760050_Inspection_20180418

Division of Water Resources
Facility Number ®- O Division of Soil and Water C rvation
0 Other Agency,
Type of visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: $ 20 Arrival Time: @p20 Departure Time: County: PA O" Region: w 1zb
Farm Name: 11 I QXA5 b di f y Owner Email:
Owner Name: `rP_td rl tie \N) i 110-YA S Phone:
Mailing Address:
Physical Address:
Facility Contact: Ri c-1t- i a Q IY1`5 Title:
OnsiteRepresentative: '`I cv_ I Y o-wls
Certified Operator:
Back-up Operator:
Location of Farm:
us 'f ZS
0 rN i )
Phone: W tnn 2 Z — q137—
Integrator:
N !a h r5 b y
Certification Number: I Z �31.7—O 1$
© Certification Number:
Latitude: 3j�'O /'� I l Longitude: %9 ° 3 b'l I `i l,
ce turn f2 i t W i t l l a lnS R d. � -Form
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 Oj�No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes [-]No
❑ Yes eNo
[—]Yes tNo
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: 0 ` Date of Ins ection: 19 , 18
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
XNo
❑ NA
❑ NE
I a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
i5
Structure 5
Structure 6
��,w5 P ,�kS lOW-10�Q�dentifier:
beA0 Spillway?:
Designed Freeboard (in):
1 r ®l
Observed Freeboard (in): 0 g ®
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
y
bVI No
T
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
N
6. Are there structures on -site which are not properly addressed and/or managed through a
[—]Yes
[%
❑ 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 J)d'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [, xTo ❑ 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 I yl No ❑ NA ❑ NE
maintenance or improvement? •ram
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes [KNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes Dj�iQo ❑ NA ❑ NE
❑ Excessive Pending ❑ 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
9
12. Crop Type(s): '
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
(—]Yes [1 ivo
❑ 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
❑ Yes Wo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes [,d No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes j5 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes Cg(No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes V No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists El Design ❑Maps ❑ Lease Agreements El Other:
2 Does record keeping need i provement? a R9pF@f iateJYonthly
❑ Yes No ❑ A ❑ NE
Waste Applic ion Weekly Freebol aste Analysisil Analysis ers [Weather Code
[Rainfall Stocking Crop Yield 1120 Minute Inspections and 1" Rainfall Inspections n 9
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [N(No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No �P3A ❑ NE
Page 2 of 3 21412015 Continued

Falcifity Number: - t7 Date of Inspection:
24. Did the,facility fail to calibrate waste application equipment as required by the permit? WYes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No 5614A ❑ 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 rtNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EVNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Ef 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 El Yes I XI No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) 11 ''
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
14 Yes
❑ No
❑ NA
❑ NE
rVr
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�ZNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E31No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�Io
❑ NA
❑ NE
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Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
17
Phone: — 7 6
Date: g ��
21412015