Blank-SWPPP Gen#1

6/30/2006

Storm Water Pollution Prevention Plan

NPDES General Permit # 1

For

______

Date:______

Table Of Contents

  1. General Facility Information
  2. Introduction
  3. Facility Description
  4. Objectives of the Storm Water Program
  5. General Requirements of a SWPPP
  6. Special Requirements of a SWPPP
  7. Storm Water Pollution Prevention Team
  8. Existing Environmental Management Plans or Permits
  9. Facility Site Map
  10. Significant Materials, Potential Pollutants, Exposure to Storm Water, Past Spills and/or Leaks and Hazardous Condition
  11. Non-Storm Water Discharge Assessment
  12. Non-Storm Water Discharge Assessment Certification Statement
  13. Existing Monitoring Data
  14. Facility Evaluation Summary and Existing and/or New BMP Options
  15. Additional Best Management Practices
  16. Storm Water Pollution Prevention Plan
  17. Annual Report and SWPPP Compliance Evaluation
  18. Certification of the SWPPP

List Of Tables

Table 1:Storm Water Pollution Prevention Team

Table 2:Significant Materials, Potential Pollutants, Exposure to Storm Water, Past Spills and Leaks and Hazardous Condition

Table 3:Non-Storm Water Discharge Assessment

Table 4:Existing Monitoring Data

Table 5:Facility Evaluation Summary and Existing and/or New BMP Options

Table 6:Additional Best Management Practices

Table 7: Storm Water Pollution Prevention Plan - Summary

Attachment 1: Inspection and Reporting Forms

A. General Facility Information

Name of Facility:

Facility Address:

Telephone:

Owner:

Facility Contact:

Title:

Telephone:

Mailing Address

Standard Industrial classification (SIC) Code:

Permit Information:General Permit # 1

Permit Number:

Effective Dates of Coverage:

Number of Storm Water Outfalls:

Receiving Waters:

Emergency Contact:

B. Introduction

This storm water pollution prevention plan (SWPPP) covers the operations at our facility. It has been developed as required under Iowa’s National Pollutant Discharge Elimination System (NPDES) General Permit for storm water discharges. This SWPPP describes facility operations, identifies potential sources of storm water pollution at the facility, lists best management practices (BMPs) or pollution control measures to reduce the discharge of pollutants in storm water runoff, and provides a plan for periodic review of this SWPPP.

C. Facility Description

D. Objective of the Storm Water Program

The goal of the storm water permit program is to improve the quality of surface waters by reducing the amount of pollutants potentially contained in the storm water runoff being discharged. Industrial facilities subject to an NPDES permit must prepare and implement a SWPPP for their facility.

The objective of the SWPPP is three-fold:

  • Identify potential sources of pollution.
  • Describe best management practices (BMPs) consistent with our processes and activities.
  • Provide other elements such as, but not limited to, a facility inspection program, site compliance evaluation program, record keeping and reporting program that will help us comply with the terms and conditions of Iowa’s storm water discharge permit

E. General Requirements of a SWPPP

All forms, including the proof of Public Notice, the Notice of Intent form, the SWPPP, annual reports, certification forms and any information submitted to the IDNR, or the operator of a large or medium municipal separate storm sewer system will be signed by ______.

This SWPPP will not be sent to the DNR, however, it will be located at the facility and made public as appropriate.

F. Special Requirements

(check all that apply)

Our facility discharges storm water through a Municipal Separate Storm Sewer System in a city with a population of 100,000 or more.

Our facility stores, handles, processes or transfers SARA Title III, Section 313 Water Priority Chemicals

Our facility has salt storage piles used for deicing or other commercials purposes.

G. Storm Water Pollution Prevention Team

The storm water pollution prevention team is responsible for developing, implementing, maintaining, and revising this SWPPP. The members of the team are familiar with management and operations of our facility.

The members of the team and their primary responsibilities, such as, implementing programs, maintaining practices, record keeping, submitting reports, conducting inspections, employee training, conducting annual compliance evaluation, testing for non-storm water discharges, signing the required certifications, and others are listed in Table 1.

Table 1: Storm Water Pollution Prevention Team
Name & Title / Responsibility

H. Existing Environmental Management Plans or Permits

(check the appropriate box)

Our facility is required to comply with other environmental plans, they are listed:

1.

2.

OR

Our facility is not required to comply with other environmental plans

I. Facility Site Map

Our facility’s site map is inserted on the next page and includes the following information and features.

An outline of the drainage area of each storm water outfall including drainage patterns, direction of flows and discharge points (numbered as: Outfall 001, 002, etc.).

Existing structural storm water pollution control measures (physically constructed features used to control storm water flows), such as, flow diversion structures, retention/detention ponds, vegetative swales, sediment traps

The name of receiving water (or if through a Municipal Separate Storm Sewer System)

The location and name of surface water bodies, including any neighboring stream, river, lake or water body receiving storm water discharges from the site.

