NCG190057_COMPLETE FILE - HISTORICAL_20100318

STORMWATER DIVISION CODING -SHEET
RESCISSIONS .
PERMIT NO..
LV Vl .n
DOC TYPE
COMPLETE FILE - HISTORICAL
DATE OF
RESCISSION
❑
YYYYMMDD

North Carolina
Beverly Eaves Perdue, Govemor
Robert A. Scarpena
100 Quality Drive
Navassa, NC 28451
Dear Mr. Scarpena,
AMA.
NC®ENR
Department of Environment and
March18, 2010
Natural Resources
Subject: NPDES Compliance Evaluation Inspection
NPDES Permit CDC NCG190057
Brunswick County
Dee Freeman, secretary
A compliance evaluation inspection of the Sea Ray facility was conducted on March 15, 2010. This inspection was to verify that the
facilities are operating in compliance with the requirements specified in the NPDES General Permit NCG 190000, The findings and
comments noted during this inspection are provided in the enclosed copy of the inspection report entitled "Compliance Inspection
Report".
The facility does not appear to have any industrial activity. Please contact this office if you would like to pursue a no exposure or
would like to request rescission of the permit. Should you have any questions concerning this correspondence or the enclosed
inspection report, please contact me at 910-796-7343,
Sincerely,
Linda Willis
Wilmington Regional Office
Division of Water Quality
Surface Water Protection Section
CC: WiRO NPDES NCG 190 Brunswick
CO DWQ files
One
NorthCarolina
Naturally
1601 Mail Sarvica Center, Raleiah, Norlh Carolina 27699-1601
Phone: [phone],841 FAX: [phone] Internet: vrww.enr.staie.nc.us/ENRI
An Erpu;l Opco,n miry l AIE�rotative A.dirnt Employer 50'%, RM:jdod 110 /, Post CCnsnmer Prn+er

Permit: NCG190057
SOC:
County: Brunswick
Region: Wilmington
Compliance Inspection Report
Effective:09/01/04 Expiration: 08/31/09
Effective: Expiration:
Contact Person: Robert A Scarpena
Directions to Facility:
System Classifications:
Primary ORC:
Secondary ORC(s):
On -Site Representative(s):
Related Permits:
Title:
Certification:
Owner: US Marine
Facility: US Marine
100 Quality Dr
Navassa NC 28451
Phone:[phone]
Phone:
Inspection Date: 03/15/2010 Entry Time: 09:00 AM Exit Time: 09:20 AM
Primary Inspector: Linda Willis .,r„ lam. )f' Phone: [phone]
Secondary Inspector(s):
Reason for Inspection: Routine Inspection Type: Compliance Evaluation
Permit Inspection Type: Ship and Boat Building Stormwater Discharge COC
Facility Status: El Compliant ❑ Not Compliant
Question Areas:
® Storm water
(See attachment summary)
Page:1

Permit: NCG190057 Owner -.Facility: US Marine
Inspection Date: 03/15/2010 Inspection Type: Compliance Evaluation Reason for Visit: Routine
Inspection Summary:
The site is closed, no activity, abandoned building. No exposure threat to stormwater concerning the operation was seen
by Division Representative Linda Willis and Jean Conway.
Page:2

Mr. Bob Scarpena
US Marine
100 Quality Drive
Navassa, NC 28451
Dear Mr. Scarpena:
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
Coleen H. Sullins, Director
Division of Water Quality
June 16, 2008 R- I-E C T-L'I V ED
JUN 1.8 2008
BY:
Subject: NPDES General Permit NCG190000
Certificate of Coverage NCG 190057
US Marine
Formerly KCS International, Inc.
Brunswick County
Division personnel have reviewed and approved your request to transfer coverage under the General Permit,
received on February 22, 2008.
Please find enclosed the revised Certificate of Coverage. The terms and conditions contained in the General
Permit remain unchanged and in full effect. This revised Certificate of Coverage is issued under the requirements
of North Carolina General Statutes 143-215.1 and the Memorandum of Agreement between North Carolina and
the U.S. Environmental Protection Agency.
If you have any questions, please contact the Stormwater Permitting Unit at [phone], extension 502.
Sincerely,
ORIGINAL SIGNED BY
KEN PICKLE
Coleen H. Sullins
cc: DWQ Central Files
Wilmington Regional Office
Stormwater Permitting Unit
`
rCarolina
urn!/y
North Carolina Division of Water Quality 1617 Mail Service Center Raleigh, NC 27699-1617 Phone [phone] Customer Service
Internet: h2o.encstale,nc.us 512 N. Salisbury St. Raleigh, NC 27604 FAX [phone]
An Equal Opportunity/Affirmative Action Employer — 50% Recycledl10% Post Consumer Paper

if .%
STATE OF NORTH CAROLINA
DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES
DIVISION OF WATER QUALITY
GENERAL PERMIT NO. NCG190000
CERTIFICATE OF COVERAGE No. NCG190057
STORMWATER DISCHARGES
NATIONAL POLLUTANT DISCHARGE ELIMINATION SYSTEM
In compliance with the provision of North Carolina General Statute 143-215.1, other lawful standards and
regulations promulgated and adopted by the North Carolina Environmental Management Commission, and the
Federal Water Pollution Control Act, as amended,
US MARINE
is hereby authorized to discharge stormwater from a facility located at
US MARINE
100 QUALITY DRIVE
NAVASSA
BRUNS W ICK COUNTY
to receiving waters designated as the Cape Fear River Basin in accordance with the effluent limitations, monitoring
requirements, and other conditions set forth in Parts I, II, III, IV, V, and VI of General Permit No. NCG 190000 as
attached.
This certificate of coverage shall become effective June 16, 2008.
This Certificate of Coverage shall remain in effect for the duration of the General Permit.
Signed this day June 16, 2008.
ORIGINAL SIGNED BY
KEN PICKLE
Coleen H. Sullins, Director
Division of Water Quality
By Authority of the Environmental Management Commission

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Copyright (C) 1997, Maptech, Inc

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
Industrial SWPPP Template
Introduction
To help you develop a SWPPP that is consistent with the 2008 MSGP, the U.S Environmental Protection
Agency (EPA) has created this Industrial SWPPP Template (or, "the Template"). Use of the Template will
help ensure that your SWPPP addresses all the necessary elements required in Part 5 of the 2008 MSGP.
Before completing the Template, make sure you read and understand the requirements in the 2008 MSGP.
A copy of the MSGP is available at www.epa.gov/npdes/stormwater/msqp.
Using the Industrial SWPPP Template
Tips for completing the Template:
• This Template is designed for use by all facilities eligible for coverage under the 2008
MSGP. The Template is NOT tailored to your individual industrial sector. Depending on
which industrial sector you fall under (see Appendix D of the 2008 MSGP) and on where
your facility is located (see Appendix C of the 2008 MSGP), you will need to address
additional SWPPP requirements outlined in Part 8 and/or Part 9 of the permit, respectively.
• Complete a SWPPP before submitting your Notice of Intent (NO1) for permit coverage.
• Each section includes "instructions" and space for your facility's specific information.
You should read the instructions for each section before you complete that section.
• The Template was developed in Microsoft Word so that you can easily add tables and
additional text. Some sections may require only a brief description while others may
require several pages of explanation.
• To make it easier to complete, the Template generally uses blue text where the operator is
expected to enter information.
EPA notes that while EPA has made every effort to ensure the accuracy of all instructions and guidance
contained in the Template, the actual obligations of regulated industrial facilities are determined by the
relevant provisions of the permit, not by the Template. In the event of a conflict between the Template and
any corresponding provision of the MSGP, the permit controls. EPA welcomes comments on the Template
at any time and will consider those comments in any future revision of this document.
EPA Industrial SWPPP Template, January 13, 2009

Stormwater Pollution Prevention Plan (SWPPP)
INSERT 17ACII-ITY NAME and DATE
Stormwater Pollution Prevention Plan
for:
Insert Facility Name
Insert Facility Address
Insert City, State, Zip Code
Insert Facility Telephone Number (if applicable)
SWPPP Contact(s):
Insert Facility Operator
Insert Name
Insert Address
Insert City, State, Zip Code
Insert Telephone Number
Insert Fax/Email
SWPPP Preparation Date:
EPA Industrial SWPPP Template, January 13, 2009

t
Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME" and DATE
Contents
SECTION 1: FACILITY DESCRIPTION AND CONTACT INFORMATION......................................................1
1.1
Facility Information.................................................................................................................
1
1.2
Contact Information/Responsible Parties................................................................................
?3
1.3
Stormwater Pollution Prevention Team..................................................................................
33
1 A
Activities at the Facility.........................................................................................................
33
1.5
General Location Map..........................................................................................................
44
1.6
Site Map..............................................................................................................................»
SECTION
2: POTENTIAL POLLUTANT SOURCES.....................................................................................66
2.1
Industrial Activity and Associated Pollutants...........................................................................
66
2.2
Spills and Leaks...................................................................................................................
7-7
2.3
Non-Stormwater Discharges Documentation..........................................................................
7-7
2.4
Salt Storage........................................................................................................................
88
2.5
Sampling Data Summary ......................................................................................................
88
SECTION
3: STORMWATER CONTROL MEASURES.................................................................................88
3.1
Minimize Exposure...............................................................................................................
99
3.2
Good Housekeeping.............................................................................................................
99
3.3
Maintenance........................................................................................................................94
3.4
Spill Prevention and Response..........................................................................................
101-0
3.5
Erosion and Sediment Controls.........................................................................................
104-0
3.6
Management of Runoff.....................................................................................................
101-0
3.7
Salt Storage Piles or Piles Containing Salt.........................................................................
1144
3.8
MSGP Sector -Specific Non -Numeric Effluent Limits............................................................
1144
3.9
Employee Training...........................................................................................................1144
3.10
Non-Stormwater Discharges.............................................................................................
1 144
3.11
Waste, Garbage and Floatable Debris...............................................................................
124-2-
3.12
Dust Generation and Vehicle Tracking of Industrial Materials ...............................................
121-3
SECTION
4: SCHEDULES AND PROCEDURES FOR MONITORING.....................................................1343
SECTION
5: INSPECTIONS.......................................................................................................................1545
SECTION
6: DOCUMENTATION TO SUPPORT ELIGIBILITY CONSIDERATIONS UNDER OTHER
FEDERALLAWS.......................................................................................................................................1646
6.1
Documentation Regarding Endangered Species.................................................................
1646
6.2
Documentation Regarding Historic Properties.....................................................................
1164-6
6.3
Documentation Regarding NEPA Review (if applicable)......................................................
164-6
SECTION
7: SWPPP CERTIFICATION.....................................................................................................16U
SECTION
8: SWPPP MODIFICATIONS....................................................................................................1848
SWPPP ATTACHMENTS...........................................................................................................................1949
Attachment A - General Location Map
Attachment B - Site Maps
Attachment C - 2008 MSGP
EPA Industrial SWPPP Template, January 13, 2009 ii

Stormwater Pollution Prevention Plan (SWPPP)
INSERTFACILITY NAME and DATE
i
SECTION 1: FACILITY DESCRIPTION AND CONTACT INFORMATION
1.1 Facility Information
Facility Information
Name of Facility:
Street:
City: State: ZIP Code:
County or Similar Subdivision:
Permit Tracking Number: (if covered under a previous permit)
Latitude/Longitude (Use one of three possible formats, and specify method)
Latitude: Longitude:
1. _ _ ° _ _' _ _" N (degrees, minutes, seconds) 1. _ _ ° _ _' _ _" W (degrees, minutes, seconds)
2. _ _ ° _ _ . _ _' N (degrees, minutes, decimal) 2. _ _ ° _ _ . _ _' W (degrees, minutes, decimal)
3. _ _ .----IN (decimal) 3. _ _ . _ _ _ _ ° W (decimal)
Method for determining latitude/longitude (check one):
❑ USGS topographic map (specify scale: ) ❑ EPA Web site ❑ GPS
❑ Other (please specify):
Is the facility located in Indian Country? ❑ Yes ❑ No
If yes, name of Reservation, or if not part of a Reservation, indicate "not applicable."
Is this facility considered a Federal Facility? ❑ Yes ❑ No
Estimated area of industrial activity at site exposed to stormwater:
Discharge Information
EPA Industrial SWPPP Template, January 13, 2009
(acres)

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME -and DATE
Does this facility discharge stormwater into an MS4? ❑ Yes ❑ No
If yes, name of MS4 operator: _
Name(s) of water(s) that receive stormwater from your facility
Are any of your discharges directly into any segment of an "impaired" water? ❑ Yes ❑ No
If Yes, identify name of the impaired water (and segment, if applicable):
Identify the pollutant(s) causing the impairment:
For pollutants identified, which do you have reason to believe will be present in your discharge?
For pollutants identified, which have a completed TMDL?
Do you discharge into a receiving water designated as a Tier 2 (or Tier 2.5) water? ❑ Yes ❑ No
Are any of your stormwater discharges subject to effluent guidelines? ❑ Yes ❑ No
If Yes, which guidelines apply?
Primary SIC Code or 2-letter Activity Code:
(refer to Appendix D of the 2008 MSGP)
Identify your applicable sector and subsector:
1.2 Contact Information/Responsible Parties
Instructions:
— List the facility operator(s), facility owner, and 24 hour emergency contact. Indicate respective
responsibilities, where appropriate:
— You will need the information from this section of the SWPPP Template for your NOI.
— Refer to Section B of the NOI instructions (available in Appendix G of the 2008 MSGP).
Facility Operator (s):
Name: Insert Name
Address: Insert Address
City, State, Zip Code: Insert City, State, Zip Code
Telephone Number: Insert Telephone Number
Email address: Insert email address
Fax number: Insert fax number (optional)
Facility Owner (s):
Name: Insert Name
Address: Insert Address
City, State, Zip Code: Insert City, State, Zip Code
EPA Industrial SWPPP Template, January 13, 2009 2

Stormwater Pollution Prevention Plan (SWPPP) ;
INSERT FACILITY NAME and DATE
Telephone Number: Insert Telephone Number
Email address: Insert email address
Fax number: Insert fax number (optional)
SWPPP Contact:
Name: Insert SWPPP Contact Name
Telephone number: Insert Telephone Number
Email address: Insert email address
Fax number: Insert fax number (optional)
1.3 Stormwater Pollution Prevention Team
Instructions (see 2008 MSGP Part 5.1.1)`.
— Identify the staff members (byname or title) that comprise the facility's stormwater pollution prevention team
as well as their individual responsibilities.
Your stormwater pollution prevention team is responsible for assisting the facility manager in developing and
revising the facility's SWPPP, implementing and maintaining control measures/BMPs, and taking corrective,
actions where required. Each member of the stormwater pollution prevention team must have ready access
to either an electronic or paper copy.of applicable portions of the MSGP and your SWPPP.
Staff Names
Individual Responsibilities
Insert name of SWPPP team
member
Insert explanation of that staff person's responsibilities relating to
compliance with the permit
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
1.4 Activities at the Facility
Instrdctioris (see 2008 MSGP Part 5°11):'
Provide'a general description of the nature of the industrial activities at your facility .
Insert text here
EPA Industrial SWPPP Template, January 13, 2009 3

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE:
1.5 General Location Map
Instructions (see 2008 MSGP Part 5.1.2):
Provide a general location map (e.g., U:S. Geological Survey (USGS)`quadrangle map) with enough detail to
identify the location of your facility and all receiving waters for your stormwater discharges (include as
Attachment A of this SWPPP Template).
Include a copy of the general location map for this facility in Attachment A.
EPA Industrial SWPPP Template, January 13, 2009

Stormwater Pollution Prevention Plan (SWPPP) r
INSERT FACILITY NAME and DATE
1.6 Site Map
Instructions (see:2008.MSGP Part5.1.2):
Include a map showing the followinginformation. The site map should be included as Attachment B
of thisSWPPP Template:
the size of the property in acres;
■ the location and extent of'significant structures and impervious surfaces;
• directions of stormwater flow (use arrows);
■, locations of all existing structural control measures;
• locations of all receiving waters in the immediate vicinity of your facility, indicating if any of the
waters are impaired and, if so, whether the waters have TMDLs established for them_ ;
■ locations of all stormwater conveyances including ditches, pipes, and swales;
■ locations of potential pollutant sources identified under MSGP, Part 5.1.3.2;
• locations where significant spills or leaks identified under MSGP, Part 5.1.3.3 have occurred;
• locations of all stormwater monitoring points;
■ . locations of stormwater inlets and outfalls, with a unique identification code,for each outfall
(e.g:, OutfalLNo. 1, No. 2, etc), indicating if you are treating one or more outfalls as -
"substantially identical" under MSGP; Parts 4.2.3, 5.1.5.2, and 6.1.1, and an approximate
outline of the areas draining to,each outfall;
" ■ 'municipal separate storm sewer systems, where your stormwater discharges to them;,
locations"and descriptions of all non-stormwater discharges identified under MSGP, Part
21.210;
locations of the following activities where such activities are exposed to precipitation:
o " fueling stations;
o vehicle and equipment"maintenance,and/or cleaning areas,
o loading/unloading areas;
o locations used for the treatment;`storage, or disposal of wastes;
� ouid,stor"ge '
. , li g atanks; .. ...
o processing, and storage areas;
o " immediate, access'roads and rail lines used or traveled bycarriers of raw materials,
manufactured products, waste material, or by products used or created by the facility;
o transfer, areas for substances in bulk; .
o., machinery; and
locations and sources Y 1 P P Y, contains significant
quantities of ollutantsof run-on to, our site from ad;acent ro ert that contai f
Include a copy of the site map for this facility in Attachment B.
EPA Industrial SWPPP Template, January 13, 2009

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
SECTION 2: POTENTIAL POLLUTANT SOURCES
Instructlons (see 2008 MSG P Part 51 3)K.
— ° In this section you are regmred to dekribde a,reas at your facili 'where"industrial dmatenals or activities are
p to stormwater or from which allowable non stormwater discharges are`released.
exposed
�F
2.1 Industrial Activity and Associated Pollutants
Instructlons (see 2008 MSGP Parts 51 31 and 51 3 2 f Js
Ld@ 91 :IY�d; d F ddi ilbtVdF :'
Include a'Ilst of industnal activities exposed to stormwaler (e g matenal storagi3egwpment/vehicle fueling
maintenance ,and cleamng `cutting steel beams)'arid the poll�gtatoFpollutant constltuentsl(esg f motor oil
fuel battery acid and cleamng solvents) associated with t 6Wactiwties ' ' `} F s
h do 61f" Ei i 4it3{'� dl lsa WF d ad33 d a 1 t e
— In ygilf list of pollutantsiassoclated with yourmdustnal activities llnclFude,allislgnl5cant matenals that have
mwv
been handledrtreated stored or disposed and that have been exposed tostormwater In the 3 years pnorto
....y: :I.
the date you prepare -yourP..SWPPP
Industrial Activity
Associated Pollutants
Insert specific industrial activity
Insert names of pollutants or pollutant constituents
that could be associated with this activity and
released in stormwater
Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
EPA Industrial SWPPP Template, January 13, 2009 6

