HomeMy WebLinkAboutx11-28-2012 11.08-Appendix E - Direct User Inspection form.pdf EEC/PCI PRETREATMENT AUDIT
DIRECT INDUSTRIAL USER INSPECTION FORM
Section A — General Information
Bolded sections are required to be completed
1. Date: Arrival Time:
2. Company Name:
3. Facility Address:
4. Permit# Effective Date: Expiration Date:
5. Persons present during Current Ins ection:
Name Title City/ Phone E-mail
Company
6. SIU Permit Signatory: Present at Inspection: YES [ ] NO [ ]
7. Last Inspection Information
Last Inspection Inspected
Date: by:
Recommendations and Deficiencies Noted at Last Corrective Action Taken by Facility Since Last
Inspection or Since Last Inspection Inspection or Identified in IU Correspondence
8. Date Facility went into operation? Date of discharge to POTW?
Section B — Product or Service Information
1. Brief Description of manufacturing or service activity at this facility:
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SIC Codes: NAIC Codes:
SIC Codes: NAIC Codes:
SIC Codes: NAIC Codes:
2. Industrial Category: CIU SIU_ IU Applicable Standards
3. List products manufactured indicating the appropriate production units(N/A if not applicable):
Products Approximate Production Volume(Products/month)
Has production rate increased significantly(20%)since last inspection? Yes [ ] No [ ]
Has production rate decreased significantly(20%)since last inspection? Yes[ ] No[ ]
4. List type and amount of raw materials utilized,indicating the appropriate units:
Raw Materials Amounts used per month
5. List any by-products:
6. Inspection Notes:
Section C - Production Information
1. Hours per day of operation: 8[ 1 101 ] 16[ ] 24[ ] Other-Specify
2. Days of operation
3. Is production seasonal? YES [ ] NO [ ]
H yes,indicate time period(e.g.Nov-March)of maximum production and minimum production:
Maximum- Minimum-
4. Een to ees/Schedule Data:
Shift 1 Shift 2 Shift 3 Shift 4 Shift 5
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Time of Shift
Work Days
#of Full Time
#of Part Time
#of Seasonal
3. Do scheduled shutdowns occur? YES [ ] NO [ ]
If yes,list time period(s):
5. Total days of production for the latest calendar year:
6. Are expansion plans scheduled within the next three(3)years?
If yes,check the appropriate box(es):
[ ] New Products
[ ] Same products- additional capacity
[ ] New Facility [ ] Expand current facility
[ ] Relocate within or outside existing district.
7. Inspection Notes:
Section D — Water Use Information
1. Water supply information:
a)Public Source [ ] Account Number:
b) Surface water(stream,creek,river,canal,pond): (GPD)
c)Well water(usage): 1 (GPD)
d) Other-specify: 1 (GPD)
2. List average daily total plant water use(GPD):
3. Does usage vary widely during the production day: Yes [ ] No [ ]
If yes,list maximum periods:
4. Are corrosion or biological inhibiting chemicals added to facility water systems which are
discharged to the sewer? Yes [ I No [ ] If yes,Please attach MSDS sheets have not been
Previouslv submitted to the City.
5. a)Are raw water treatment processes employed? Yes I I No [ I
If yes,list process(es):
b) Is any residue/regenerant disposed to sewer(e.g.,reverse osmosis reject)? Yes [ I No [ ]
If yes,list type(s) and amount(s):
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7. Inspection Notes:
Section E — Wastewater Discharge Information
1. Is facility connected to the SARI sanitary sewer system? Yes [ ] No [ ]
If no,what type of system: If yes,Account No:
2. Does the facility have a separate sewer system connection to a local POTW?Yes [ ] No [ ]
Comments:
3. a)Does the facility have more than one sanitary sewer connection to the public sewer?Yes[ ] No[ ]
If yes,list number of connections:
b)Is sanitary waste discharged separately to the public sewer from process waste?Yes [ ] No [ ]
Comments:
4a. List sources of industrial wastewater discharged to the SARI sewer collection system:
Source Batch/Continuous Volume Treated(Y/N) Categorical
(Y/N)
4b. List sources of industrial wastewater discharged to the local POTW sewer collection system:
Source Batch/Continuous Volume Treated(Y/N) Categorical
(Y/N)
5. Are any of the process discharges regulated by Federal Categorical Standards? Yes [ ] No [ ]
If yes,list processes and standards:
Process: Standard:
Process: Standard:
Process: Standard:
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6.Waste Streams:
Are waste streams separated at the facility? Yes No NA
Is piping diagram available on site? Yes No NA
If visible,are pipes labeled or color coded? Yes No NA
Are system alarms or shut off valves in place? Yes No NA
7. Pretreatment System-Indicate below which system(s)is used:
[ [ Biological Treatment,type:
[ [ Chemical Treatment,type:
[ [ Physical Treatment,type:
[ [ Rainwater Diversion or Storage:
[ [ Other,type:
Types of Biological Treatment include:
Types of Chemical Treatment include: chemical precipitation,neutralization,ph Control,
chlorination,ion exchange
Types of Physical Treatment include: filtration(air or mechanical),flow equalization,screening,
sedimentation,reverse osmosis, separation(e.g. interceptor or GOSI).