The locations of “significant materials1 ” exposed to storm water.

The locations of past spills and leaks (if any during the past three years)

The locations for each of the following activities where exposed to storm water: fueling stations, vehicle/equipment washing and maintenance areas and unloading and loading areas.

The location of aboveground tanks for liquid storage (if any exist)

Industrial waste management areas (landfills, waste piles, treatment plants, disposal area)

Outside storage areas for raw materials, by products, and finished products

Outside manufacturing or processing areas

Other areas of concern (specify: ______)

1“Significant materials” are defined as: “Raw materials, fuels, materials such as solvents, detergents, and plastic pellets, finished materials such as metallic products, raw materials used in food processing or production, hazardous substances designed under Section 101(14) of CERCLA, any chemical the facility is required to report pursuant to EPCRA Section 313, fertilizers, pesticides and waste products such as ashes, slag and sludge that have the potential to be released with storm water discharges.”

(Facility Map is inserted following this page)

J. Significant Materials1, Potential Pollutants, Exposure to Storm Water, Past Spills and Leaks and Hazardous Conditions2

Table 2 is an inventory of “significant materials1” on site. For each significant material on site an evaluation has been conducted to determine the potential for these materials to contaminate storm water runoff being discharged from the facility and noted if they were exposed to storm water in the past three years. Also recorded in Table 2 is information regarding our investigation into spills or leaks over the past three years. If spills or leaks created a “hazardous condition 2”the quantity and actions taken are found in Table 2.

2“Hazardous condition” is defined as: ‘… any substance or mixture of substances that presents a danger to the public health or safety and includes but is not limited to a substance that is toxic, corrosive or flammable, that is an irritant or that, in confinement, generates pressure through decomposition, heat or other means. Examples: acids, alkalis, explosives, fertilizers, heavy metals such as chromium, arsenic, mercury, lead and cadmium, industrial chemicals, paint thinners, pesticides, petroleum products, poisons, radioactive materials, sludge and organic solvents, any substance identified by EPA under RCRA or any toxic pollutant listed under Section 307 of WPCA or any DOT designated hazardous material.

Table 2: Significant Materials1, Potential Pollutants, Exposure to Storm Water, Past Spills and Leaks and Hazardous Conditions2
Location, Process or Activity / Significant
Materials1 / Quantity
(units) / Exposed in past 3 years
(yes/no) / Spills/Leaks: date, quantity / Hazardous Condition2
(yes/no)

K. Non – Storm Water Discharge Assessment

The permit requires that all discharge locations be evaluated for the presence of non-storm water discharges. Examples of non-stormwater discharges that may require additional coverage under a NPDES permit include any water used in the manufacturing process (process water/wastewater) and outside vehicle or equipment washing where detergent is used.

Allowablenon-stormwater discharges include:

Uncontaminated ground water discharge,

Wetlands

Foundation or footing drains where flows are not contaminated with process materials,

Discharges from springs,

Routine exterior building wash down which does not use detergents or other compounds,

Air conditioning condensate,

Pavement wash waters where spills or leaks or hazardous materials have not occurred and where detergents are not used.

Discharges from fire fighting activities,

Fire hydrant flushing,

Potable water sources including waterline flushing,

Irrigation drainage, and

Lawn watering.

Any unauthorized storm water discharges will be eliminated, or covered under another NPDES permit. Table 3 summarizes the evaluation results.

Table 3: Yearly Non-Storm Water Discharge Assessment
Date / Outfall / Assessment Method Used / Location, Process or Activity / Person Evaluating / Result of assessment and potential significant sources

NON-STORM WATER DISCHARGE ASSESSMENT 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 ensure that qualified personnel properly gather and evaluate 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 aware that there are significant penalties for submitting false information, including the possibility of fine or imprisonment for knowing violations and that such notification will be kept on site and made available to the IDNR anytime, after 180 days from the discharge authorization date, if non-stormwater certification cannot be provided.

______

NameOfficial Title

______

Area Code & Phone NumberDate

______

Signature

L. Existing Monitoring Data

Table 4 includes information regarding existing monitoring data for our facility.

(check one)

Our company has existing surface runoff monitoring data found in Table 4.

OR

Our company does not have monitoring data to report.

Table 4: Existing Monitoring Data
Date / Location or Outfall / Parameter
Analyzed / Employee Collecting Sample / Method of Collection / Lab Analyst

M. Facility Evaluation Summary and Existing and/or New BMP Options

This is a description of activities identified with a high potential to contaminate storm waterat our facility and includes areas, activities and materials associated with loading, unloading, outdoor storage, outdoor manufacturing or processing, on-site waste disposal and significant dust or particulate generating activities. The results of our evaluation is found in Table 5.

