Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

United States Environmental Protection Agency 

Stormwater Management 

Including Discharges from Developed Sites 

Transportation-Related Municipal Separate Storm 

Sewer Systems (MS4s) Questionnaire 

Survey ID: ________________ 

An Agency may not conduct or sponsor, and a person is not required to respond to, a collection 

of information, unless it displays a currently valid OMB control number. 

The public reporting and recordkeeping burden for this collection of information is estimated to 

average 55 hours per response. Send comments on the Agency's need for this information, the 

accuracy of the provided burden estimates, and any suggested methods for minimizing 

respondent burden, including through the use of automated collection techniques to the 

Director, Collection Strategies Division, U.S. Environmental Protection Agency (2822T), 1200 

Pennsylvania Ave., NW, Washington, D.C. 20460. Include the OMB control number in any 

correspondence. Do not send the completed questionnaire to this address. 

Owner/Developer Short Questionnaire Page 1 of 45
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Purpose of the Questionnaire 

Stormwater discharges from developed land can negatively impact water quality through 

increases in stormwater volume and increased pollutant loads to the receiving waters. . To 

strengthen its stormwater regulations, EPA’s Office of Water (OW) is considering revisions to 

the current National Pollutant Discharge Elimination System (NPDES) regulations including the 

establishment of standards for long term stormwater discharges from developed sites. 

To collect data to inform decisions and support analysis of the technical and economic feasibility 

associated with this rulemaking, EPA is sending the following questionnaire to owners/operators 

of transportation-related facilities like state and county departments of transportation that 

own/operate roadway systems. This questionnaire will provide EPA with information to: 

 Characterize scope, components, and implementation of existing transportation-related 

stormwater programs; and ordinances and laws that may constrain long term stormwater 

best management practices; and 

 Estimate the burden and expenditures to comply with and enforce existing requirements. 

The survey is presented in three sections covering the following topic areas: 

 Section A: Technical Information 

 Section B: Financial Information 

 Section C: Contact Information 

Transportation MS4 Questionnaire Page 2 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

General Information, continued 

Authority 

EPA has authority to administer this questionnaire under section 308 of the Clean Water Act 

(Federal Water Pollution Control Act, 22 U.S.C. Section 1318). Participation in this 

questionnaire is mandatory, and you are required to respond. You must retain a copy of 

the completed questionnaire for your files. EPA may contact you with follow-up questions to 

clarify your answers. Late filing of the questionnaire, or failure to follow any related EPA 

instruction, may results in civil penalties, criminal fines, or other sanctions provided by law 

including the possibility of fines and imprisonment as explained in Section 308 of the Clean 

Water Act (33 U.S.C., Section 1318). 

When to Complete the Questionnaire 

You must complete this questionnaire, then print, sign and return the certification statement to 

EPA no later than 60 calendar days after receiving the survey link. 

If you wish to request an extension, you must do so in writing no later than one week of the due 

date of this questionnaire. Written requests may be e-mailed to Mr. Brian D’Amico at 

damico.brian@epa.gov. 

Certification Statement 

A responsible MS4 official or authorized representative must verify the accuracy of the 

responses to the questionnaire by reading and signing the Certification Statement. After 

completing the survey, you must print the Certification statement, sign it, and return it to EPA at 

the following address: 

 U.S. Environmental Protection Agency 

Stormwater Management Including Discharges from New Developed and Redeveloped 

Sites MS4 Questionnaire 

c/o Eastern Research Group, Inc. 

14555 Avion Parkway, Suite 200 

Chantilly, VA 20151 

Where to Get Help 

If you have any questions regarding completion of this questionnaire you can request assistance 

using EPA’s e-mail helpline provided below. Please include the name of the survey to which 

you are responding, the question number along with your questions. Respondents who desire 

assistance by telephone should send an e-mail with “Please Call Me” in the subject line. Please 

provide the call-back phone number, contact name, and desired day and time to call. The return 

phone call will be free of charge to the respondent. 

E-mail address for help line: _________________________________ 

Transportation MS4 Questionnaire Page 3 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Confidential Business Information 

Because the information requested in this questionnaire is not business confidential, EPA may 

make the information available to the public without further notice. 

Transportation MS4 Questionnaire Page 4 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Detailed Instructions for Completing the Questionnaire 

Complete the questionnaire considering the following instructions: 

 This questionnaire is available at the following link: ____________________. 

 Personnel most knowledgeable about the subject areas covered by a specific section should 

complete that section of the questionnaire. 

 For all questions and sections, read all instructions and definitions carefully. Pay particular 

attention to the distinction between establishments and firms. 

 Do not leave any entry blank. If the answer is zero, write “0" or “zero”. If a question is not 

applicable, write “NA.” 

 Answer all of the questions in sequence unless you are directed to SKIP forward in the 

questionnaire. This is important since some questions and/or sections are only applicable to 

some respondents. 

 Use the units specified when responding to questions requesting measurement data (e.g., 

acres). If not specified and applicable, include units in your response. 

 The period of interest for the survey is your fiscal year (FY) 2009 unless indicated otherwise. 

 Provide the requested information based on data you currently have. EPA is not requesting or 

recommending that respondents collect new data to provide information for this survey. 

Transportation MS4 Questionnaire Page 5 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Certification Statement 

The individual responsible for directing or supervising the preparation of the enclosed 

Stormwater Discharges from Developed Sites MS4 Survey must read and sign the Certification 

Statement below before returning both documents to the U.S. Environmental Protection Agency. 

The certifying official must be an MS4 official duly authorized representative. The Certification 

Statement must be printed, signed and submitted in accordance with the requirements contained 

in the Code of Federal Regulations at 40. CFR 122.22. 

 I certify under penalty of law that the attached questionnaire was prepared under my 

direction or supervision in accordance with a system designed to ensure that qualified personnel 

properly gathered and evaluated the information submitted. The information submitted is, to the 

best of my knowledge and belief, accurate and complete. In those cases where we did not possess 

the requested information, we have provided best engineering and/or financial estimates or 

judgment. I am aware that there are significant penalties for submitting false information, 

including the possibility of fines and imprisonment as explained in Section 308 of the Clean 

Water Act (33 U.S.C., Section 1318). 

_____________________________ _________________________ 

Signature of Certifying Official Date 

_____________________________ (______)_______________ __

Printed Name of Certifying Official Telephone Number 

_____________________________ 

Title of Certifying Official 

Transportation MS4 Questionnaire Page 6 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Definitions 

Note that the following terms are defined for the purposes of this questionnaire only. 

These definitions were written as broadly as possible, relying on our regulations, guidance, fact 

sheets, etc. We acknowledge that there are likely local or regional differences in the meanings of 

some of these terms. Where those differences will affect their answer to the questions, 

respondents should provide information on those differences in the survey blanks provided. 

Term Definition 

Construction 

The period of time during which construction activity 

(clearing, grading, and excavation) and other earth-disturbing 

activities are occurring on a site and prior to the time that 

disturbed portions of the site are considered stabilized. 

Bioretention cells 

Landscaping features adapted to provide on-site removal of 

pollutants from stormwater discharges. Surface discharges are 

directed into shallow, landscape depressions, which are 

designed to incorporate many of the pollutant removal 

mechanisms that operate in forested or other natural (prairies, 

wetlands, etc) ecosystems. Includes rain gardens, sidewalk 

planters, curb extensions and other plant or soil systems 

designed to infiltrate or evapotranspirate stormwater. 

Capacity 

Describes the hydraulic capacity that the storm sewer system is 

designed for in terms of the volume of stormwater that it can 

convey without flooding beyond design. 

Catch Basin 

An inlet to the storm sewer system, which typically includes a 

grate or curb inlet, and a sump, to capture sediment, debris, 

and other pollutants. Also known as “storm drain inlets” or 

“curb inlets”. 

Catch Basin Insert 

Retractable or non-retractable devices inserted into catch 

basins to provide removal of oil and grease, trash, and 

sediments from stormwater discharge, and to improve the 

efficiency of the catch basin. Inserts can either be dropped 

directly into the catch basin, or may require retrofit 

construction. Examples include filter fabrics and a system of 

trays with media filters. 

Cistern 

Large storage devices that are often built below ground, at 

ground level, or on rooftops, for storing captured stormwater 

and can be integrated with more sophisticated pumping 

devices. For example, some cisterns collect stormwater that is 

subsequently used for non-potable plumbing, such as flushing 

of toilets, or irrigation applications. 

Transportation MS4 Questionnaire Page 7 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Term Definition 

Combined Sewer 

System (CSS) 

A publicly owned conveyance system that conveys stormwater 

discharges combined with municipal sewage (domestic, 

commercial and industrial wastewater) through a single pipe 

system to a publicly owned treatment works. 

Constructed Wetland 

A man-made basin that contains water, a substrate (soil, gravel, 

rock, organic materials, etc.), plants (vascular and nonvascular), and organisms similar to those usually found in 

natural wetlands. The number of plants and the biodiversity of 

a constructed wetland are greater than that of wet retention 

pond. Constructed wetlands usually use a relatively 

impermeable subsurface layer to prevent water from seeping 

into the ground. 

Co-Permittee 

A permitting arrangement under which two or more MS4s are 

covered under the same NPDES permit. Responsibilities 

under the permit may be divided among the different MS4 copermittees in accordance with jurisdictional boundaries. 

Curb and Gutter 

An engineering approach to convey stormwater through the 

use of a raised, concrete or stone border along a roadside 

(curb) and a channel (gutter) that directs stormwater discharge 

to a storm sewer system. 

Detention/ Extended 

Detention Practices 

Practices which hold stormwater temporarily and discharge the 

stormwater over an extended period of time (hours to days) 

generally by controlling the size of the discharge volume and 

flow rate. Also known as “wet/dry ponds”, “extended detention 

basins”, “detention ponds”, “extended detention ponds.” 

Dry Well 

A well, other than an improved sinkhole, or subsurface fluid 

distribution system, completed above the water table so that its 

bottom and sides are typically dry except when receiving 

fluids. 

Existing Development 

Describes an existing lot/parcel with a significant amount of 

impervious surfaces from prior development, or is significantly 

degraded and is covered with sand, gravel, stones, or other 

non-vegetative covering, or is considered a “brownfield site”. 

Filter Strip / Vegetated 

Buffer 

Vegetated surfaces used to reduce stormwater velocity from 

nearby less pervious surfaces, and to filter out pollutants from 

stormwater and allow infiltration into the underlying soil. Also 

referred to as “riparian buffer” if established around streams, 

lakes, and/or wetlands. 

Flood event 

Describes an overflow of stormwater from a storm sewer 

system during peak flow conditions as a result of a storm 

event. 

Transportation MS4 Questionnaire Page 8 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Term Definition 

Full Time Equivalent 

(FTE) 

The number of full-time employees that could have been 

employed if the reported number of hours worked by part-time 

employees had been worked by full-time employees. This 

statistic is calculated separately for each function of a 

government by dividing the “part- time hours paid” by the 

standard number of hours for full-time employees in the 

particular government and then adding the resulting quotient to 

the number of full-time employees. 

Green Roof 

A vegetative system installed on top of and in addition to the 

traditional roof system. A green roof includes engineered soil 

layers (e.g., a waterproof membrane, drainage, high inorganic 

growing media), and appropriate plant species. Green roofs 

reduce surface discharge from the rooftop by absorbing 

stormwater and slowing stormwater flow rates, and provide 

ancillary benefits such as summer cooling, lowered urban heat 

island effect, and improved air quality. 

Green Infrastructure 

Wet weather management approaches and technologies that 

infiltrate, evapotranspire, capture and reuse stormwater to 

maintain or restore natural hydrology. 

Impervious Area 

The total area of a parcel or right-of-way that consists of 

buildings and associated constructed facilities; areas that are 

covered with a low-permeability material such as asphalt or 

concrete; or areas such as gravel roads and unpaved parking 

areas that are compacted through design or use to reduce their 

permeability. Common impervious areas include, but are not 

limited to, roads, rooftops, walkways, patios, driveways, 

parking lots or storage areas, concrete or asphalt paving, 

packed earthen materials, and macadam or other surfaces 

which similarly impede the natural infiltration of storm water. 

Industrial Facility 

A facility engaged in any of the industrial activities 

specifically listed in 40 CFR 122.26(b)(14) or has been 

designated as causing a water quality standard exceedance or is 

a significant contributor of pollutants to waters of the U.S. 

under 40 CFR 122.26(a)(1)(v). 

Infill Development 

Describes development activity that occurs on a generally 

undeveloped lot/parcel that is situated in an area in which most 

lots/parcels have already been developed. 

Infiltration Basins and 

Trenches/Dry Well 

A shallow rock-filled trench or depression with no outlet 

intended to detain and then infiltrate stormwater into the 

underlying soil. Typically stormwater first passes through a 

swale or other stormwater control before reaching this device. 

Transportation MS4 Questionnaire Page 9 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Term Definition 

Linear Development 

Development that results from the installation, placement, or 

assembly of linear structures, such as highways, bridges, or 

other transportation-related structures; oil or gas pipelines; 

wastewater and stormwater sewers, pipes, or other 

conveyances; or similar structures. 

Long Term (Post 

Construction) 

Stormwater Controls 

See Post Construction 

Low Impact 

Development (LID) 

Development that is designed to be hydrologically functional 

by mimicking pre-development hydrology conditions. This is 

achieved by using design techniques that infiltrate, filter, 

evaporate, and store discharge close to its source. 

Media Filters 

Filters that stormwater passes through for removal of solids. 

Filters can be made out of sand, peat, foam, crushed glass, 

textile, or other suitable material. 

Mixed Use 

Development 

Development that includes a combination of residential, 

commercial, industrial, office, institutional, or other land uses. 

Municipal Separate 

Storm Sewer System 

(MS4) 

A conveyance or system of conveyances (including roads with 

drainage systems, municipal streets, catch basins, curbs, 

gutters, ditches, man-made channels, or storm drains) that is 

owned by a state, city, town, village, or other public entity 

having jurisdiction over disposal of sewage, industrial wastes, 

stormwater, or other wastes, including special districts under 

state law such as a sewer district, flood control district or 

drainage district, or similar entity, or an Indian tribe or an 

authorized Indian tribal organization, or a designated and 

approved management agency under section 208 of the CWA 

that discharges to waters of the U.S., which is not a combined 

sewer, and which is not part of a Publicly Owned Treatment 

Works (sewage treatment plant). 

MS4 Service Area Area over which an MS4 operator has jurisdiction to collect 

and dispose of stormwater. 

New Development 

Development that occurs on land where generally no or 

minimal structures and other impervious surfaces, such as 

buildings, parking lots, and roads exist and includes 

agricultural, forested and open/barren land. These sites are 

commonly referred to as greenfield sites. 

NPDES 

EPA’s or a State’s “National Pollutant Discharge Elimination 

System” program for issuing, modifying, revoking and 

reissuing, terminating, monitoring and enforcing permits under 

the authority of the Clean Water Act. 

Transportation MS4 Questionnaire Page 10 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Term Definition 

Outfall 

Describes the place where a point source, as defined by 40 

CFR 122.2, discharges stormwater to waters of the U.S. The 

term “outfall” does not include open conveyances connecting 

two MS4s, or pipes, tunnels or other conveyances which 

connect segments of the same stream or other waters of the 

U.S. and are used to convey waters of the U.S. 

Phase I MS4 

A “large” (population of 250,000 or more) or “medium” 

(population of 100,000 or more) sized MS4, as defined in 40 

CFR 122.26(b)(4) and (7), required to obtain an EPA or State 

NPDES permit. 

Phase II MS4 

A “small” MS4, defined by 40 CFR 122.26(b)(16), not defined 

as “large” or “medium”, that is located in an urbanized area as 

determined by the latest Decennial Census by the Bureau of 

the Census, and therefore required to obtain an EPA or State 

NPDES permit. Small MS4s include non-traditional systems, 

for example: universities and systems maintained by 

transportation authorities such as a state’s department of 

transportation. 

Permeable Pavement 

Pavement composed of a permeable pavement material, which 

allows distributed infiltration into the underlying soil. There 

may also be an underlying stone reservoir that temporarily 

stores the surface discharge before it infiltrates into the 

underlying soil. Examples include pervious concrete, porous 

asphalt, permeable pavers. 

Post Construction 

Describes the phase of development immediately following the 

termination of construction activities on a site. “Postconstruction discharges” are discharges of stormwater from 

developed sites. Post-construction controls are those 

stormwater controls that are installed and maintained to 

permanently manage stormwater discharged from the 

developed sites. 

Public Entity 

A public agency or body of a state, city, town, village or other 

municipal entity. Includes special districts under state law 

such as a sewer district, flood control district or drainage 

district, or similar entity, or an Indian tribe or an authorized 

Indian tribal organization, or a designated and approved 

management agency. 

Private Entity A non-public body or institution, such as a private university. 

Redevelopment 

Development at a site with existing structures or impervious 

surfaces. Redevelopment does not include projects that are 

solely remodeling or alterations to the interior of a structure. 

Transportation MS4 Questionnaire Page 11 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Term Definition 

Retention Practices 

Stormwater techniques that manage stormwater on-site through 

infiltration, evapotranspiration, or harvesting. Commonly 

referred to as Low Impact Development or Green 

Infrastructure practices. 

Retrofit 

The installation or modification of stormwater control 

measures on sites with existing development (including 

existing storm sewers) to enhance the reduction of stormwater 

pollutants, or discharge volume or flow rates. 

Riparian Buffer 

An area surrounding a shoreline, wetland, or stream within 

which development is restricted or prohibited. The primary 

function of aquatic buffers is to physically protect and separate 

a stream, lake, or wetland from future disturbance or 

encroachment. These areas are also called “resource 

protection areas.” 

Site plan review 

A procedure used by MS4s and other entities for conducting a 

review of development site plans for conformance with 

stormwater control requirements, such as sediment and erosion 

controls, and post-construction controls. 

Soil Amendments 

Material(s) added to the soil to enhance one or more of its 

attributes in order to improve the control of stormwater (e.g., 

drainage, water retention). 

State-defined source 

water protection area 

for public water 

supplies 

The area delineated by the state for a public water system or 

including numerous public water systems, whether the source 

is ground water or surface water or both, as part of the state 

Source Water Assessment Program approved by EPA under 

section 1453 of the Safe Drinking Water Act. For ground 

water sources of drinking water, this is the surface and 

subsurface area surrounding a well or well field, supplying a 

public water system, through which contaminants are 

reasonably likely to move toward and reach such water well or 

well field. For surface water sources of drinking water, it is the 

topographic boundary, up to the state’s border, that is the 

perimeter of the catchment basin that provides water to the 

intake structure of a public water system. 

Storm Sewer System 

A conveyance or system of conveyances, including roads with 

drainage systems, municipal streets, catch basins, curbs, 

gutters, ditches, manmade channels, or storm drains designed 

or used for collecting or conveying stormwater. 

Stormwater Runoff, snow melt runoff, and surface runoff and drainage. 

Stormwater Control Practices that are installed and maintained to control 

stormwater discharges. 

Stormwater Quality 

Control 

Stormwater control used to reduce or eliminate pollutants 

carried in stormwater discharges. 

Stormwater Quantity 

Control 

Stormwater control used to control or convey the volume of 

water being discharged during storm conditions. 

Transportation MS4 Questionnaire Page 12 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Term Definition 

Subsurface fluid 

distribution system 

An assemblage of perforated pipes, drain tiles, or other similar 

mechanisms intended to distribute fluids below the surface of 

the ground. This could include a seepage pit, infiltration 

trench, or commercially manufactured stormwater infiltration 

device if it has a subsurface fluid distribution system. 

Swales: Grassed 

A broad, shallow channel used for conveying and management 

stormwater discharge. Grass on the side slopes and bottom acts 

to slow discharge velocity, trap particulates, and promote 

infiltration. Grassed swales are often referred to as bio-swales, 

enhanced swales, or water quality swales and can be classified 

as wet swales, dry swales, and grassed channels. See Swales: 

Other Vegetation. 

Swales: Other 

vegetation 

A broad, shallow channel used for conveying stormwater 

discharge. Vegetation on the side slopes and bottom acts to 

slow discharge velocity, trap particulates, and promote 

infiltration. Vegetated swales are often referred to as bioswales, enhanced swales, or water quality swales and can be 

classified as wet swales, dry swales, and grassed channels. 

A dry swale (bio-swale) incorporates additional elements with 

the vegetated swale design. Infiltration is aided by a soil bed 

(not necessarily natural soil) with an underdrain system 

composed of a perforated pipe surrounded by gravel. Check 

dams may be used to temporarily retain stormwater discharge. 

A wet swale is capable of temporarily retaining stormwater 

discharge, but, unlike the dry swale, lacks an underdrain 

system. The wet swale is marshlike and relies on and supports 

wetland vegetation 

Tree Box 

Stormwater controls that direct stormwater discharges to a 

treebox, where it can be filtered by the soil and vegetation. 

Some tree boxes may drain to a channel below, which conveys 

stormwater to the selected collection system. 

Underground Detention 

Underground vaults, storage cells, or water piping systems 

used for stormwater flow rate and volume control. This is an 

alternative to storage above ground (e.g., pond). 

Undeveloped Describes land that has not been subject to prior development. 

See “new development.” 

Urbanized Area 

A land area comprising one or more places — central place(s) 

— and the adjacent densely settled surrounding area — urban 

fringe — that together have a residential population of at least 

50,000 and an overall population density of at least 1,000 

people per square mile. Any MS4 located within a 2000 

Census-defined “urbanized area” is required to obtain an 

NPDES permit for discharges from its storm sewer system. 

Water of the U.S. / 

Water of the State Defined at 40 CFR 122.2. 

Transportation MS4 Questionnaire Page 13 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Term Definition 

Wetland Basin 

(Permanent Pool and 

No Permanent Pool) 

Similar to wet and dry ponds, stormwater control structure that 

incorporates wetland plants. Storm discharge is directed into 

the basin to control both water quality and quantity. Basin 

outlets are designed to detain and treat the stormwater 

discharge: 1) for a minimum duration (e.g., 24 hours) for no 

permanent pool and 2) until the water is displaced by discharge 

from a later storm (permanent pool). 

Transportation MS4 Questionnaire Page 14 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Section A: Technical Information 

A-1 Fill in the following identifying and contact information 

 ______________________________________________________ 

 Your Name and Title: 

 

 ______________________________________________________ 

 Address: 

 

 ______________________________________________________ 

 Phone Number: 

 ______________________________________________________ 

 Email Address: 

 

 ______________________________________________________ 

 Best Time to Contact: 

 

 ______________________________________________________ 

A-2 MS4 Owner and Operator Department/Agency 

 

 ______________________________________________________ 

 

A-3 Is the MS4 owner/operator: 

 □ State Department of Transportation 

 □ County Department of Transportation 

□ Local Department of Transportation 

 □ Other, Specify: ____________________________________________ 

 

A-4 Which example best describes your agency’s hierarchy? 

□ The agency has one overarching office with regional offices underneath that deal with 

various aspects of the stormwater program. 

□ The agency has one overarching office with watershed offices underneath that deal 

with various aspects of the stormwater program. 

□ The agency has one overarching office, regional offices underneath, and districts that 

deal with various aspects of the stormwater program. 

□ The agency has one overarching office that deals with the various aspects of the 

stormwater program. 

□ Other, Specify: ___________________________________________________ 

 

Transportation MS4 Questionnaire Page 15 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

A-5 Which best describes your MS4 permit? 

Individual Permit:

□ Large/Medium MS4 permit (Phase I) 

Specify any co-permittees: ____________________________________________ 

□ Small MS4 permit (Phase II) 

Specify any co-permittees: ____________________________________________ 

General Permit:

□ Large/Medium MS4 permit (Phase I) 

Specify any co-permittees if this permit is not statewide:____________________ 

□ Small MS4 permit (Phase II) 

Specify any co-permittees if this permit is not statewide:____________________ 

A- 6 How many permits terms have you completed under the stormwater program (usually 

MS4 permits are issued every 5 years, however some permits may have continued after 

they expired) 

□ None, we have not yet completed our first permit term 

□ 1 permit term – we are currently covered under our second MS4 permit 

□ 2 permit terms– we are currently covered under our third MS4 permit 

□ 3 permit terms– we are currently covered under our forth MS4 permit 

□ 4 or more permit terms– we are currently covered under our fifth or more permit 

A-7 In addition to your MS4, how else is stormwater conveyed in the area under your 

 control? Check all that apply. 

□ Separate storm sewer that is not permitted 

□ Combined sewer system 

□ De-centralized storm sewer system (i.e. unpiped/on-site practices, discharges directly 

to a stream, swales, natural conveyances such as ditches or gullies, ephemeral drainages) 

□ Other, specify ____________________________________ 

□ None, only MS4 

Transportation MS4 Questionnaire Page 16 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Extent of Coverage

EPA is obtaining information about the extent of that your MS4 is covered by an NPDES permit. 

Under the Phase II stormwater regulations, small MS4s located within a Census-defined 

urbanized area are required to be regulated. Some permitting authorities, however, have extended 

permit coverage beyond the urbanized area to cover the entire area under your control if only 

part of an MS4 was located within an urbanized area. In addition permitting authorities have 

extended coverage to other small MS4s outside of the urbanized area. The following questions 

are focused on determining the extent to which your MS4 is regulated under an NPDES permit. 

The questions collect information about three areas: 

 1. MS4 permitted area – area covered by Phase I/II MS4 permit 

2. MS4 service area – area over which an MS4 is the owner and operator of the municipal 

separate storm sewer system and has the authority to collect and discharge stormwater, 

may extend beyond the permitted area. 

 3. Area under your control – boundaries of the area which you control/operate 

A-8 Which of the following best describes the basis for how stormwater discharges from your 

MS4 are permitted? 

□ Based on the urbanized area boundary (as defined by the U.S. Census) 

□ Based on the entire area under my control (state roads, county roads, etc) 

□ Based on sewer, irrigation, drainage, flood control district 

□ Based on watershed boundaries 

□ Based on watershed districts (or other watershed entity) 

□ Other, Specify: __________________________________________________ 

A-9 Does your stormwater permit cover discharges beyond the Census-defined 

 urbanized area? 

□ Yes 

□ No 

A-10 Do you have a GIS map showing the area covered by your permit? 

□ Yes - Provide the location citation of the GIS information. Provide the URL if the GIS 

information is posted on the web: _______________________________ 

□ No 

A-11 What are the total area, and estimated percent impervious area of both the permitted MS4 

portion of the area under your control (as described in A-7) and the entire area under your 

control. 

□ My boundary falls entirely within an urbanized area (in this case please fill out only the 

“entire area under your control” column). 

Permitted MS4 Area Entire Area Under Your 

Control 

Total Area 

Estimated % Impervious 

Area (if available) 

Transportation MS4 Questionnaire Page 17 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

A-12 If your stormwater permit does not cover the entire area under your control (for example 

the entire roadway), which of these MS4 stormwater program activities apply to the 

entire area under your control? 

□ Public education and outreach 

□ Public involvement 

□ Illicit discharge and Elimination 

□ Pollution Prevention/Good Housekeeping (includes street sweeping) 

□ Record keeping 

□ Erosion and Sediment Controls for Construction Activities 

□ Post Construction stormwater requirements for new and redevelopment 

□ Industrial stormwater inspections 

□ Stormwater monitoring 

□ Other controls, Specify: ___________________________________ 

□ None 

A-13 Do you allow other entities to construct in your right of way/area under your control 

where you apply the components of the stormwater program? 

□ Yes 

□ No 

□ Unknown 

Specific Stormwater Program Components 

The following section collects information on the activities that you are currently doing as part of 

your stormwater program. 

A-14 Do you have data or other information to show the effectiveness of any of the 

 following components of your stormwater program to protect waterbodies from 

 stormwater impacts? (Check all that apply.) 

__ Public Education and Outreach 

__ Public Participation/Involvement 

__ Illicit Discharge Detection and Elimination 

__ Construction Site discharge control (including erosion/sediment control) 

__ Post Construction discharge control (including detention, retention and treatment) 

practices 

__ Pollution Prevention/Good Housekeeping (including street sweeping) 

__ Industrial Inspections 

__ Wet weather outfall monitoring 

__ Monitoring to measure the performance of specific stormwater controls 

__ Instream monitoring 

 __ Implementation of watershed management plans 

 __ MS4 training programs 

 __ Source control (limits on fertilizer or pesticides) 

 __ Other, please describe___________________________ 

Transportation MS4 Questionnaire Page 18 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

A-15 What parts of your stormwater management program are carried out by other departments 

or other governmental agencies (for example some departments of transportation may 

combine their efforts for public education with a city)? 

  Public education and outreach 

  Public involvement 

  Illicit discharge detection and elimination 

  Pollution prevention/good housekeeping 

  Construction stormwater program 

  Post construction stormwater program 

  Record keeping/ annual reporting 

  Other, please describe_____________ 

  None (skip to A-16) 

A- 16 Does your agency have oversight over those departments or governmental agency’s 

stormwater management activities? 

  Yes 

  No 

  Not all activities 

  Not applicable 

A-17 Which of the following activities have been part of the public education and 

 outreach component of your stormwater program from 2005 - 2009? (Check all that 

apply.) 

 Brochures, fact sheets, guides, or similar documents for the general public 

 Brochures, fact sheets, guides, or similar documents for your agency’s staff 

 Radio features 

 Television advertisements 

 Educational programs (for the general public, school children, teachers, etc.) 

 Event participation (conference participation, earth day events, fairs, etc.) 

 Staff training 

 Contractor training 

 Municipality training 

 Storm drain stenciling 

 Stormwater hotlines 

 Tributary signage 

 Website 

 Car washing public program 

  Other, please describe_____________ 

 None 

A-18 Which of the following activities have been part of the public involvement component of 

your stormwater program from 2005 - 2009? (Check all that apply.) 

  Public meetings/citizen panels 

 Public notification and review of stormwater program elements 

 Informational briefings for public officials (politicians, managers, etc.) 

 Volunteer water quality monitoring 

Transportation MS4 Questionnaire Page 19 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

 Volunteer educators/speakers 

 Storm drain stenciling 

 Public reporting of litter/pollution (telephone hotline or website) 

 Community clean-ups 

 Citizen watch groups 

 Coordination with highway patrol (or similar entity) regarding stormwater complaints 

 “Adopt A Highway” programs 

  Other, please describe_____________ 

 None 

A-19 Which of the following activities have been part of the illicit discharge component of 

your stormwater program from 2005 - 2009? (Check all that apply.) 

 Paper tracking/inventory of outfalls 

 Database tracking/inventory of outfalls 

 Outfalls that drain to sensitive watersheds are tracked separately/differently 

 Storm sewer system mapping 

 Field staff training (to identify and eliminate illicit discharges) 

 Field/indicator sampling 

 Laboratory analyses 

 Priority area identification (i.e. prioritizing specific areas of your system where the 

probability of illicit discharges may be higher) 

  Public reporting (i.e. hotline for reporting illicit discharges) 

 Adoption of ordinances/codes established by local jurisdictions 

  Other, please describe_____________ 

 None 

A-20 Which of the following activities have been part of the pollution prevention/good 

housekeeping component of your stormwater program from 2005 - 2009? (Check all that 

apply.) 

 Inventory of your facilities 

 Facility assessment (to determine the facility’s potential to discharge pollutants) 

 Vehicle washing requirements 

 Fueling operations requirements 

 Vehicle maintenance requirements

 De-icing/Anti-icing material storage 

 Facility inspections 

 Storm sewer system maintenance activities (includes inspections and cleaning) 

 Street sweeping activities

 Pesticide/herbicide application and management requirements 

 Fertilizer application and management requirements 

 Field staff training

 Contractor training

  Other, please describe_____________ 

 None 

Transportation MS4 Questionnaire Page 20 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

A-21 Which of the following activities has been part of the record keeping component of your 

stormwater program from 2005 - 2009? (Check all that apply.) 

 Spill response 

 Construction inspection 

 Industrial inspection 

 Illicit discharge detection and elimination 

 Annual reporting 

  Other, please describe_____________ 

 None 

A-22 Do you use other departments, governmental agencies, or contractors to complete any of 

the following parts of your stormwater program? (Check all that apply.) 

□ Designing stormwater controls 

□ Constructing stormwater controls 

□ Maintaining stormwater controls 

□ Inspecting construction stormwater controls 

□ Inspecting post-construction stormwater controls 

□ Other, Specify: ___________________________________________________ 

□ None (skip to Question A-24) 

A-23 For those parts of your stormwater program that are performed by other departments, 

governmental agencies, or contractors, do you include any stormwater requirements in 

your contracts or other binding agreements for the following activities? (Check all that 

apply.) 

 Yes No Not applicable

Designing stormwater controls □ □ □

Constructing stormwater controls □ □ □ 

Maintaining stormwater controls □ □ □

Inspecting construction stormwater controls □ □ □

Inspecting post-construction stormwater controls □ □ □

Other, Specify: ________________________ □ □ □

 Justification: 

A-24 What mechanisms other than ordinances do you use to implement your stormwater 

program? (Check all that apply.) 

□ Internal policies 

□ Cooperative agreements 

□ Third party construction contracts contain stormwater requirements 

□ Third party contracts related to operating and/or maintaining stormwater control 

measures contain stormwater requirements 

□ Other, Specify: ___________________________________________________ 

Transportation MS4 Questionnaire Page 21 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

A-25 When planning, developing, and designing transportation projects, when is stormwater 

management first considered? 

□ During the transportation planning process (considering the stormwater management 

needs of the transportation system), Specify: ___________________ 

□ During the project development (NEPA) process or preliminary design stage for 

individual projects, Specify: __________________________________________ 

□ During final design, Specify: ________________________________________ 

□ Other, Specify: ___________________________________________________ 

A-26 Which of the following activities have been part of the industrial component of your 

stormwater program from 2005 - 2009? (Check all that apply.) 

 Inventory of industrial facilities 

 Education of industrial operators about stormwater requirements and/or controls 

 Site inspection of industrial facilities 

 Site inspection of commercial facilities 

 Training of inspectors 

 Other, Specify: ___________________________________________________ 

 None - There is no industrial component in your stormwater program 

A- 28 Which of the following activities have been part of the construction component of your 

stormwater program from 2005 - 2009? (Check all that apply.) 

 Review site plans 

 Tracking/ inventory of sites

 Inspections 

 Approved construction control manual 

 Field staff training

 Contractor training

 Other, please describe_____________ 

 None - There is no construction component in your stormwater program 

A-30 Are there major roadway projects that are either under construction or in the process of 

being funded, which have the potential to open rural portions of your state to suburban or 

urban development over the next three decades? 

 Yes 

 No 

 Not applicable 

If you answered yes to this question please supply the requested information in the 

following table for each project that has this potential. If available please attach a map of 

the project. 

Transportation MS4 Questionnaire Page 22 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Project Name Type of project (check one) Anticipated 

Project 

Completion 

Date 

Web Address for 

Additional Project 

Information (if available) 

 New roadway 

 Expansion of an existing 

roadway 

 Both an addition of a new 

road and expansion of an 

existing roadway 

 New roadway 

 Expansion of an existing 

roadway 

 Both an addition of a new 

road and expansion of an 

existing roadway 

 New roadway 

 Expansion of an existing 

roadway 

 Both an addition of a new 

road and expansion of an 

existing roadway 

 New roadway 

 Expansion of an existing 

roadway 

 Both an addition of a new 

road and expansion of an 

existing roadway 

 New roadway 

 Expansion of an existing 

roadway 

 Both an addition of a new 

road and expansion of an 

existing roadway 

Transportation MS4 Questionnaire Page 23 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

POST CONSTRUCTION 

A-31 Which of the following activities have been part of the post construction component of 

your stormwater program from 2005 - 2009? (Check all that apply.) 

 Review construction site plans for post construction stormwater water quality and/or 

water quantity requirements 

 Tracking/inventory of sites

 Tracking/inventory of post-construction practices 

 Inspections 

 Field staff training

 Contractor training

 Inspection and maintenance of practices

 Other, please describe_____________ 

 None 

A-32 Who reviews your site plans for stormwater control structures? (Includes reviews for both 

water quality and quantity concerns. Check all that apply) 

  State 

  County 

  Municipality 

  EPA 

  Self-review 

 Third party contractor/entity 

 Other, Specify: __________________________________________________ 

A-33 For long term (post construction) stormwater controls located on public property within 

your MS4 service area do you track, inspect and/or maintain these controls? (Check all 

that apply.) 

□ MS4 tracks post construction controls on public property 

□ MS4 inspects post construction controls on public property 

□ MS4 maintains post construction controls on public property

□ Other, describe __________________ 

□ No 

A-34 Do you have stormwater controls located on privately-owned properties? 

□ Yes 

□ No, we do not allow our stormwater controls to be located on privately-owned 

properties 

□ Not applicable, Specify: __________________________________________ 

Transportation MS4 Questionnaire Page 24 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

NEW DEVELOPMENT AND REDEVELOPMENT 

A-35 Do you consider the following part of new development or redevelopment? 

Infill projects on existing undeveloped parcels □ New □ Redevelopment □ Neither 

Bridge repair □ New □ Redevelopment □ Neither 

Development extensions that add □ New □ Redevelopment □ Neither 

imperviousness onto previously undeveloped 

land, but are part of the same plot/parcel 

(e.g. a rest stop parking lot is extended 

into an adjoining forested area) 

Reconstruction/ Road widening projects □ New □ Redevelopment □ Neither 

(e.g. adding a lane or modifying an older 

roadway to improve safety) 

Replacement of impervious surfaces (road □ New □ Redevelopment □ Neither 

resurfacing, sidewalk replacement, etc) 

Pavement structural and joint repair □ New □ Redevelopment □ Neither 

Removal or protection of roadside obstacles □ New □ Redevelopment □ Neither 

Other, specify ________________________ □ New □ Redevelopment □ Neither 

A-36 How many linear square feet have you developed in the last 5 years, if readily available? 

Provide your best estimate. 

Linear Square Feet of New Development 

Fiscal year 

2005 2006 2007 2008 2009 

Linear square feet 

of development 

Stormwater Management: Specific or Numeric Performance Standard 

and/or Design Criteria for Long term (post construction) controls 

A-37 Are new development or redevelopment activities in your MS4 service area subject to 

performance and/or design standards for stormwater retention, volume control, or 

discharge rate? 

□ Yes 

□ No (skip to A-48) 

Transportation MS4 Questionnaire Page 25 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

A-38 What is the enforcement mechanism to assure that post construction standards or design 

criteria are met? 

□ Site inspection 

□ Site plan review/approval acceptance 

□ Review self-reporting/ self-certification database 

□ None, there are no post construction standards applied to my MS4 

A-39 Do you participate in an alternative program to compliance with your performance 

standard or design standard? 

□ Yes, it is a stormwater off-site mitigation program; Specify: _______________ 

□ Yes, it is a payment in lieu program 

□ Yes, it is a stormwater crediting program; Specify: _________________ 

□ Yes, it is a mitigation banking system; Specify: ____________________ 

□ Yes, there is another type of alternative compliance program, please 

 describe___________ 

□ No, but there is an alternative compliance program offer by another level of 

government (state, county, etc), Specify: ______________________________ 

□ No, an alternative compliance program does not exist

A-40 Who determined your MS4’s stormwater performance standards and/or design criteria 

requirements for long term (post construction) controls for new or redevelopment 

activities? (Check all that apply.) 

□ The State enacted these requirements that are implemented through the MS4 permit 

□ The State enacted these requirements that are implemented through the state 

 construction stormwater permit 

□ The County enacted these regulations that the MS4 is required to implement 

□ It is imposed by our local government 

□ Other, describe__________________________________________ 

A-41 Is your long term (post construction) standard for redevelopment projects different than 

for new development projects? 

□ Yes (Answer questions A-42 – A-44 regarding your standard for new development, 

answer questions A-45 – A-47 regarding your standard for redevelopment) 

□ No (Answer question A-42 – A44 regarding your standard for development, skip 

questions A45- A47) 

Stormwater Performance Standard and/or Design Criteria for (New) 

Development Projects 

A-42 For new development projects, what is the threshold to which the long term (post 

construction) stormwater performance standards and/or design criteria apply? 

 Size of site 

□ 1⁄2 acre 

□ 1 acre 

□ 5,000 sq ft 

□ Other: ____________________ 

Transportation MS4 Questionnaire Page 26 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

 Other threshold 

□ ____quality of impervious surface 

□ Other: ____________________ 

A-43 Indicate which specific or numeric stormwater performance standards and/or design 

criteria requirements apply to new development projects. Please provide your standard in 

the “specify” blank. Check all that apply. Attach copies and/or citations for the relevant 

standards and criteria (such as a copy of your design requirements for stormwater 

controls or a citation to the state law or a web page link to the design manual that 

contains the information). 

 Note: Standards that require detention or extended detention are those which hold 

 stormwater temporarily and discharge the stormwater over an extended period of time 

(hours to days) generally by controlling the size of the discharge volume and flow rate. 

Standards that require retention are those that do not discharge stormwater off-site or to 

surface water below a certain design capacity (design volume, stormwater size, 

etc.). The stormwater is infiltrated, evapotranspired, or harvested. 

□ Post-development peak runoff/discharge rate must match pre-development peak 

runoff/discharge rate for a specified storm return interval or intervals 

□ 1 year storm □ 25 year storm 

□ 2 year storm □ 100 year storm 

□ 5 year storm □ Other (Specify) __________ 

□ 10 year storm 

□ Detention of a specified storm depth or volume (such as 0.5 inch per acre or 1 inch per 

impervious acre) 

 (Specify) __________ 

□ Detention of a specified storm volume (such as 1,800 cubic feet per acre or 3,600 cubic 

feet per impervious acre) 

 (Specify) __________ 

□ Detention of a specified percentile storm event (such as the 80th percentile storm) 

 (Specify) __________ 

□ Retention of a specified storm depth or volume (such as 0.5 inch per acre or 1 inch per 

impervious acre) 

 (Specify) __________ 

□ Retention of a specified storm volume (such as 1,800 cubic feet per acre or 3,600 cubic 

feet per impervious acre) 

 (Specify) __________ 

Transportation MS4 Questionnaire Page 27 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

□ Retention of a specified percentile storm event (such as the 80th percentile storm) 

 (Specify) __________ 

□ Pollutant reduction requirement (for example, stormwater control practices must be 

installed to remove 80% of the post-construction TSS loading and 40% of the postconstruction nitrogen loading) 

Specify: ____________ 

□ Channel protection measures (such as a maximum allowable discharge velocity or 

other metric) 

 Specify: ____________ 

□ Infiltration/groundwater recharge requirement (for example, maintain predevelopment 

groundwater recharge levels or infiltrate the first 0.5 inch of runoff) 

 Specify: ____________ 

□ Limits for effluent concentrations of specific pollutants measured at the stormwater 

control 

 Specify: ____________ 

□ Limits for effluent concentrations of specific pollutants in receiving waters 

 Specify: ____________ 

□ Requirements for control of temperature 

 Specify: ____________ 

Does this standard apply to all areas under your control or only to certain sites or 

waterbodies? 

□ All areas 

□ Only certain areas (Specify: ____________) 

 

□ Flood control requirements other than the peak discharge rate control and on-site 

detention/retention requirements specified above. 

 Specify: ____________ 

□ Stream buffer requirements (for example, a 50 foot vegetated buffer must be 

maintained/implemented adjacent to waters of the state) 

 Specify: ____________ 

 

□ Limits on the maximum percent imperviousness for the site, or maximum 

 directly connected impervious surface or other limits on impervious surfaces. 

 Specify: ____________ 

□ Other Standards Not Identified Above 

Specify: ___________________ 

Transportation MS4 Questionnaire Page 28 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

A-44 Which type of new development do your stormwater performance and/or design 

standards (described in Question A-55) apply? (Check all that apply.) 

□ Requirements are the same for all new development 

□ Bridge deck replacement 

□ Roadway resurfacing 

□ Roadway widening 

□ Maintenance yard creation 

□ Creation of a roadway bypass or a new roadway 

□ Road reconstruction projects 

□ Parking lot expansion 

□ Pavement structural and joint repair 

□ Removal or protection of roadside obstacles 

□ Other, Specify: __________ 

Stormwater Performance Standards and/or Design Criteria for 

Redevelopment Projects 

A-45 For redevelopment projects in your MS4, what is the threshold to which long term (post 

construction) stormwater performance standards and/or design criteria apply? 

 

 Size of site 

□ 1⁄2 acre 

□ 1 acre 

□ 5,000 sq ft 

□ Other: ____________________ 

 Other threshold 

□ ____quality of impervious surface 

□ Other: ____________________ 

A-46 Indicate which specific or numeric stormwater performance standards and/or design 

criteria requirements apply to redevelopment projects. Please provide your standard in 

the “specify” blank. Check all that apply. Attach copies and/or citations for the relevant 

standards and criteria (such as a copy of your design requirements for stormwater 

controls or a citation to the state law or a web page link to the design manual that 

contains the information). 

□ Post-development peak runoff/discharge rate must match pre-development peak 

runoff/discharge rate for a specified storm return interval or intervals 

□ 1 year storm □ 25 year storm 

□ 2 year storm □ 100 year storm 

□ 5 year storm □ Other (Specify) __________ 

□ 10 year storm 

Transportation MS4 Questionnaire Page 29 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

□ Detention of a specified storm depth or volume (such as 0.5 inch per acre or 1 inch per 

impervious acre) 

 (Specify) __________ 

□ Detention of a specified storm volume (such as 1,800 cubic feet per acre or 3,600 cubic 

feet per impervious acre) 

 (Specify) __________ 

□ Detention of a specified percentile storm event (such as the 80th percentile storm) 

 (Specify) __________ 

□ Retention of a specified storm depth or volume (such as 0.5 inch per acre or 1 inch per 

impervious acre) 

 (Specify) __________ 

□ Retention of a specified storm volume (such as 1,800 cubic feet per acre or 3,600 cubic 

feet per impervious acre) 

 (Specify) __________ 

□ Retention of a specified percentile storm event (such as the 80th percentile storm) 

 (Specify) __________ 

□ Pollutant reduction requirement (for example, stormwater control practices must be 

installed to remove 80% of the post-construction TSS loading and 40% of the postconstruction nitrogen loading) 

 Specify: ____________ 

□ Channel protection measures (such as a maximum allowable discharge velocity or 

other metric) 

 Specify: ____________ 

□ Infiltration/groundwater recharge requirement (for example, maintain predevelopment 

groundwater recharge levels or infiltrate the first 0.5 inch of runoff) 

 Specify: ____________ 

□ Limits for effluent concentrations of specific pollutants measured at the stormwater 

control 

 Specify: ____________ 

□ Limits for effluent concentrations of specific pollutants in receiving waters 

 Specify: ____________ 

□ Requirements for control of temperature 

 Specify: ____________ 

Does this standard apply to all areas under your control or only to certain sites or 

waterbodies? 

Transportation MS4 Questionnaire Page 30 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

□ All areas 

□ Only certain areas (Specify: ____________) 

 

□ Flood control requirements other than the peak discharge rate control and on-site 

detention/retention requirements specified above. 

 Specify: ____________ 

□ Stream buffer requirements (for example, a 50 foot vegetated buffer must be 

maintained/implemented adjacent to waters of the state) 

 Specify: ____________ 

 

□ Limits on the maximum percent imperviousness for the site, or maximum 

 directly connected impervious surface or other limits on impervious surfaces. 

 Specify: ____________ 

□ Other Standards Not Identified Above 

Specify: ___________________ 

A-47 To which type of redevelopment does your stormwater performance and/or design 

standards apply (described in Question A-38)? 

□ Requirements are the same for all new development 

□ Bridge deck replacement 

□ Roadway resurfacing 

□ Roadway widening 

□ Maintenance yard creation 

□ Creation of a roadway bypass or a new roadway 

□ Road reconstruction projects 

□ Parking lot expansion 

□ Pavement structural and joint repair 

□ Removal or protection of roadside obstacles 

□ Other, Specify: __________ 

Retrofit of Stormwater Management Practices 

The following questions collect information about retrofit practices in your MS4. Retrofit is the 

installation or modification of structural control measures on sites with existing development 

(including existing storm sewers) to enhance the reduction of stormwater pollutants, or runoff 

volume or flow rates. 

A-48 Does your MS4 have a stormwater retrofit program? 

□ Yes 

□ No (skip) 

A-49 What are the components of your retrofit program? (Check all that apply.) 

□ We are required to retrofit 

□ We receive incentives for retrofits 

Transportation MS4 Questionnaire Page 31 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

□ We initiate retrofits on public property 

□ We initiate retrofits on private property 

□ Stream restoration is part of our retrofit plan 

A-50 Who is responsible for paying for the retrofit projects? (Check all that apply.) 

□ We pay for all retrofits on public and private property 

□ We pay for retrofits only on public property 

□ Private entities are required to pay for retrofits on their property 

□ None 

A-51 What is the purpose of your stormwater retrofit program? (Check all that apply.) 

□ To comply with stormwater permit requirements 

□ To address flood control 

□ To comply with Total maximum daily load (TMDL) or other water quality 

 requirement(s) 

□ Other requirements, such as state requirements, please describe 

□ Not to meet a requirement listed above, but to address watershed plan or local 

water quality, habitat or stream stability or geomorphology concerns 

□ Other: ________________________________________ 

□ Not applicable 

A-52 Provide any additional details of your retrofit program.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________ 

A-53 What kind of retrofit projects could make the most effective difference in terms of 

restoring water quality in your area?

 ________________________________________________________________________

 ________________________________________________________________________

 ________________________________________________________________________

 ________________________________________

Transportation MS4 Questionnaire Page 32 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

SPECIFIC STORMWATER CONTROLS 

In this section EPA is obtaining information about specific stormwater practices that exist in 

your MS4 including both detention and retention practices. 

Detention or extended detention practices are those which hold stormwater temporarily and 

discharge the stormwater over an extended period of time (hours to days) generally by 

controlling the size of the discharge volume and flow rate. Also known as wet/dry ponds, 

extended detention basins, detention ponds, extended detention ponds. 

Questions in this section also refer to the implementation of retention stormwater practices. 

These are practices that do not discharge stormwater off-site or to surface water below a certain 

design capacity (design volume, stormwater size, etc.). The stormwater is infiltrated, 

evapotranspired, or harvested. Examples are bioretention cells (includes rain gardens, sidewalk 

planters, curb extensions and other plant or soil systems designed to infiltrate or evapotranspirate 

stormwater), porous pavement, green roofs, vegetated swales, cisterns and other practices. These 

practices are commonly referred to as Low Impact Development (LID) or Green Infrastructure 

(GI) practices. 

A-54 What process do you have for determining which stormwater controls are selected for use 

on your projects? (Check all that apply.) 

□ We have a stormwater control testing program. 

□ We consult with the permitting authority for an approved list of stormwater controls. 

□ The state has a testing program that we reference. 

□ We have a process that is part of our retrofit program. 

□ We do not have a formal process for approving particular stormwater controls for use 

on our projects. 

□ We have specific design standards that we created and follow. 

A-55 (a) Which of the following stormwater controls are installed within your MS4 (includes 

those controls located on both public and private property)? 

 (b) Which stormwater controls in the MS4 responsible for maintaining (at any level of 

service)? 

 (c) For which practices do you have available cost information, including both capital 

cost and operation and maintenance cost? 

 (d) For which stormwater controls do you have performance data? 

(Note: An EPA representative may contact you at a later date in order to get more 

detailed information about this cost and performance data.) 

