07_Illicit Discharge Inspection Worksheet

Illicit Discharge Inspection Worksheet
Date of inspection: Time: Duration of inspection:
Type of inspection: Initial / Site Visit / Return
Primary Inspector:
Secondary Inspector:
Weather Condition: Clear / Overcast / Raining
Time of Discharge: Estimated Volume of Discharge:
Map Number:
Visual Screeninq
Owner/Operator Name:
Business Description:
Business Type:
Address:
City:
Zip:
Connection Type: Occurred on Land:
Flow Observed: Occurred in Air:
Comments: Occurred in Water:
High Risk Industry?: Yes / No Industry Type:
Discharge Directly into Water?: Yes / No Receiving Water Name:
Responsible Party Notified: Yes / No Date Notified:
Discharge Stopped?: Yes / No Date Stopped:
minutes
Yes / No
Yes / No
Yes / No

Illicit Flow Characterization Data Sheet
Field Parameters (Circle the appropriate answer)
Bioloaical Color Odor Sedimentation
None
Clear
None
None
Not Applicable
Red
Chlorine
Slight 1 — 3 inches
Other (name)
Yellow
Fuel / Oil
Moderate 3 — 6 inches
Brown
Fishy
> Excessive 6 in
Green
Musty
Litter
Gray
Sewage
Oily
Dark
Rotten Egg / Sulfur
Sewage
Tannin
Sour Milk
Not Applicable
White
Not Applicable
Not Applicable
Floatables Turbiditv Stains Miscellaneous
None
Clear
None
Not Applicable
Oil
Slightly Turbid
Not Applicable
Other (name)
Sheen
Moderately Turbid
Other (name)
Garbage / Trash
Very Turbid
Sewage / Milt
Suspended Solids
Not Applicable
Not Applicable
Other (name)
Is Discharge Hazardous?: Yes / No Corrective Actions Required?: Yes / No
Possess a Health Threat?: Yes / No
Inspection Result: Pass / Fail / In Compliance / Out of Compliance / Unknown