Stormwater Pollution Prevention Plan (SWPPP) ;
INSERT FACILITY NAME and DATE
2.2 Spills and Leaks
Instructions (See,2008 MSGP Part 5.1.3.3): ,
Include the following in this section:
.o Potential,spills and leaks: A description -of where potential spills and leaks could occur at your
site that could contribute pollutants to your stormwater discharge, and specify which ouffall(s) are'
likely to be affected bysuch spills and leaks.
o.., Past spills and leaks: A description of significant spills and leaks in the past 3 years of oil or toxic,
or hazardous pollutants that actually occurred at exposed areas, or that draineflo a stormwater
conveyance.
Note: Significant spills and leaks include, but are not limited to, releases of oil or hazardous substances in
excess of quantities that are reportable under CWA Section. 311 (see 40 CFR I'10.6 and.40 CFO 117.21) or
Section 102 of the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA), 42
USC §9602.
Areas of Site Where Potential Spills/Leaks Could Occur
Location Outfalls
Insert description of area where spill/leak could occur Specify which outfall(s) would be
affected
[Repeat as necessary] [Repeat as necessary]
[Repeat as necessarvl fReoeat as necessarvl
[Repeat as necessary] ] [Repeat as necessary]
Description of Past Spills/Leaks
Date Description Outfalls
Insert date of Insert description of spill/leak (where it occurred, what Specify which outfall(s)
spill/leak happened, types of pollutants, extent of damage) were affected
[Repeat as [Repeat as necessary] [Repeat as necessary]
[Repeat as I [Repeat as necessary] I [Repeat as
[Repeat as I [Repeat as necessary] I [Repeat as necessary]
necessary]
2.3 Non-Stormwater Discharges Documentation
Inst ructions.(see 2008'MSGP Part 51.3.4):. .
The questions below, require you'to provide documentation of the following
o Your evaluation for, the presence of non-stormwater discharges at your site; and `
o "Your elimination of any unauthorized non-stormwater discharges.
EPA Industrial SWPPP Template, January 13, 2009 7

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
• Date of evaluation: Insert the date(s) of your evaluation.
• Description of the evaluation criteria used: Describe the method you used to conduct your
evaluation and to determine for each non-stormwater sources whether it is prohibited or allowed
under the permit.
• List of the outfalls or onsite drainage points that were directly observed during the evaluation: Insert
outfalls/drainage points observed.
• Different types of non-stormwater discharge(s) and source locations: Describe types of non-
stormwater discharges observed and the corresponding outfall or drainage point.
• Action(s) taken, such as a list of control measures used to eliminate unauthorized discharge(s), if
any were identified. For example, a floor drain was sealed, a sink drain was re-routed to sanitary,
or an NPDES permit application was submitted for an unauthorized cooling water discharge:
Describe actions taken to eliminate unauthorized non-stormwater discharges and the
corresponding outfall/drainage point affected.
2.4 Salt Storage
Instructions (see, 2008IMSGP Part 5.1.3.5):
Document the location of any storage piles containing salt used for deicing or other commercial or industrial
purposes.
- Note: You will be asked additional questions concerning salt storage in Section 3.7 of this SWPPP template,
below.`
Insert description of the location of any storage piles containing salt.
2.5 Sampling Data Summary
Instructions (See 2008 MSGP Part 5.1.3.6):
summari
ze all stormwater sampling data collected,from your permitted outfalls during the previous permit
term.
Insert summary of stormwater sampling data collected for the past permit, and/or attach discharge
monitoring reports or laboratory results.
SECTION 3: STORMWATER CONTROL MEASURES
Instructions (See 2006 MSGP Pans 5.1.4.1 and 2.1.2):
that you have installed at our site to meet each of the permit's "non -numeric
— In Sections 3.1 - 3.12 of this SWPPP tem late,' ou are asked'to describe thestormwater control measures .
y y p � effluent limits" In Part 2.1.2 of ,
the 2008 MSGP.
f . °
EPA Industrial SWPPP Template, January 13, 2009

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
3.1 Minimize Exposure
Instructions (see 2008 MSGP Part 2.1.2.1):
Describe any structural controls or practices used to minimize the exposure of industrial activities t — o rain,
snow, snowmelt, and runoff. Describe where the controls or practices are being implemented at your site.
INSERT DESCRIPTION OF CONTROL MEASURES HERE,
3.2 Good Housekeeping
Instructions (see 2008 MSGP Parts 2.1.2.2 and.5.1.5.1):
'Describe any practices you are implementing to keep exposed areas of your site clean. Describe where each
practice is being implemented at,your site. Include here your schedule for: (1) regular pickup and disposal of
waste materials, and (2) routine inspections for leaks and of the condition of drums, tanks, and containers.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.3 Maintenance
Instructions (see 2008 MSGP Parts 2.1.2.3 and5.1.5.1):
— Describe procedures (1) to maintain industrial equipment so that spills/leaks are avoided, and (2) to maintain
any of your site's control measures in effective operating condition. Include the schedule you will follow for
such maintenance activities. Describe where „each applicable procedure is being implemented at the site.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
EPA Industrial SWPPP Template, January 13, 2009

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
3.4 Spill Prevention and Response
Instructions (see 2008 MSGP Parts 2.1.2.4 and 5.1`.5.1):
Describe any structural controls or procedures used to minimize the potential for leaks, spills, and other
releases.. You mustiimplement the following at a minimum:
• Procedures for plainly labeling containers (e.g., "Used Oil," "Spent Solvents," "Fertilizers and
Pesticides,° etc.) that could be susceptible to spillage or leakage to encourage proper handling and
facilitate raid response if spills or leaks occur;
Preventative measures such as barriers between material storage and traffic areas, secondary.
containment provisions, and procedures for material storage and handling;
Procedures for expeditiously stopping, containing, and cleaning up leaks, spills, and other releases; and
Procedures'for,notification of appropriate facility personnel, emergency response agencies, and
regulatory agencies.
Describe where each'control is to be located or where applicable'procedures will be implemented.
Note: Some facilities may be required to develop a Spill Prevention Control and Countermeasure (SPCC)
plan under a separate regulatory program (40 CFR 112): If you are required to develop an SPCC plan, or
you already have one; you should include references to the relevant requirements from your plan,
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.5 Erosion and Sediment Controls
Instructions (see 2068 MSGP Part 2.11.5):
Describe structural or non-structural controls used at your site to stabilize exposed areas and contain runoff to
minimize'onsite erosion and potential offsite discharges. of sediment. Note: You must at a minimum implement
flow velocity dissipation devices at outfalls and discharge channels. Describe the location at your site where
each control will be implemented.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.6 Management of Runoff
Instructions ( See 2008 MSGP Part 2your
" ter'runoff.
Describe controls used at oursite to divert, infiltrate; reuse, contaln;;or otherwise reduce stormwa
Describe the location at your site where each control will be implemented.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
EPA Industrial SWPPP Template, January 13, 2009 10

Stormwater Pollution Prevention Plan (SWPPP) ;
INSERT FACILITY NAME and DATE
3.7 Salt Storage Piles or Piles Containing Salt
Instructions (see, 2008 MSGP Part 2.1.2.7).
If applicable, descnlie structures at your site that either cover or enclose salt storage piles or piles containing salt,
or that prevent the discharge of stormwater from'such piles. Also, describe any controls or procedures used to
minimize exposure resulting from adding to or removing materials from the pile. Describe the location at your site
where each control^and/or procedure will be implemented.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.8 MSGP Sector -Specific Non -Numeric Effluent Limits
Instructions (see 2008 MSGP Part 2.1..2.8):
Describe any controls orprocedures that will,be used at your site to comply with.any sector -specific
requirements that apply to you in Pan 8 of the 2008 MSGP. Describe the location at your site where
each control and/or procedure will be implemented.
Note: Sector -specific effluent limits apply to Sectors A, E,`F, G, H, 111, M,N, 0, P, Q, R, S, T,'U, V, X,
Y, Z, and AA,
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.9 Employee Training
Instructions (see 2008 MSGP,Parts 2.1.2.9 and 5.1.5.1):1
Describe your plan^for training the employees who work in areas where industrial materials or activities are
exposed to stormwater, or, who are responsible:for implementing activities necessary to meet the conditions of
the 2008 MSGP, including all:members of your pollution Prevention Team IncludW,in your description must be
the frequency.of training (note: °recommended at least one time peryear), and the schedule you will follow.'
INSERT DESCRIPTION OF PLAN FOR TRAINING APPLICABLE STAFF HERE.
3.10 Non-Stormwater Discharges
Instructions (see 2008 MSGP 2.1:2.10):
Describe how you eliminated any unauthorized horn stor1.mwater discharges at your site. The unauthorized non-"
stormwater discharges include any non-stormwater discharges that are not specifically identified in Part 1.1,3 of. ,
the 2008 MSGP Note'. If this section is already addressed by your documentation for Section 2.3 of the SWPPP
template you,can simply include a cross reference to that wction'of your SWPPP ^,` ^
INSERT DESCRIPTION OF YOUR APPROACH TO ELIMINATING UNAUTHORIZED NON-
STORMWATER DISCHARGES HERE.
EPA Industrial SWPPP Template, January 13, 2009

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
3.11 Waste, Garbage and Floatable Debris
Instructions (see 2008 MSGP.Part 2.1.2.11):
Describe controls and procedures that will be used at your site to minimize discharges of waste, garbage, and
floatable debris. Describe the location at your site where each control and/or procedure will be implemented.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.12 Dust Generation and Vehicle Tracking of Industrial Materials
Instructions (see 2008 MSGP Part 2.1.2.12):
Describe controls and procedures you will use at your site to minimize the generation of dust and off -site tracking
of raw, final, or waste materials. Describe the location at your site where each control and/or procedures will be
implemented: "
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
EPA Industrial SWPPP Template, January 13, 2009 12

Stormwater Pollution Prevention Plan (SWPPP) i
INSERT FACILITY NAME and DATE
SECTION 4: SCHEDULES AND PROCEDURES FOR MONITORING
Instructions (see 2008 MSGP Part 5.1.5.2):
Describe your procedures for conducting the five types of analytical monitoring specified by the MSGP,,
where applicable to your facility, including:,
• , Benchmark monitoring (2008 MSGP, Part 6.2.1 and relevant requirements in Part 8 and/or Part 9);
Effluent limitations guidelines monitoring (2008 MSGP, Part 6.2.2 and relevant requirements in Part 8);
State- or Tribal -specific monitoring (2008 MSGP, Part 6.2.3 and relevant requirements in Part 9);„
Impaired waters monitoring (2008. MSGP; Part 6.2.4); and
Other monitoring as required by EPA (2008 MSGP, Part 62.5).
Depending on the type of facility you operate, and the monitoring requirements to which you are subject, you
must collect and analyze stormwater samples and document monitoring activities consistent with the
procedures described in 2008 MSGP, Part 6 and Appendix B, Subsections`10 —12, and any additional
sector -specific or StatelTribal-specific requirements in 2008 MSGP, Parts 8 and 9, respectively. Refer to
2008 MSGP, Part 7 for reporting and recordkeeping requirements. Note: All monitoring must be conducted
in accordance with the relevant sampling and analysis requirements at 40 CFR Part 136. Include in your
description_ procedures for ensuring compliance with these requirements.
If you are invoking the exception for inactive and unstaffed sites for benchmark monitoring, you mustinclude
in your SWPPP the information to support this claim as.required by 2008 MSGP, Part 6.2.1.3.
If.you plan to'use the substantially identical ouffall exception for your benchmark monitoring requirements in
2008 MSGP; Part 6.2.1 and/or your quarterly visual assessment:requirements in 2008 MSGP, Part 4.2.3,
you must include the following documentation:
• . Location of each of the substantially identical outfalls;
Description of the general industrial activities conducted in the drainage area'. of each ouffall;
" • Description of the control measures implemented in the drainage area of each ouffall;
• Description of the exposed materials located in the drainage area of each ouffall that are likely to be .
significant contributors of pollutants to stormwater discharges
• An estimate of the runoff coefficient of the drainage areas (low = under 40%; medium = 40 to 65%; high
above 65%); and
` • Why the ouffalls;are expected to discharge substantially identical,effiuents.
For each type of monitoring, your SWPPP must include a description of:
1. Sample Location(s). Describe where samples will be collected, including any determination that two or
more ouffalls are substantially identical. INSERT TEXT HERE.
2. Pollutant Parameters to be Sampled. Include a list of the pollutant parameters that will be sampled and
the frequency of sampling for each parameter. INSERT TEXT HERE
3. Monitoring Schedules. Include the schedule you will follow for monitoring your stormwater discharge,
including where applicable any alternate monitoring periods to be used for facilities in climates with irregular
stormwater runoff (2008 MSGP, Part 6.1.6). INSERT TEXT HERE
EPA Industrial SWPPP Template, January 13, 2009 13

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
4. Numeric Limitations. List here any pollutant parameters subject to numeric limits (effluent limitations
guidelines), and which outfalls are subject to such limits. Note that numeric limits are only included for
Sectors A, C, D, E, J, K, L, and 0. INSERT TEXT HERE
5. Procedures. Describe procedures you will follow for collecting samples, including responsible staff who will
be involved, logistics for taking and handling samples, laboratory to be used, etc. INSERT TEXT HERE
Note: It may be helpful to create a table with columns corresponding to # 1 - 5 above for each type of monitoring you
are required to conduct.
Inactive and Unstaffed sites exception (if applicable)
If you are invoking the exception for inactive and unstaffed sites for benchmark monitoring, include information to
support this claim.
INSERT TEXT HERE
Substantially identical outfall exception (if applicable)
If you plan to use the substantially identical outfall exception for your benchmark monitoring and/or quarterly visual
assessment requirements, include the following information here to substantiate your claim that these outfalls are
substantially identical:
• Location of each of the substantially identical outfalls: INSERT TEXT HERE
• Description of the general industrial activities conducted in the drainage area of each outfall: INSERT TEXT
HERE
• Description of the control measures implemented in the drainage area of each outfall: INSERT TEXT HERE
• Description of the exposed materials located in the drainage area of each ouffall that are likely to be
significant contributors of pollutants to stormwater discharges: INSERT TEXT HERE
• An estimate of the runoff coefficient of the drainage areas (low=under 40%; medium=40 to 65%; high
=above 65%): INSERT TEXT HERE
• Why the outfalls are expected to discharge substantially identical effluents: INSERT TEXT HERE
EPA Industrial SWPPP Template, January 13, 2009 14

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
SECTION 5: INSPECTIONS
Instructions:
Describe your procedures for performing the three types of inspections required by the 2008 MSGP,
including:
• Routine facility nspections.(2008 MSGP; Part 4.1);
• : Quarterly visual assessment of stormwater discharges (2008 MSGP, Part 4.2); and
• Comprehensive site inspections (2008 MSGP, Part 4.3).
If youare invoking the exception for inactive and unstaffed sites relating to routine facility inspections and
quarterly visual assessments, you must'include in your SWPPP the information to support this claim as
required by 2008 MSGP,'Parts 4,1.3 and 4.2.3.
pa�mp!.e routine
(www.6agov/npdes/stormwater/msgp) in the 'Additio al MSGP Documentation" webs efacility p lassessment form Iavailable n EPA's MSGP
on" file. Appendix I of
the 2008 MSGP includes a comprehensive site inspection form (Annual Reporting Form).
For the routine facility inspections and the comprehensive site inspections to be performed at your site, include a
description of the following:
The names of the person(s), or the positions of the person(s), responsible for inspection: INSERT TEXT
HERE
The schedules to be used for conducting inspections. Include here any tentative schedule that will be used
for facilities in climates with irregular stormwater runoff discharges (2008 MSGP, Part 4.2.3): INSERT TEXT
HERE and
Specific areas of the facility to be inspected, including schedules for specific outfalls: INSERT TEXT HERE
For the quarterly visual assessments to be performed at your site, include a description of the following:
• The names of the person(s), or the positions of the person(s), responsible for inspection: INSERT TEXT
HERE
• The schedules to be used for conducting inspections. Include here any tentative schedule that will be used
for facilities in climates with irregular stormwater runoff discharges (2008 MSGP, Part 4.2.3): INSERT TEXT
HERE and
• Specific areas of the facility to be inspected, including schedules for specific outfalls: INSERT TEXT HERE
Inactive and Unstaffed sites exception (if applicable)
If you are invoking the exception for inactive and unstaffed sites for your routine facility inspections and quarterly
visual assessments, include information to support this claim.
INSERT TEXT HERE
EPA Industrial SWPPP Template, January 13, 2009 15

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
SECTION 6: DOCUMENTATION TO SUPPORT ELIGIBILITY
CONSIDERATIONS UNDER OTHER FEDERAL LAWS
6.1 Documentation Regarding Endangered Species.
Instructions (see 2008 MSGP Part 5.1.6.1):
`Include any documentation you have that supports your determination of eligibility consistent with 2008 MSGP,
Part 1.1.4.5 (Endangered and Threatened Species and Critical Habitat Protection). Refer to Appendix E of the
2008 MSGP for specific instructions for establishing eligibility.
INSERT TEXT HERE OR KEEP DOCUMENTATION WITH SWPPP.
6.2 Documentation Regarding Historic Properties
Instructions (see 2008,MSGP Part 5.1.6.2):
Include any documentation you have that supports your determination of eligibility consistent with 2008 MSGP,
Part 1.1.4.6 (Historic Properties Preservation). Refer to Appendix F of the 2008 MSGP for specific instructionsfor
establishing eligibility.
INSERT TEXT HERE OR KEEP DOCUMENTATION WITH SWPPP.
6.3 Documentation Regarding NEPA Review (if applicable)
( 5.1.6.3):
Instructions see 2008 MSGP Part
Include any documentation you have that supports your determination of eligibility consistent with MSGP 2008
Part 1.1.2.5 (Discharges Subjectto Any New Source Performance Standards).
INSERT TEXT HERE OR KEEP DOCUMENTATION WITH SWPPP.
SECTION 7: SWPPP CERTIFICATION
Instructions (see 2008 MSGP Part 5.1.7):
The following certification statement must be signed and dated by a person who meets the requirements of
Appendix B, Subsection 11.A or 113, of the 2008 MSGP. Note: This certification must be re -signed in the event
of a SWPPP modification in response
p to a Part3.1 trigger for corrective"action.
„
EPA Industrial SWPPP Template, January 13, 2009 16

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
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.
Name:
Signature:
Title:
Date:
EPA Industrial SWPPP Template, January 13, 2009 17

Stonnwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATF
SECTION 8: SWPPP MODIFICATIONS
Instructions (see 2008 MSGP Part 5.2): .
Your SWPPP is a "living" document and is required to be modified and updated, as necessary, in response
to corrective actions. See Part 3.4 of the 2008 MSGP.
o If you need to modify the SWPPP in response to a corrective action required by Part, 3.1 of the 2008
MSGP, then the certification statement in section 7 of this SWPPP template must be re -signed in
accordance with 2008 MSGP Appendix B, Subsection 11.A or 11.B..
o ., -For any other SWPPP modification, you should keep a log with a description of the modification, the
name of the person making it, and the date and signature of that person. See 2008 MSGP.
Appendix B, Subsection 11.C.
INSERT LOG HERE or REFERENCE ATTACHMENT
EPA Industrial SWPPP Template, January 13, 2009 18

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
SWPPP ATTACHMENTS
Attach the following documentation to the SWPPP:
Attachment A - General Location Map
Include a copy of your general location map in Attachment A.
Attachment B - Site Map
Include a copy of your site map(s) in Attachment B.
Attachment C - 2008 MSGP
Note: It is helpful to keep a printed -out copy of the 2008 MSGP so that it is accessible to you for
easy reference. However, you do not need to formally incorporate the entire 2008 MSGP into your
SWPPP. As an alternative, you can include a reference to the permit and where it is kept at the
site.
EPA Industrial SWPPP Template, January 13, 2009 19

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
Additional MSGP Documentation Template
Introduction
After you become permitted under the 2008 MSGP, you are required to keep certain minimum
records (or documentation) as part of the implementation of your permit responsibilities. As
required in Part 5.4 of the 2008 MSGP, these records must be kept in the same place your SWPPP
(which you completed prior to submitting your NOI to be covered) is kept. This "Additional MSGP
Documentation Template' (or "Template") will assist you in complying with this requirement.
Using the Additional MSGP Documentation Template
Tips for using the Template:
This Template is designed for use by all facilities permitted under the 2008 MSGP.
The Template is NOT tailored to your individual industrial sector. Depending on
which industrial sector(s) you fall under (see Appendix D of the 2008 MSGP) and
where your facility is located (see Appendix C of the 2008 MSGP), you will need to
address any additional documentation requirements outlined in Part 8 and/or Part
9 of the permit, respectively.
• Each section of the template includes "instructions" and space for your facility's
specific information. You should read the instructions before you complete each
section. The text you will need to complete is generally indicated through the use
of blue form fields (e.g., "Insert Facility Name"). Click on the form field and your
text will replace the instructional text.
• The Template was developed in Microsoft Word so that you can easily add tables
and additional text.
• Because many of the activities you are required to document occur throughout
the permit term, you will need to continually modify and add records to this
Template. You may wish to create separate electronic files for each category of
documentation (e.g., files for monitoring, employee training, etc.) so that they can
be easily modified.
• The records you create using this Template must be kept in the same location as
your SWPPP.
EPA notes that while EPA has made every effort to ensure the accuracy of all instructions and
guidance contained in the Template, the actual obligations of regulated industrial facilities are
determined by the relevant provisions of the permit, not by the Template. In the event of a conflict
between the Template and any corresponding provision of the MSGP, the permit provisions
establish your actual requirements. EPA welcomes comments on the Template at any time and
will consider those comments in any future revision of this document.
EPA Additional MSGP Documentation Template, January 13, 2009

Additional MSGP Documentation t
INSERT FACILITY NAME INSERT- FACILITY PERMIT TRACKING NUMBER
Additional MSGP Documentation
For:
Insert Facility Name
Insert Facility Address
Insert City, State, Zip Code
Insert Facility Telephone Number (if applicable)
Insert Facility Permit Tracking Number
Instructions: k
Keep the following inspection oni mtoring and certification records in the same location that you'Wep your
SWPPR _
Az Copy!of the N01 submitted to EPA along with any correspondence exchanged between you and
,EPA specific to coverage under this permit (you should already have this)
A copy`of the acknowledgment letter you received from the NO[ Processing :Center oreNOI system
assigning you[ permit tracking number (you should'already have"fhis)
• A copy of P008 MSGP (ybu Can provide an electronic'copy),
= Descriptions anddates of any:incidences of significant spills leaks or other releases;,,,.- N
Records of employee training;I`'
Documentation ofmaintenance and tepairs of control, measures
AlHnspection reports
4,.
+. Description of any;deviations from the schedule for visual assessments and/or monitoring,
Description of any corrective action taken at your site
Documentation of any benchmark exceedances and how they were responded to
in .'F 3 :' ��
• ff .,
Documentation toaupport anydetermination that pollutants of concern are not expected to be
present above natural background levels; and that such pollutantsywere not detected in your E �o
discharge or were solely attributable to natural background sources and4
• ' Documentation to support your claim'that your facility has changed its status'from ac ivetto mactive`44;
w t s
and unstaffed r :
QE
a J M x. ,..:^cf Iv.. ..n , .,
With the exception of the frst 3 items these
e are records that you will be updating throughout theVpermit r{
term z ,u�
1 x S,
'4C 4 yt ,r ` u,
Follow the instructions in sections A through M of'this template to keep your records complete ' u
r..J
_�.�:_ .. .'� � :� e._4r:2 A.r.=.%e`� .�x_:•[•. �; .lw..-a�edu ni ...: �?syt ...=a..e."�* `�' �-'
EPA Additional MSGP Documentation Template, January 13, 2009 i

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
Contents
A. Significant spills, leaks or other releases
B. Employee training..............................................................................................................
2
C. Maintenance......................................................................................................................
3
D. Routine Facility Inspection Reports......................................................................................
5
E. Quarterly Visual Assessment Reports................................................................................
10
F. Comprehensive Site Inspection Reports.............................................................................
12
G. Monitoring results............................................................................................................
13
H. Deviations from assessment or monitoring schedule...........................................................
14
I. Benchmark Exceedances...................................................................................................
15
J. Impaired Waters Monitoring: Documentation of Natural Background
Sources or Non -Presence
ofImpairment Pollutant.........................................................................................................
16
K. Active/Inactive status change............................................................................................
17
L. SWPPP Amendment Log..................................................................................................
18
M. Miscellaneous Documentation..........................................................................................
19
EPA Additional MSGP Documentation Template, January 13, 2009 iii

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
A. Significant spills, leaks or other releases
Instructions:
— Include the descriptions and dates of any incidences of significant spills, leaks, or other releases that
resulted in discharges of pollutants to waters of the U.S., through stonnwater or otherwise; the. -
circumstances leading to the release and actions taken in response to the release; and measures taken to
prevent the recurrence of such releases (see Part 2.1:2.4 of the 2008 MSGP):.
— .Provide information; as shown below, for each incident, and attach additional documentation (e.g., photos,
spill cleanup records) as necessary: Repeat as necessary by copying and pasting the fields below.'
Date of incident: Insert Date of Incident
Location of incident: Insert Location of Incident
Description of incident: Insert Description of Incident
Circumstances leading to release: Describe circumstances leading to release
Actions taken in response to release: Describe actions taken in response to release
Measures taken to prevent recurrence: Describe measures taken to prevent recurrence
Date of incident: Insert Date of Incident
Location of incident: Insert Location of Incident
Description of incident: Insert Description of Incident
Circumstances leading to release: Describe circumstances leading to release
Actions taken in response to release: Describe actions taken in response to release
Measures taken to prevent recurrence: Describe measures taken to prevent recurrence
Date of incident: Insert Date of Incident
Location of incident: Insert Location of Incident
Description of incident: Insert Description of Incident
Circumstances leading to release: Describe circumstances leading to release
Actions taken in response to release: Describe actions taken in response to release
Measures taken to prevent recurrence: Describe measures taken to prevent recurrence
Date of incident: Insert Date of Incident
Location of incident: Insert Location of Incident
Description of incident: Insert Description of Incident
Circumstances leading to release: Describe circumstances leading to release
Actions taken in response to release: Describe actions taken in response to release
Measures taken to prevent recurrence: Describe measures taken to prevent recurrence
EPA Additional MSGP Documentation Template, January 13, 2009

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT "TRACKING NUMBER
B. Employee training
Instructions:
Keep records'of employee training, including the date of the training (see Part 2.1.2.9 of the 2008 MSGP).
— For in -person training, consider using the tables below to document your employee traihings. For
computer -based or other types of training, keep similar records on who was trained and the type of training
conducted.
Training Date: Insert Date of Training
Training Description: Insert Description of Training
Trainer: Insert Trainers names
Employee(s) trained
Employee signature
Insert Name
Insert Name
Insert Name
Insert Name
Insert Name
Insert Name
Training Date: Insert Date of Training
Training Description: Insert Description of Training
Trainer: Insert Trainers names
Employee(s) trained
Employee signature
Insert Name
Insert Name
Insert Name
Insert Name
Insert Name
Insert Name
Training Date: Insert Date of Training
Training Description: Insert Description of Training
Trainer: Insert Trainers names
Employee(s) trained
Employee signature
Insert Name
Insert Name
Insert Name
Insert Name
Insert Name
Insert Name
EPA Additional MSGP Documentation Template, January 13, 2009

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
C. Maintenance
Instructions:
— Include in your records documentation of maintenance and repairs of control measures and industrial
equipment, including:
the control measure/equipment maintained,
-"' date(s) of regular maintenance,
- O discovery p P and for repairs, .
dates of discove of areas in need of re airlre lacement, ,
date(s) that the control measure/equipment was returned to full function, and
- the justification for any extended maintenance/repair schedules (see Part 2.1:2:3 of.the
2008 MSGP).
— Provide information, as shown below, to document your maintenance activities for each control 'measu'Ye
and industrial equipment. Repeat as necessary by copying and pasting the information below for
additional control measures. ,
Control Measure Maintenance Records (copy information below for each control measure)
Control Measure: Insert Name of Control Measure
Regular Maintenance Activities: Describe maintenance activities
Regular Maintenance Schedule: Insert Maintenance Schedule
Date of Action: Insert Date of Action
Reason for Action: ❑ Regular Maintenance ❑ Discovery of Problem
If Problem,
• Description of Action Required: Describe actions taken in response to problem
• Date Control Measure Returned to Full Function: Insert Date
• Justification for Extended Schedule, if applicable: Insert Justification (if applicable)
Notes: Insert Notes (if applicable)
EPA Additional MSGP Documentation Template, January 13, 2009 1 3

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMITTRACKING NUMBER
Industrial Equipment and Systems Maintenance Records (copy information below for each
industrial equipmenUsystem)
Industrial Equipment/Systems: Insert Name of Industrial EquipmenUSystem
Regular Maintenance Activities: Describe maintenance activities
Regular Maintenance Schedule: Insert Maintenance Schedule
Date of Action: Insert Date of Action
Reason for Action: ❑ Regular Maintenance ❑ Discovery of Problem
If Problem,
• Description of Action Required: Describe actions taken in response to problem
• Date Industrial Equipment Returned to Full Function: Insert Date
• Justification for Extended Schedule, if applicable: Insert Justification (if applicable)
Notes: Insert Notes (if applicable)
EPA Additional MSGP Documentation Template, January 13, 2009

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
D. Routine Facility Inspection Reports
Instructions:
Include in your records copies of all routine facility inspection reports completed for the facility:
The "sample inspection report is consistent with the requirements in Parts 4.1 of the 2008 MSGP relating to
routine facility inspections. Facilities subject to State industrial stormwater permits may also find this form
useful. If your permitting authority provides you with an inspection report, use that form.,
Using the Sample Routine Facility Inspection Report ,
— This inspection report is designed to be customized according to the specific control measures and
activities at your facility. For ease 'of use, you should take a copy of your site plan and number all of the
stormwater control measures and areas of industrial activity that will be inspected. A brief "description of .
'the control measures and areas that were inspected should then be listed in the site -specific section of the
inspection report.
You can complete the items in the "General Information" section that will remain constant, such as the
facility name, NPDES tracking number, and inspector (if you only use one inspector). Print out multiple ,. ,4
copies of this customized inspection `report to use during your inspections.
— When conducting the inspection, walk the site.byfollowing ,your site map and numbered control:
measures/areas of industrial activity to be inspected. Also note whether the "Areas of Industrial Materials
or Activities exposed to stormwater" have been addressed(customize' this Irst according'to .the conditions
at your facility). Note any required corrective actions and the date and responsible person.for the
correction.
EPA Additional MSGP Documentation Template, January 13, 2009 5

Stormwater Industrial Routine Facility Inspection Report
General Information
Facility Name
Insert Name
NPDES Tracking No.
Insert Tracking No.
Date of Inspection
Insert Date
Start/End Time
I Insert Start/End Time
Inspector's Name(s)
Insert Name
Inspector's Title(s)
Insert Title
Inspector's Contact Information
Insert Contact Info
Inspector's Qualifications
I Insert qualifications or add reference to the SWPPP
Weather Information
Weather at time of this inspection?
❑ Clear ❑Cloudy ❑ Rain
❑ Other:
❑ Sleet ❑ Fog ❑ Snow ❑ High Winds
Temperature:
Have any previously unidentified discharges of pollutants occurred since the last inspection? ❑Yes ❑No
If yes, describe: Describe
Are there any discharges occurring at the time of inspection? ❑Yes ❑No
If yes, describe: Describe
Control Measures
• Number the structural s'tormwater control measures identified in your SWPPP on your site map and list them below (add
as many control measures as are implemented on -site). Carry a copy of the numbered site map with You during your
inspections. This list will ensure that you are inspecting all required control measures at your facility.
• Describe corrective actions initiated, date completed, and note the person that completed the work in the Corrective Actior
Log.
Structural Control
Control
If No, In Need of
Corrective Action Needed and Notes ' j
Measure
Measure is
Maintenance,
(identify needed maintenance and repairs, or any
Operating
Repair, or
failed control measures that need replacement) Qlj
Effectively?
Replacement?
I
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement
z
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement
4
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement
5
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement
6
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement
7
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement
8
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement

Structural Control :
Control
If No, In Need of
_Corrective Action Needed and Notes
Measure
Measure is
Maintenance,
(identify needed maintenance and repairs, or any
Operating
Repair, or
failed control measures that need replacement).
Effectively?
Replacement?
9
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement
10
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement
Areas of Industrial Materials or Activities exposed to stormwater
Below are some general areas that should be assessed during routine inspections. Customize this list as needed for the specific
types of industrial materials or activities at vour facility.
Area/Activity
Inspected?
Controls
Corrective Action Needed and Notes
Adequate
(appropriate,
effective,
and
operating)?
I
Material
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
loading/unloading and
storage areas
2
Equipment operations
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
and maintenance areas
3
Fueling areas
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
4
Outdoor vehicle and
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
equipment washing areas
5
Waste handling and
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
disposal areas
6
Erodible
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
areas/construction
7
Non-stormwater/ illicit
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
connections
8
Salt storage piles or pile
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
containing salt
9
Dust generation and
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
vehicle tracking
10
(Other)
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
11
(Other)
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
12
(Other)
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
Non -Compliance

Additional Control Measures
Describe any additional control measures needed to comply with the permit requirements:
Describe Additional Controls Needed
Notes
Use this space for any additional notes or observations from the inspection:
Additional Notes
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 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."
Print name and title:
Signatu

Additional MSGP Documentation
INSEKT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
E. Quarterly Visual Assessment Reports
Instructions:
— Include in your records copies of all quarterly visual assessment reports completed for the facility. An
example quarterly visual assessment report can be found on the following pager
EPA Additional MSGP Documentation Template, January 13, 2009 10

MSGP Quarterly Visual Assessment Form
(Complete a separate form for each outfall you assess)
Vame of Facility: Name of Facility NPDES Tracking No. Insert Tracking No.
Dutfall Name: Name "Substantially Identical Outfall"? ❑ No ❑ Yes (identify substantially identical outfalls):
'erson(s)ITitle(s) collecting sample: Name/Title
'erson(s)/Title(s) examining sample: Name/Title
Dale & Time Discharge Began: Date & Time Sample Collected: Date & Time Sample Examined:
Enter date and time Enter date and time Enter date and time
Substitute Sample? ❑ No ❑ Yes (identify quarterlyear when sample was originally scheduled to be collected):
Nature of Discharge: ❑ Rainfall ❑ Snowmen
If rainfall: Rainfall Amount: No of Previous Storm Ended > 72 hours ❑ Yes ❑ No' (explain):
riches inches Before Start of This Storm?
Parameter
Color ❑ None ❑ Other (describe):
Odor ❑ None ❑ Musty ❑ Sewage ❑ Sulfur ❑ Sour ❑ Petroleum/Gas
❑ Solvents ❑ Other (describe):
Clarity ❑ Clear ❑ Slightly Cloudy ❑ Cloudy ❑ Opaque ❑ Other
Floating Solids ❑ No ❑ Yes (describe):
Settled Solids" ❑ No ❑ Yes (describe):
Suspended Solids ❑ No ❑ Yes (describe):
Foam (gently shake sample) ❑ No ❑ Yes (describe):
Oil Sheen ❑ None ❑ Flecks ❑ Globs ❑ Sheen ❑ Slick
❑ Other (describe):
Other Obvious Indicators ❑ No ❑ Yes (describe):
of Stormwater Pollution
The 72-hour interval can be waived when the previous stone did not yield a measurable discharge or if you are able to document (attach applicable documentE
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.
Detail any concerns, additional comments, descriptions of pictures taken, and any corrective actions taken below (attach additional
sheets as necessary). Insert details
Certification by Facility Responsible Official (Refer to MSGP Subpart i t Appendix IS for Signatory Requirements)
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 a
that qualified personnel propedy gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or U
persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I ai
aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.
A. Name: B. Title:
C. Signature: D. Date Signed:

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
F. Comprehensive Site Inspection Reports
Instructions:
- Include in your records copies of all comprehensive site inspection reports completed for the facility.
Copies of the comprehensive site inspection report form (also called the Annual Reporting Form) can be
obtained at hftp://www.epa.gov/nodes/pubs/msgp2008 appendixi odf
— For corrective actions, complete part (Corrective Actions) of the Annual Reporting Form..
EPA Additional MSGP Documentation Template, January 13, 2009 12

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
G. Monitoring results
Instructions:
— Include in your records copies of all monitoring results (including benchmarks, effluent limits, and other
monitoring conducted) for the facility. Also include copies of MSGP Industrial Discharge Monitoring
Reports (DMRs) submitted to EPA, or copies of monitoring data submitted to EPA's eN01 reporting
system, .
EPA Additional MSGP Documentation Template, January 13, 2009 13

