National Database Information	General
Inspection Type	Inspector Name
NPDES ID Number	Telephone
Inspection Date	Entry Time
Inspector Type

(circle one)	EPA	State	EPA Oversight	Exit Time
Facility Type

(circle one)	Commercial
/Industrial	Residential	Municipal	Signature

Facility Location Information
Name/Location/ Mailing Address
GPS Coordinates	Latitude	Longitude
Receiving Water(s)
Disturbed Area	Start Date	Stop Date

Contact Information
Name(s)	Telephone
Name(s) and Role(s) of All Parties Meeting the Definition of Operator
Facility Contact
Authorized Official(s)

Site Information: (circle all that apply)
Nature of Project	Residential	Commercial/

Industrial	Roadway	Private	Federal	State/ Municipal	Other
Construction Stage	Clearing/ Grubbing	Rough Grading	Infrastructure	Building Const.	Final Grading	Final

Stabilization
Basic Permit Information	Basic SWPPP Information
Permit Coverage

ESO Element 3 & 4	Y

N	SWPPP Prepared & Available

ESO Element 5 & 30	Y	N
Permit Type	General	Individua
l	SWPPP Contents Satisfactory

ESO Elements 5 - 31	Y	N
Permit notice/sign visibly posted including: copy of NOI, contact name & phone number, location of SWPPP

ESO Element 41	Y	N	SWPPP Implementation Satisfactory

ESO Elements 32 - 48

Y	N
NOI Date	SWPPP Date
If applicable, is waiver certifi-
cation & approval on file?	Y	N	Intentionally left blank

SWPPP Review (can be completed in office)
General	Notes:
Is there a SWPPP?

ESO Element 5	Y	N
SWPPP completed prior to NOI submission?

ESO Element 6	Y	N
Copy of permit language?

ESO Element 25	Y	N
Is SWPPP consistent with state/tribal/local regulations and permits?

ESO Element 26	Y	N
SWPPP updated to incorporate changes to State, Tribal, Local erosion plans? ESO Element 27	Y	N
Have copies of inspection reports/all other documentation been retained as part of the SWPPP for 3 years from date permit coverage expires?

ESO Element 28	Y	N
Is a copy of the SWPPP on site or made available?

ESO Element 30	Y	N
Did all "operators" sign/certify the SWPPP?

ESO Element 31	Y	N
Site Description	Notes:
SWPPP identifies potential sources of pollution? ESO Element 7	Y	N
SWPPP identifies all operators and their areas of control? ESO Element 8	Y	N
Is there a site description?

ESO Element 9	Y	N
Nature/sequence of construction activity?

ESO Element 9A - 9B	Y	N
Total area of site and total area to be disturbed?

ESO Element 9C	Y	N
Is there a general location map?

ESO Element 9D	Y	N
Is there a site map?

ESO Element 9E	Y	N

Site Description (cont'd)	Notes:
Drainage patterns/outfalls on site map?

ESO Element 9F	Y	N
Area of soil disturbance on site map?

ESO Element 9F	Y	N
Location of major structural controls on site map?

ESO Element 9F	Y	N
Location of storm water discharges to a surface water on site map?

ESO Element 9F	Y	N
Location of materials or equipment storage on site map (on-site or off-
site)?

ESO Element 9F	Y	N
Location/description industrial activities?

ESO Element 9G	Y	N
Name of Receiving water(s) or MS4 listed?

Y	N	Note: Indicate whether receiving water is 303(d) listed.
Does the SWPPP include dates of major grading activities, temporary/permanent construction cessation, and initiation of stabilization practices?

ESO Element 14	Y	N
Endangered Species Documentation?

ESO Element 23	Y	N
Controls to Reduce Pollutants	Notes:
Does the SWPPP include a description of all pollution control measures (BMPs) that will be implemented to control pollutants in storm water discharges, including sequence and which operator responsible for implementation? ESO Element 10 A - C	Y	N
Does the SWPPP include a description of interim and permanent stabilization

practices (e.g., seeding, mulching, riprap for the site)?

