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Type of Visit: ISACompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 4L Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:I o14Ic I�� Arrival Time:I 1k`{Oc. '_t5j p I Departure Time:I County: pT! Region:
Farm Name: �pk?t�l 0 d 1'tV f Owner Email:
Owner Name: ()vv.,1 i p FaucQt Phone:
Mailing Address: 11 eJYGI_ e
541 1 F-Ga •, eiro-vvfl cjurri,+ IfC 71a1
Physical Address: csq 9 ii v e)(Criak, Or. 1 12o1n ceA1 d ) NC, '-13 I b
Facility Contact: Phi Ll ( i e J(J -I---,Q.., Title: Phone:
Onsite Representative: �p/ j� Integrator:
Certified Operator: ►l t n rc(U(',(,-f'f v_, Certification Number:
Back-up Operator: 1 ✓1 In Ci# ('. 4c 5 -i- [1st C) Certification Number:
Location of Farm: Latitude: Longitude:
ilw� 44 from sn ro ) Z V YS1 d.Q • ) -1V` OiA
0000ut a t\,v►1e 5-
t
.' 2 _ 3 ..op. 'E Wets: ..�_ .. ;+37" - s as _ fi R�
q Wean to Finish Layer ,? Dai Cow -- i
Wean to Feeder Non Laker •Dai Calf
Feeder to Finish flhj C�� ' . •Dai Heifer
Farrow to Wean �:•D Cow
Farrow to Feeder s Non-Dai ��
Farrow to Finish . II Beef Stocker ��
Gilts ` ,•Non-La ers =•Beef Feeder
Boars Pullets -- Beef Brood Cow --
;; Turke Pouets -- ,. At,
1Other I ' •O the:
�
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes Xj No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes ❑ 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 EtNA ElNE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No El NA El NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
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(Facility Number:�{j - () (Date of Inspection: ' DI IflICI
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes XNo ❑ 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: 0 ►- (,aWl?A--
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): '.fl .9a41
5.Are there any immediate threats to the integrity of any of the structures observed? 0 Yes 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 m( No ❑ NA ❑ NE
waste management or closure plan? 7�
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 VI No ❑ 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 IA No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN 0 PAN> 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 10 Evidence of Wind Drift ❑ Application Outside of Approved Area
12.Crop Type(s): COOY n 9►u�4 , W &tcA r oyttin -5ut, hal
13. Soil Type(s): lJ
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 'j No El NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 1No ❑ NA ❑ NE
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 ❑ NE
Required Records& Documents
19. Did the facility fail to have the Certificate of Coverage& Permit readily available? ❑ Yes NI No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes,check El Yes /4 No ❑ NA 0 NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes,check the appropriate box below. .20 Yes❑ Yes w No ❑ NA ❑ NE
Waste Application Weekly Freeboard %Waste Analysis Nj Soil Analysis n Wnct T"^"t_. Weather Code
lAtainfall NStockingtgi Crop Yield 11120 Minute Inspections 14 Monthly and 1" Rainfall Inspections %Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes rig No ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No XNA ❑ NE
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!Facility Number: ''� - !Date of Inspection: 1 b I i 6'(q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes LNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes tylNo ❑ 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 IA 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 154 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 120 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 KI 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 KI No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ryal No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes VI No ❑ NA ❑ NE
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Reviewer/Inspector Name: a tutt Phone: 6-11
Reviewer/Inspector Signa Date: A l 6
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