8. Does Agency have drawing of the system. Yes [ ] No [ ] Not Applicable [ ]
If no, attach drawing or have action item for ID to provide drawing
9. Pretreatment system provides continuous [ ] or batch [ ] treatment.
10. Is there a full-time wastewater treatment operator(s)? Yes [ ] No [ ]
Operator Name Training Received
11. Are all wastewater treatment units in service? Yes [ ] No [ ]
12. Is there a wastewater treatment Operations and Maintenance Manual? Yes [ ] No [ ]
13. Is there a spare parts inventory of critical parts? Yes [ ]No [ ] Not Applicable [ ]
14. Are there any bypasses? Yes [ ]No [ ]
15. Are air pollution control devices employed? Yes[ ]No [ ]
If yes,where?
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16. Check the space(s)for substances that could potentially be contained in the wastewater:
[ [ Sanitary/Domestic waste only
[ [ Acids and Acidic Waste [ I Soaps,Surfactants,Detergents
[ [ Alkali and Caustic Wastes [ I Oils
[ [ Pickling Wastes [ I Fats and Grease
[ [ Metal Cleaning and Preparation Wastes [ I Aldehydes,Ketones
[ [ Metal Finishing Wastes [ I Ethers
[ [ Electroplating Wastes [ I Organic Acids
[ [ Photographic Wastes [ I Pesticides,Herbicides,Rodenticide
[ [ Latex Wastes [ I Phenol Containing Wastes
[ ] Paints and Pigments I I Benzene and Benzene Derivatives
[ [ Glues [ ] Organic Solvents,Thinners
[ ] Inks and Printing Wastes [ ] Halogenated Organic Compounds
[ [ Dyes,Coloring Agents [ ] Hot Wastes
[ ] Waxes [ ] Radioactive Wastes
[ [ Other Wastes,describe:
17. Inspection Notes:
Section F — Stored Chemicals & Waste Production
1. Is evaluation of Spill/Slug Discharge Control Plan Required? Yes [ I No [ I
If yes,date of last evaluation (Must be performed at least every two years)
2. Does facility have a written spill control plan?Yes [ I No I I
If yes,is a copy of the spill plan on file at POTW?Yes [ ] No I ]
If yes,submittal date
3. Are notification procedures posted in the plant? Yes [ ] No [ I Needed [ ]
4. Are liquid chemicals used/stored in quantities of 55 gallons or more and/or dry chemicals in
quantities of 500 pounds or more(fuels,oils,solvents,acids,caustics,etc.)? Yes [ I No [ I
If yes,provide a list showing the chemical and amount storedlused:
Chemical Name Amount Stored Amount Used Time Frame for
Quantity Used
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Chemical Name Amount Stored Amount Used Time Frame for
Quantity Used
See attached list:Yes [ ] No [ ]
5. Chemical Storage and Containment:
Are MSDSs available for inspection? Yes No NA
Are incompatible chemicals separated properly? Yes No NA
Is chemical containment necessary at this facility? Yes No NA
Chemical Containment Method:
Inspection Notes:
6. Floor Drainage
Do floor drains exist in process/storage areas? Yes No NA
Are chemicals or hazardous waste located near
any floor drains? Yes No NA
Are chemicals isolated from existing floor
drains? Yes No NA
Do floor drains lead to city collection system? Yes No NA
Are floors washed down Floor drains? Yes No NA
7. Are chemicals stored outside the facility?Yes [ ] No [ ] If yes, are they covered?Yes [ [No [ ]
8. Describe any spill control methods or facilities:
9. Is heavy equipment serviced or cleaned on your property(forklifts,cranes,trucks,etc.)?Yes[ ]No [ ]
If yes,what provisions are made for disposal of oil,steam cleaning wastes or other wastes?