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
H. Deviations from assessment or monitoring schedule
Instructions:
Include in your records:
A description of any deviations from the schedule you provided in your SWPPP for visual assessments
and/or monitoring, and
The reason for the deviations (e.g., adverse weather or it was impracticable to collect samples within the
first 30 minutes of a measurable storm event) (see Parts 4.2.1, 6.1.4, and 6.2.1.2 of the 2008 MSGP).
Use the fields below to document the deviations. Repeat as necessary for any deviations.
Date: Insert Date
❑ Visual assessments ❑ Monitoring
Describe deviation from schedule: Describe deviation
Reason for deviation: Describe reason
Date: Insert Date
❑ Visual assessments ❑ Monitoring
Describe deviation from schedule: Describe deviation
Reason for deviation: Describe reason
Date: Insert Date
❑ Visual assessments ❑ Monitoring
Describe deviation from schedule: Describe deviation
Reason for deviation: Describe reason
Date: Insert Date
❑ Visual assessments ❑ Monitoring
Describe deviation from schedule: Describe deviation
Reason for deviation: Describe reason
EPA Additional MSGP Documentation Template, January 13, 2009 14

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
I. Benchmark Exceedances
Instructions:
Include in your records documentation of any benchmark"exceedances and how they were responded to,
including either.
— (1) corrective action taken,
— (2) a finding that the exceedence was due to natural background pollutant levels, or
— (3) a finding that no further pollutant reductions were 'technologically available and economically
practicable and achievable in light of best industry practice consistent with Part 6.2.1.2 of the 2008 MSGP,
Date: Insert Date
Parameter Exceeded and Results: Insert Parameter Name
Quarter 1 (Sample date: Insert Sample Date) Result: Insert Sample Result
Quarter 2 (Sample date: Insert Sample Date) Result: Insert Sample Result
Quarter 3 (Sample date: Insert Sample Date) Result: Insert Sample Result
Quarter 4 (Sample date: Insert Sample Date) Result: Insert Sample Result
Average Result: Insert Value
Benchmark Value: Insert Benchmark Value from 2008 MSGP
Document how benchmark exceedance(s) responded to:
❑ Corrective action taken
Parameter(s): Insert Parameter
Complete Part D (corrective actions) of the Annual Report Form (see section F of the
Additional MSGP Documentation).
❑ Finding that the exceedence was due to natural background pollutant levels
Parameter(s): Insert Parameter
Attach the following documentation:
• An explanation of why you believe that the presence of the pollutant causing the
impairment in your discharge is not related to the activities at your facility; and
• Data and/or studies that tie the presence of the pollutant causing the impairment in
your discharge to natural background sources in the watershed.
❑ Finding that no further pollutant reductions are technologically available and
economically practicable and achievable in light of best industry practice consistent with
Part 6.2.1.2.
Parameter(s): Insert Parameter
Attach documentation.
EPA Additional MSGP Documentation Template, January 13, 2009 15

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT" I RACKING NUMBER
J. Impaired Waters Monitoring: Documentation of Natural
Background Sources or Non -Presence of Impairment Pollutant
Instructions:
This se
ction applies only if your facility:
• Discharges directly to an impaired water without an EPA approved or established total
maximum daily load (TMDL), and either your impaired Waters monitoring results shows that the
pollutant(s) for which the water is Impalred is
.1. Not present and not expected,to be present in;your discharge, or
2. Present, but you have determined its presence is caused solely by natural '
background sources. See Part 6;2.4.2 of the 2008 M SGP.
If # 1. applies to your facility, include here documentation that the impairment pollutant(s) was not
detected in your discharge sample.
,
If # 2 applies to your facility, include the following documentation here:
• An explanation of why you believe thatthe presence of the pollutants) causing the impairment
in your discharge is not related to the activities at your facility; and
•. Data,and/or studies that tie the presence of the pollutant(s) causing the 'impairment in your
discharge to natural background sources in the watershed.
p
Note: You are reminded that the ermit requires, y you,to mclude,a notification that you have met either
condition # 1 or # 2 (above), in your monitoring report that you submit to EPA.
Date: Insert Date
Check one of the boxes below and complete the additional documentation:
❑ #1— Pollutant(s) for which the water is impaired is not present and not expected to be
present in your discharge
Attach documentation that the impairment pollutant(s) was not detected in your discharge
sample(s).
❑ #2 — Pollutant(s) for which the water is impaired is present, but you have determined its
presence is caused solely by natural background sources.
Attach the following documentation:
• An explanation of why you believe that the presence of the pollutant(s) causing the
impairment in your discharge is not related to the activities at your facility; and
• Data and/or studies that tie the presence of the pollutant(s) causing the impairment in your
discharge to natural background sources in the watershed.
EPA Additional MSG Documentation Template, January 13, 2009 16

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT" TRACKING NUMBER
K. Active/Inactive status change
Instructions:
If your facility changes it status from active to inactive and unstaffed (or from inactive/unstaffed to active), include
documentation in this section, to support your claim.
Date: Insert Date of Change in Status
New Facility Status: ❑ Inactive and Unstaffed ❑ Active
Reason for change in status: Describe reason
EPA Additional MSGP Documentation Template, January 13, 2009 17

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
L. SWPPP Amendment Log
Instructions:,
Include in your records:
— A log of the date and Description of any amendments to your SWPPP.
Fill in the appropriate columns of this table for each amendment to your SWPPP. Copy and paste additional rows
into the table as necessary.
Amerid.
No.
Description of'tlie Amendment
Daterof
Amendment
x
Amendment Prepared'
by [Name(s) and Twit ej
1
Insert description of amendment
Insert date
Insert name/title
2
Insert description of amendment
Insert date
Insert name/title
3
Insert description of amendment
Insert date
Insert nameltitle
4
Insert description of amendment
Insert date
Insert name/title
5
Insert description of amendment
Insert date
Insert name/title
6
Insert description of amendment
Insert date
Insert name/title
7
Insert description of amendment
Insert date
Insert name/title
8
Insert description of amendment
Insert date
Insert name/title
9
Insert description of amendment
Insert date
Insert name/title
10
Insert description of amendment
Insert date
Insert name/title
11
Insert description of amendment
Insert date
Insert name/title
EPA Additional MSGP Documentation Template, January 13, 2009 18

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
M. Miscellaneous Documentation
Instructions:
Use this section to keep records of any additional documentation that relates to your compliance with the permit.
EPA Additional MSGP Documentation Template, January 13, 2009 19

I.
Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
Industrial SWPPP Template
Introduction
To help you develop a SWPPP that is consistent with the 2008 MSGP, the U.S Environmental Protection
Agency (EPA) has created this Industrial SWPPP Template (or, "the Template"). Use of the Template will
help ensure that your SWPPP addresses all the necessary elements required in Part 5 of the 2008 MSGP.
Before completing the Template, make sure you read and understand the requirements in the 2008 MSGP.
A copy of the MSGP is available at www.epa.gov/npdes/stormwater/msgp.
Using the Industrial SWPPP Template
Tips for completing the Template:
• This Template is designed for use by all facilities eligible for coverage under the 2008
MSGP. The Template is NOT tailored to your individual industrial sector. Depending on
which industrial sector you fall under (see Appendix D of the 2008 MSGP) and on where
your facility is located (see Appendix C of the 2008 MSGP), you will need to address
additional SWPPP requirements outlined in Part 8 and/or Part 9 of the permit, respectively.
• Complete a SWPPP before submitting your Notice of Intent (NO1) for permit coverage.
Each section includes "instructions" and space for your facility's specific information.
You should read the instructions for each section before you complete that section.
• The Template was developed in Microsoft Word so that you can easily add tables and
additional text. Some sections may require only a brief description while others may
require several pages of explanation.
• To make it easier to complete, the Template generally uses blue text where the operator is
expected to enter information.
EPA notes that while EPA has made every effort to ensure the accuracy of all instructions and guidance
contained in the Template, the actual obligations of regulated industrial facilities are determined by the
relevant provisions of the permit, not by the Template. In the event of a conflict between the Template and
any corresponding provision of the MSGP, the permit controls. EPA welcomes comments on the Template
at any time and will consider those comments in any future revision of this document.
EPA Industrial SWPPP Template, January 13, 2009

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
Stormwater Pollution Prevention Plan
for:
Insert Facility Name
Insert Facility Address
Insert City, State, Zip Code
Insert Facility Telephone Number (if applicable)
SWPPP Contact(s):
Insert Facility Operator
Insert Name
Insert Address
Insert City, State, Zip Code
Insert Telephone Number
Insert Fax/Email
SWPPP Preparation Date:
EPA Industrial SWPPP Template, January 13, 2009 i

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
Contents
SECTION 1: FACILITY DESCRIPTION AND CONTACT INFORMATION......................................................1
1.1
Facility Information.................................................................................................................
1
1.2
Contact Information/Responsible Parties................................................................................
23
1.3
Stormwater Pollution Prevention Team..................................................................................
33
1.4
Activities at the Facility.........................................................................................................
33
1.5
General Location Map..........................................................................................................
44
1.6
Site Map..............................................................................................................................
54
SECTION
2: POTENTIAL POLLUTANT SOURCES.....................................................................................66
2.1
Industrial Activity and Associated Pollutants...........................................................................
66
2.2
Spills and Leaks...................................................................................................................
7-7
2.3
Non-Stormwater Discharges Documentation..........................................................................
7-
2.4
Salt Storage........................................................................................................................
88
2.5
Sampling Data Summary ......................................................................................................
88
SECTION
3: STORMWATER CONTROL MEASURES.................................................................................88
3.1
Minimize Exposure...............................................................................................................
99
3.2
Good Housekeeping.............................................................................................................
99
3.3
Maintenance........................................................................................................................99
3.4
Spill Prevention and Response..........................................................................................
104-0
3.5
Erosion and Sediment Controls.........................................................................................
104-0
3.6
Management of Runoff.....................................................................................................
101-0
3.7
Salt Storage Piles or Piles Containing Salt.........................................................................
1 144
3.8
MSGP Sector -Specific Non -Numeric Effluent Limits............................................................
1 144
3.9
Employee Training...........................................................................................................
1 144
3.10
Non-Stormwater Discharges.............................................................................................
1 1144
3.11
Waste, Garbage and Floatable Debris...............................................................................
121-3
3.12
Dust Generation and Vehicle Tracking of Industrial Materials ...............................................
124-3
SECTION
4: SCHEDULES AND PROCEDURES FOR MONITORING.....................................................1333
SECTION
5: INSPECTIONS.......................................................................................................................1545
SECTION
6: DOCUMENTATION TO SUPPORT ELIGIBILITY CONSIDERATIONS UNDER OTHER
FEDERALLAWS
.......................................................................................................................................1646
6.1
Documentation Regarding Endangered Species.................................................................
164-6
6.2
Documentation Regarding Historic Properties.....................................................................
164-6
6.3
Documentation Regarding NEPA Review (if applicable)......................................................
161-6
SECTION
7: SWPPP CERTIFICATION.....................................................................................................1646
SECTION
8: SWPPP MODIFICATIONS....................................................................................................1848
SWPPPATTACHMENTS...........................................................................................................................1949
Attachment A — General Location Map
Attachment 8 — Site Maps
Attachment C — 2008 MSGP
EPA Industrial SWPPP Template, January 13, 2009 ii

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
SECTION 1: FACILITY DESCRIPTION AND CONTACT INFORMATION
1.1 Facility Information
Facility Information
Name of Facility:
Street:
City: State: ZIP Code:
County or Similar Subdivision:
Permit Tracking Number: (if covered under a previous permit)
Latitude/Longitude (Use one of three possible formats, and specify method)
Latitude: Longitude:
1. _ _ ° _ _' _ _" N (degrees, minutes, seconds) 1. _ _ ° _ _' _ _" W (degrees, minutes, seconds)
2. _ _ ° _ _ . _ —'N (degrees, minutes, decimal) 2. _ _ ° _ _ . _ —'W (degrees, minutes, decimal)
3. _ _ . _ _ _ _ ° N (decimal) 3. _ _ . _ _ _ _ ° W (decimal)
Method for determining latitude/longitude (check one):
❑ USGS topographic map (specify scale: ) ❑ EPA Web site ❑ GPS
❑ Other (please specify):
Is the facility located in Indian Country? ❑ Yes ❑ No
If yes, name of Reservation, or if not part of a Reservation, indicate "not applicable."
Is this facility considered a Federal Facility? ❑ Yes ❑ No
Estimated area of industrial activity at site exposed to stormwater: (acres)
Discharge Information
EPA Industrial SWPPP Template, January 13, 2009

Stormwater Pollution Prevention Plan (SWPPP)
INSBR"I FACILITY NAML and DATE
Does this facility discharge stormwater into an MS4? ❑ Yes ❑ No
If yes, name of MS4 operator: _
Name(s) of water(s) that receive stormwater from your facility
Are any of your discharges directly into any segment of an "impaired" water? ❑ Yes ❑ No
If Yes, identify name of the impaired water (and segment, if applicable):
Identify the pollutant(s) causing the impairment:
For pollutants identified, which do you have reason to believe will be present in your discharge?
For pollutants identified, which have a completed TMDL?
Do you discharge into a receiving water designated as a Tier 2 (or Tier 2.5) water? ❑ Yes ❑ No
Are any of your stormwater discharges subject to effluent guidelines? ❑ Yes ❑ No
If Yes, which guidelines apply?
Primary SIC Code or 2-letter Activity Code:
(refer to Appendix D of the 2008 MSGP)
Identify your applicable sector and subsector:
1.2 Contact Information/Responsible Parties
Instructions:
List the facility, operator(s),,facility owner, and 24 hour emergency contact. Indicate respective
responsibilities, where appropriate.
You will need the information from this section of the SWPPP Template for your NO1.
Refer to Section B of the NO1 instructions available in Appendix G of the 2008 MSGP):
- ( PP
,
Facility Operator (s):
Name: Insert Name
Address: Insert Address
City, State, Zip Code: Insert City, State, Zip Code
Telephone Number: Insert Telephone Number
Email address: Insert email address
Fax number: Insert fax number (optional)
Facility Owner (s):
Name: Insert Name
Address: Insert Address
City, State, Zip Code: Insert City, State, Zip Code
EPA Industrial SWPPP Template, January 13, 2009 2

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAM17 and DATE
Telephone Number: Insert Telephone Number
Email address: Insert email address
Fax number: Insert fax number (optional)
SWPPP Contact:
Name: Insert SWPPP Contact Name
Telephone number: Insert Telephone Number
Email address: Insert email address
Fax number: Insert fax number (optional)
1.3 Stormwater Pollution Prevention Team
. Instructions (see 2008 MSGP Part 5.1:1):
Identify the staff members (by name or title) that comprise the facility's stormwater pollution prevention team'
as well as their individual responsibilities.
Your stormwater pollution prevention team is responsible for assisting the facility manager in developing and
revising the facility's SWPPP,implementing and maintaining control measures/BMPs, and taking corrective
actions where reguired. Each member of the stormwaterpollution prevention team must have ready access ;
to either an electronic or paper copy of applicable ortions of the MSGP and your SWPPP.
..
Staff Names
Individual Responsibilities
Insert name of SWPPP team
member
Insert explanation of that staff person's responsibilities relating to
compliance with the permit
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary)
[Repeat as necessary]
[Repeat as necessary)
[Repeat as necessary]
[Repeat as necessary]
1.4 Activities at the Facility
Instructions,(see 2008 MSGP Part 51 2).
Provide a general description of the nature of.the industrial activities at your facility
Insert text here
EPA Industrial SWPPP Template, January 13, 2009

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
1.5 General Location Map
Instructions (see 2008 MSGP Part5.1.2):
Provide a general location map (e.g., U.S. Geological Survey (USGS) quadrangle map) with enough detail to
identify the location of your facility and all receiving waters for your stonnwater discharges (include as
Attachment A of this SWPPP Template).
Include a copy of the general location map for this facility in Attachment A.
EPA Industrial SWPPP Template, January 13, 2009

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
1.6 Site Map
Instructions (see 2008 MSGP Part 5.1.2):
— Include a map showing the following information., The site map should be Included as Attachment
of this SWPPP Template.
• the size of the property in acres;
• the location and extent of significant structures and Impervious surfaces,
directions
dons of stormwater flow (use arrows); , '
• locations of all existing structural control measures;
■ `locations of all receiving waters in the immediate vicinity of your facility; indicating if any of the "
waters are impaired and, if so, whether the waters have TMDLs established for them;`
■ locations of all stormwater conveyances including ditches, pipes, and swales; `
■ locations of potential pollutant sources identified underMSGP, Part"5.13.2;"
■ locations where significant spills or leaks identified'under MSGP, Part 5.1.3.3 have occurred;
• ° water monitoring points;
locations of all storm
• locations of stormwater inlets and outfalls, with a unique identification code for each outfall
(e.g. Outfall No. 1, No. 2, etc), indicating if you are treating one or more outfalls as .
"substantially identical" under MSGP, Parts 4:2.3, 5.1.5.2, and 6.1.1, and an approximate
outline of the areas draining to each outfall;
municipal separate storm sewer systems, where your s ° • tormwater discharges to them;
•' locations and descriptions of all non-stormwaterdischarges identified under MSGP, Part °
: °p
locations of followin9activities where such activities are exposed to, precipitation:
o" fueling stations;
o vehicle and equipment maintenance and/or cleaning areas;
o loading/unloading areas;
o locations used for,the treatment, storage, or disposal of wastes;
oliquid storage tanks;
o processing and storage areas, '
o' ;immediate access roads and raillines used "or traveled by carriers of raw materials,
manufactured products, waste material, or by-products used or created bythe facility; `
o transfer areas for substances in bulk;
o machinery; and
locations and sources of.run=onto your site from adjacent'property that contains'significant
quantities of pollutants.
Include a copy of the site map for this facility in Attachment B.
EPA Industrial SWPPP Template, January 13, 2009

Storrnwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
SECTION 2: POTENTIAL POLLUTANT SOURCES
.Instructions (see 200.8 MSGP Part 5.1.3). .. e
Ih this section, you are required to describe areas at your facility where Industrial materials or activties arel .
exposed to"stortnwater or from vihich allowable non-stormwater discharges°are'released
,.: f .:vP.fiIFF
2.1 Industrial Activity and Associated Pollutants
►nstructlons (see 2008`MSGP Parts 51 3 t'andl5 l 3 2) iPE
t i9 ' 1 ke " ljfk41 j Id9.33Y G:PFpC£'j,I9 9y 3 9� Ii9�?@PlttBbd of f A {
— Include a Ilst of uidustnal activities exposed,to stormwater (e gj�m�a�tenhal storage egwpmenU ehicIe3fueling
maintenance and cleaning cutting steel beams) and4he ppoltuttants"or�polfutant constiWents (e'g motor od
fuel battery'acid andbl6wirig solvents) associated with these aphvlbes yk�u sF yoE i' k '
— In your list of pollutants associated with your. industrial activlftles include `tall Fslgmficant materials that have
been h6h'dled treated stored,` orr disposed and that have been'exposed to stonnwater In th"e 3 y'ea'rs phor"to
l er. -
the date you prepare your.SWPPP.
Industrial Activity
Associated Pollutants
Insert specific industrial activity
Insert names of pollutants or pollutant constituents
that could be associated with this activity and
released in stormwater
Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
Repeat as necessary]
EPA Industrial SWPPP Template, January 13, 2009 6

