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Smith Island Facility — Sludge Disposal Site Cap Construction <br />ESC Inspection Form <br />Stormwater Dischar es From the Site <br />Observed? <br />Y N Problem/Corrective Action <br />Location <br />Turbidity <br />Discoloration <br />Sheen <br />Location 1 I I <br />Turbidity _ <br />Discoloration 11 <br />Sheen <br />General Comments end Notes <br />Includes BMP repairs, maint, lance, or installations made as a result of the inspection <br />Were photos taken? ❑Yes o <br />If photos taken describe below: <br />Based on the results of the inspection; the site was judged to be: <br />with the terms and conditions of the SWPPP <br />In compliance <br />LO Out of compliance <br />1 certify that this report is true, accurate, and complete, to the best of my knowledge and belief. <br />L/ <br />Name Title Signature Dq e <br />SEP 2 2 2010 <br />on_ic !. Page 4 of 4 <br />