Section_J_-_Visual_Assessment_template.pdf

Area/Building Number: State: VA Zip Code: 22060

No outfalls):

Substitute Sample?: No

Quarter/Year:

Date & Time Storm or snowmelt

Nature of Discharge: Rainfall

Rainfall amount: Yes No* (explain):

None

None Musty Sulfur Sour

Solvents

Clear Cloudy Opaque

No

No

No

None Globs Sheen Slick

No

No

No

No:

Certification by Field Sampling Personnel that completed the Visual Assessment.

A. Name B. Title

C. Signature

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.

D. Date Signed

* The 72-hour interval can be waived when the previous storm did not yield a measurable discharge or if you are able to document (attach applicable documentation) that less than a 72-hour interval is representative of local storm events during the sampling period.

** Observe for settled solids after allowing the sample to sit for approximately one-half hour.

Sampling not performed due to adverse conditions: Yes (explain:)

Sampling not performed due to no measurable storm event occurring that resulted in a discharge during the monitoring quarter:

Yes (explain):

Detail any concerns, additional comments, descriptions of pictures taken, and any corrective actions taken below

(attach additional sheets as necessary).

Foam (gently shake sample) Yes (describe):

Other Obvious Indicators of Storm

Water Pollution

Yes (describe):

Suspended Solids Yes (describe):

Oil Sheen Flecks Other (describe):

Floating Solids Yes (describe):

Settled Solids** Yes (describe):

Clarity Slightly Cloudy Other (describe):

Snowmelt

Previous Storm Ended > 72 hours Before Start of This Storm

Parameter

Color Other (describe):

Odor

Sewage Petroleum/Gas

Other (describe):

Person(s)/Title(s) examining sample:

Date & Time Sample Collected: Date & Time Sample Examined:

Began:

Person(s)/Title(s) collecting sample:

Fort Belvoir

Outfall Number:

"Substantially Identical Outfall"? Yes (identify substantially identical

Yes (identify quarter/year when sample was originally scheduled to be collected):

Fort Belvoir Quarterly Visual Assessment Form

(Complete a separate form for each outfall you assess)

Name of Facility/Organization: U.S. Army Garrison Fort Belvoir Permit Number: VA0092771

Date:

Time:

Sampler:

Comment:

Date:

Time:

Sampler:

Comment:

Fort Belvoir Quarterly Visual Assessment Form

Photographs