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
2.2 Spills and Leaks
Instructions (See 2008 MSGP Part 5.1.3.3):
Include the following in this section:
o Potential spills and leaks: A description of where potential spills and leaks could occur it your
site that could contribute pollutants to your stormwater discharge, and specify which outfall(s) are
likely to be affected by such spills and leaks.
o Past spills and leaks: A description of significant spills and leaks in the past 3years of oil or toxic
or hazardous pollutants that actually occurred at exposed areas, or that drained to a stormwater'''
conveyance.
Note: Significant spills and leaks include, but are not limited to; releases of oil or hazardous substances in
'excess of quantities that are reportable underCWA Section 311(see 40 CFR 110.6 and 40 CFR 117.21) or
Section 102 of the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA), 42 .
USC §9602.
Areas of Site Where Potential Spills/Leaks Could Occur
Location IOutfalls
Insert description of area where spill/leak could occur Specify which outfall(s) would be
affected
[Kepeat as necessary) I [Repeat as necessary]
[Repeat as necessarvl I [Repeat as necessary]
[Repeat as necessary] [ [Repeat as necessary]
Description of Past Spills/Leaks
Date Description Outfalls
Insert date of Insert description of spill/leak (where it occurred, what Specify which outfall(s)
spill/leak happened, types of pollutants, extent of damage) were affected
as I [Repeat as necessary] I [Repeat as necessary]
[Repeat as I [Repeat as necessary] I [Repeat as necessary]
[Repeat as I [Repeat as necessary] I [Repeat as necessary]
necessary]
2.3 Non-Stormwater Discharges Documentation
_instiuctioos,(see 2608 MSGP Part 5.1.3.4) '
— .The questions below require you to provide documentation of the following:;
o Yourrevaluation for the presence of non-stomiwatertlischarges at your sit e, and, ";, `' " . -
o Your elimination of any unauthorized non-stormwater discharges.
EPA Industrial SWPPP Template, January 13, 2009

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
• Date of evaluation: Insert the date(s) of your evaluation.
• Description of the evaluation criteria used: Describe the method you used to conduct your
evaluation and to determine for each non-stormwater sources whether it is prohibited or allowed
under the permit.
• List of the outfalls or onsite drainage points that were directly observed during the evaluation: Insert
outfalls/drainage points observed.
• Different types of non-stormwater discharge(s) and source locations: Describe types of non-
stormwater discharges observed and the corresponding outfall or drainage point.
• Action(s) taken, such as a list of control measures used to eliminate unauthorized discharge(s), if
any were identified. For example, a floor drain was sealed, a sink drain was re-routed to sanitary,
or an NPDES permit application was submitted for an unauthorized cooling water discharge:
Describe actions taken to eliminate unauthorized non-stormwater discharges and the
corresponding outfall/drainage point affected.
2.4 Salt Storage
Instructions (see 2008 MSGP Part 5.1.3.5):
— Document the location of any storage piles containing salt used for deicing or other commercial or industrial
purposes.
— Note: You will be asked additional questions concerning salt storage in Section 3.7 of this SWPPP template,
below.
Insert description of the location of any storage piles containing salt.
2.5 Sampling Data Summary
Instructions (See 2008 IVISGP Part 5.1.3.6):
- Summarize all stormwater sampling data collected from your permitted outfalls during the previous permit
term:
Insert summary of stormwater sampling data collected for the past permit, and/or attach discharge
monitoring reports or laboratory results.
SECTION 3: STORMWATER CONTROL MEASURES
Instructions (See 2008 MSGP Parts 5.1.4.1 and 212):."
In Sections r asked to describe the — ons 3.1 - 3.12 of this SWPPP.itemplate, you are stormwater control measures
that you have installed at your site to meet each of the permit's."non-numeric effluent limits" in Part 2.1.2 of
the 2008 MSGP.
EPA Industrial SWPPP Template, January 13, 2009 8

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
3.1 Minimize Exposure
Instructions (see 2008 MSGP Part 2.1.2.1):
Describe any structural controls or practices'used to minimize the exposure of industrial activifies to rain,
snow, snowmelt, and runoff.'. Describe where the controls or practices are being implemented !at your site.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.2 Good Housekeeping
Instructions (see 2008,MSGP Parts 2.1.2.2 and 5.15.1):
Describe any practices you are, implementing to keep exposed areas of.your site clean. Describe where each
practice is being implemented at yoursite. Include here your schedule for: (1) regular pickup and disposal of
waste materials, and (2) routine inspections for'leaks and of the condition of drums, tanks; and containers.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.3 Maintenance
Instructions (see 2008 MSGP Parts 2.1.2.3 and 5.1.5.1):
Describe procedures (1) to maintain industrial equipment so that spills/leaks are avoided, and (2) to maintain
any of your site s'controll asures in effective operating condition.;, Include the schedule you will follow for
such maintenance activities. Describe where each applicable procedure is being implemented at the site.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
EPA Industrial SWPPP Template, January 13, 2009 9

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME" and DATE
3.4 Spill Prevention and Response
Instructions (see 2008 MSGP Parts 2.1.2.4 and 5.1.5.1):
Describe any structural controls or procedures used to minimize the potential for leaks, spills, and other,
releases. You must implement the following at a minimum:
Procedures for plainly labeling containers (e.g., ".Used Oil," "Spent Solvents, "Fertilizers and
Pesticides," etc.) that could be susceptible to spillage or leakage to encourage proper handling and
facilitate,rapid response if spills or leaks occur;
• Preventative measures such as barriers between material storage and traffic areas, secondary
containment provisions, and procedures for material storage and handling;
Procedures for expeditiously stopping, containing, and cleaning up leaks, spills, and other releases; and
•Procedures for notification of appropriate facility personnel, emergency response agencies, and
regulatory agencies.
Describe where each control is to be located or where applicable procedures will be implemented. `
Note: Some facilities may be required to develop a Spill Prevention Control and'Countermeasure (SPCC)
plan under a separate regulatory program,(40 CFR 112). If you are required to develop anSPCCplan, or
you already have one, you should include references to the relevant requirements from your, plan.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.5 Erosion and Sediment Controls
Instructions (see 2008 MSGP Part 2.1:2.5):
Describe structural or non-structural controls used at your site to stabilize exposed areas and contain runoffto
minimize onsite erosion and potential offsite discharges of sediment. Note: You must at a minimum implement
flow velocity dissipation devices at outfalls and discharge channels. Describe the location at your site where .
each control will be implemented.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.6 Management of Runoff
Instructions (See 2008 MS. GP Part 2.1.2.6 ) ,
Describe controls used at your site to divert, infiltrate, reuse, contain, or otherwise reduce stormwater runoff..
Describe the location at your site where each control will be implemented.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
EPA Industrial SWPPP Template, .January 13, 2009 10

Stormwater Pollution Prevention Plan (SWPPP)
INSI R"r FACILITY NAME and DATE
3.7 Salt Storage Piles or Piles Containing Salt
Instructions (see 2008 MSGP°Part 2.1.2.7):
If applicable, describe structures at your site that either cover or enclose salt storage piles or piles containing salt,
or that prevent the discharge of stormwater,from such piles. Also, describe any controls or procedures used to
minimize exposure resulting from adding to or removing materials from the pile. Describe the location at your site
where each control and/or procedure will be implemented.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.8 MSGP Sector -Specific Non -Numeric Effluent Limits
Instructions (see 2008 MSGP°Part 2.1.2.8):
Describe any controls or procedures that will be used at your site to comply with any sector -specific
requirements that apply to you in Part of the 2008 MSGP. •. Describe the location at your site where
each control and/or procedure Will be implemented.,,,
Note: Sector -specific effluent limits apply to SectorsA, E, F, G, H, I, L, M; N, 0, P, Q,.R, S, T,"U, V, X,
.Y, Z. and AA.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.9 Employee Training
Instructions (see 2008 MSGP Parts 2.1.2.9'and 5.1.5.1): ;
Describe your plan for training the employees who work in areas where industrial materials or activities are
exposed to stormwater, or who are responsible for implementing activities necessary to meet the conditions of
the 2008 MSGP; including all members of your Pollution Prevention Team Included in your description must be
the frequency of training (note: recommended at least one time per year), and the schedule you,will follow.,,
INSERT DESCRIPTION OF PLAN FOR TRAINING APPLICABLE STAFF HERE,
3.10 Non-Stormwater Discharges
Instructions (see 2008,MSGP 2.1.2.10): In ,
Des
cribe how you eliminated any "unauthorized non-stormwater discharges at your site. The unauthorized non
stormwater discharges include any non-stormwater discharges that are not specifically identified,in Part 1.1.3 ofu„
the, 2008 MSGP. 'Note::If this section is already addressed by your documentabon'for Section 2.3 of the SWPPP'
template ,you'ean simply include'a,cross-reference to that section of your SWPPP:
INSERT DESCRIPTION OF YOUR APPROACH TO ELIMINATING UNAUTHORIZED NOW
STORMWATER DISCHARGES HERE.
EPA Industrial SWPPP Template, January 13, 2009

Stormwater Pollution Prevention Plan (SW PPP)
INSERT FACILITY NAME and DATE"
3.11 Waste, Garbage and Floatable Debris
Instructions (see 2008 MSGP Part 2.1.2.1,1):
Describe controls and procedures that will be used at your site to minimize discharges of waste, garbage, and
floatable debris. Describe the location at your site where each control and/or procedure will be implemented.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.12 Dust Generation and Vehicle Tracking of Industrial Materials
Instructions(see 2008'MSGP Part 2.1.2.12):
Describe controls and procedures you will use at your site to minimize the generation of dust and off -site tracking
of,raw, final,'or waste materials. Describe the location at your site where each control and/or procedures will be "
implemented.
INSERT DESCRIPTION OF CONTROL MEASURES HERE,
EPA Industrial SWPPP Template, January 13, 2009 12

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
SECTION 4: SCHEDULES AND PROCEDURES FOR MONITORING
Instructions (see 2008 MSGP Part 5.1.5.2):
Describe your procedures for conducting'the five types of analytical -monitoring specified by the MSGP, .
where applicable to your facility; including:
Benchmark monitoring (2008 MSGP, Part 6.2.1 and relevant requirements in Part 8 and/or Part9);
• „ Effluent limitations guidelines monitoring (2008 MSGP, Part 6:2.2 and relevant requirements in Part 8);
• State- or Tribal -specific monitoring (2008 MSGP, Part 6.2.3 and relevant requirements in Part 9);,',
• Impaired waters monitoring (2008 MSGP,"Part 6:2.4); and
• Other°monitoring as required by EPA (2008 MSGP, Part 6.2.5);
- Depending on the type of facility you operate, and the monitoring requirements to which you are subject, you
must collect and analyze stormwater samples,and document monitoring activities consistent with the
procedures described in 2008 MSGP, Part 6 and Appendix B, Subsections 10 -12, and any, additional
sector -specific or State/Tribal-specific requirements in 2008 MSGP, Parts 8 and 9 respectively. Refer to
2008 MSGP, Part 7 for reporting and mcordkeeping requirements. Note: All monitoring must be conducted
in accordance with the relevant sampling and analysis requirements at 40 CFR Part 136. Include in your,
description procedures for ensuring compliance with these requirements.
If you are invoking the exception for inactive and unstaffed sites for benchmark monrtoring, you must include
in your SWPPP the infomiation,to support this claim as required by 2008 MSGP; Part 6.2:1.3.
-` If you plan to'use the substantially identical outfall exception for your benchmark monitoring requirements in
2008 MSGP, Part 6.2.1 and/or your quarterly visual assessment requirements in 2008 MSGP; Part 4.2.3,
you must include the,following documentation:
• Location of each of the substantially identical outfalls,
• Description of the general industrial activities conducted in the drainage area of each outfall;
Description of the control measures implemented in the drainage area of each ouffall;
Description of the exposed materials located in the drainage area of each outfall that
are likely to' be
significant contributors of pollutants to stonmwater discharges;
An estimate of the runoff coefficient of the drainage areas (low under 40° - ° g • , /o; medium - 40 to 65 /o; high
above 65%); and
• ^ Why, the outfalls are expected to discharge substanfially. identical effluents.
For each type of monitoring, your SWPPP must include a description of:
1. Sample Location(s). Describe where samples will be collected, including any determination that two or
more outfalls are substantially identical. INSERT TEXT HERE
2. Pollutant Parameters to be Sampled. Include a list of the pollutant parameters that will be sampled and
the frequency of sampling for each parameter. INSERT TEXT HERE
3. Monitoring Schedules. Include the schedule you will follow for monitoring your stormwater discharge,
including where applicable any alternate monitoring periods to be used for facilities in climates with irregular
stormwater runoff (2008 MSGP, Part 6.1.6). INSERT TEXT HERE
EPA Industrial SWPPP Template, January 13, 2009 13

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
4. Numeric Limitations. List here any pollutant parameters subject to numeric limits (effluent limitations
guidelines), and which ouffalls are subject to such limits. Note that numeric limits are only included for
Sectors A, C, D, E, J, K, L, and 0. INSERT TEXT HERE
5. Procedures. Describe procedures you will follow for collecting samples, including responsible staff who will
be involved, logistics for taking and handling samples, laboratory to be used, etc. INSERT TEXT HERE
Note: It may be helpful to create a table with columns corresponding to # 1 - 5 above for each type of monitoring you
are required to conduct.
Inactive and Unstaffed sites exception (if applicable)
If you are invoking the exception for inactive and unstaffed sites for benchmark monitoring, include information to
support this claim.
INSERT TEXT HERE
Substantially identical outfall exception (if applicable)
If you plan to use the substantially identical outfall exception for your benchmark monitoring and/or quarterly visual
assessment requirements, include the following information here to substantiate your claim that these ouffalls are
substantially identical:
• Location of each of the substantially identical ouffalls: INSERT TEXT HERE
• Description of the general industrial activities conducted in the drainage area of each outfall: INSERT TEXT
HERE
• Description of the control measures implemented in the drainage area of each outfall: INSERT TEXT HERE
• Description of the exposed materials located in the drainage area of each outfall that are likely to be
significant contributors of pollutants to stormwater discharges: INSERT TEXT HERE
• An estimate of the runoff coefficient of the drainage areas (low=under 40%; medium=40 to 65%; high
=above 65%): INSERT TEXT HERE
• Why the ouffalls are expected to discharge substantially identical effluents: INSERT TEXT HERE
EPA Industrial SWPPP Template, January 13, 2009 14

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
SECTION 5: INSPECTIONS
Instructions:
Describe your procedures for performing the three types of inspections required by the 2008 MSGP,
including:
• Routine facility inspections (2008 MSGP, Part 4.1);
Quarterly visual assessment of stormwater discharges (2008 MSGP, Part 4.2); and
Comprehensive site inspections (2008 MSGP, Part 4.3).
y gexception,inactive andvnstaffed sites relating' to routine facility inspections and
If you invoking the for y p
quarterly visual assessments, you must include in your SWPPP the information to support this claim as
required by 2008 MSGP, Parts 4.1.3 and 4,2.3.
A sample routine facility inspection and quarterly,visual assessment form is available on EPA's MSGP
website (www.epa.gov/npdes/stormwater/msqp) in the "Additional MSGP Documentation" file., Appendix I.of
the 2008 MSGP includes a comprehensive site inspection form (Annual Reporting Form).
For the routine facility inspections and the comprehensive site inspections to be performed at your site, include a
description of the following:
• The names of the person(s), or the positions of the person(s), responsible for inspection: INSERT TEXT
HERE
• The schedules to be used for conducting inspections. Include here any tentative schedule that will be used
for facilities in climates with irregular stormwater runoff discharges (2008 MSGP, Part 4.2.3): INSERT TEXT
HERE and
• Specific areas of the facility to be inspected, including schedules for specific outfalls: INSERT TEXT HERE
For the quarterly visual assessments to be performed at your site, include a description of the following:
• The names of the person(s), or the positions of the person(s), responsible for inspection: INSERT TEXT
HERE
• The schedules to be used for conducting inspections. Include here any tentative schedule that will be used
for facilities in climates with irregular stormwater runoff discharges (2008 MSGP, Part 4.2.3): INSERT TEXT
HERE and
• Specific areas of the facility to be inspected, including schedules for specific outfalls: INSERT TEXT HERE
Inactive and Unstaffed sites exception (if applicable)
If you are invoking the exception for inactive and unstaffed sites for your routine facility inspections and quarterly
visual assessments, include information to support this claim.
INSERT TEXT HERE
EPA Industrial SWPPP Template, January 13, 2009 15

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
SECTION 6: DOCUMENTATION TO SUPPORT ELIGIBILITY
CONSIDERATIONS UNDER OTHER FEDERAL LAWS
6.1 Documentation Regarding Endangered Species.
Instructions (see 2008 MSGP Part 5.1.6.1):
Include any documentation you have that supports your determination of eligibility consistent with 2008 MSGP,`
Part 1.1.4.5 (Endangered and Threatened Species and Critical Habitat Protection). Refer to Appendix E of the
2008 MSGP for specific instructions for establishing eligibility.
INSERT TEXT HERE OR KEEP DOCUMENTATION WITH SWPPP.
6.2 Documentation Regarding Historic Properties
Instructions (see 2008 MSGP Part 5.1.6.2):
Include any documentation you have that supports your determination of eligibility consistent with 2008 MSGP;
Part 1.1.4.6 (Historic Properties Preservation). Refer to Appendix, F of the 2008 MSGP for specific instructions for
establishing eligibility.
INSERT TEXT HERE OR KEEP DOCUMENTATION WITH SWPPP.
6.3 Documentation Regarding NEPA Review (if applicable)
Instructions (see 2008 MSGP Part 5.1.6.3):
Include any documentation you have that supports your determination of eligibility consistent with MSGP 2008
(Discharges t to An New Source Performance Standards). Part1.1.2.5 Discha esSubect
y ..
INSERT TEXT HERE OR KEEP DOCUMENTATION WITH SWPPP.
SECTION 7: SWPPP CERTIFICATION
Instructions (see 2008 MSGP Part 5.1.7):
The following certification statement must be signed and dated by a person who meets the requirements of
AppendixB, Subsection 11.A or 11.B, of the 2008 MSGP. Note: This certification must be re -signed in the event
of a SWPPP modification in response to a Part 3.1.trigger for corrective action.. .
EPA Industrial SWPPP Template, January 13, 2009 16

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
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.
Name:
Signature:
Title:
Date:
EPA Industrial SWPPP Template, January 13, 2009 17

