490008_Complaint Investigation_20210113

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine ®omplaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
( Arrival Time:
I' U c /- r'-K-P-u
if '3 d
Departure Time:
Mailing Address:
Physical Address:
Facility Contact:
Or) &x,
S4S
Owner Email:
Phone:
County:
Region:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Integrator:
Phone:
Certification Number:
Certification Number:
Longitude:
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 ❑ No ❑ NA ❑ NE
�(,,.siP -C. c 11—‘',41 a71- bt,tidd,E
[Yes ❑ No
[Yes ❑ No
etnti
IY Ies
Yes
D No
No
Yes ❑ No
El NA ❑NE
El NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
El NA ❑NE
Page 1 of 3
2/4/2015 Continued

Facility Number: 9-q
Date of Inspection: /e-/9-2oZ-/
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No ❑ NA CNE
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes
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
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 El7Y es
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ yes
34. Does the facility require a follow-up visit by the same agency? [Yes
n No ❑ NA [NE
❑ No ❑ NA NE
❑ No ❑ NA NE
❑ No ❑ NA ®°NE
❑ No ❑ NA ❑ NE
® No ❑ NA U 1V
❑ NA
® NA
❑ NA
NE
® NE
NE
DLR-s iobi
Cop ,P (
Cw e
(/vo $ vi i- Wcr
(� f ed / 's
1kV
cJ
sC p l
1
3 cam}- / S- `� , S p I `/ a,- / 5 ,' l 0
5 }'A(< ©Ie /� �2° UlidVter-
tA,W. �� C©4 _ ? 3 - /
Reviewer/Inspector Name: d p li / 717
Reviewer/Inspector Signature:
Page 3 of 3
G
+
re
aV
/
and 114ey
426 - rt4,41A
drr
t:; } 11-J-. 5 I/ sip le c 2 l S 'C6 2-i
SeAm-fi/e j4j7 /s.2>,
b &r>tej ciraittl
he; on s<1-9 I- / : Lz.
Phone: , - 75 _0(73
/-(3 2-0zt
Date:
2/4/2015