Dry Weather Outfall Inspection Form
| Location Information
Date:
Time:
Outfall ID:
Inspector:
Outfall Location:
Receiving Waterbody:
Photo Taken: Yes No Ph
Weather: Clear
Precipitation in the past 3 days:
Cloudy
No Yes
Trickle
Trickle
None
None
Pipe Flow:
Seepage Flow:
Color (if flow is present):
oto ID:
Approximate Temp:
inches
Steady
Steady
1/4 pipe flow or more
1/4 pipe flow or more
Wind Present: Yes No
| Inspection Information
Obvious Debris/Pollution:
None
Foam
Staining
Floating Green Scum
Oil / Film
Vegetative Mat/or Gray Mat
Sewage Solids 1
TOTAL |
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GRAND TOTAL SCORE =
Select all that are applicable
Odor:
None/Natural
Musty 5
Sewage/septic 10
Petroleum 10
TOTAL
Water Clarity:
Clear
Cloudy
Opaque 10
TOTAL
Additional Information
Sediment Condition: 1/4 Full
Structure Condition:
Trash/litter present:
General Comments:
Open
Excellent
Yes No
1/2 Full 3/4 Full
Good Fair Poor
Yard waste observed:
Plugged
Yes No
Potential Sources / Actions Taken:
Sample collected? Yes No
By whom?
Parameters:
Results:
Follow up required: Yes No
NOTE: Sketch site map/note on back.
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Hic it Discharge Detection and Eimination Plan
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