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME" and DATE
SECTION 8: SWPPP MODIFICATIONS
Instructions (see 2008 MSGP Part 5.2):
Your SWPPP is a "living" document and is required to be modified and updated, as, necessary, in response,
to corrective actions. See Part3.4 of the 2008 MSGP.
o ''If you need to modify the SWPPP in response to a corrective action required by Part 3.1 of the 2008
MSGP, then the certification statement in section 7 of this SWPPP template must be resigned in
accordance with 2008 MSGP Appendix B, Subsection 11.A or 11.B. I",
o For any other SWPPP modification, you should keep a log with a description of the modification, the
.name of the person making it, and the date and signature of that person. See 2008 MSGP
Appendix B, Subsection 11.C.
INSERT LOG HERE or REFERENCE ATTACHMENT
EPA Industrial SWPPP Template, January 13, 2009 18

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
SWPPP ATTACHMENTS
Attach the following documentation to the SWPPP:
Attachment A - General Location Map
Include a copy of your general location map in Attachment A.
Attachment B - Site Map
Include a copy of your site map(s) in Attachment B.
Attachment C - 2008 MSGP
Note: It is helpful to keep a printed -out copy of the 2008 MSGP so that it is accessible to you for
easy reference. However, you do not need to formally incorporate the entire 2008 MSGP into your
SWPPP. As an alternative, you can include a reference to the permit and where it is kept at the
site.
EPA Industrial SWPPP Template, January 13, 2009 19

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
Industrial SWPPP Template
Introduction
To help you develop a SWPPP that is consistent with the 2008 MSGP, the U.S Environmental Protection
Agency (EPA) has created this Industrial SWPPP Template (or, "the Template'). Use of the Template will
help ensure that your SWPPP addresses all the necessary elements required in Part 5 of the 2008 MSGP.
Before completing the Template, make sure you read and understand the requirements in the 2008 MSGP.
A copy of the MSGP is available at www.epa.gov/npdes/stormwater/msqp.
Using the Industrial SWPPP Template
Tips for completing the Template:
• This Template is designed for use by all facilities eligible for coverage under the 2008
MSGP. The Template is NOT tailored to your individual industrial sector. Depending on
which industrial sector you fall under (see Appendix D of the 2008 MSGP) and on where
your facility is located (see Appendix C of the 2008 MSGP), you will need to address
additional SWPPP requirements outlined in Part 8 and/or Part 9 of the permit, respectively.
• Complete a SWPPP before submitting your Notice of Intent (NO1) for permit coverage.
• Each section includes "instructions" and space for your facility's specific information.
You should read the instructions for each section before you complete that section.
• The Template was developed in Microsoft Word so that you can easily add tables and
additional text. Some sections may require only a brief description while others may
require several pages of explanation.
• To make it easier to complete, the Template generally uses blue text where the operator is
expected to enter information.
EPA notes that while EPA has made every effort to ensure the accuracy of all instructions and guidance
contained in the Template, the actual obligations of regulated industrial facilities are determined by the
relevant provisions of the permit, not by the Template. In the event of a conflict between the Template and
any corresponding provision of the MSGP, the permit controls. EPA welcomes comments on the Template
at any time and will consider those comments in any future revision of this document.
EPA Industrial SWPPP Template, January 13, 2009

y {
Stormwater Pollution Prevention Plan (SWPPP) '
INSERT FACILITY NAME and DATE
Stormwater Pollution Prevention Plan
for:
Insert Facility Name
Insert Facility Address
Insert City, State, Zip Code
Insert Facility Telephone Number (if applicable)
SWPPP Contact(s):
Insert Facility Operator
Insert Name
Insert Address
Insert City, State, Zip Code
Insert Telephone Number
Insert Fax/Email
SWPPP Preparation Date:
EPA Industrial SWPPP Template, January 13, 2009

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DA'1'6
Contents
SECTION 1: FACILITY DESCRIPTION AND CONTACT INFORMATION......................................................1
1.1 Facility Information.................................................................................................................
1
1.2 Contact Information/Responsible Parties..................................................................................
2
1.3 Stormwater Pollution Prevention Team....................................................................................
3
1.4 Activities at the Facility...........................................................................................................
3
1.5 General Location Map............................................................................................................
4
1.6 Site Map................................................................................................................................
5
SECTION 2: POTENTIAL POLLUTANT SOURCES.......................................................................................6
2.1 Industrial Activity and Associated Pollutants.............................................................................
6
2.2 Spills and Leaks.....................................................................................................................
7
2.3 Non-Stormwater Discharges Documentation............................................................................
7
2.4 Salt Storage..........................................................................................................................
8
2.5 Sampling Data Summary ........................................................................................................
8
SECTION 3: STORMWATER CONTROL MEASURES...................................................................................8
3.1 Minimize Exposure.................................................................................................................
9
3.2 Good Housekeeping...............................................................................................................
9
3.3 Maintenance..........................................................................................................................9
3.4 Spill Prevention and Response..............................................................................................
10
3.5 Erosion and Sediment Controls.............................................................................................
10
3.6 Management of Runoff.........................................................................................................
10
3.7 Salt Storage Piles or Piles Containing Salt.............................................................................
11
3.8 MSGP Sector -Specific Non -Numeric Effluent Limits................................................................
11
3.9 Employee Training...............................................................................................................11
3.10 Non-Stormwater Discharges.................................................................................................
11
3.11 Waste, Garbage and Floatable Debris...................................................................................
12
3.12 Dust Generation and Vehicle Tracking of Industrial Materials ...................................................
12
SECTION 4: SCHEDULES AND PROCEDURES FOR MONITORING.........................................................13
SECTION 5: INSPECTIONS...........................................................................................................................15
SECTION 6: DOCUMENTATION TO SUPPORT ELIGIBILITY CONSIDERATIONS UNDER OTHER
FEDERALLAWS...........................................................................................................................................16
6.1 Documentation Regarding Endangered Species.....................................................................
16
6.2 Documentation Regarding Historic Properties.........................................................................
16
6.3 Documentation Regarding NEPA Review (if applicable)..........................................................
16
SECTION 7: SWPPP CERTIFICATION.........................................................................................................16
SECTION 8: SWPPP MODIFICATIONS........................................................................................................18
SWPPPATTACHMENTS...............................................................................................................................19
Attachment A — General Location Map
Attachment B — Site Maps
Attachment C — 2008 MSGP
EPA Industrial SWPPP Template, January 13, 2009 ii

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
SECTION 1: FACILITY DESCRIPTION AND CONTACT INFORMATION
1.1 Facility Information
Facility Information
Name of Facility:
Street:
City:
County or Similar Subdivision:
Permit Tracking Number: _
State
ZIP Code:
(if covered under a previous permit)
Latitude/Longitude (Use one of three possible formats, and specify method)
Latitude: Longitude:
1. _ _ ° _ _' _ _" N (degrees, minutes, seconds) 1. _ _ ° _ _' _ _" W (degrees, minutes, seconds)
2. _ _ ° _ _ _ _' N (degrees, minutes, decimal)
3. _ _ . _ _ _ _ ° N (decimal)
Method for determining latitude/longitude (check one):
❑ USGS topographic map (specify scale:
❑ Other (please specify):
2. _ _ ° _ _ _ _' W (degrees, minutes, decimal)
3. _ _ . _ _ _ _ ° W (decimal)
❑ EPA Web site ❑ GPS
Is the facility located in Indian Country? ❑ Yes ❑ No
If yes, name of Reservation, or if not part of a Reservation, indicate "not applicable."
Is this facility considered a Federal Facility? ❑ Yes ❑ No
Estimated area of industrial activity at site exposed to stormwater:
Discharge Information
EPA Industrial SWPPP Template, January 13, 2009
(acres)

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
Does this facility discharge stormwater into an MS4? ❑ Yes ❑ No
If yes, name of MS4 operator: _
Name(s) of water(s) that receive stormwater from your facility
Are any of your discharges directly into any segment of an "impaired" water? ❑ Yes ❑ No
If Yes, identify name of the impaired water (and segment, if applicable):
Identify the pollutant(s) causing the impairment:
For pollutants identified, which do you have reason to believe will be present in your discharge?
For pollutants identified, which have a completed TMDL?
Do you discharge into a receiving water designated as a Tier 2 (or Tier 2.5) water? ❑ Yes ❑ No
Are any of your stormwater discharges subject to effluent guidelines? ❑ Yes ❑ No
If Yes, which guidelines apply?
Primary SIC Code or 2-letter Activity Code:_
(refer to Appendix D of the 2008 MSGP)
Identify your applicable sector and subsector:
1.2 Contact Information/Responsible Parties
.Instructions:.
. r emergency . t... .
List the facility dperator(s), facility owner, 24 hour y pective
responsibilities, where appropriate. contact. Indicate res
— You will need the information from this section of the SWPPP Template for your NO1. '
— (- pp. )
Refer Section B of the NOl instructions available. in Appendix G of the 2008 MSGP
Facility Operator (s):
Name: Insert Name
Address: Insert Address
City, State, Zip Code: Insert City, State, Zip Code
Telephone Number: Insert Telephone Number
Email address: Insert email address
Fax number: Insert fax number (optional)
Facility Owner (s):
Name: Insert Name
Address: Insert Address
City, State, Zip Code: Insert City, State, Zip Code
EPA Industrial SWPPP Template, January 13, 2009 2

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
Telephone Number: Insert Telephone Number
Email address: Insert email address
Fax number: Insert fax number (optional)
SWPPP Contact:
Name: Insert SWPPP Contact Name
Telephone number: Insert Telephone Number
Email address: Insert email address
Fax number: Insert fax number (optional)
1.3 Stormwater Pollution Prevention Team
Instructions (see 2008 MSGP Part 5.1.1):
— Identify the staff members (by name or title) that comprise the facility's stonnwaterpollution prevention team
as well as their individual responsibilities.
Your stormwater pollution prevention team is responsible for assisting the facility manager in developing and
revising the facility's SWPPP, implementing and maintaining control measures/BMPs, and taking corrective
actions where required Each member of the storrrlwater pollution prevention team must have ready access
to either an electronic or paper copy of applicable portions of the MSGP and you' SWPPP.
Staff Names
Individual Responsibilities
Insert name of SWPPP team
member
Insert explanation of that staff person's responsibilities relating to
compliance with the permit
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
1.4 Activities at the Facility
Provide a general description of the nature o
Instructions see 2008 MSGP Part 5.1.2
"' g p f the industrial activities at your facility.
Insert text here
EPA Industrial SWPPP Template, January 13, 2009 3

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE.
1.5 General Location Map
Instructions (see 2008 MSGP'Part 5.1.2):
,
— Provide a general location map (e.g., U.S.. Geological Survey (USGS) quadrangle map) with enough detail to
identify the location of your facility and all receiving waters for your stormwater discharges (include as
Attachment A of this SWPPP Template).
Include a copy of the general location map for this facility in Attachment A.
EPA Industrial SWPPP'Iemplate, January 13, 2009

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
1.6 Site Map
Instructions (see 2008 MSGP Part 5.1.2):
— include a map showing the following information. The site map should be included as Attachment B
of this°SWPPP Template.
■ - the size ofthe property in acres;
• the location and extent of significant structures and impervious surfaces;
■ directions of stormwaterflow (use arrows);
■ locations of all existing structural control measures;'
locati• waters are f all areceiving ired and, f ter whether the waters to vicinity of your facility, indicating if any of the
y , ters have TMDLs established for them;
all stormwater conve ■ locations of a 'antes including ditches, pipes, and swales; °
■ locations of potential pollutant sources identified under MSGP, Part 5.1.3.2
• _
locations where significant spills or leaks identified under MSGP, Part 5.1.3.3 have occurred, ■ locations of all stormwater monitoring points;
-• locations of stormwater inlets and outfalls; with a unique identification code for each outfall
(e.g., Outfall No. 1, No. 2, etc), indicating if you are treating one or more outfalls as
"substantially, identical" under MSGP; Parts 4.2.3, 5.1.5.2, and 6:1.1, and an approximate
outline of the"areas draining to each" outfall;
■ municipal separate storm sewer systems, where your stormwater discharges,to them;
locations and descriptions of all non-stormwater discharges identified under MSGP; Part
2.1.2.10;
locations of the following activities are ex osed to precipitation:
g ere such p
o fueling stations; n activities where
o vehicle and equipment maintenance and/or cleaning areas;
o loadjnglunloading areas;
o :locations used for the treatment, storage, or disposal of wastes;
o 'liquid storage tanks;' ;
o processing ;and storage'' areas;
o immediate access roads and rail lines used or"traveled by carriers of raw materials,
manufactured promaterial,
ducts, waste mal, or by-products, used orcreated by the facility;` "
o transfer areas =for substances in bulk;
o, •machinery; and
locations and sources of run-on to your site from adjacent property that contains significant . .
quantities of pollutants.
Include a copy of the site map for this facility in Attachment B.
EPA Industrial SWPPP Template, January 13, 2009

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
SECTION 2: POTENTIAL POLLUTANT SOURCES
Instructions;(see 2008'MSGP Part5.1.3)r
In this section, you 'are required to descnbe,areas at younfacility..wherelindustrial,materials or activities are
exposed to stonmwater or from which allowable non-stormwater discharges are 'released.:.! ,
2.1 Industrial Activity and Associated Pollutants
Industrial Activity
Associated Pollutants
Insert specific industrial activity
Insert names of pollutants or pollutant constituents
that could be associated with this activity and
released in stormwater
Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
Repeat as necessary]
[Repeat as necessary]
[Repeat as necessary]
Repeat as necessary]
Repeat as necessary]
[Repeat as necessary]
EPA Industrial SWPPP Template, January 13, 2009 6

Storrnwater Pollution Prevention Plan (SWPPP)
INSFRT FACILITY NAME and DATE
2.2 Spills and Leaks
Instructions (See 2008 MSGP Part 5.1.3.3):
Include the following in this section:.
o "Potential spills and teaks:A description of where potential spills and, leaks could occur at your
site that could contribute pollutants to your stormwater discharge, and specify which outfall(s) are.
likely to be affected by such spills and leaks. "
o : Past spills and leaks: A description of significant spills and leaks in the past 3'years of oil or toxic • or hazardous pollutants that actually occurred at exposed areas; or that drained to a stonnwater
conveyance.
Note: Significant spills and leaks include, but are not limited to' releases of oil or hazardous substances in
excess of quantities that are report02 of the Comprehensive En able under CWA Section 311(see 40 CFR 110.6 and 40 CFR 117.21) or
ection p vironmental Resp onse, Compensation and Liability Act (CERCLA),, 42
USC §9602.
Areas of Site Where Potential Spills/Leaks Could Occur
Location Outfalls
Insert description of area where spill/leak could occur Specify which outfall(s) would be
affected
[Repeat as necessary] [Repeat as necessary]
[Repeat as necessarvl lReoeat as necessarvl
[Repeat as necessary] [ [Repeat as necessary]
Description of Past Spills/Leaks
Date Description Outfalls
Insert date of Insert description of spill/leak (where it occurred, what Specify which outfall(s)
spill/leak happened, types of pollutants, extent of damage) were affected
[Repeat as [Repeat as necessary] [Repeat as necessary]
[Repeat as I [Repeat as necessary] I [Repeat as necessary]
[Repeat as I [Repeat as necessary] I [Repeat as necessary]
necessary]
2.3 Non-Stormwater Discharges Documentation
"Instructions (see 2008'MSGP Part 5.1.3.4):
The questions below require you,to provide'documentation of the following:
o Your evaluation"for, the prese,nce,of non-stonnwater dischaiges at your site and
,o Your elimination of any unauthorized non-stonnwater discharges 4
EPA Industrial SWPPP Template, January 13, 2009 7

Stormwater Pollution Prevention Plan (SWPPP)
INSFRT FACILITY NAME and DATE-
• Date of evaluation: Insert the date(s) of your evaluation.
• Description of the evaluation criteria used: Describe the method you used to conduct your
evaluation and to determine for each non-stormwater sources whether it is prohibited or allowed
under the permit.
• List of the outfalls or onsite drainage points that were directly observed during the evaluation: Insert
outfalls/drainage points observed.
• Different types of non-stormwater discharge(s) and source locations: Describe types of non-
stormwater discharges observed and the corresponding outfall or drainage point.
• Action(s) taken, such as a list of control measures used to eliminate unauthorized discharge(s), if
any were identified. For example, a floor drain was sealed, a sink drain was re-routed to sanitary,
or an NPDES permit application was submitted for an unauthorized cooling water discharge:
Describe actions taken to eliminate unauthorized non-stormwater discharges and the
corresponding outfall/drainage point affected.
2.4 Salt Storage
Instructions (see 2008 MSGP Part 51.3.5):.
— Document the location of any storage piles containing salt used for,deicing or other commercial or industrial
purposes.
- Note: You will be asked additional questions concerning salt storage in Section 3.7 of this SWPPP template,
below.
Insert description of the location of any storage piles containing salt.
2.5 Sampling Data Summary
Instructions (See 2008 MSGP'Part5:1.3.6):
Summarize all stormwaler sampling data collected from your permitted outfalls during the previous permit "
term.
Insert summary of stormwater sampling data collected for the past permit, and/or attach discharge
monitoring reports or laboratory results.
SECTION 3: STORMWATER CONTROL MEASURES
`Instructions See2008 MSGP; Parts,5.1.4.1 and 2.1.2):
In Sections 3.1 -3.12 of this SWPPP template, you are asked to describe the stormwater control measures
that you have installed'at your site to meeteach of the permit's "non -numeric effluent limits", in Part 2.1.2 of
the"2008 MSGP:
EPA Industrial SWPPP Template, January 13, 2009 8

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
3.1 Minimize Exposure
Instructions (see.2008 MSGP Part 2.1.2.1):
Describe any structural controls or practices used to minimize the exposure of industrial activities to rain,
snow, snowmelt, and runoff. Describe where the controls or practices are being implemented at your site.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.2 Good Housekeeping
Instructions (see 2008 IVISGP Parts 2.1.2.2 and 5.1.5.1)`:
Describe any practices you are implementing to keep exposed areas.of your site clean. Describe where each
practice is being implemented at your site. Include here your schedule for: (1) regular pickup and disposal of
waste materials, and (2) routine inspections for leaks and of the condition of drums, tanks, and containers.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.3 Maintenance
Instructions (see 2008 MSGP Parts 2.11.3 and5A.5.1):
— Describe procedures (1) to maintain industrial equipment so that spills/leaks are avoided, and (2) to'maintain
any of your site's control measures in effective operating condition Include the scheduleyou will follow for
such maintenance activities. Describe where,each applicable procedure is being implemented at the site.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
EPA Industrial SWPPP Template, January 13, 2009 9

