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	[Select Submittal 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 & 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)]
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):
Identify all sources of non-stormwater discharges occurring at the site and the associated control measures in place.
Sources of non-storm water discharges:	Control measures associated with the non-storm water discharges:
1.	[Select applicable non-stormwater discharge type.]	1.	[Select applicable control measure.]
2.	[Select applicable non-stormwater discharge type.]	2.	[Select applicable control measure.]
3.	[Select applicable non-stormwater discharge type.]	3.	[Select applicable control measure.]
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)	Observations
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
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
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
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
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

Section III. Condition and Effectiveness of All On-site Control Measures
Location of Control Measures	Type of Control Measure:	Additional Controls required?	Repairs or other maintenance needed?	Corrective action required? Date of discovery	Specify stabilization method (mulch, rock, planted vegetation, etc.)
1. [Insert location (e.g., Station 0000+00–0000+00, Staging Yard).]	[Select applicable control measure.]	Yes No	Yes No	Yes No
[Select Date to be Completed.]
Notes:
2. [Insert location (e.g., Station 0000+00–0000+00, Staging Yard).]	[Select applicable control measure.]	Yes No	Yes No	Yes No
[Select Date to be Completed.]
Notes:
3. [Insert location (e.g., Station 0000+00–0000+00, Staging Yard).]	[Select applicable control measure.]	Yes No	Yes No	Yes No
[Select Date to be Completed.]
Notes:

Corrective Actions, Maintenance, Upgrading, or Additional Controls
Except for items listed below, all BMPs/areas indicated above have been inspected and do not require maintenance, upgrades, or additional controls. Document any/all changes to the SWPPP.
Location/Station	Issue/BMP	Action/Mitigation	Is this Corrective Action?*	Date Completed
[Insert location (e.g., Station 0000+00–0000+00, Staging Yard).]	[Insert text pertaining to a stormwater control measure and what needs what needs correction, maintenance, and/or additional controls.]	[Insert text pertaining to the remedy of stormwater control measure issues.]	Yes No	[Select Date to be Completed.]
Other/Notes: Cause:
[Insert location (e.g., Station 0000+00–0000+00, Staging Yard).]	[Insert text pertaining to a stormwater control measure and what needs what needs correction, maintenance, and/or additional controls.]	[Insert text pertaining to the remedy of stormwater control measure issues.]	Yes No	[Select Date to be Completed.]
Other/Notes: Cause:
[Insert location (e.g., Station 0000+00–0000+00, Staging Yard).]	[Insert text pertaining to a stormwater control measure and what needs what needs correction, maintenance, and/or additional controls.]	[Insert text pertaining to the remedy of stormwater control measure issues.]	Yes No	[Select Date to be Completed.]
Other/Notes: Cause:
[Insert location (e.g., Station 0000+00–0000+00, Staging Yard).]	[Insert text pertaining to a stormwater control measure and what needs what needs correction, maintenance, and/or additional controls.]	[Insert text pertaining to the remedy of stormwater control measure issues.]	Yes No	[Select Date to be Completed.]
Other/Notes: Cause:

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.
Location/Station	Stabilization Measure	Date Initiated	Other/Notes
[Insert location (e.g., Station 0000+00–0000+00, Staging Yard).]	[Select Date to be Initiated.]
[Insert location (e.g., Station 0000+00–0000+00, Staging Yard).]	[Select Date to be Initiated.]
[Insert location (e.g., Station 0000+00–0000+00, Staging Yard).]	[Select Date to be Initiated.]
[Insert location (e.g., Station 0000+00–0000+00, Staging Yard).]	[Select Date to be Initiated.]

Additional Notes

SECTION IV. CERTIFICATION AND SIGNATURE
Section IV.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)]

Section IV.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 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 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)]