Table 5: Facility Evaluation Summary and Existing and/or New BMP Options
Location, Process or Activity / Storm Water
Pollutant Source / Pollutant / Existing BMP / New BMP Options/ / Implement New BMP (date) / Who Does

N. Additional Best Management Practices

In addition to best management practices identified during the facility evaluation, we will also implement the following general best management practices specifically intended to reduce the amount of pollution entering surface waters from our facility. Some of these controls are non-structural and will deal with pollution at the source, while others are structural and will require time and resources prior to implementation. To be sure each of these BMPs is instituted in a reasonable and timely manner, we have developed an implementation schedule.

Table 6: Additional Best Management Practices
Location, Process or Activity / BMP / When (date or how often) / Who Does It
Good House
Keeping
Preventive Maintenance
Visual
Inspections
Spill Prevention and Response
Sediment and Erosion
Prevention
Runoff Control
Employee Training
Record Keeping, Internal Reporting

O. Storm Water Pollution Prevention Plan

A summary of our Storm Water Pollution Prevention Plan of action is found in Table 7.

Table 7: Storm Water Pollution Prevention Plan

(Compiled information from Tables 1-6)

Location, Process or Activity / Inspection Schedule / Existing BMP / New BMP or Options / Use New BMP or Options (date) / Who Does
Loading and Unloading Operations
Maintenances & Equipment Cleaning
Outdoor Storage Operations
Dust or Particulate Generating Processes
Above Ground Liquid Storage Tank
Outdoor Processes or Manufacturing
Good House Keeping
Preventive Maintenance
Visual Inspections
Spill Prevention and Response
Sediment and Erosion Prevention
Runoff Control
Employee Training
Record Keeping, Internal Reporting
Annual Report
SWPPP Changes

P. Annual Report and SWPPP Compliance Evaluation

Each year a short written report will be prepared by the designated member of the Storm Water Pollution Prevention Team (see Table 1). The report will recap the previous year’s storm water management activities, problems, and successes. If changes are required to the management plan, they will be recorded in the SWPPP annual report and changes will be made to the SWPPP within 14 days. Attachment 1 includes inspection and reporting forms that can be used in the annual inspection and included with the annual report. The annual report must be signed by an authorized representative of the facility and kept with the SWPPP for at least three years.

Q. SWPPP Certification Statement

CERTIFICATION OF THE SWPPP

I certify under penalty of law that this SWPPP has been developed in accordance with good engineering practices. To the best of my knowledge and belief, the information submitted is true, accurate, and complete. And at the time this plan was completed no unauthorized discharges were present. I am aware that there are significant penalties for submitting false information, including the possibility of fine or imprisonment for knowing violations.

______

NameOfficial Title

______

Area Code & Phone NumberDate

______

Signature

Attachment 1

Inspection And Reporting Forms

Significant1Spill Report

Annual Non-Storm Water Inspection Report

Employee Training Record

Good Housekeeping Report

Preventative Maintenance Inspection Report

Visual Inspection Report

Annual Site Compliance Evaluation Form

Significant1Spill Report

Date of Occurrence: ______

Discovered by Whom: ______

Location: ______

Material Type & Volume: ______

______

______

Cause of Spill: ______

______

______

______

Corrective Action Taken: ______

______

______

______

______

______

Agencies/Persons Contacted: ______

______

______

______

Signature
Non-Storm Water Inspection Report

Date of Inspection: ______Time: ______

Inspected by (printed name): ______

Signature: ______

Description of type of inspection (check those that apply):

  • visual observation
  • dye tests
  • smoke tests
  • TV line survey
  • analysis of accurate schematics
  • sampling/monitoring
  • other (specify) ______

Observations/Results: ______

______

______

______

______

______

______

Are there any non-storm water discharges?

yes

no

Is the discharge authorized under this permit?

yes

no

Is the discharge covered under another National Pollutant Discharge Elimination System (NPDES) permit?

yes

no

Employee Training Record

Date of Session: ______Time: ______

Trainer: ______Topic______

****************************************************************************

Employees Attending (names, printed):Signature:

______

______

______

______

______

______

______

______

______

______

Specifics of Training: ______

______

______

______

______

______

______

Good Housekeeping Inspection Report

Date: ______Time: ______

Inspected by: ______

Signature: ______

Areas Inspected / Observations / Actions Taken

Preventive Maintenance Inspection Report

Date: ______Time: ______

Inspected by: ______

Signature: ______

Areas/Equipment Inspected / Observations / Actions Taken

Visual Inspection Report

Date: ______Time: ______

Inspected by: ______

Signature: ______

Area/Equipment/BMP Inspected / Observations / Actions Taken

Annual Site Compliance Evaluation Form

Date: ______Time: ______

Conducted by: ______

Signature: ______

Area/Equipment/BMP Inspected / Observations / Actions Taken