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PAT Martinek - Heavyinsp.doc .Page 1 <br />Stormwater Insnection Short Form (Heavy Industry) <br />Stormwater Program (WQCD-B2-PE) <br />Phone (303) 692-3575 Fax (303) 782-0390 <br />Email: cdphewQSmrm@cdphe.state.co.us <br />General Informa 'on <br /> Name of facility: 0 ~ CDPS#: COR-02_ <br /> Facility Information <br />q~D~ City: ~ E County:_S Address/Duections: <br /> Name(s) of Onsite Representative(s): 1 hone: (3p3) ^ZSD'0 <br /> Permittee noY ermitted er or O erator <br /> Co any <br />N~~e: ~ lU~ Name of Responsible Official: <br /> ~ <br />Title of Responsible Official: o W iV u I~ phone: ( ) <br /> Address: <br />~ <br /> d.o-~ <br />Inspector(s):~T ~r~f-1t~~ Persons present: 1"~ri"I~~l.t~ d7t~.!),L~tO~ <br /> ~~~ Kt~ <br /> Date conducted: ~/ u-!~ Pictures Taken? Yes o <br /> Records <br /> Copy of SWMP confirmed on site? Yes No <br /> Inspection records kept? Yes o Confumed on site? Yes No <br /> Site Ins ection <br /> BMPs implemented for Stormwater diversion azound potential pollution sources? Yes No <br /> Notes: <br /> <br /> B1YIPs implemented for materials handling, spill prevention, and spill cleanup? Yes No <br /> Notes: <br /> <br /> BMPs implemented for sediment and erosion prevention? Yes No <br /> Notes: <br /> <br /> BiV1Ps implemented for good housekeeping? ~ es No <br /> Notes: <br /> <br />BIYIPs implemented for inspection and maintenance of stoanwater management devices? Yes No <br />Notes: <br />