Construction General Permit Inspection Report Press the ¶ button on the ribbon above to show hidden guidance text.
Section I. General Information
Name of Project:	CGP Authorization No. Click here to enter EPA and/or ADEQ Authorization Number(s).	Inspection Date: [Inspection Date.]
Check box when using this form to inspect an inactive/unstaffed construction site (this option applies to an entire site only).
Inspector Name, Title, and Contact Information	Name:	[Insert applicable name/names]	Title:	[Insert applicable title.]
Contact Information:	[Insert address (Street, Suite/Unit/etc., City, State abbrev. zip code)]	[Insert phone number (111-222-3333)]
[Insert email address (Jdoe@email.com)]
Attendee(s)
Present Phase of Construction
Inspection Schedule (all days are calendar days) [Select applicable agency-specific text regarding inspection frequency. If both ADEQ and EPA Construction General Permits (CGPs) are applicable to your project, then select whichever is the more stringent language option from the drop-down list to satisfy requirements for both CGPs.]
Was this inspection triggered by either a 0.25” or 0.5” storm event? Yes No If yes, duration of storm event: <1 hour < 6 hrs > 6 hrs If yes, how was the storm event determined (either 0.25” or 0.5”)? Rain gauge on site Weather station representative on site. Specify weather station source.
Total rainfall amount that triggered the inspection (in inches):
Adverse or Unsafe Conditions for Inspection Did you determine that any portion of the site was unsafe for inspection per CGP? Yes No If “yes”, complete the following: ▪ Describe the conditions that prevented you from conducting the inspection in this location: ▪ Location(s) where conditions were found:
Section II. Description of Discharges and Conditions of the Discharge Locations
Outfall (Listed in the NOI Summary and indicated on Site Map(s))	Observations Utilize the notes section to describe the characteristics of the discharge (color, odor, clarity, etc.), any visible signs of erosion or sediment accumulation, and what actions are needed to correct the problem of discharge.
1.	Describe the discharge: Stormwater Non-stormwater None Since the last inspection, do you see any evidence of erosion, sediment accumulation, and/or other pollutants that can be attributed to your discharge? Yes No
Notes:
2.	Describe the discharge: Stormwater Non-stormwater None Since the last inspection, do you see any evidence of erosion, sediment accumulation, and/or other pollutants that can be attributed to your discharge? Yes No
Notes:
3.	Describe the discharge: Stormwater Non-stormwater None Since the last inspection, do you see any evidence of erosion, sediment accumulation, and/or other pollutants that can be attributed to your discharge? Yes No
Notes:
4.	Describe the discharge: Stormwater Non-stormwater None Since the last inspection, do you see any evidence of erosion, sediment accumulation, and/or other pollutants that can be attributed to your discharge? Yes No
Notes:
5.	Describe the discharge: Stormwater Non-stormwater None Since the last inspection, do you see any evidence of erosion, sediment accumulation, and/or other pollutants that can be attributed to your discharge? Yes No
Notes:
Identify all sources of non-stormwater discharges occurring at the site and the associated control measures in place.
Sources of non-stormwater discharges:	Control Measures associated with the non-storm water discharges:
1.	[Select applicable non-stormwater discharge type.]	[Select applicable control measure.]
2.	[Select applicable non-stormwater discharge type.]	[Select applicable control measure.]
3.	[Select applicable non-stormwater discharge type.]	[Select applicable control measure.]

Section III. Stabilization and Erosion Control
When construction activities permanently cease and are not expected to resume for 14 or more days on a disturbed portion of the site, stabilization and erosion measures must be initiated immediately. Indicate the stabilization measures that have been initiated under these circumstances. Earth disturbance for areas within 50-feet of a protected surface water that is a WOTUS and is listed as impaired or not-attaining or an OAW must be stabilized within seven (7) calendar days of the most recent earth disturbance.
Location/Station	Date Earth Disturbances Ceased	Date Stabilization Initiated	Type of Control Measure	Specify Stabilization
[Insert location (e.g., Station 0000+00–0000+00, Staging Yard).]	[Select Date Earth-disturbance ceased]	[Select Date to be Initiated.]	[Select applicable control measure.]
[Insert location (e.g., Station 0000+00–0000+00, Staging Yard).]	[Select Date Earth-disturbance ceased]	[Select Date to be Initiated.]	[Select applicable control measure.]