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
3.4 Spill Prevention and Response
Instructions (see 2008 MSGP Parts 2.1.24 and 5.1.5.1):
Describe any structural controls or procedures used to minimize the.potential for leaks, spills, and other
releases. You must implement the following at a minimum:
• Procedures for plainly labeling containers (e.g., "Used Oil," "Spent Solvents, "Fertilizers and
Pesticides," etc.),that could be susceptible to spillage or leakage to encourage proper handling and
facilitate rapid response if spills or leaks occur,
Preventative measures such as barriers between material storage and traffic areas,secondary
containment provisions, and procedures for material storage and handling;
• Procedures for expeditiously stopping, containing; and cleaning up leaks, spills, and other releases; and
• Procedures for notification of appropriate facility personnel, emergency response agencies, and
regulatory agencies.
Describe where each control is to be located or where applicable procedures:will be implemented.,
„
Note: Some facilities may be required to develop a Spill Prevention Control and Countermeasure (SPCC)
plan under a separate regulatory program (40 CFR 112) If you are required to'develop an SPCC'plan, or
you already have one,^you should include references to the relevant requirements from your plan.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.5 Erosion and Sediment Controls
Instructions (see 2008 MSGP Part 2.1.2.5)
Describe structural or non-structural controls used at your site to stabilize exposed areas and contain runoff to
minimize onsite erosion and potential offsite discharges of sediment. Note: You must at a minimum implement
flow velocity dissipation devices at ouffalls and discharge channels' Describe the location at your site where
each control will be implemented.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.6 Management of Runoff
Instructions "(See )°
See 2008 MSGP Part 21 2.6
Describe controls used,atyoursite to divert; "infiltrate, reuse, contain, or otherwise reduce stonnwater nmoff.
y controlwill be implemented.
Describe the location at our site where each con
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
EPA Industrial SWPPP Template, January 13, 2009 10

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
3.7 Salt Storage Piles or Piles Containing Salt
Instructions (see 2008,MSGP Part 2.1.2.7);
If applicable, describe structures at your site that either cover or enclose salt storage piles or piles containing salt,
or that prevent the discharge of stormwater from such piles. Also, describe any controls or procedures used to
minimize exposure resulting from adding to or removing materials from the pile. Describe the location at your site
where each control and/or.procedure will be implemented.;
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.8 MSGP Sector -Specific Non -Numeric Effluent Limits
Instructions (see 2008 MSGP Part 2.1.2.8): .
Describe any controls or procedures that will be used at your site to comply with any sector -specific
41
requirements that, apply,to you in Part8 of the 2008 MSGP... Describethe location at your site where "
each control and/or procedure will be implemented.
Note- �H�1,L�M,N,01P,Q,R,S,T,U�"V,X,
Y, Z,.andct�or-specifceffluent limits apply to Sectors A, E, F, G
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.9 Employee Training
Instructions (see, 2008.MSGP Parts 2.1.2.9 and 5.1.5.1):
Describe your plan for training the employees who work inareas where industrial materials or activities are
,exposed to stormwater, or who are responsible for implementing activities necessary. to, meet the conditions of
the 2008 MSGP, including all members of your Pollution Prevention Team. Included in your description must be
,
the frequency of training (note:. recommended at least one time per year), and y
the schedule ouwill follow.
INSERT DESCRIPTION OF PLAN FOR TRAINING APPLICABLE STAFF HERE.
3.10 Non-Stormwater Discharges
Instructions, (see 2008 MSGP 21.210): ;
Describe how you`eliminat6d any unauthorized non-stormwater discharges at your site. 'The unauthorized non-
stor
mwater discharges include any non-stormwater discharges that are not specifically identified'm Part 1:1.3 of
the 2008 MSGP. Note: If this section is already;addressed by your documentation for Section 2.3 of the SWPPP
template, you can simply include a°"cross reference to that section of your SWPPP."
INSERT DESCRIPTION OF YOUR APPROACH TO ELIMINATING UNAUTHORIZED NON-
STORMWATER DISCHARGES HERE.
EPA Industrial SWPPP Template, January 13, 2009

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
3.11 Waste, Garbage and Floatable Debris
Instructions (see 2008 MSGP Part 2.1.2.11):
Describe controls and procedures that will be used at your site to minimize discharges of waste, garbage, and
floatable debris. Describe the location at your site where each control and/or procedure will be implemented.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
3.12 Dust Generation and Vehicle Tracking of Industrial Materials
Instructions (see 2008ASGP Part 2.1.2.12):
p y y your site where_ each control and/or pro off -site tracking Describe controls and procedures you will use at our site to minimize the eneration of dust a
of raw, final, or waste materials. Describe the location at o procedures will be ..,
implemented.
INSERT DESCRIPTION OF CONTROL MEASURES HERE.
EPA Industrial SWPPP Template, January 13, 2009 12

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
SECTION 4: SCHEDULES AND PROCEDURES FOR MONITORING
Instructions (see 2008 MSGP Part 5.1.5.2):
= Describe your procedures for conducting the five types of analytical monitoring specified by the MSGP;
Where applicable to your facility, including:
• Benchmark monitoring (2008 MSGP, Part 6.2.1 and relevant requirements in Part 8 and/or Part 9);
• Effluent limitations guidelines monitoring (200.8 MSGP, Part 62.2 and relevant requirements in Part 8);
• State- or Tribal -specific monitoring (2008 MSGP, Part 6.2 3 and,relevant requirements in Part 9);
• .Impaired waters monitoring (2008 MSGP,,Part 6.2.4); and
• Other monitoring as required by EPA (2008 MSGP, Part 6.2.5).
Depending on the type of facility you operate, and the monitoring`requirements'to which' you are subject, you
must collect and anaWe stormwater samples and document monitoring activities consistent with the
procedures described in 2008 MSGP; Part 6 and Appendix B, Subsections 10 =12, and any additional. „
sector -specific or State/Tribal-specific requirements in 2008 MSGP, Parts 8 and 9, respectively. Refer to
2008 MSGP, Part 7 for reporting and recordkeeping requirements. Note` All monitoring must be conducted
in accordance, with the relevant sampling and analysis requirements of 40 CFR Part 136. Include in'your
description procedures for ensuring compliance with these requirements..
If you are invoking the exception for inactive and "unstaffed sites for benchmark monitoring, you must include
in your SWPPP the information to support this,claim as required by 2008 MSGP, Part 6.2:1.3.
If you plan to use the substantially identical outall exception for your benchmark monitoring,reguirements in `
2008 MSGP, Part 6:2.1 and/or your quarterly visual assessment.requirements in 2008 MSGP, Part 4.2.3,4
you must include the following documentation:
• • Location of each, of the substantially identical outfalls;
• Description of the general industrial activities conducted in the drainage area of each outall;
• " Description of the'comrol,measures implemented in the drainage area of each outfall;
• Description of the exposed materials located in. the drainage area of each ouffall that are likely to be
significant contributors of pollutants to stormwater discharges
An estimate of the runoff coefficient of_the drainage areas (low = under 4l)%; medium = 40 to 65%; high
= above 65%); and
• Why " the ouffalls are expected p to discharge rg substantially identical effluents:
For each type of monitoring, your SWPPP must include a description of:
1. Sample Location(s). Describe where samples will be collected, including any determination that two or
more outfalls are substantially identical. INSERT TEXT HERE
2. Pollutant Parameters to be Sampled. Include a list of the pollutant parameters that will be sampled and
the frequency of sampling for each parameter. INSERT TEXT HERE
3. Monitoring Schedules. Include the schedule you will follow for monitoring your stormwater discharge,
including where applicable any alternate monitoring periods to be used for facilities in climates with irregular
stormwater runoff (2008 MSGP, Part 6.1.6). INSERT TEXT HERE
EPA Industrial SWPPP Template, January 13, 2009 13

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAML and DATE
4. Numeric Limitations. List here any pollutant parameters subject to numeric limits (effluent limitations
guidelines), and which outfalls are subject to such limits. Note that numeric limits are only included for
Sectors A, C, D, E, J, K, L, and 0. INSERT TEXT HERE
5. Procedures. Describe procedures you will follow for collecting samples, including responsible staff who will
be involved, logistics for taking and handling samples, laboratory to be used, etc. INSERT TEXT HERE
Note: It may be helpful to create a table with columns corresponding to # 1 - 5 above for each type of monitoring you
are required to conduct.
Inactive and Unstaffed sites exception (if applicable)
If you are invoking the exception for inactive and unstaffed sites for benchmark monitoring, include information to
support this claim.
INSERT TEXT HERE
Substantially identical outfall exception (if applicable)
If you plan to use the substantially identical outfall exception for your benchmark monitoring and/or quarterly visual
assessment requirements, include the following information here to substantiate your claim that these outfalls are
substantially identical:
• Location of each of the substantially identical outfalls: INSERT TEXT HERE
• Description of the general industrial activities conducted in the drainage area of each outfall: INSERT TEXT
HERE
• Description of the control measures implemented in the drainage area of each outfall: INSERT TEXT HERE
• Description of the exposed materials located in the drainage area of each outfall that are likely to be
significant contributors of pollutants to stormwater discharges: INSERT TEXT HERE
• An estimate of the runoff coefficient of the drainage areas (low=under 40%; medium=40 to 65%; high
=above 65%): INSERT TEXT HERE
• Why the outfalls are expected to discharge substantially identical effluents: INSERT TEXT HERE
EPA Industrial SWPPP Template, January 13, 2009 14

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
SECTION 5: INSPECTIONS
Instructions:
— : Describe, your, procedures for performing the three types of inspections required by the 2008 MSGP,
including:
• Routine facility inspections (2008 MSGP, Part 4.1);
"Quarterly visual assessment of stormwater discharges (2008 MSGP, Part 4.2); and
• Comprehensive site inspections (2008 MSGP, Part 4.3).
— If you are invoking the exception for inactive and unstaffed sites relating to routine facility inspections and
quarterly visual assessments, you must include in your SWPPP the information to support this claim as
required by 2008 MSGP, Parts 4.1 3 and
—` A sample routine facility, inspection and quarterly visual assessment form is available on EPA's MSGP`
website (wvvw.epa.q'6v/npdes/stormwater/msgp) in the "Additional MSGP Documentation" file. Appendix l of.
the 20,08 MSGP includes a comprehensive site inspection form (Annual Reporting Form).
For the routine facility inspections and the comprehensive site inspections to be performed at your site, include a
description of the following:
• The names of the person(s), or the positions of the person(s), responsible for inspection: INSERT TEXT
HERE
• The schedules to be used for conducting inspections. Include here any tentative schedule that will be used
for facilities in climates with irregular stormwater runoff discharges (2008 MSGP, Part 4.2.3): INSERT TEXT
HERE and
• Specific areas of the facility to be inspected, including schedules for specific outfalls: INSERT TEXT HERE
For the quarterly visual assessments to be performed at your site, include a description of the following:
• The names of the person(s), or the positions of the person(s), responsible for inspection: INSERT TEXT
HERE
• The schedules to be used for conducting inspections. Include here any tentative schedule that will be used
for facilities in climates with irregular stormwater runoff discharges (2008 MSGP, Part 4.2.3): INSERT TEXT
HERE and
• Specific areas of the facility to be inspected, including schedules for specific outfalls: INSERT TEXT HERE
Inactive and Unstaffed sites exception (if applicable)
If you are invoking the exception for inactive and unstaffed sites for your routine facility inspections and quarterly
visual assessments, include information to support this claim.
INSERT TEXT HERE
EPA Industrial SWPPP Template, January 13, 2009 15

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME" and DATE"
SECTION 6: DOCUMENTATION TO SUPPORT ELIGIBILITY
CONSIDERATIONS UNDER OTHER FEDERAL LAWS
6.1 Documentation Regarding Endangered Species.
Instructions (see 2008 MSGP Part 5.1.6.1):
Include any documentation you have that supports your determination of eligibility consistent with 2008 MSGP,
Part 1.1.4.5 (Endangered and Threatened Species and Critical Habitat Protection). Refer to Appendix E of the
2008 MSGP for specific instructions for establishing eligibility.
INSERT TEXT HERE OR KEEP DOCUMENTATION WITH SWPPP.
6.2 Documentation Regarding Historic Properties
Instructions (see 2008 MSGP Part 5.1.6.2):
Include any documentation you have; that supports your determination of eligibility consistent with 2008 MSGP,
Part 1.1.4.6 (Historic Properties Preservation). Refer to Appendix of the 2008 MSGP for specific instructions for
establishing eligibility.
INSERT TEXT HERE OR KEEP DOCUMENTATION WITH SWPPP.
6.3 Documentation Regarding NEPA Review (if applicable)
Instructions (see 2008 MSGP Part 5.1.6.3)`.
Include any documentation you have that supports your determination of eligibility consistent with MSGP 2008
Part 1.1.2.5 (Discharges Subject to Any New Source Perfor ante Standards).
INSERT TEXT HERE OR KEEP DOCUMENTATION WITH SWPPP,
SECTION 7: SWPPP CERTIFICATION
Instructions (see 2008'MSGP Part 5.1.7):
The following certification statement must be signed and dated by a person who meets the requirements of
Appendix B, Subsection 11 A or 113, of.the 2008 MSGP. Note. This certification must be re -signed in the,event
of a SWPPP modification in response to a, Part 3.1 trigger for corrective action.
EPA Industrial SWPPP Template, January 13, 2009 16

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATL
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.
Name:
Signature:
Title:
Date:
EPA Industrial SWPPP Template, January 13, 2009 17

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME" and DATE
SECTION 8: SWPPP MODIFICATIONS
Instructions (see 2008 MSGP Part 5.2):
Your SWPPP is a °living" document and is required to be modified and;updated, as necessary, in response
to corrective actions. See Part 3.4 of the 2008 MSGP.
o If you need to modify the SWPPP in response to a corrective action required by Part 3.1 of the 2008
MSGP, then the certification statement in section 7 of this SWPPP template must be re -signed in
accordance with 2008 MSGP Appendix B, Subsection 11.A or 11.B.
name of the person making it, the date a d signature of that person. See 2008 MSGP modification, the
o 'For Y Y P 9description
Appendix B, Subsection 11.C.
INSERT LOG HERE or REFERENCE ATTACHMENT
EPA Industrial SWPPP Template, January 13, 2009 18

Stormwater Pollution Prevention Plan (SWPPP)
INSERT FACILITY NAME and DATE
SWPPP ATTACHMENTS
Attach the following documentation to the SWPPP:
Attachment A - General Location Map
Include a copy of your general location map in Attachment A.
Attachment B - Site Map
Include a copy of your site map(s) in Attachment B.
Attachment C - 2008 MSGP
Note: It is helpful to keep a printed -out copy of the 2008 MSGP so that it is accessible to you for
easy reference. However, you do not need to formally incorporate the entire 2008 MSGP into your
SWPPP. As an alternative, you can include a reference to the permit and where it is kept at the
site.
EPA Industrial SWPPP Template, January 13, 2009 19

S
Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
Additional MSGP Documentation Template
Introduction
After you become permitted under the 2008 MSGP, you are required to keep certain minimum
records (or documentation) as part of the implementation of your permit responsibilities. As
required in Part 5.4 of the 2008 MSGP, these records must be kept in the same place your SWPPP
(which you completed prior to submitting your NOI to be covered) is kept. This "Additional MSGP
Documentation Template" (or "Template") will assist you in complying with this requirement.
Using the Additional MSGP Documentation Template
Tips for using the Template:
This Template is designed for use by all facilities permitted under the 2008 MSGP.
The Template is NOT tailored to your individual industrial sector. Depending on
which industrial sector(s) you fall under (see Appendix D of the 2008 MSGP) and
where your facility is located (see Appendix C of the 2008 MSGP), you will need to
address any additional documentation requirements outlined in Part 8 and/or Part
9 of the permit, respectively.
• Each section of the template includes "instructions" and space for your facility's
specific information. You should read the instructions before you complete each
section. The text you will need to complete is generally indicated through the use
of blue form fields (e.g., "Insert Facility Name"). Click on the form field and your
text will replace the instructional text.
• The Template was developed in Microsoft Word so that you can easily add tables
and additional text.
• Because many of the activities you are required to document occur throughout
the permit term, you will need to continually modify and add records to this
Template. You may wish to create separate electronic files for each category of
documentation (e.g., files for monitoring, employee training, etc.) so that they can
be easily modified.
• The records you create using this Template must be kept in the same location as
your SWPPP.
EPA notes that while EPA has made every effort to ensure the accuracy of all instructions and
guidance contained in the Template, the actual obligations of regulated industrial facilities are
determined by the relevant provisions of the permit, not by the Template. In the event of a conflict
between the Template and any corresponding provision of the MSGP, the permit provisions
establish your actual requirements. EPA welcomes comments on the Template at any time and
will consider those comments in any future revision of this document.
EPA Additional MSGP Documentation Template, January 13, 2009

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
Additional MSGP Documentation
For:
Insert Facility Name
Insert Facility Address
Insert City, State, Zip Code
Insert Facility Telephone Number (if applicable)
Insert Facility Permit Tracking Number
'Instructions:',Xl
Keep the folldwing inspection momtonrig and certification records m the same location that you keep your
SWPPP x 5
A copy of the N01 submitted to EPA along with any correspondence exchanged betweenyou andv
EPA specific to:coverage under this permit;(you should already, fiave this)
A copy of the acknowledgment letter you received from`the N01 Processmg Center or.. NOl,syster'n10
.
assigning your permit tracking number{you should already have this) _'
A copy*of 2001i M$GP (you sari provide ah electronic copy) 3 4, f a a
'Description
s and dates of any;incidences of significant spills" leak§ or other releases
P Records of employee training y . z
Documentation of maintenance and repairs of control measures a
All Linspection reports * c ` A
Description of'any deviations from the schedule for visual assessments and/or monitoring
Description of any corrective action taken at your site _,'
Documentation of any benchmark exdeedahces and how they were, respontled to
Documentahofi to:support any _determination that'pollutants of concern are :not expected_ to be a
present, above natural background levels Lnd that such pollutants; aere,notdetected m yourr .I
dlscharge,oGwere solely attributable to natural background sources and r�
0 - ., T 4 1 * ✓ � l t �6p
Documentation to support your claim that your facility has changed its status from activetoinactiv'l
f'* s:. Eand unstaffed ,azra ,
EPA Additional MSGP Documentation Template, January 13, 2009 ii

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUM1317R
Contents
A. Significant spills, leaks or other releases
B. Employee training..............................................................................................................
2
C. Maintenance......................................................................................................................
3
D. Routine Facility Inspection Reports......................................................................................
5
E. Quarterly Visual Assessment Reports................................................................................
10
F. Comprehensive Site Inspection Reports.............................................................................
12
G. Monitoring results............................................................................................................
13
H. Deviations from assessment or monitoring schedule...........................................................
14
I. Benchmark Exceedances...................................................................................................
15
J. Impaired Waters Monitoring: Documentation of Natural Background
Sources or Non -Presence
ofImpairment Pollutant.........................................................................................................
16
K. Active/Inactive status change............................................................................................
17
L. SWPPP Amendment Log..................................................................................................
18
M. Miscellaneous Documentation..........................................................................................
19
EPA Additional MSGP Documentation Template, January 13, 2009 iii

