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City of Rosemead IC Inspection Form
Prepared for:
Submitted Time:
Current Source
Status:
Inspection Information
| Submission ID | form-46-20260429-163300 |
|---|---|
| Inspector | |
| Date | |
| Inspection Type |
Facility Information
| Business Name | |
|---|---|
| Business Address | |
| City | |
| State | |
| Zip | |
| Type of Business | |
| Business Assistance / Outreach Activity Undertaken | |
| Materials Provided |
Contact Information
| Contact Name | |
|---|---|
| Phone | |
SIC & NAICS
| SIC # | |
|---|---|
| Revisions to SIC # Information? | |
| NAICS # | |
| Revisions to NAICS # Information? |
Permit Status
| Permit Filed | |
|---|---|
| Date Filed | |
| Waste Discharge ID (WDID) # | |
| Last Inspection Date | |
| SWPPP & MIP Onsite |
Water Quality Related Information and Observations
| Initial Receiving Water | |
|---|---|
| TMDL or 303(d) Listed | |
| Potential to Contribute to Receiving Water Impairments | |
| Activities Potentially Exposed to Stormwater | |
| Actual or Potential IC/ID Observed | |
| Actual or Potential Non-Stormwater Discharge Noted | |
| Inspection Status |
Minimum Source Control BMPs Assessment Checklist
Template syntax: inserts a value, shows a block when a value exists, and shows a block when a field matches a specific value.
Inspection Summary
| Activities / BMP Effectiveness Assessment | |
|---|---|
| Follow-up Required? | |
| Conditions Warrant Referral |
Photos
Report Notes
| Notes |
|---|