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Form 1 <br />Sampling Event Visual Observations and Analytical Results <br /> <br /> <br />Form 1 – Page 1 of 2 <br /> <br /> <br /> <br /> <br /> <br />Facility Name: San Joaquin County North County Landfill <br />Name of the sampler / observer: <br />Qualified Storm Event (QSE) Evaluation: <br />Did the storm produce a discharge for at least one drainage area? <br />Was it preceded by at least 48 hours with no discharge from any drainage area? <br />Scheduled facility operating hours: <br />Date & time discharge began: <br />Date & time of sampling & observation: <br /> <br />Outfall Observations: <br />Outfall Name <br />Is water from an <br />impounded source <br />(i.e. retention <br />basin)? (Yes/No) <br />Time <br />discharge <br />began <br />Time of <br />observation / <br />sampling <br />Note with an “X” if any of the following pollutants were observed: <br />Likely pollutant source Floating <br />debris <br />Suspended <br />material <br />Oil <br />sheen Color Turbidity Odor Trash / <br />debris <br />SW-3 Yes <br />SW-4 No <br /> <br /> <br /> <br />Corrective Action Based on Visual Observations: <br />Based on the visual observations of the storm water discharge, summarize corrective action needed or taken in the box below. <br /> <br />Sampling event visual observations shall be conducted at the same time sampling occurs at a discharge location. At each discharge location where a sample is obtained, the Discharger shall <br />observe the discharge of storm water associated with industrial activity. <br />