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pe of Visit: ®'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance.
ason for Visit: IligRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access to of Visit: �Arrival Time: f p r(u' Departure Time: '11 L-5 County: 5A-I'Ut('b iRegion: FA- '
rm Name: K i I C� iti(,t,� ./ `1 ev'r l l �ac v Owner Email:
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vner Name: .ifi1 k. �3 014:L.� Phone:
'fling Address:
ysical Address:
cili Contact:
ty 1/14 ke -ej tut,VV--f 5 -Title: Phone:
isite Representative: L( Integrator: i4i i3 — 5 t^1L' c r%t.CC/'
t •z (,� Certification Number: `ci 43 2
rtified Operator: J Giti� f �� 'l=�V C?to ti'1
ick-up Operator: Certification Number:
(cation of Farm: Latitude: Longitude:
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lischarges and Stream Impacts
.Is any discharge observed from any part of the operation? El Yes [}-N ❑NA ❑ NE
•
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ©--I�A ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes ❑ No M 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 n No [ NA ❑ NE
Is there evidence of a past discharge from any part of the operation? ❑ Yes allo ❑ NA. E NE
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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2/4/2015 Continued

Facility Number: 0 a-- `j Date of Inspection:_b3 4110 202�
Waste Collection&Treatment •
4.Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes er'❑ NA ❑ NE
a.If yes,is waste level into the structural freeboard? ❑ Yes ❑ No LJ NA. El NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (3 D Z3
Spillway?: 1,
Designed Freeboard(in):
Observed Freeboard(in): 2-Z,
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [g'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 [r 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? ❑ Yes [9fflo ❑ 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 Eg-90 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes ®moo ❑ NA ❑ NE
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.)
El 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): 12)
13.Soil Type(s): '1 U / (3 f �o� to
14.Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 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 [ le- ❑ NA '❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes to ❑ NA ❑ NE
18.Is there a lack of properly operating waste application equipment? ❑ Yes io El NA ❑ NE
Required Records&Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? 0 Yes ❑-1 ❑ NA , ❑,NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes ❑ Ni ❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists El Design El Maps El Lease Agreements ['Other:
21.Does record keeping need improvement?If yes,check the appropriate box below. ❑ Yes [.1 Ts— ❑ NA ❑ NE
El Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis ❑Waste Transfers ❑Weather Code
El Rainfall ❑Stocking El Crop Yield ❑120 Minute Inspections El Monthly and 1" Rainfall Inspections ❑Sludge Survey
22.Did the facility fail to install and maintain a rain gauge? ❑ Yes ES ❑ NA ❑ NE
23.If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? , ❑ YesEr‘ ❑ NA ❑ NE
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Facility Number: 4' Date of Inspection: 13 4 J& _'
24.Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes aici ,,❑ NA ❑ NE
25.Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes E ❑ 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 . No ❑ NA - D NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes alliT ❑ 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 To ❑ 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 [ to ❑ 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 ❑ i ❑ NA ❑ NE
El Application Field ❑ Lagoon/Storage Pond ❑ Other: /
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ [-�Yes 'NO ❑ NA El NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [ 1‹ ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? El Yes to ❑ NA ❑ NE
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Reviewer/Inspector Name: IS l �� -V���1, Phone: t 33-333(e
Reviewer/Inspector Signature: Lj 6ifriuizr Date: 13 At/V 20
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