Annual pretreatment inspection checklist
All ius except zero discharge
What does this form include?
This form contains 83 sections:
Inspector Name(s):
Reason for inspection
Permit #:
SIU Permit Signatory:
Section 1 - General Information
Emergency Contact Phone:
Persons present during current inspection
Last inspected by:
Date of last inspection: Date
Date Facility went into operation? Date
Date of initial discharge to POTW: Date
Date of last application/BMR Date
Comments:
Brief description of manufacturing or service activity at this facility:
SIC Codes:
NAIC Codes:
Industrial Category:
Section 2 - Product or Service Information
Applicable Standards:
List products manufactured, indicating the appropriate production units. (Skip if not applicable):
Product
Units
List type and amount of raw materials utilized, indicating the appropriate units:
Material
Total hours per day of operation
Employees / Schedule:
Number of full-time employees:
Number of part-time employees:
Hours of operation
Days of operation:
Section 3 - Production Information
- Monday - Friday
- Monday - Saturday
- Seven days per week
- Other
Total days of production for the latest calendar year:
Water supply information:
Section 4 - Water Use Information
- Public Source
- Surface Water
- Well Water
- Other
List total average daily plant water use (Gallons):
Section 5 - Wastewater Discharge Information
- Is facility connected to the SLC sanitary sewer system?
- Does the facility have more than one sanitary sewer connection to the public sewer?
- Does IU discharge industrial/process wastewater to the POTW?
Source:
Volume currently discharged:
Batch or continuous?
Section 5 (a) - Waste Streams
- Are waste streams separated at the facility?
Section 5 (b) - Pretreatment
- Pretreatment System(s) in use?
Describe the process flow. (Be specific):
Does the pretreatment system provide "continuous" or "batch" treatment?
Section 5 (c) - Pollutants
- Could pollutants potentially be contained in the wastewater?
Which of the above-noted pollutants come into direct contact with water that is discharged to the POTW?
Section 6 - Stored Chemical & Waste Production
- Are liquid chemicals used/stored in quantities of 55 gallons or more and/or dry chemicals in quantities of 500 pounds or more?
Chemical name:
Amount currently stored:
Quantity used:
Time frame for quantity used:
Section 6 (a) - Spill Control
- Does facility have a written Spill/Slug Discharge Control Plan?
Describe any spill control methods or facilities:
Name and title of person responsible for chemicals:
Section 6 (b) - Offsite Disposal
- Are any solid wastes, sludges or other residues generated which require offsite disposal?
Waste:
Amount generated per month GPM:
Waste hauler:
Disposal location:
Section 6 (c) - Management of Toxic Organics
- Is the facility subject to 40 CFR 413 or 433?
Section 7 - Self-Monitoring Sampling & Testing
- Does Industrial User (Permittee) perform all monitoring?
Section 8 - Record Keeping
- Does the Permit require any other reports, such as Zero Discharge Periodic Compliance Reports or TTO certification statements?
Section 9 - Enforcement
- Is the IU presently under an informal/formal enforcement action by Salt Lake City?
- Is the IU under a compliance schedule?
Section 10 - Walk Through
- If visible, are pipes labeled or color coded?
- Are system alarms or shut off valves in place?
Section 10 (a) - Interior Inspection
- Chemicals/Raw Materials - Storage and Use
- Chemicals/Raw Materials - Labeling
- Waste Storage - Containment
- Waste Disposal
- Floor Drains - Location
- Floor Drains - Protected from Pollutants
- Mop Water - Proper Disposal
- Spill Containment Equipment / Spill Kits
- Maintenance shop, storage, garages, etc.
- Pretreatment Equipment - Maintenance
- Pretreatment Equipment - Operation
- Pretreatment Equipment - Authorized
- MSDS - Complete
- MSDS - Available
- Slug/Spill/Emergency Notification Procedures - Posted
- Lab - Plumbing
- Lab - Procedures
- pH meters/ORP Meters - Provided
- pH meters/ORP Meters - Properly Calibrated / Complete Records
- pH meters/ORP Meters - Operation & Maintenance
- Incompatible chemicals - Properly Separated
- Chemical Containment - Adequate
- Flammable Cabinet
- Sampling Points
What manufacturing processes were observed/identified?
Additional Comments:
Section 10 (b) - Exterior Inspection
- Perimeter of Building
- Storm Drains
- Outside Chemical Storage Areas - Containment
- Outside Chemical Storage Areas - Covered
- Grease removal devices
Type
Number of chambers:
Size:
Location:
Date of most recent cleaning Date
By whom?
Cleaning frequency schedule:
Narrative: Describe the pretreatment system at this facility:
Section 11 - Inspection Summary
- Wastewater is free from potential of prohibited pollutant discharges listed in 40 CFR 403.5(b)
- Wastewater is free from potential of pollutant discharges not previously noted.
- Wastewater effluent is not being diluted as a substitute for adequate treatment.
- There is no evidence of spill, upset or bypass.
Note any action items (facility or POTW) and summarize overall observations of the facility:
Information/handouts given to industry (titles: RCRA, Local Limits, etc):
Inspection result:
Additional photo
Inspector Signature:
Permitee Signature (or authorized representative):
Section 12 - Signature Block
- Copy of inspection report to be sent to IU?
Use this template