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