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pe of Visit: CO Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
ason for Visit: titRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
to of Visit: ,! (0, Arrival Time: . J3/' 4,Departure Time:( 2k-W M County: 8 AN 1 Region:F
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E Owner Email: 1
rm Name: � SC ��.����
vner Name: 4.�t e ��1 �'0��', L-� Phone:
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ailing Address: I
iysical Address:
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tcility Contact: ,lit(-4 1)6"/ 1 f6Ott (J Title: Phone: 1.
'site Representative: Z( Integrator: -W. (3 — altiti) �`61je" 1
E�6(( �f Certification Number:
rtified Operator: '�
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ick-up Operator: Certification Number: 1
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cation of Farm: Latitude: Longitude: 1
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.Is any discharge observed from any part of the operation? Yes o NA NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: •
a. Was the conveyance man-made? ❑ Yes ❑ No [5NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes E No NA ❑ NE
c. What is the estimated volume that reached waters of the State(gallons)?
d. Does the discharge bypass the waste management system?(If yes,notify DWR) ❑ Yes ❑ No IA ❑ NE
2.Is there evidence of a past discharge from any part of the operation? ❑ Yes u `V V ❑ NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes arNo ❑ NA n NE
of the State other than from a discharge?
Fnoolnf3
2/4/2015 Continued
1

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Facility Number: gam- Ca.6 IDate of Inspection: 1 � 4
Waste Collection&Treatment •
4.Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes Q! 'o ❑ NA ❑ NE
a.If yes,is waste level into the structural freeboard? ❑ Yes ❑ No far f -U NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): 53
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ago ❑ NA ❑ NE
(i.e.,large trees,,severe erosion,seepage,etc.)
6.Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes [ 10 ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes,and the situation poses an immediate public health or environm ntal threat,notify DWR
7.Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes [aP4"o ❑ NA ❑ NE
(not applicable to roofed pits,dry stacks,and/or wet stacks)
9.Does any part of the waste management system other than the waste structures require ❑ Yes [ 11V O ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes Pri-3{10 ❑ NA ❑ NE
maintenance or improvement?
11.Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑ PAN> 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12.Crop Type(s): �i� -1—( .5 6-0
13.Soil Type(s): 46(,
14:Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ®No ❑ NA ❑ NE
15.Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable El Yes No ❑ NA ❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yeso ❑ NA ❑ NE
18.Is there a lack of properly operating waste application equipment? ❑ Yes I-1 O E❑ NA ❑ NE
Required Records&Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ['Other:
21.Does record keeping need improvement?If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and 1"Rainfall Inspections ❑Sludge Survey
22.Did the facility fail to install and maintain a rain gauge? ❑ Yes [l No ❑ NA ❑ NE
23.If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

261
Facility Number: C cs c Date of Inspection: / .4 jy6 P
24.Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o-ff' El NA ❑ NE
25.Is the facility out of compliance with permit conditions related to sludge?,If yes,check ❑ Yes ©'No ❑ NA ❑ NE
the appropriate box(es)below.
❑Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑Non-compliant sludge levels in any lagoon
List structure(s)and date of first survey indicating non-compliance: -
26.Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [i]'No ❑ NA ❑ NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes [✓]/No ❑ NA ❑ NE
Other Issues
28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Q o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes LJ No ❑ NA ❑ NE
If yes,contact a regional Air Quality representative immediately.
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30.Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [No ❑ NA ❑ NE
permit?(i.e.,discharge,freeboard problems,over-application)
31.Do subsurface tile drains exist at the facility?If yes,check the appropriate box below. ❑ Yes [o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ErNo ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes LJNo ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes �No ❑ NA ❑ NE
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Reviewer/Inspector Name: VO � ` v 4 V43 Phone: o'I 3 33 r
Reviewer/Inspector Signature: ' (/ CLR4/\h Date: C 20
Pate 3 of 3 2/4/2015