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
A. Significant spills, leaks or other releases
Instructions:
Include the
criptions and
ates
any
ces of
nificant
ks� or other releasds that'
r circumstances dig to pollutants
of and actions aken" inresponsethe release; and measures take
resulted in discharges of llutants to waters of the U S., through stormwater or otherwise; the
c n to
prevent the recurrence of such releases (see Part 2.1.2.4 of the 2008 MSGP)
Provide information, as shown below, for eachincident, and attach additional documentation (e.g., photos,'
spill cleanup records) as necessary. Repeafas necessary by copying and pasting the fields below:.
Date of incident: Insert Date of Incident
Location of incident: Insert Location of Incident
Description of incident: Insert Description of Incident
Circumstances leading to release: Describe circumstances leading to release
Actions taken in response to release: Describe actions taken in response to release
Measures taken to prevent recurrence: Describe measures taken to prevent recurrence
Date of incident: Insert Date of Incident
Location of incident: Insert Location of Incident
Description of incident: Insert Description of Incident
Circumstances leading to release: Describe circumstances leading to release
Actions taken in response to release: Describe actions taken in response to release
Measures taken to prevent recurrence: Describe measures taken to prevent recurrence
Date of incident: Insert Date of Incident
Location of incident: Insert Location of Incident
Description of incident: Insert Description of Incident
Circumstances leading to release: Describe circumstances leading to release
Actions taken in response to release: Describe actions taken in response to release
Measures taken to prevent recurrence: Describe measures taken to prevent recurrence
Date of incident: Insert Date of Incident
Location of incident: Insert Location of Incident
Description of incident: Insert Description of Incident
Circumstances leading to release: Describe circumstances leading to release
Actions taken in response to release: Describe actions taken in response to release
Measures taken to prevent recurrence: Describe measures taken to prevent recurrence
EPA Additional MSGP Documentation Template, January 13, 2009

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT "[RACKING NUMBER
B. Employee training
Instructions:
— Keep records of employee training, including the date of the training (see Part 2.1.2.9 of the 2008 MSGP).
— For in -person training, consider using the tables below to document your employee trainings. For
computer -based or other types of training, keep similar records on who was trained and the type of training
conducted.
Training Date: Insert Date of Training
Training Description: Insert Description of Training
Trainer: Insert Trainers names
Employee(s) trained
Employee signature
Insert Name
Insert Name
Insert Name
Insert Name
Insert Name
Insert Name
Training Date: Insert Date of Training
Training Description: Insert Description of Training
Trainer: Insert Trainers names
Employee(s) trained
Employee signature
Insert Name
Insert Name
Insert Name
Insert Name
Insert Name
Insert Name
Training Date: Insert Date of Training
Training Description: Insert Description of Training
Trainer: Insert Trainers names
Employee(s) trained
Employee signature
Insert Name
Insert Name
Insert Name
Insert Name
Insert Name
Insert Name
EPA Additional MSGP Documentation Template, January 13, 2009 2

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
C. Maintenance
Instructions:
Include 'in"your records documentation of maintenance and repairs of control measures and: industrial
equipment, including:
the control measure/equipment maintained,
date(s) of regular maintenance,
- date(s) of discovery of areas in need of repair/replacement, andfor repairs,
- date(s) that the control measure/equipment was returned to full function, and
- the justification for any extended maintenance/repair schedules (see Part 2.1.2.3 of the
2008 MSGP).
Provide information, as shown below, to document your maintenance activities for each control measure
and industrial equipment. Repeat as necessary by copying and pasting the information below for
additional, control measures.
Control Measure Maintenance Records (copy information below for each control measure)
Control Measure: Insert Name of Control Measure
Regular Maintenance Activities: Describe maintenance activities
Regular Maintenance Schedule: Insert Maintenance Schedule
Date of Action: Insert Date of Action
Reason for Action: ❑ Regular Maintenance ❑ Discovery of Problem
If Problem,
- Description of Action Required: Describe actions taken in response to problem
- Date Control Measure Returned to Full Function: Insert Date
- Justification for Extended Schedule, if applicable: Insert Justification (if applicable)
Notes: Insert Notes (if applicable)
EPA Additional MSGP Documentation Template, January 13, 2009 3

Additional MSGP Documentation
INSERT FACILITY NAM17 INSERT FACILITY PERMIT' TRACKING NUMBER
Industrial Equipment and Systems Maintenance Records (copy information below for each
industrial equipment/system)
Industrial Equipment/Systems: Insert Name of Industrial Equipment/System
Regular Maintenance Activities: Describe maintenance activities
Regular Maintenance Schedule: Insert Maintenance Schedule
Date of Action: Insert Date of Action
Reason for Action: ❑ Regular Maintenance ❑ Discovery of Problem
If Problem,
• Description of Action Required: Describe actions taken in response to problem
• Date Industrial Equipment Returned to Full Function: Insert Date
• Justification for Extended Schedule, if applicable: Insert Justification (if applicable)
Notes: Insert Notes (if applicable)
EPA Additional MSGP Documentation Template, January 13, 2009

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
D. Routine Facility Inspection Reports
Instructions:
Include in your records copies of all routine facility inspection reports completed for the facility.
The sample inspection report is consistent with the requirements in Parts 4.1 of the 2008 MSGP relating to
routine facility inspections. Facilities subject to State.industrial stormwater permits may also find this form
useful. � If your permitting authority provides you with an inspection, report, use that form.; ,
Using the Sample, Routine Facility Inspection RepgN
This inspection reportis designed to be customized according to the specific control measures and
activities at your facility. For ease of use, you should take.a copy of your site plan and number all of the
stormwater control measures and areas of industrial activity that will be inspected': Abrief description of
the control measures and areas that were inspected should then be listed in thesite-specific section of the
inspection report.
You can complete the items in the "General Information" section that will remain constant, such.as the
facility name, NPDES tracking number, and inspector (if you only use one inspector). Print out multiple
copies of this customized inspection report to use duringyour inspections.
- When conducting the inspection, walk the site by following your site map and numbered control`
measures/areas of industrial activity to be inspected. Also note whether the "Areas of Industrial Materials
or Activities exposed to stormwater" have been addressed (customize this list according to the conditions
at your facility). Note any"required corrective actions and the date and responsible person for the
correction..
EPA Additional MSGP Documentation Template, January 13, 2009 5

Stormwater Industrial Routine Facility Inspection Report
General Information
Facility Name
Insert Name
NPDES Tracking No.
Insert Tracking No.
Date of Inspection
Insert Date
start/End Time
I Insert Start/End Time
Inspector's Name(s)
Insert Name
Inspector's Title(s)
Insert Title
Inspector's Contact Information
Insert Contact Info
Inspector's Qualifications
Insert qualifications or add reference to the SWPPP
Weather Information
Weather at time of this inspection?
❑ Clear ❑Cloudy ❑ Rain ❑ Sleet ❑ Fog ❑ Snow ❑ High Winds
❑ Other: Temperature:
Have any previously unidentified discharges of pollutants occurred since the last inspection? ❑Yes ❑No
If yes, describe: Describe
Are there any discharges occurring at the time of inspection? ❑Yes ❑No
If yes, describe: Describe
Control Measures
• Number the structural stormwater control measures identified in your SWPPP on your site map and list them below (add
as many control measures as are implemented on -site). Carry a copy of the numbered site map with you during your
inspections. This list will ensure that you are inspecting all required control measures at your facility.
• Describe corrective actions initiated, date completed, and note the person that completed the work in the Corrective Actiot
Lo .
StructuralControl
Control
If No, In Need of
Corrective Action Needed and Notes
Measure
Measure is
Maintenance,
(identify needed maintenance and repairs, or any
Operating
Repair, or
failed control measures that need replacement)
Effectively?
Replacement?
I
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement
Z
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement
3
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement
4
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement
5
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement
6
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement
7
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement
8
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement

Structural Control
Control
If No, In Need of
Corrective Action Needed and Notes
Measure
Measure is
Maintenance,
(identify needed maintenance and repairs, or any
Operating
Repair, or
failed control measures that need replacement)
Effective) ?
Re lacement?
9
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement
10
Insert Control Measure
❑Yes ❑No
❑ Maintenance
Describe Corrective Actions
Name
❑ Repair
❑ Replacement
Areas of Industrial Materials or Activities exposed to stormwater
Below are some general areas that should be assessed during routine inspections. Customize this list as neededfor the specific
hpes of industrial materials or activities at your facility.
Area/Activity
Inspected?
Controls
Corrective Action Needed and Notes
Adequate
(appropriate,
effective,
and
1
Material
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
loading/unloading and
storage areas
2
Equipment operations
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
and maintenance areas
3
Fueling areas
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
4
Outdoor vehicle and
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
equipment washing areas
5
Waste handling and
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
disposal areas
6
Erodible
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
areas/construction
7
Non-stormwater/ illicit
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
connections
8
Salt storage piles or pile
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
containing salt
9
Dust generation and
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
vehicle tracking
10
(Other)
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
11
(Other)
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
12
(Other)
❑Yes
❑No
❑ N/A
❑Yes
❑No
Describe Corrective Actions
Non -Compliance

Use this space for any additional notes or
Additional Notes
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 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."
Print name and title:
Signature:

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
E. Quarterly Visual Assessment Reports
Instructions:
— Include in your records copies of alfquarterly visual assessment reports completed for the facility. An
example quarterly visual assessment report can be found on the following page.
EPA Additional MSGP Documentation Template, January 13, 2009 10

MSGP Quarterly Visual Assessment Form
(Complete a separate form for each outfall you assess)
Name of Facility: Name of Facility NPDES Tracking No. Insert Tracking No.
Outfall Name: Name "Substantially Identical Outfall"? ❑ No ❑ Yes (identify substantially identical outfalls):
Person(s)/Title(s) collecting sample: Name/Title
Person(s)/Title(s) examining sample: Name/Title
Date & Time Discharge Began: Date & Time Sample Collected: Date & Time Sample Examined:
Enter date and time Enter date and time Enter date and time
Substitute Sample? ❑ No ❑ Yes (identify quarter/year when sample was originally scheduled to be collected):
Nature of Discharge: ❑ Rainfall ❑ Snowmen
If rainfall: Rainfall Amount: No of Previous Storm Ended > 72 hours ❑ Yes ❑ No' (explain):
riches inches Before Start of This Storm?
Parameter
Color ❑ None ❑ Other (describe):
Odor ❑ None ❑ Musty ❑ Sewage ❑ Sulfur ❑ Sour ❑ Petroleum/Gas
❑ Solvents ❑ Other (describe):
Clarity ❑ Clear ❑ Slightly Cloudy ❑ Cloudy ❑ Opaque ❑ Other
Floating Solids ❑ No ❑ Yes (describe):
Settled Solids" ❑ No ❑ Yes (describe):
Suspended Solids ❑ No ❑ Yes (describe):
Foam (gently shake sample) ❑ No ❑ Yes (describe):
Oil Sheen ❑ None ❑ Flecks ❑ Globs ❑ Sheen ❑ Slick
❑ Other (describe):
Other Obvious Indicators ❑ No ❑ Yes (describe):
of Stormwater Pollution
' 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 document<
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.
Detail any concerns, additional comments, descriptions of pictures taken, and any corrective actions taken below (attach additional
sheets as necessary). Insert details
Certification by Facility Responsible official (Refer to MSGP Subpart 11 Appendix B for Signatory Requirements)
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 a
that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the person or persons who manage the system, or tt
persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I ai
aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations.
A. Name: B. Title:
C, Signature: D. Date Signed:

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT" 1 RACKING NUMBER
F. Comprehensive Site Inspection Reports
Instructions:
— Include in your records copies of all comprehensive site inspection reports completed for the facility. "
Copies of the comprehensive site inspection report form (also called the'Annual Reporting Form) can be
obtained at hffp://www.epa.gov/npdes/pubs/msqp2008'appendixi.pdf
— For corrective actions, complete part D (Corrective Actions) of the Annual Reporting Form.
EPA Additional MSGP Documentation Template, January 13, 2009 12

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT'IRACRING NUMBER
G. Monitoring results
Instructions:
— Include in your records copies of all monitoring results (including benchmarks, effluent limits, and other
monitoring conducted) for the facility. Also include copies of MSGP Industrial Discharge Monitoring
Reports (DM) submitted to EPA, or copies of monitoring data submitted to EPA's eN01 reporting
system.
EPA Additional MSGP Documentation Template, January 13, 2009 13

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
H. Deviations from assessment or monitoring schedule
Instructions:
Include in your records:
— A description of any deviations from the schedule, you provided In your SWPPP for visual assessments
and/or monitoring, and
The reason for the deviations (e.g., adverse weather"or it was impracticable to collect samples within the
first 30 minutes of a measurable storm event) (see Parts 4.2.1, 6.1 4,,and 6:2.1.2 of the 2008 MSGP)
Use the fields below to document the deviations. Repeat as necessary for any deviations.
Date: Insert Date
❑ Visual assessments ❑ Monitoring
Describe deviation from schedule: Describe deviation
Reason for deviation: Describe reason
Date: Insert Date
❑ Visual assessments ❑ Monitoring
Describe deviation from schedule: Describe deviation
Reason for deviation: Describe reason
Date: Insert Date
❑ Visual assessments ❑ Monitoring
Describe deviation from schedule: Describe deviation
Reason for deviation: Describe reason
Date: Insert Date
❑ Visual assessments ❑ Monitoring
Describe deviation from schedule: Describe deviation
Reason for deviation: Describe reason
EPA Additional MSGP Documentation Template, January 13, 2009 14

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMITTRACKING NUMBER
I. Benchmark Exceedances
Instructions:
Include in your records documentation of any benchmark exceedances and how they were,respondeddo,
including either:'
— (1) corrective action taken,
(2) a finding that the exceedence was due to natural background pollutant levels, or
— . (3) a finding that no further pollutant reductions were technologically available and economically
practicable and achievable in light of best industry practice consistent with Part 6.2:1.2 of the'2008 MSGP.
Date: Insert Date
Parameter Exceeded and Results: Insert Parameter Name
Quarter 1 (Sample date: Insert Sample Date) Result: Insert Sample Result
Quarter 2 (Sample date: Insert Sample Date) Result: Insert Sample Result
Quarter 3 (Sample date: Insert Sample Date) Result: Insert Sample Result
Quarter 4 (Sample date: Insert Sample Date) Result: Insert Sample Result
Average Result: Insert Value
Benchmark Value: Insert Benchmark Value from 2008 MSGP
Document how benchmark exceedance(s) responded to:
❑ Corrective action taken
Parameter(s): Insert Parameter
Complete Part D (corrective actions) of the Annual Report Form (see section F of the
Additional MSGP Documentation).
❑ Finding that the exceedence was due to natural background pollutant levels
Parameter(s): Insert Parameter
Attach the following documentation:
• An explanation of why you believe that the presence of the pollutant causing the
impairment in your discharge is not related to the activities at your facility; and
• Data and/or studies that tie the presence of the pollutant causing the impairment in
your discharge to natural background sources in the watershed.
❑ Finding that no further pollutant reductions are technologically available and
economically practicable and achievable in light of best industry practice consistent with
Part 6.2.1.2.
Parameter(s): Insert Parameter
Attach documentation.
EPA Additional MSGP Documentation Template, January 13, 2009 15

Additional MSGP Documentation
INSERTFACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
J. Impaired Waters Monitoring: Documentation of Natural
Background Sources or Non -Presence of Impairment Pollutant
Instructions:
•This section applies only if your facility:
• Discharges directly to an impaired water without an:EPA approved or established total
maximum daily load'(TMDL); and eitheryour impaired waters monitoring results shows'that the
pollutant(s) for which the water is impaired is
1. Notpresent and not expected to be present in yourdischarge, or
2. Present, but you have determined its presence is caused solely by natural
background sources., See Part 6:2A.2 of the 2008 MSGP:
If # 1 applies to your facility, include here documentation that the impairment pollutant(s) was not
detected in your discharge sample,
If # 2 applies to your facility, include the following documentation here: ^'
• An explanation of why you believe that the presence of the pollutant(s) causing the impairment
in your discharge is not related to the activities at your facility; and "
• .Data and/or studies that tie the, presence of the pollutant(s) causing the 'impalrrnent in your
discharge to natural background sources in the watershed,
Note: You are reminded that the permit requires you to include a notification that you have met either
condition # 1 or # 2 (above) in your monitoring report that you submit to EPA.
Date: Insert Date
Check one of the boxes below and complete the additional documentation:
❑ #1— Pollutant(s) for which the water is impaired is not present and not expected to be
present in your discharge
Attach documentation that the impairment pollutant(s) was not detected in your discharge
sample(s).
❑ #2 — Pollutant(s) for which the water is impaired is present, but you have determined its
presence is caused solely by natural background sources.
Attach the following documentation:
• An explanation of why you believe that the presence of the pollutant(s) causing the
impairment in your discharge is not related to the activities at your facility; and
• Data and/or studies that tie the presence of the pollutant(s) causing the impairment in your
discharge to natural background sources in the watershed.
EPA Additional MSGP Documentation Template, January 13, 2009 16

Additional MSGP Documentation
INSERT FACILITY NAME INSEKT FACILITY PERMIT"TRACKING NUMBER
K. Active/inactive status change
Instruction's:
If your facility changes it status from active to inactive and unstaffed (or from inactive/unstaffed to active), include
documentation in this section to support your claim.
Date: Insert Date of Change in Status
New Facility Status: ❑ Inactive and Unstaffed ❑ Active
Reason for change in status: Describe reason
EPA Additional MSGP Documentation Template, January 13, 2009 17

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
L. SWPPP Amendment Log
Instructions:
Include in your records:
— A log of the date and description of any amendments to your SWPPP. '
Fill in the appropriate columns of this table for each amendment to your SWPPP. Copy and paste additional rows
into the table as necessary.
sAmend.
No:'
Descri"ption of"the Ain'enHroerit'
Date of
Amendment
Amendment Prepaied
by [Namets) and 7r tl'e]
1
Insert description of amendment
Insert date
Insert name/title
2
Insert description of amendment
Insert date
Insert name/title
3
Insert description of amendment
Insert date
Insert name/title
4
Insert description of amendment
Insert date
Insert name/title
5
Insert description of amendment
Insert date
Insert name/title
6
Insert description of amendment
Insert date
Insert name/title
7
Insert description of amendment
Insert date
Insert name/title
8
Insert description of amendment
Insert date
Insert name/title
9
Insert description of amendment
Insert date
Insert name/title
10
Insert description of amendment
Insert date
Insert name/title
11
Insert description of amendment
Insert date
Insert name/title
EPA Additional MSGP Documentation Template, January 13, 2009 18

Additional MSGP Documentation
INSERT FACILITY NAME INSERT FACILITY PERMIT TRACKING NUMBER
M. Miscellaneous Documentation
Instructions:
Use this section to keep records of any additional documentation that relates to your compliance with the permit.
EPA Additional MSGP Documentation Template, January 13, 2009 19