the applicable EPA/STATE NPDES Stormwater permit.

FEDERALfilGHWAY ADMINISTRATION.

·WESTERN FEDERAL LANDS

WGHWAYDIVISION

SWPPP TRAINING LOG

Sediment auut Erosion Control/NPDES Training

PrajectName:~....,...~~--..~~~~~~~~~~~~~~~~~~~~~~~-

CourseTltle: __________________ ~----------

Instructor~s Na~e(s)/Title(s):. _____________ __,. _________ _

Course Date: __________ _ Course Length (hours): _____ _

Trammg Topics:'

D Erosion Control BMPs

D Sediment Collllt:rol BMPs

D Nan.Storm Water BMPs

Na~~fA.tt~~

WFLBD 157-3 (5/2011)

D Qoml Housekeeping BMPs

D SWPPP Provisions

D Conducting Inspections

D Turbidity Monitoring

D Other (Specify) r 1'

FEDERAL HIGHWAY ADMINISTRATION

WESTERN FEDERAL LANDS

HIGHWAY DIVISION

SWPPP TRAINING LOG

Sediment and-Erosion Control/NPDES Training

Project Name:---------------------------.,-----

. Instructor'~ Name(s)/Title(s): ___________ --------------

Course Location:-----------------------------

Course Date: ___________ _ Course Length (hours): _ __, ____ _

Training Topics:

· D Erosion Control BMPs

D Sediment Control BMPs

D Non-Storm Water BMPs

D Emergency Procedures

D Good Housekeeping BMPs

0 · SWPPP Provisions

D Conducting Inspections

D Turbidity Monitoring

Attendee Roster: [at;tach additional pages as necessary)

WFLHD 157-3.(5/2011)

FEDERAL HI.GHWAY ADMINISTRATION

WESTERN FEDERAL LANDS

IDGHWAY DIVISION

SWPPP TRAINING LOG

Sediment a~d Erosion ControllNPDES Training

Project Name: ____________________ .,.._ ________ _

Course Title:

Instructor's Name(s)/Ti.tle(s): _____________ ...,.,_ ___ ......__ ______ _

Course Location:--------------~--------------

Course Date: ------------ Course Length (hours): ______ _

Training Topics:

D Erosion C~ntrol BMPs

D Sediment Control Bl\1Ps

D Non-Storm Water BMPs

D ·Emergency Procedm·es

D Good Housekeeping BMPs

D ·swPPP Provisions

D Conducting Inspections

D Turbidity Monitoring

Attendee Roster: (attach additional pages as.necessary)

WFLHD 157-3 (5/2011)

D Otber (Specify)

FEDERAL IDGHWAY. ADMINISTRATION

WESTERN FEDERAL LANDS

IDGHWAY DIVISION

SWPPP TRAINING LOG

~ediment and Erosion Control/NPDES Training

Course Title:------------------------------

Instructor·'s Name(s)/Title(s): ________________________ _

Course Date: ------------ Course Length (hours): ______ _

Training Topics: .

0 Erosion Control BMPs

0 · "Sediment Control BMPs

0 Non-Storm Water BMPs

0 Emergency Procedures

0 Good Housekeeping BMPs

0 SWPPP Provisions

0 Conducting Inspections

0 Turbidity Monitodng

Attendee Roster: (attach additio.nal pages as necessary)

WFLBD 157-3 (5/2011)

0 Other (Specify)

FEDERAL IDGHWAY ADMINISTRATION

WESTERN FEDERAL LANDS

HIGHWAY DIVISION

SWPPP TRAINING LOG

Sediment and Erosion Cont.rol/NPDES Training

ProjectName:-------------------'--------~-'---

Course Title:------------------------------

Instructor's Name(s)/Title(s): ____________________________ _

Course Date:. ___________ ._ Course Length (hours): ______ _

Training Topics:

D Erosion Control BMPs

D Sediment Control BMPs

D Non7Storm Water BMPs

D Emergency Procedures

D Good Housekeeping BMPs

D SWPPP Provisions

D . Conducting Inspections

D · Turbidity Monitoring-

Attendee Roster: (attach additional pages q_s necessary)

WFLHD 157-3 (5/2011)

.TAB 13: Waste or Borrow Site Information

Tab 13

ALL STATES

Insert location maps and site maps for aU Government-Selected Waste, Bonow, and Staging Areas.

On site maps, display the locations and types of BMPs used at each site.

TAB 14: Grading and Stabilization Log

Tab 14

ALL STATES

Record in the Grading.and Stabiliza~ion Log the start and end dates of major grading activities and when tempora:ry stabilization was initiated on these sites.

