Section 1. Facility Operation or Field Activity

This section is where the operations or field activities are identified that have the potential of pollutant discharges to Stormwater. We will be using a separate form for each operation or field activity record the following information for facilities.

Evaluator Name:______________________________	Date:________________________

Facility Name:________________________________	Facility Contact:______________

Facility Address:______________________________	Phone No:___________________

Operation:____________________________________________________________________________

Proposed Inspection Frequency:__________________________________________________________

NOTE: The Proposed Inspection Frequency is included in this section as a reminder to the evaluator and/or inspector as to when the operation should be inspected or monitored.

We will be using a similar form for Field activities. The following information should be recorded on a separate form for each Field activity.

Evaluator Name:_______________________________________	Date:________________________

Department:___________________________________________________________________________

Department Contact:____________________________________________________________________

Name of Field Activity:__________________________________________________________________

Proposed Inspection Frequancy:__________________________________________________________

NOTE: The Proposed Inspection Frequency is included in this section as a reminder to the evaluator and/or inspector as to when the activity should be inspected or monitored.

Section 2. Potential Pollutants

After the potential to pollute Stormwater of an operation or field activity has been identified, the potential pollutants need to be identified so that the proper actions can be taken to reduce or eliminate these pollutants from entering Stormwater. In section 2 the following pollutants are identified and there impact on water quality is explained. This is not a complete list of all possible pollutants but it does represent some of the most common pollutants. On the form mark an x by those that apply to the listed operation or activity.

Potential Pollutants

Sediment___	Nutrients___	Trash___	Metals___	Bacteria___ Oil and Grease___

Organics___	Pesticides__	Other__

Sediment: Sediment is a common component of Stormwater, and can be a pollutant. Sediment can be detrimental to aquatic life (invertebrates, and fish) by interfering with the photosynthesis, respiration, growth, reproduction, and oxygen exchange in water bodies.

Nutrients: Nutrients including nitrogen and phosphorous are the major plant nutrients used for fertilizing landscapes, and are often found in Stormwater. These nutrients can result in excessive or accelerated growth of vegetation, such as algae, resulting in impaired use of water in lakes and other sources of the water supply.

Trash: Trash in all forms ends up in Stormwater and eventually ends us in the receiving waters of the state and along with being unsightly can case a number of other hazards to humans and wildlife.

Metals: Metal including lead, zinc, cadmium, copper, chromium and nickel are commonly found in Stormwater. Many of the artificial surfaces of the urban environment (i.e. galvanized metal, paint, automobiles, or preserve wood) contain metals that corrode, flake, dissolve, decay, or leach into the sediments in the Stormwater. Metals are toxic to aquatic organisms and can accumulate to toxic levels in drinking water supplies.

Bacteria: Bacteria and viruses are common contaminants of Stormwater. Sources such as animal excrement and septic system overflow can lead to high levels of bacteria in Stormwater which can cause dangerous exposures to humans and wildlife when the Stormwater reaches waters used for recreation.

Oil & Grease: Oil and Grease include a wide array of hydrocarbons, some of which are toxic to aquatic life even in low concentrations. Sources of Oil and Grease include leakage, spills, cleaning associated with vehicle and equipment maintenance, breaks and leaks in hydraulic lines and hoses, restaurants and food service and waste oil disposal.

Organics: Organics can be found in Stormwater. Often synthetic organic compounds (i.e. adhesives, cleaners, sealants, solvents) that are widely used can cause harm to waterways.

Pesticides: Pesticides (including herbicides, fungicides, and, insecticides) have been repeatedly detected in Stormwater. The accumulation of these compounds in simple organisms has an adverse effect on the fish and birds that feed on these organisms.

Section 3: BMP’s Employed

In this section the BMP’s that are currently being used are listed. Please list all BMP’s that relate to the operation or field activity. Example the Spill Cleanup materials in the Shop or the practice of sweeping the maintenance area and disposing of the dust and waste in the proper manner. Any action that reduces or eliminates the potential for pollutants in Stormwater is a BMP.

BMP’s employed:

Sweeping Shop floor and disposing of waste properly
Oil and Grease rags in marked closed container.
Trash bins covered and in a contained area

Section 4: BMP’s Recommended

In this packet are training outlines and in-house inspection checklists that may be used in BMP selection for operations or field activities. These are among the more common areas outlined but there are many outlines available through different sources with information to deal with almost any kind of pollutant problem. If you can’t find a training outline or a BMP that you need for a specific problem or pollutant please ask your Stormwater Manager for assistance. As the Stormwater issue evolves and more and more people are made aware of the problems there will be more new and innovative solutions introduced all the time please watch for these and feel free to discuss these alternatives to the traditional BMP’s with your Stormwater manager.

BMP’s recommended:

Maintenance work to be preformed indoors only
Clean up of spills immediately using dry method
Store waste fluids in properly marked and capped and labeled storage containers

Section 5: PPD and BMP Effectiveness Rating for years 2007-2010

In this section the Potential Pollutant Discharge (PPD) is rated on a Scale of:

1= High Potential

2= Medium Potential

3= Low Potential

This Potential Pollutant Discharge rating is derived at by monitoring and/or inspection. The regular inspection form is a tool that can be used to make this determination. Or perhaps you have observed the operation or field activity enough that you have a good idea of the pollutant potential the operation or field activity has.

PPD and BMP Effectiveness Rating for years 2007-2010

BMP’s employed Yes No PPD 1-3	EFFECTIVENESS RATING

Year 2007 [ ] [ X] [ 2 ]	1 2 3 4 5
Year 2008 [ ] [ ] [ ]	1 2 3 4 5
Year 2009 [ ] [ ] [ ]	1 2 3 4 5
Year 2010 [ ] [ ] [ ]	1 2 3 4 5

The Effectiveness Rating will be assigned annually to each operation or field activity. The Effectiveness Rating is as follows:

1. No BMP’s used Stormwater pollution likely

2. Some BMP’s used but not effective

3. Some BMP’s used and moderately effective

4. Source control BMP’s used and very effective/structural BMP’s needed

5. All necessary BMP’s used and very effective

This rating will be done annually for each operation or field activity and should show an increase as the recommended BMP’s are implemented.

Section 6: Facility Inspection, Field Activity Inspection / Monitoring Report

These Inspection / Monitoring Reports are designed for the Facility Managers, and department heads to monitor the existing and implemented BMP’s using the inspection checklists that accompany the BMP’s for operations and field activities. If you have any questions or need further information please contact your Stormwater Manager.

Section 7: Annual Assessment Form

The Annual Assessment Form is completed annually for each operation or field activity. This report along with the results from spot check inspections by Stormwater Management or the NDEQ or EPA will be incorporated into the Cities required Annual Report to NDEQ. The Annual Report contains information on the status of the Pollution Prevention and Good Housekeeping for Municipal Operations Program. Please file this form with Stormwater Management by December 31st. If you have any questions or comments please contact your Stormwater Manager.

Section 1

garyw

2007-02-15

City Of Grand Island