10. Are employees properly trained to handle hazardous waste and other chemicals?Yes [ [ No [
11. Name and title of person responsible for chemicals:
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12. Are any solid wastes,sludges or other residues generated which require off site disposal?
Yes [ I No [ I If yes,provide the information for each waste type below:
Waste Types Hazardous Waste Amount Describe How and Where All Waste Is
Yes No Generated Per Generated.
Month(GPM)
Waste Haulers
Waste Hauler Waste Handled Disposal Location Manifests
12. Based on the above,does the facility need a spill/slug discharge control plan? Yes [ ] No [ I
If yes,does the facility have an adequate spill/slug discharge control plan? Yes [ I No [ ]
If facility needs a plan and does not have a plan and/or it is not adequate,require
facility to submittrevise.
13. Inspection Notes:
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Section G — Self-Monitoring Sampling & Testing Information
1. Self-monitoring information:
a)Person responsible for sampling: (title)
b)Date IU last sampled discharge:
c)Type of sample: Grab [ ] Composite[ ] Both [ ]
d)Sampling frequency:
e)Reporting frequency:
2. Is sampling point identified in permit being used? Yes I I No I 1
Description:
3. Does the ID have sampling procedures? Yes [ ] No [ ]
Does sampling procedure reference 40 CFR 136? Yes [ ] No [ J
Does procedure appear adequate? Yes [ ]No [ ]
Comments:
4. Are samples properly preserved? Yes [ ] No [ ]
Comments:
5. Are samples iced or refrigerated? Yes [ J No [ I
Comments:
6. Are grab samples being collected for:
pH Yes [ ] No [ ] Oil& Grease Yes [ ] No [ ]
Cyanide Yes [ ] No [ ] TTO(Volatiles) Yes [ ] No [ ]
Phenols Yes [ ] No [ ] Other:
7. a)Is pH measured immediately after collection? Yes [ ] No [ ]
b)Is pH measured with a pH meter? Yes [ ] No [ ]
c)Is a continuous recording pH meter used? Yes [ ] No [ ]
d)Are recording charts [ ] or summary reports [ ] being submitted? Yes [ ] No [ ]
e)How often is pH meter calibrated?
f)What buffers are used? 4 I 1 7 I 1 10 11 other 11 specify
g)Are logs being kept for the calibration?Yes [ I No [ I
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8. a)Are samples being tested by a certified lab? Yes [ ] No [ ]
b) Name ofLab:
Contact person:
Phone Number:
c)Are samples delivered to the lab within holding times?Yes [ [ No [ ]
d)Are 40 CFR Part 136 procedures followed? Yes [ ] No [ ]
9. Inspection Notes:
Section H — Record Keeping
Does the industry routinely perform self-monitoring? Yes [ ] No [ ]
Items 1-8 are applicable only if the industry routinely performs self monitoring.
1. Are self-monitoring reports being submitted according to permit requirements? Yes [ ] No [ ]
Comments:
2. Did IU monitor for all permit parameters since the last inspection? Yes [ ] No [ ] If no,
which parameters were not monitored?
3. Has the IU violated any pollutant limits or reporting requirements since the last inspection?
Yes [ I No [ I If yes,explain:
4. Was the POTW notified of violation within 24 hours? Yes [ ] No [ ] N/A [ ]
5. Was corrective action of violations documented? Yes [ I No [ ] N/A [ ]
6. Was sampling increased in last reporting period? Yes [ ] No [ I N/A [ ]
7. Was POTW notified of ALL sample results taken at permitted monitoring point?
Yes [ ] No [ I N/A [ 1
8. Self monitoring reports consistent with results? Yes [ ] No [ ] N/A [ ]
The following items are applicable independent of who performs the routine sampling
9. Has the IU notified the POTW of any non-routine sampling conducted at the permitted monitoring
point? Yes [ ] No I I No additional Sampling Performed I I
10. Is the current wastewater discharge control permit on file? Yes [ I No [ ]
Comments:
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11. Are on-site records maintained and available for review for at least a minimum of three(3)years?
Yes [ ] No [ ]
Comments:
12. Are all reports signed by an authorized representative? Yes [ ] No [ ] N/A [ ]
Comments:
13. Are spill and/or upset/bypass reports being submitted?
Yes [ ] No [ ] No evidence of spill,upset or bypass [ }
Comments:
14. a)Is the facility subject to 40 CFR 413 or 433. Yes [ ] No [ ] If yes answer questions b—it.
b)Has a Toxic Organic Management Plan(TOMP)been submitted and reviewed by the POTW?
