410021_Compliance Evaluation Inspection_20201214

Facility Number: 1-1 A JDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes ❑ No XNA ❑ 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 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 No ❑ 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
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
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
❑ No
NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ 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:
Reviewer/Inspector Signatw
Page 3 of 3
21 ZIP j31 k.0 I (clt6
y 0.O3 1.h
Phone: 3j(o�- OLD
Date: _0
2/4/201

FaciliNumber: L - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �6 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes V , No ❑ 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 No ❑ 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 environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) yl
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
��T���T`"�"'
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 i ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
I l�
12. Crop Type(s): i Y nl .4)01 Lt l l C1 V it 1 u l.W V M tA A_ U<� (A A
13. Soil Type(s): j
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes XNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes JZ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes OTNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes 4 No
❑ Yes No
❑ Yes ` No
❑ Yes No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [;�,No NA NE
Waste Application Weekly Freeboard] Waste Analysis Soil Analysis �r Weather Code
Rainfall Stocking oCrop Yield �120 Minute Inspections Monthly and 1" Rainfall Inspections —� Sludge-Sutvey-
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes )6 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ���❑ No D4 NA ❑ NE
Page 2 of 3 21412015 Continued
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE

type of visit: C mpliance Inspection V Operation Review V structure Evaluation V i ecumcal Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
r
Date of Visit: Arrival Time: Departure Time: 0 County: ` (a Region: WS M
Farm Name: Owner Email:
Owner Name: I - rYy Phone: �_�� p q 4 - -M .�
Physical Address:
Facility Contact: A j� m �� 1 P I l Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone: 50 - 5 l (o - 04 ✓E
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: 3 (DG O 1 1 5q A Longitude: j g a 3 Z i L{ 0,
DN, Erie de Mtnks � i h V c V8
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes K No ❑ NA ❑ NE
[—]Yes ❑ No
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued