100005_Structural Inspection_20180801

W Division of Water Resources /
Facility Number O Division of Soil and Water Conservation
O Other Agency
for Visit: O Routine O Complaint O Follow-up O Referral
Other U Denied Access
Date of Visit: ( ( Arrival Time: 17 Departure Time: F7_,51_571 County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title:
Onsite Representative: (t \ n 1 t'14 & 1-1 e-L10- I
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Region:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts zI
1. Is any discharge observed from any rt of the operation?
Ej Yes
❑ No
❑ NA
❑ NE
Discharge originated at: Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
L] No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Q Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
nn
`� ® '
e5j i r—C4L'
15, PoD ,r fS
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
t No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ED"No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: 16 - Date of inspection: i
Waste Collection & Treatment
4. Ia storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? es ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
es ❑ No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envi
r
o
nmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ZYes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes f:j No ❑ 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 E!rNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ONE
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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ffN
15. Does the receiving crop and/or land application site need improvement? ❑Yes ❑ No ❑ NA LJ
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No [3 NA C]'NIE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA ENE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA gNE
the appropriate box.
❑WUP ❑Checklists []Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA DINE
❑ 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 ❑ No ❑ NA
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA gNE
Page 2 of 3 21412015 Continued

Facilit Number: I S I jDate of Inspection:
24. Did t)te'facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA [�,NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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?
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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
/ NE
❑ Yes
❑ No
❑ NA
E] NE
❑ Yes
No ❑ NA ❑ NE
❑ Yes
Io ❑ NA ❑ NE
E�I/yes
❑ No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
/ NE
❑ Yes
o ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
Uomments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
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Reviewer/Inspector Name: 0 /.,, r Z Ve) --e
Reviewer/Inspector Signature:
Page 3 of 3
Atone: R I() 71 7 3 o y
Date: IF I
21412015

Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of com Hance with permit conditions related to sludge? If yes, check ❑ Yes [:]No ❑ NA ❑ NE
the appropriate box(es) be w.
❑ Failure to complete annual s e survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any con
List structure(s) and date of first survey i ' ating non-compliance:
26. Did the facility fail provide documentation of an act ly certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments LAT) certificati
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 ho a or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an o or air quality concern?
If yes, contact a regional Air Quality representativwfmmediately.
30. Did the facility fail to notify the Regional O ce of emergency situations as required by the
permit? (i.e., discharge, freeboard prob;e1hs, over -application)
31. Do subsurface tile drains exist at e facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Yes [:]No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
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
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
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Reviewer/Inspector Name: tom' Qof �) hone: A4
Reviewer/Inspector Signature: 1 �" " 1 Date:
Page 3 of 3 21412015

ivision of Water Resources
Facility Number - S 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evalu 'on 0 Technical Assistance
Reason for Visit:: 0o Routine 0 Complaint 0 Follow-up 0 Referral mergency 0 Other 0 Denied Access
`
Date of Visit: E R4 //�l' Arrival Time: Departure Time: 22 County: Region:
Farm Name: �i"' Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: (y e ^ _ , o, y hG� L Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Phone:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Dry Poultry Canacitv Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any p of the operation?
Discharge originated at: any
❑ 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)?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
es ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
El-fes ❑ No ❑ NA ❑ NE
1j`,JOn0 96j 15
d. Does the discharge bypass the waste management system? (If yes, notify DWR) �es ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 0 No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 21412014 Continued

Facilit Number: JDate of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? es ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? Yes ❑ 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 envi mental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ 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 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?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA LJ 'sr
❑ 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)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
[ijM
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
[J'NG
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
[]-NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
D-NK
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
L_l ivy
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
�
E] ��
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑jNE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA
❑ 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 ❑ No ❑ NA
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [—]No ❑ NA &NE
Page 2 of 3 21412015 Continued

Facilit Number: - Date of Inspection: 1kr
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA [i NF
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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?
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
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
❑ No
❑ NA
❑'4ff—
❑ Yes
❑ No
EJ-IgA
❑ NE
❑ Yes
❑ No
G]IA
❑ NE
❑ Yes ErNNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
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
to
e drawings of facility to better
answers
❑No ❑NA 0IE
n
NA ❑ NE
NA ❑ NE
NA ❑ NE
or any
C',%zo��(!!o�_��
L y
bee e�Li�
A` d
10 (A7— dell 5L,wN-r✓' �l„(� �Rale,/� /^���^��
j-(oQ-(=1��-Il.�.�'s d,s<(�j/�• ��^^,ww�lcd,�e wi�l,0/rrR, vY p��
ct.,d-,//I <<j �1�e,,,,/wlAl
!l¢o
Reviewer/Inspector Name: `/G Lt CY "t l/ olu al'u%)
Reviewer/Inspector Signature: L-4 �U
Page 3 of 3
Phone: '7 0;7rD 7j 9X
Date: 3, Ar
21412015

C "Division of Water Resources /
Facility Number - O Division of Soil and Water Conservation
O Other Agency
Reason for Visit: O Routine O Complaint O Follow-up O Referral talmergency O Other O Denied Access
Date of Visit: 7 l Arrival Time: Departure Time: County: Region:
Farm Name: �—^ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Weal) to I
Wean to I
Feeder to
Farrow to
Farrow to
Farrow to
Other
Other
Phone:
Title:
C ov n � Ko j (' L&4 •® Integrator:
Latitude:
Phone:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
N
Non -La er
Design Current
Dry Poultry Capacity POD.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes LLJ 1VO ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Yes
❑ No
❑ NA
❑ NE
❑ Yes
Io
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facili Number: 10- jDate of Inspection: /
Waste Collection & Treatment
4. Is, storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ErYes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? es ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes F_] 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 ICJ 9E
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ 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 ❑ 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?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA �E�
❑ 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
12. Crop Type(s)
13. Soil Type(s):
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
❑ Yes
❑ No
❑ NA
E
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
[] E
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA �E
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA Q E
❑ 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
❑ No
❑ NA D NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA I3E�
Page 2 of 3
21412015 Continued

Facility Number: Date of Inspection:
24. Did th€ facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑.NL--
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No
❑ NA
❑-N'E"
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA 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
�
DINE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
QiqA-
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
.Ergo�❑
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?
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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 121 Io ❑ NA [D NE
❑ Yes ❑ No ❑ NA ,0'N>�
❑ Yes ❑ No ❑ NA,-E]1QE
❑ Yes []`No ❑ NA ❑ NE
❑ Yes ❑�N-o ❑ NA ❑ NE
❑ Yes Io "❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
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sub.wl� reLki��cr SaIS�^�U�,��S /PPo�
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OZO ?
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: O -116.130q
Date: 7 / U
21412015