Yes [ ] No [ ]
If yes,is the TOMP being implemented and followed? Yes ] ] No [ ] N/A [ ]
If yes,is the periodic certification being submitted as required? Yes [ ] No [ ]
Comments:
c)Has a request to utilize TTO certification been submitted and reviewed by the POTW?
Yes [ ] No [ ]
If yes,are periodic certifications being submitted?Yes [ ] Frequency_No [ ] N/A [ ]
If yes are the parameters specified by the POTW being monitored? Yes [ ] No [ ]
d)Are TTO'S being monitored? Yes [ ] No [ ] N/A [ ]
If yes,by whom and how often?
If yes,are all the required TTO's being monitored(624,6259 608,1613B)
Comments:
15. Any evidence of UNREPORTED violations?Yes ] ] No [ ]
Comments:
16. Inspection Notes:
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Section I — Enforcement
1. Is the IU presently under an informal/formal enforcement action by Salt Lake City?Yes[ ] No[ [
If yes,describe status:
2. a)Is the IU under a compliance schedule? Yes [ ] No [ ]
b)Is the compliance schedule contained in the permit? Yes [ ] No [ [
Comments:
c)Are compliance schedule progress reports being submitted? Yes [ ] No [ [
Comments:
Section J — DrawinE
Plant Layout/Schematic on file at POTW?Yes [ ] No [ ]
If yes,date of last schematic submitted?
Pretreatment System Process Diagram on file at POTW? Yes[ ] No [ ] NA [ ]
Note: The culmination of drawings on file should allow the POTW to assess the process and location of
connections to the sewer system. The drawings should show water/wastewater lines and connections,
including internal and extemal drains and sewer c mection(s). Permitted monitoring locations must be
indicated. Process areas most show all tanks or other vessels that contain liquids. Pretreatment System
Process diagrams must show stepwise or sequence for the processing of all materials(. Drawings need to be
on 8.5"x 11"paper(or 8.5"x 14'). Updated drawings are required whenever a change in process,
operations,or discharge are made at the facility. If the required information can be included on the plant
layout drawings,only one drawing is required.
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Section K — Walk Through
Note any deviations or inconsistencies with the information in sections A through J. Make note of
the material condition of the specified items(e.g., clean, cluttered,rusted, good operating condition,
etc. )
Exterior Inspection
1. [ ] Walk perimeter of building
*Note all sewer manholes
Comments:
2. [ ] Locate all storm drains
Comments:
3. [ ] Locate any outside chemical storage areas
Comments:
4. [ ] Examine current condition of sampling point(s)
Comments:
Interior Inspection
For each inspection area:
1. [ ] Chemical/raw material storage and use
Comments:
2. [ ] Waste production, storage (containment), and disposal (manifests)
Comments:
3. [ ] Location of floor drains and what pollutants can reach them?
Comments:
4. [ ]What pollutants are/could be in any wastewater?
Comments:
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5. [ ] What emergency spill equipment (e.g., absorbent, berms,etc.) is available?
Comments:
6. [ ] What manufacturing processes were identified?
Comments:
7. [ ] what is the process flow?
Comments:
8. [ ] Inspect maintenance area
Comments:
9. [ ] Inspect the interior of all buildings, storage areas, garages, etc. (including
inspecting behind all doors)
Comments:
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Pretreatment Equipment
1. [ ] Describe any pretreatment equipment not listed in Section XXX and describe condition of all
the equipment?
2. [ ] If there are, list any grease removal devices.
a)Type of device:
Size(gallons): Number of chambers:
Location:
When was it last cleaned? Cleaning frequency?
Device cleaned by(Person or Company:
b) Type of device:
Size(gallons): Number of chambers:
Location:
When was it last cleaned? Cleaning frequency?
Device cleaned by(Person or Company:
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Section L — Visit Summary
Note any action items(facility or POTR) and summarize overall observations of the facility.
Comments:
Informafion/handouts given to industry(titles: RCRA,Local Limits,etc):
Deficiencies:
Corrective action due date:
Follow-up:
Departure Time:
Section M — Signature
1. Date report completed:
2. Inspector: Inspector:
Inspector: Inspector:
3. Copy of inspection report sent to IU? Yes [ ]No[ ] Date sent:
4. Reclassification? Yes [ ] No [ ] If yes,Old Class: Potential New Class:
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