Wastewater Discharge Compliance Inspection Form
Facility Information
Facility Name
Facility Address
Permit Number
Inspection Date
Inspection Time
Inspector Name
Contact Person
Discharge Information
Discharge Location(s)
Type of Discharge
Sanitary
Non-Sanitary
Industrial
Other
Sample Taken?
Yes
No
Type of Sample
Observations
Inspection Notes / Observations
Non-Compliance Issues
Describe any violations, deficiencies, or non-compliance issues observed
Corrective Actions
Recommendations / Required corrective actions
Inspector Signature
Date