Surveys are conducted of all maintenance facilities
to establish compliance with federal, state and local
environmental regulations. The form used to conduct
these surveys covers areas of concern.
District____
1- Facility
Name: ___________________________ Date: ________/_________/_______
Address: _________________________ City : _________________
Zip: _______
2- Drinking Water
Private System _____ Distance to Public system ______
miles
Public System _____ Name: ______________________________
Backflow Preventer where needed: Yes______ No ______
Comment: _________________________________________________________
3- Sewage system
Private System: _____ Lagoon: _____ Tile field:
_____ Working? ________
Distance to public system______ miles Name: ____________________
Public System: ______ Name: ___________________________________
Floor Drains Yes ___ No ____ (If yes) Connected
to sewer ____ Tile field____
Daylight to ditch _____ Drains: plugged _____ covered
_____
Comments: ______________________________________________________
4- Salt Storage
Type of Salt Building : Fabric ____ Dome _____ Bay
_____ (# bays) _____
Gabriel _____ Outside pile _____ (covered? No ____Yes____
Type of cover ________________________)
Storage Building Condition : _____________________
Salt Basin ______ Salt Pond ______ (needed yes ____
no ____)
Salt Damage Yes____ No____ if yes----Onsite: ____
Offsite: ____
Damage result of Storage _____ salt pond_____ accident
____
Result of Past ______ Current ______ problems
Claim paid or land bought Yes _____ No _____
Comment : _______________________________________________________
5-Hazardous Material Storage
Evidence of Leaks or Spills Yes ____ No _____ (ongoing
Yes ____ No ____)
Incompatible Chemicals stored separately Yes ____
No _____
Containers Properly Labeled Yes ____ No _____
Comments: ________________________________________________
Closed ____ Open _____
Parts Cleaner Closed _____ Open _____ Brand ______________________
Recycled ____ Filtered ____
Old Lead Acid Batteries Yes ____ No _____ (properly
stored Yes ____ No ___
Comment: _________________________________________________________
____________________________________________________________
____________________________________________________________
6-Gasoline, Diesel Fuel, Oil, Asphalt, and Used
Oil
Tank Number & Size (gallons): Gasoline (___)_______,
Diesel (___)________
Kerosene (___)________Asphalt (___)________ (in
service Yes ___
No___) Used Oil (___)________ Other _________________________
Containment: Largest tank plus %10 Yes ____ No _____
Some _______
Total Tanks/containers over 1,320 gallons Yes ____
No _____
(containers under 55 gallons not counted in total)
List Tanks that need containment: ____________________________
________________________________________________________
________________________________________________________
SPCC plan Yes _____ No _____ In the works _______
Containers Labeled Yes ____ No ____ Need _______________________
New Oil In containment Yes ____ No____
Floor Drains if present plugged Yes ____ No ____
connect to oil/water separator Yes ____ No ____
Used Oil in containment Yes____ No____ Tank or drum
size _______ gal.
Used Oil Heater used at site Yes ____ No ____
If not for heat, disposal method ________________________________
Cost per gallon ______ Company ________________________
Comments : ______________________________________________________
7-Solid Waste Management
Waste Tires Hauled by Corrections Yes ____ No ____
(company)____________
No. Stored on site _______ More than 25 under cover
Yes ____ No ____
Types of Waste Segregated Yes ____ No ____
Street Sweepings stored at site Yes ____ No ____
Disposal Method ___________
Landfill Name & Location ____________________________________________
Oil Filter Disposal: Landfill ______ Recycle _____
Company _______________
Comments: ________________________________________________________
8-Neighboring Environmental Concerns
One Mile – NPL Site ______________________,
RCRA site ________________
Landfill site________________________________
Adjoining Property – UST _________________,
RCRA site ________________,
Discharge to site _________________, Storage Tanks
_______________,
Drums ___________, Stressed Vegetation _________Pits/Ponds
_______,
Lagoons __________, Septic Waste ________, Wells
_______________,
Property use for (i.e. residential, industrial or
rural)__________________
9-Comments
Inspector Sign: __________________________________
Date: ___________________
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