ESO Element 11; 12	Y	N
Controls to Reduce Pollutants (cont'd)	Notes:
Does the SWPPP identify the contractor(s) and timing by which stabilization practices will be implemented?

ESO Element 13	Y	N
Does the SWPPP include a description of structural practices (e.g., vehicle track-out, silt fences, sediment traps, storm drain inlet protection) for the site?

ESO Element 15	Y	N
Does the SWPPP identify the contractor(s) and timing by which structural practices will be implemented?

ESO Element 10B - 10C	Y	N
Does the SWPPP identify storm water management measures to address storm water runoff once the construction is completed (e.g., retention ponds, velocity dissipation controls)?

ESO Element 16	Y	N
Does SWPPP describe measures to prevent discharge of dredge/fill materials to waters of the U.S.? Does site have 404 permit? ESO Element 17	Y	N
Does SWPPP describe measures to minimize off-site vehicle tracking and generation of dust? ESO Element 18	Y	N
Does SWPPP describe controls for pollutants from storage of construction or waste materials? ESO Element 19	Y	N
Does the SWPPP describe controls for pollutants from non-construction activities?

ESO Element 20	Y	N
Does SWPPP identify allowable non-storm water discharges?

ESO Element 21	Y	N
Does SWPPP ensure implementation of pollution prevention measures for non-
storm water discharges?

ESO Element 22	Y	N
Is SWPPP revised when BMPs added/modified within 7 days after inspection reveals problems?

ESO Element 29	Y	N

Inspections	Notes:
Inspections performed once every 7 days, or every 14 days within 24 hours of a rain event greater 0.5"?

ESO Element 32	Y	N
Inspections performed by qualified personnel?

ESO Element 33	Y	N
All disturbed areas and/or used for storage and exposed to rain inspected?

ESO Element 34	Y	N
All pollution control measures inspected to ensure proper operation?

ESO Element 35	Y	N
All discharge locations inspected if accessible, or if not accessible, are nearby downstream locations inspected?

ESO Element 36; 37	Y	N
Entrance/exit inspected for off-site tracking?

ESO Element 38	Y	N
Inspection report contain all required items and certified?

ESO Element 39; 40	Y	N
Notes on SWPPP Review
Site Description:

SWPPP Implementation (complete in field)
Stabilization Practices
List and describe stabilization practices

ESO Element 43, 48

(e.g., seeding, mulching, geotextiles, sod stabilization)

Are stabilization measures initiated no more than 14 days after temporary or permanent construction cessation?

ESO Element 46

(e.g., indicate "yes" or "no"; if "yes", how long without stabilization measures?)

Structural Practices
List and describe structural controls

ESO Element 42, 43, 47	(e.g., silt fences, hay bales, storm drain inlet protection, sedimentation pond, rip rap, check dam, diversion structure, off-site vehicle track-out)

Non-Structural Practices
Street Cleaning

ESO Element 44	(e.g., describe measures taken to remove offsite accumulation of sediment)

Good Housekeeping & Waste Disposal Practices

ESO Element 45	(e.g., describe measures taken to prevent litter and debris from becoming a pollutant source)

Non-Structural Practices (cont'd)
Equipment Wash/ Maintenance Area

ESO Elements 43	(provide brief description)

Concrete Washout Areas

ESO Elements 43	(provide brief description)

Miscellaneous
Evidence of Sediment Deposition to Surface

Waters

*ESO Eligibility - if "yes," site not eligible for ESO	(e.g., significant turbidity observed in a receiving water body)

Pollution prevention measures for non-
storm water discharges?

*ESO Eligibility - If evidence of non-allowable non-storm water discharges, site not eligible for ESO	(provide brief description and determine whether/if non-storm water discharges allowable)

Miscellaneous (cont'd)
Has implementation of additional/modified BMPs been completed before next anticipated storm event?

ESO Element 43.C.1	(provide brief description)
Notes on SWPPP Implementation
Photograph Log
1.	*Insert additional rows as needed