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Quarterly Visual Storm Water Monitoring Report

Quarterly visual monitoring is designed to help you assess the effectiveness of your Stormwater Pollution Prevention Plan (SWP3) in reducing pollution in stormwater runoff from your facility. (Complete a separate form for each outfall you assess)
Jake's Finer Foods
04/30/2024

Quarterly Visual Storm Water Monitoring Report

Quarterly visual monitoring is designed to help you assess the effectiveness of your Stormwater Pollution Prevention Plan (SWP3) in reducing pollution in stormwater runoff from your facility. (Complete a separate form for each outfall you assess)

    Facility Name

    Permit Authorization No.

    Quarter

    Outfall Id.

    Substantially Similar Outfall?

    • Yes
    • No
    • N / A

    Date & Time Discharge Began

    Date & Time Sample Collected

    Date & Time Sample Examined

    Person’s Name/Title collecting sample

    Person’s Name/Title examining sample

    Nature of Discharge

    No sample was obtained since no qualifying storm events occurred in this quarter during operating hours. No sample was obtained due to adverse conditions that were dangerous to personnel or prohibited access to discharge.

    Rainfall Amount (inches)

    Parameters & Observation Results

    Parameters & Observation Results - Color

    Parameters & Observation Results - Odor

    Parameters & Observation Results - Clarity or Turbidity

    Parameters & Observation Results - Floating Solids

    Parameters & Observation Results - Settled Solids

    Parameters & Observation Results - Suspended Solids

    Parameters & Observation Results - Foam

    Parameters & Observation Results - Oil Sheen

    Other Obvious Indicators of Stormwater Pollution

    Probable Sources of any Observed Stormwater Contamination and Corrective Actions

    Additional Information - As needed, in the space below, provide an explanation to why sampling could not be conducted within the first 30 minutes of a discharge, any adverse conditions that prevented a sample from being obtained, or corrective actions completed as a result of identified sources of observed stormwater contamination.

    Additional Information

    Certification - 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 awar

    Certifier's Name

    Certifier's Title

    Signature

    Click here to sign

    Date of Certification

Source: Jake's Finer Foods (Community Member)

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