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Location <br />Structure Configuration and Size: Inspection Date <br />[:]Vault feet x feet <br />❑ Manhole feet diameter <br />❑ Catch Basin feet x feet <br />Number and Height of Cartridge Stacks: Media Type: <br />Count each ❑12" ❑ 18" ❑ 24" ;❑ 30" ❑ ZPC ❑ Perlite ❑ Other <br />Condition of Internal Components <br />Notes: <br />❑ Good ❑ Damaged ❑ Missing <br />Inlet or Outlet Blockage or Obstruction <br />Notes: <br />❑ Yes ❑ No <br />Floating Trash and Debris <br />Notes: <br />❑ Significant ❑ Not Significant <br />Floating Oils <br />Notes: <br />❑ Significant ❑ Not Significant ❑ Spill <br />Sediment Depth in Inlet Chamber <br />Notes: <br />❑ Inches of Sediment: <br />Sediment Depth in Treatment Chamber <br />Notes: <br />❑ Inches of Sediment: <br />Standing Water in Treatment Chamber <br />Notes: <br />❑ Inches of Standing Water: <br />Maintenance Required <br />❑ Yes - Schedule'Maintenance ❑ No - Inspect Again in Months <br />A dear copy can be viewed at: <br />City of San t.,ea.ndro, 8.35 Last 10 '^itreef, City Hall, <br />`pan 1-candro, C'A 945'77 <br />