Section IV. Condition and Effectiveness of All On-site Control Measures
Location of Control Measure	Type of Control Measure	Additional Controls required?	Repairs or other maintenance needed?	Corrective action required?	Specify stabilization method (mulch, rock, planted vegetation, etc.)
1. [Insert location (e.g., Station 0000+00–0000+00, Staging Yard, Discharge Point).]	[Select applicable control measure.]	Yes No	Yes No	Yes No
Date discovered: [Select Date of Discovery]	If yes, complete Section V. Corrective Actions.
Date to be completed: [Select Date to be Completed.]
Notes (specify issues/necessary repairs):
2. [Insert location (e.g., Station 0000+00–0000+00, Staging Yard, Discharge Point).]	[Select applicable control measure.]	Yes No	Yes No	Yes No
[Select Date to be Completed.]	[Select Date to be Completed.]
Notes (specify issues/necessary repairs):
3. [Insert location (e.g., Station 0000+00–0000+00, Staging Yard, Discharge Point).]	[Select applicable control measure.]	Yes No	Yes No	Yes No
[Select Date to be Completed.]	[Select Date to be Completed.]
Notes (specify issues/necessary repairs):
4. [Insert location (e.g., Station 0000+00–0000+00, Staging Yard, Discharge Point).]	[Select applicable control measure.]	Yes No	Yes No	Yes No
[Select Date to be Completed.]	[Select Date to be Completed.]
Notes (specify issues/necessary repairs):

Section V. Corrective Actions
Deadline for completing corrective action: ☐ Work will be completed no more than 7 calendar days after the date the problem was discovered (enter date): / / ☐ It is infeasible to complete work within the first 7 days; therefore, the work will be completed as soon as practicable following the 7th day (enter date): / / If the estimated date of completion falls after the 7-day deadline, document the following: (1) The reason it is infeasible to complete work within 7 days, and (2) The schedule for installing and making the new or modified stormwater control operational in the soonest practicable timeframe. NOTE: Any corrective actions that result in changes to any of the stormwater controls or procedures shall be documented in the SWPPP within 7 calendar days of completing the corrective action work.
Location/Station	Issue/Control Measures to be modified, replaced, and/or added	Date Initiated	Date Completed
[Insert location (e.g., Station 0000+00–0000+00, Staging Yard, Discharge Point).]	[Select Date Initiated]	[Select Date to be Completed.]
Other/Notes: Cause:
[Insert location (e.g., Station 0000+00–0000+00, Staging Yard, Discharge Point).]	[Select Date Initiated]	[Select Date to be Completed.]
Other/Notes: Cause:
[Insert location (e.g., Station 0000+00–0000+00, Staging Yard, Discharge Point).]	[Select Date Initiated]	[Select Date to be Completed.]
Other/Notes: Cause:
[Insert location (e.g., Station 0000+00–0000+00, Staging Yard, Discharge Point).]	[Select Date Initiated]	[Select Date to be Completed.]
Other/Notes: Cause:

SWPPP Upkeep
Based on the results of this inspection, all site maps have been updated and any additional SWPPP amendments have been added and logged as required (see SWPPP Attachment 7). ECC Initials: ________
Additional Notes

SECTION VI. CERTIFICATION AND SIGNATURE
Section VI.A. Certification and Signature by Contractor or Subcontractor Performing Inspections (if applicable)
Check one of the following: No instances of non-compliance were discovered during the inspection. Project is in full compliance with SWPPP and CGP. Inspection follow-up is required, in accordance with the CGP and or Provision 104.09. “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 assure that qualified personnel properly gathered and evaluated 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 and imprisonment for knowing violations.” Signature of Contractor or Subcontractor: Title: [Insert applicable title.] Printed Name: [Insert applicable name/names] Date: [Select certification date.] Affiliation: [Insert Company Name] Phone Number: [Insert phone number (111-222-3333)] Email Address: [Insert email address (Jdoe@email.com)]
Section VI.B. Certification and Signature by ADOT Representative
Check one of the following: No instances of non-compliance were discovered during the inspection. Project is in full compliance with SWPPP and CGP. Inspection follow-up is required, in accordance with the CGP and or Provision 104.09. “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 assure that qualified personnel properly gathered and evaluated the information submitted. Based on my inquiry of the operator or operators who manage the system, or those operators directly responsible for gathering 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 and imprisonment for knowing violations.” Signature of ADOT Certifying Representative: Title: [Insert applicable title.] Printed Name: [Insert applicable name/names] Date: [Select certification date.] Phone Number: [Insert phone number (111-222-3333)] Email Address: [Insert email address (Jdoe@email.com)]