For Agency Use
Permit Tracking #: ___________________
3. Did this inspection identify any sources of storm water or non-storm water discharges not
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☐
Yes
No
previously identified in your SWPPP?
If YES, describe these sources of storm water or non-storm water pollutants expected to be present in these discharges, and any
control measures in place:
4. Did you review storm water monitoring data as part of this
☐
☐
☐
NA, no monitoring
Yes
No
performed
inspection to identify potential pollutant hotspots?
If YES, summarize the findings of that review and describe any additional inspection activities resulting from this review:
5. Describe any evidence of pollutants entering the drainage system or discharging to surface waters, and the condition of and
around outfalls, including flow dissipation measure to prevent scouring:
6. Have you taken or do you plan to take corrective actions, as specified in Part 8 of the permit,
since your last annual report submission (or since you received authorization to discharge
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☐
Yes
No
under this permit if this is your first annual report), including any corrective actions identified
as a result of this annual comprehensive site inspection?
If YES, how many conditions requiring review for corrective action as specified in Parts 8.1 and 8.2 of the MSGP
were addressed by these corrective actions?
Note: Complete the attached Corrective Action Form (Section IV) for each condition identified, including any conditions identified as a result of
this comprehensive storm water inspection.
Page 2 of 6
MSGP Annual Report (Jan 2015)