Tempora:ry or permanent soil stabilization is required if no .further disturbance of an area is expected within the next 14 days.

ro ie .c t N am e:

D E

R A

L

ID

G B

W A

Y A

D M

IN

IS

T R

A T

S T

E R

N F

E D

E R

A L

L A

N D

S fi lG H

W A

Y D

IV

IS

P P

P G

R A

D

IN

G A

N D

S T

A B

IL

IZ

A T

IO

N

L a!

!e e G ra di ng

A ct iv it y In it ia te d es cr ip ti on o f G

:r ad in g

A ct iv it y an d L oc at io n

D at e G ra di ng

A d:

iv lt y C ea se d (I n di ra te

T em po ra ri ly o r ,P er m an en tl

D at eM le n ta l:

dl iz at io n

M ea

S1 Jl:

re s bi it ia te d

D es cr ip ti on o f S ta bi li za ti on

M ea su re s

W F

L

II

D

-6

(5 /2

1)

TAB 15: Hazardous Spill Plan

Tab 15

CONTRACTOR:

ALL STATES

Insert Hazardous Spill Plan or SPCC, whichever is applicable to the project.

TAB 16: Agency Cor:respond~nce Permits

Insert Threatened and Endangered Species affects determinations. Reference source documentation such as BA or CE (you may want to file a copy of the CE here, but don't include documents that have specific TES o:r Cultural Resource location information)

If Section 7 Consultation was performed, include USFWS/NMFS concurrence document.

lnse:rt Section 106 Affects Dete:rmination. lndude SHPO Concurrence document.

INCLUDE THIE FOLLOWING STATEMENT:

COI\ITRACTO R:

This information is for SWPPP·documentation only.

·.TAB J7: NPDES·Quality Assurance

·l

·J

Tab .17

This Tab is for GOVERNMENT USE ONLY.

I

Project Reviewed by:

Descdbe present phase of ~onstl(Uction: ·

, NPDES Quality Assurance. Cb,ecklist

Amendment or Modification:

•s the SWPfP s~gnage properly rulld conspicum.nsly posted? OYel; tJNo (Siguage should mclude where the SWPPP is located, who to contact for viewin the SWJ;>PP, and a co of the NOI s . ~ )licable

Are the SWPPP ~~:rntive an(]! plan sheets being updated to accurate~y re~ect tile progress of tl\e ·project?

ClYes ONo . ..

fuspectiollll Frequency Required by SWPPP: DI At least once every l 4 calendar days and within 24 hours of the end of a stonn ~v:.ent of 0.5 inches or eater,.

A:re inspections being performed and docume~ted at the above st~ted frequency? DIYes DINo

· . Are i1m~ ection .re orts inclluded in the ~WJ.l'PP? Qy es ONo Are borrow and/or waste sites dedicated to the project in'spected as part of the SWPPP c<mstniction site · .

inspection? DIYes QNo ·

Arre stormwater ollution controls effective! in lace at borrow and/or waste sjtes? DIYes CINo Are inspections an~ SWPPP documentation signed by·the Signatory Oft~.ial? DIYes D!No (Ensure all SWPPP d<;>ci.µnentation is si ned b.y the Signatory Of:µc;ial designated in T11.b 4 of the SWPPP)

Are- perimeter controls imitaUed before any ground disturbing activities take place? (JY es !JNo

Are temporary aiul permanent erosion contlt'ol )?J;acti,ces properly ~!!!stalled and effectively maintained within th~ :reqnb"e(J. timeframe? ClYes ONo ·

Are temporary and permanent sediment.control practices properly install.ed and effectively midntamed?

OYes ONo . .

If the answer is No to any of t~e a~ove questions, the following co:r:rective action js :recommended:

Are BMPs being selected, installed, implemented, and maintained as stated in the SWPPP? QYes ONo

·Is the SWPPP being updated and revised as needed to address problems and :reflect changes in the contractor's operations? DIY es (JNo (SWPPP must be updated within 7 days of revisions, amendments, and :i;nodificanons) . .

Are the BMPs adequate to minim..ize pollutants in stormwate:r discharge. ne~essa:ry to meet watea' quali,ty standards as stated by the State Water Quality Certification and/or NPDES? 0Yes CJNo (S~ate Water Quality Cei:tif'ication found in Tab 16 of the SWPPP; NPDES permit found in T~ 2 of the SWPPP)

WFLHD 157-1 (2/2011)

1:,' f j f r '

• .o'

18:

(Including NOT) l' • • .1

Tab 18

FHWA

File NOT when construction is concluded and project site is stabilized as defined in

CGP.

Insert copies of NOT and EPA/State Acknowledgement in this Tab.

CONTRACTOR:

ALASKA, IDAHO, AND WASHINGTON PROJECTS ONLY:

File NOT in accordance with contract 107.0lA(g).

Insert copies of NOT and EPA/State Acknowledgement in this Tab.