 (a) (b) (c) (d) 

 Available Performance 

 Installed/ Maintain Cost Data 

 applied Information 

Extended Detention Basin (wet or dry) □ □ □ □

Curb and Gutter/Storm Sewer □ □ □ □

Catch Basins □ □ □ □ 

Transportation MS4 Questionnaire Page 33 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Catch Basin Insert □ □ □ □

Underground Detention □ □ □ □

Underground Infiltration □ □ □ □

Infiltration Trench □ □ □ □

Dry well □ □ □ □

Sand filters □ □ □ □

Oil/water separators □ □ □ □

Vegetated Swale □ □ □ □ 

Constructed Wetland □ □ □ □

Filter Strip/Vegetated Buffer □ □ □ □

Wetland Basin/Channel □ □ □ □

Bioretention cells □ □ □ □

(includes raingardens, sidewalk 

planters, curb extensions and other 

plant or soil systems designed to 

infiltrate or evapotranspirate stormwater) 

Trees/Tree Box □ □ □ □

Media Filters □ □ □ □

Green Roof/ Ecoroof □ □ □ □

Riparian Buffers □ □ □ □

Extended Filtration □ □ □ □

(underdrained raingarden) 

Soil Amendment □ □ □ □

Permeable concrete/Permeable 

Asphalt/ Pavers □ □ □ □

Cistern □ □ □ □

Rain Barrel □ □ □ □

Downspout disconnection □ □ □ □

Native vegetation/landscaping 

planting requirements □ □ □ □

Xeriscaping or water 

efficient planting designs □ □ □ □

Conservation/protection 

of green open space □ □ □ □

Reduced Lot/Parcel Size □ □ □ □

Open Graded Friction Course □ □ □ □

Other Controls: _________________ □ □ □ □

A-56 For any construction projects that you have initiated have you completed a cost 

comparison within the past 5 years between traditional stormwater practices (such as 

stormwater ponds) and stormwater retention practices (as described at the beginning of 

this section)? 

  Yes 

  No 

Transportation MS4 Questionnaire Page 34 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

If so, is the cost data available? 

  Yes 

  No 

A-57 What is the driver for implementation of the stormwater retention practices (as described 

at the beginning of this section) in your MS4 service area? (Check all that apply.) 

□ Stormwater management requirement 

□ Flood Control 

□ TMDL or other water quality requirement 

□ Other: _______________ 

□ Unknown 

□ Not Applicable 

A-58 In your MS4 service area, which of the following ordinances or other types of regulations 

may prevent stormwater retention practices (as described at the beginning of this section) 

from being implemented? 

 Check all that apply. This question should be answered regardless of the level of 

government that imposes the requirement. 

 

 Specific Water Requirements

□ Standing water restrictions which may prevent the use of rain barrels, extended 

detention, or other practices. 

□ Water rights issues 

□ Restrictions related to groundwater contamination potential 

□ Restrictions related to sole source aquifer limitations 

□ Restrictions on tree/wetland protection requirements 

Site design/infrastructure practices

□ Curb and Gutter requirements which may restrict roadside infiltrations practices 

□ Maximum/Minimum parking lot size requirements 

□ Maximum/Minimum roadway widths 

□ Requirements setting minimum/maximum cul-de-sac radius 

□ Restrictions on the width of rights of way 

□ Conflicts in obtaining private land (e.g., for use as a public right of way) 

 Building/Structure Requirements

□ Restrictions on setbacks/frontages (e.g. for metro stations or rest stop buildings) 

□ Restrictions related to plumbing codes (e.g., prohibitions on stormwater reuse for toilet 

flushing) 

Vegetation Requirements

□ Restriction on height of vegetation (e.g. wetland vegetation or grasses) 

□ Restriction related to tree placement (e.g., restricting the places where trees may be 

planted, such as near sidewalks, utility poles, along certain stretches of roads) 

□ Aesthetic requirements for plantings 

Transportation MS4 Questionnaire Page 35 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Other Requirements

□ Requirements that may restrict the use of pervious concrete, porous asphalt, modular 

block pavers, or other alternatives to conventional/impermeable paving materials 

□ Restrictions on stormwater reuse for irrigation (e.g., health code restrictions) 

□ Other: _____________________________________________ 

 

A-59 Do you have any maintenance concerns that may prevent stormwater retention practices (as 

described at the beginning of this section) from being implemented in your MS4? 

□ Yes 

□ No 

Describe____________________________________________ 

A-60 In your MS4, are there categories or areas excluded from stormwater infiltration due to 

concerns for groundwater contamination? 

□ Yes 

□ No 

□ Not applicable, specify: ____________________________________________ 

A-61 Are there stormwater discharges from your MS4 to a state-defined source water 

 protection area for public water supplies? 

□ Yes 

□ No 

□ Not applicable, specify: ____________________________________________ 

A-62 Are any of the following implemented in your MS4 service area? Check all that apply. 

□ Requirements limiting the amount of land that can be disturbed at any given time (e.g. 

only 20 percent of the land can be disturbed for any project at any given time) 

□ Natural area protection 

□ Stream restoration/remediation program 

□ Buffer/riparian corridor requirements 

□ Incentives for green infrastructure/low impact development practices 

□ Restrictions on the amount of impervious surfaces (e.g., caps on the amount of 

impervious surfaces) 

□ Other, describe:_____________________ 

□ None 

□ Not Applicable 

A-63 Do you have a master plan or other planning process that projects development over a 

certain time period (may be done by other departments or agency in your jurisdiction)? 

□ Yes 

□ No (skip) 

A-64 In the past five years, has flooding occurred within your jurisdiction due to insufficient 

capacity of your MS4? 

□ Yes 

□ No (skip to A-67) 

□ Don’t know (skip to A-67) 

Transportation MS4 Questionnaire Page 36 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

A-65 Indicate the type of flooding that has occurred within your jurisdiction in the past five 

years due to insufficient capacity of your stormwater conveyance system. (Check all that 

apply.) 

□ Nuisance flooding, such as flooding of roads that did not cause damage to 

 infrastructure or public or private property 

□ Flooding that caused damage to infrastructure, such as roads or utilities 

□ Flooding that caused damage to private property, such as flooding of homes 

□ Flooding that caused damage to public property, such as flooding of rest stops or 

transportation buildings 

□ Other, Specify: ____________________ 

A-66 In general, how frequently do flooding events occur within your jurisdiction due to 

insufficient capacity of your stormwater conveyance system? 

□ Rarely, or less than once per year 

□ Occasionally, or once or twice every year 

□ Often, or five or more times per year 

 

A-67 Do you have a program or plan for future capital improvements to address lack of 

capacity in your stormwater conveyance system? 

□ Yes 

□ No 

□ Not applicable, Specify: ____________________________________________ 

MONITORING 

A-68 Have you performed any of the following types of monitoring? (Check all that apply.) 

□ Stormwater outfall monitoring 

□ Stormwater monitoring of specific stormwater controls 

□ In-stream monitoring for water quality parameters 

□ In-stream monitoring for biological parameters 

□ In-stream monitoring for geomorphology or physical habitat 

A-69 Are you required to perform any type of monitoring of any outfalls as part of your 

 stormwater MS4 permit? 

 Yes 

  No 

A-70 What is the total number of outfalls (pipes greater than 12 inch diameter) in your MS4 

that is subject to either a Phase I or Phase II MS4 stormwater permit? 

 _______ # of outfalls 

□ Unknown 

□ Not Applicable 

A-71 How many outfalls did you monitor in the last 5 years? 

Transportation MS4 Questionnaire Page 37 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Outfall Monitoring, FY 2005-2009

Fiscal year

2005 2006 2007 2008 2009 

Number of 

outfalls 

monitored 

A-72 Do you conduct monitoring of outfalls for pollutant levels (e.g., pH, metals, nutrients, 

suspended solids, etc.) or flow-related parameters (e.g., flow rate, volume, etc.)? 

□ Pollutant levels 

□ Flow-related parameters 

□ Both 

A-73 Do you have data indicating any chemical, biological, and/or physical changes in the 

receiving waters to which you discharge stormwater that you can attribute to your 

stormwater program (e.g., we saw a reduction in total nitrogen and an increase in 

sensitive stream microinvertebrates)? 

□ Yes, describe__________________________________________________ 

□ No 

□ Unknown 

□ Not Applicable 

A-74 Provide any additional comments for Section A in the space provided below. 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

Transportation MS4 Questionnaire Page 38 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Section B: Financial Information 

B-1 Indicate your jurisdiction’s total operating budget and stormwater related annual 

operating budget. 

 

Annual Budget ($) 

Fiscal Year 

2005 2006 2007 2008 2009 

Total 

Operating 

Budget 

Stormwater 

Related 

B-2 Select the month that begins your fiscal year? 

[Provide pull down menu with start of months?] 

B-3 For the five year period from 2005 to 2009, on average, what percent of the stormwater 

budget did you approximately spend on the following activities? (Total must equal 100%) 

___% Program administration ( e.g., clerical activities, financial management, 

NPDES compliance and reporting) 

___% Planning and engineering (e.g., surveying and document existing 

conditions, GIS development and operations, master planning) 

___% Capital improvements (e.g., capacity expansion, capital construction, 

 stream restoration, land acquisition, retrofits) 

___% Pollution prevention/good housekeeping for municipal operations (training 

for municipal staff on pollution prevention measures and techniques, regular 

street sweeping, reducing the use of pesticides or street salt, or frequent catchbasin cleaning) 

___% Other operations and maintenance (e.g., remedial maintenance, emergency 

response operations) 

___% Illicit discharge detection and elimination 

___% Other inspection and enforcement 

___% Incentives and rebates for privately initiated stormwater control measures 

___% Public education and outreach 

___% Public involvement and participation 

___% Construction site runoff control program for construction activities that 

disturb one or more acres 

___% Post-construction runoff control program for new and redeveloped areas 

___% Other 

Transportation MS4 Questionnaire Page 39 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

Funding Questions 

The following three questions request information on the sources of revenue for your stormwater 

related activities. This information is requested for three different categories – operations and 

maintenance, capital improvements, and capital debt financing. 

