Self Monitoring Form for Landscape Irrigation

Redwood City Recycled Water Project Self-Monitoring Monthly Inspection Report Landscape Irrigation

Contact Information

Red Indicates a Required Field

Site Name:
Site Number:
Site Supervisor:
Site Address:
Has the Site Supervisor changed since the last report? Yes
No

If so, provide name, phone number and e-mail address:

Supervisor's Telephone:
Supervisor's E-mail:
Observation Date:

(mm/dd/yy)
    Required
1. Is there any evidence of recycled water escaping any irrigation site through surface runoff or airborne spray?
(If yes, explain in the box at the bottom of this form.)		 Yes
No
2. Are there any odors resulting from the use of recycled water?
(If yes, note source, characterization and travel distance in the box at the bottom of this form.)		 Yes
No
3. Is there evidence of prolonged ponding of recycled water in the irrigation site as a result of excessive spray and evidence of mosquitoes breeding within the irrigation area due to ponded water? Yes
No
4. Are any recycled water warning signs, tags, stickers, and above ground markings missing or improperly located, hidden or illegible? Yes
No
5. Is there evidence of leaks, breaks, or plugs in the irrigation system pipelines, tubing, drip irrigation, sprinkler emitters, or other appurtenances? Yes
No
6. Is there evidence of direct spraying of recycled water on people, streams, passing vehicles, buildings, domestic water facilities (such as drinking fountains), or food handling facilities? Yes
No

If the answer is “yes” to any of the above questions, describe the situation below. Indicate the date that the problem was noticed, the specific location within the site that the problem occurred, and the corrective action taken.