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Municipal Facility Assessment Form Appendix J q w RK ATE Department of EnVironme-ntal. Conservation Municipal Facility Assessment Fonn For SPDES MS4 General Pem1it, GP-0-24-001 Assessments must be condlcted by a person with lhe knowledge and skills to assess conditions and activities that crud impact s!OITllwater quality at the facility and evaluate the effectiveness of best management practices required by the SPDES MS4 General Pennrt (GP-0-2+001). MS4 Permit ID: MS4 opera!.Or tfame: f'aemty N:a...1\e: Faemty Type: I oa;e: w eamer COf'.1£131'1&:- I& siormwater n.raoll' pre&er11miring ~ as.se66rnent? ore, □ No commen.is: General YN No 1:s mis a n~ n pllOrtty m1r11e1pa1 raemiy? □ □ 2 ' ff 1n1, 15 a nlgh priority rnunl::'lpal t.dlty. does me tacllty quallty ror a No Exp0&1.n cert1tea11on? □ □ J n tn1, 15 a nign pr1011ty rnun1etpa1racmy, 115 there a complete-a SW?PP ~ l>te? □ □ • Does ttle tat:ty nave aay MS-4 outran,? □ □ s Does trle racmy nave any 1meroonnecooos? □ □ • c ommem, : DOK tile racmy nave any m1.r110l)a1 racuny 1nuaoonneo!IOC1&? □ □ Good HoosekeeQing YN No 1 Ate paved &Urrace, tree or trarsl\, seam.mt. and.'o< aetlf'i&? □ □ • Date Ute pave~ atea was tasi , wepl or vacuume<1. □ □ 9 Do oooooor waste receptacies nave co"Ye15? □ □ 10 Are lrlew3&te reeeptacff l:tl'pted on a regUla, Das!$? □ □ Are ~nae 6'gns-or INS&. oootamin-ar,15 orowdil!lng a'! me wa&te receptaele area? □ □ " 12 Are tn= ro1,ow.ng f.:tc:1111)' airea, tree 01.aocmw1a1eo trasn. si:OlmE:!11. oe'X!s, oontam1nanl5., and splils.:: □ □ . s an storage arws □ □ . OOOtalnff storage arws □ □ . l.tatntenance areas □ □ 17