 

B-4 What percentage of your stormwater operations and maintenance funding comes from the 

following sources. (Total must equal 100%) 

□ Stormwater User Fee ___% 

□ Ad valorem taxes ____% 

□ Permitting and other fees___% 

□ Sales Taxes___% 

□ Special Tax districts___% 

□ New development impact fees___% 

□ Federal Highway Administration Transportation Enhancement Activity ____% 

□ State Transportation Improvement Program (STIP) _______% 

□ Transportation Improvement Program (TIP) _______% 

□ State General Fund 

□ Grants (EPA 319 Funds, etc.) 

□ Other ___% 

B-5 What percentage of your stormwater capital improvement funding comes from the 

following sources. (Total must equal 100%) 

□ Stormwater User Fee ___% 

□ Ad valorem taxes ____% 

□ Permitting and other fees___% 

□ Sales Taxes___% 

□ Special Tax districts___% 

□ New development impact fees___% 

□ Federal Highway Administration Transportation Enhancement Activity ____% 

□ State Transportation Improvement Program (STIP) _______% 

□ Transportation Improvement Program (TIP) _______% 

□ State General Fund 

□ Grants (EPA 319 Funds, etc.) 

□ Other ___% 

B-6 What percentage of your stormwater capital debt financing comes from the following 

sources. (Total must equal 100%) 

□ General obligation (tax) bonds ___% 

□ Stormwater revenue bonds ____% 

□ Sales tax bonds___% 

□ Combined stormwater/other bonds___% 

□ Benefit district bonds___% 

□ Other ___% 

The next two questions are about the funding of environmental mitigation projects. 

Transportation MS4 Questionnaire Page 40 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

B-7 Do you have an off-site mitigation program that requires developers or property owners 

to mitigate the impacts of changes to site hydrology? 

□ Yes 

□ No 

 

B-8 Do you allow for payment-in-lieu of mitigation? 

□ Yes 

□ No 

The next two questions address staffing requirements for your program. 

B-9 What is the average number of full time employees that your organization has devoted to 

stormwater related activities over the past five years? 

 _______________ # of full time employees 

B-10 What is the average number of part time employees that your organization has 

devoted to stormwater related activities over the past five years? 

________________# of part time employees 

Stormwater Fee Questions 

B-9 Does your jurisdiction have the authority to charge and/or increase stormwater 

 fees? 

□ Yes 

□ No 

The following five questions pertain to one time, development impact fees charged for property 

development. These fees are also known as system development charges. 

B-10 Do you charge a one-time development fee for new stormwater permit applications? 

□ Yes 

□ No (Skip to B-15) 

B-11 What is the basis for this one-time development fee for new, single-family residential

stormwater permit applications? 

□ Flat fee: $ 

□ $ ____ per $1000 of project value 

□ $ ____ per acre of gross area 

□ $ ____ per square foot of impervious area 

□ $ ____ per square foot of total floor area 

□ Other: ______________________ 

□ None 

Transportation MS4 Questionnaire Page 41 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

B-12 What is the basis for this one-time development fee for new, multi- family residential

stormwater permit applications? 

□ Flat fee: $ 

□ $ ____ per $1000 of project value 

□ $ ____ per acre of gross area 

□ $ ____ per square foot of impervious area 

□ $ ____ per square foot of total floor area 

□ Other: ______________________ 

□ None 

B-13 What is the basis for this one-time development fee for new, non-residential stormwater 

permit applications? 

□ Flat fee: $ 

□ $ ____ per $1000 of project value 

□ $ ____ per acre of gross area 

□ $ ____ per square foot of impervious area 

□ $ ____ per square foot of total floor area 

□ Other: ______________________ 

□ None 

B-14 Approximately what percent of your costs that are associated with new development are 

covered by these one-time development fees (e.g., construction of additional 

infrastructure to service a new development)? 

 ____ % 

 

The following five questions pertain to recurring stormwater fees charged to property owners. 

 

B-15 Do you charge recurring stormwater fees to property owners? 

□ Yes 

□ No (Skip to B-20) 

B-16 What is the basis for the recurring stormwater fees for single-family residential

properties? 

□ Flat fee: $ 

□ $ ____ per $1000 of property value 

□ $ ____ per acre of gross area 

□ $ _____per acre of gross area with runoff factor 

□ $ ____ per square foot of impervious area 

□ $ ____ per square foot of total floor area 

□ Other: ______________________ 

□ None 

B-17 What is the basis for the recurring stormwater fees for multi-family residential

properties? 

□ Flat fee: $ 

□ $ ____ per $1000 of property value 

Transportation MS4 Questionnaire Page 42 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

□ $ ____ per acre of gross area 

□ $ _____per acre of gross area with runoff factor 

□ $ ____ per square foot of impervious area 

□ $ ____ per square foot of total floor area 

□ Other: ______________________ 

□ None 

B-18 What is the basis for the recurring stormwater fees for non-residential properties? 

□ Flat fee: $ 

□ $ ____ per $1000 of property value 

□ $ ____ per acre of gross area 

□ $ _____per acre of gross area with runoff factor 

□ $ ____ per square foot of impervious area 

□ $ ____ per square foot of total floor area 

□ Other: ______________________ 

□ None 

B-19 Approximately what percent of the costs incurred by your organization associated with 

the operations and maintenance of long-term stormwater controls and services do these 

recurring fees cover? 

 ____ % 

 

Capital Improvement Project Questions 

 

B-20 Did your jurisdiction initiate capacity expansion projects to address inadequate 

stormwater system capacity anytime in the period of FY 2005 through FY 2009? 

□ Yes 

□ No (skip to B-22) 

B-21 What was the annual budget and percentage of your total stormwater system 

addressed by the capacity expansion? If not applicable, write NA. If unknown write UK. 

Capacity Expansion Activity and Budget, FY 2005-2009 

Fiscal Year 

2005 2006 2007 2008 2009 

Dollars

% of service 

area 

B-22 Did your jurisdiction initiate retrofit projects anytime in the period of FY 2005 through 

FY 2009? (Check the answer that best applies.) 

□ Yes 

□ Yes, only on public property 

□ No (skip to B-24) 

Transportation MS4 Questionnaire Page 43 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires XX/XX/XX

B-23 What was the annual retrofit budget and number of projects completed? If not 

applicable, write NA. If unknown write UK. 

Retrofit Projects and Budget, FY 2005-2009 

Fiscal Year 

2005 2006 2007 2008 2009 

Dollars

Number of 

projects 

B-24 Did your jurisdiction initiate projects for stream restoration associated with correcting or 

mitigating impairment from urban runoff anytime in the period of FY 2005 through FY 

2009? 

□ Yes 

□ No (skip to B-28) 

B-25 What was the annual budget and miles of stream restored that was associated with urban 

runoff? If not applicable, write NA. If unknown write UK. 

Stream Restoration and Budget, FY 2005-2009 

Fiscal Year 

2005 2006 2007 2008 2009 

Dollars

Stream 

Miles 

B-26 What was the purpose or goal of stream restoration? (Check all the answers that apply.) 

□ Erosion control to reduce sedimentation of downstream reservoir 

□ Stream bank stabilization to reduce scouring of infrastructure 

□ Stream bank stabilization to reduce property loss due to erosion 

□ Flood control 

□ Habitat protection, fisheries concerns 

□ Aesthetics 

□ Other: ______________________ 

 

B-27 Indicate the type of stabilization measures that were done? 

□ Vegetative stabilization 

□ Non-vegetative stabilization such as concreting, installing riprap, etc 

□ Combination of vegetative and non-vegetative measures 

Transportation MS4 Questionnaire Page 44 of 45 
Survey ID: ________________ OMB Control No. 20XX-XXXX 

 Approval expires /XX/XX

Transportation MS4 Questionnaire Page 45 of 45 

XX

B-28 Provide any additional comments for Section B in the space provided below. 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

 _______________________________________________________________ 

Section C: Contact Information 

C-1 Provide the contact information for the person who would be able to answer questions 

regarding this information that was requested in this questionnaire. 

 Name 

 _____________________________________________ 

 Title 

 _____________________________________________ 

 Phone/Fax Number 

 _____________________________________________ 

 Email 

 _____________________________________________ 

 Best Time to Contact 

 _____________________________________________ 

You have completed the questionnaire. Refer to the instructions for mailing the questionnaire 

back to the United States Environmental Protection Agency. Thank you.