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Type of Visit: @Compliance Inspection • 0 Operation Review 0 Structure Evaluation 0 Technical Assistance •
Reason for Visit: eloctine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ` 0 Arrival Time: iti,t5V Departure Time: ).L)30 County Region: FRI)
Farm Name: V,PYl 07 Pr:3 V rat!'"--' Owner Email:
Owner Name: 1 Gb-1yt�5 Phone:
Mailing Address: K •
Physical Address:
Facility Contact: &j e/—/ Title: ij( -‘3,1e' Phone:
Onsite Representative: ifl7 7- Integrator:A f, - / //-
Certified Operator: , ..e_L---.: Certification Number: /9ei,
Back-up Operator: Certification Number:
Location of Farm: - Latitude: Longitude:
•
4 ,, Designer Current , ,,,'Design Current , Design Current
;,, Sne Capacity , Pop Wet Poultry Capacity ,Pop Castle fir. Capacity Pop
.. to ,
Wean to Finish Layer Dairy Cow ..
• Wean to Feeder Non Layer Dairy Calf
.�Feeder to Finish '& 7 2 31,,�-_ _ Dairy Heifer
Farrow to Wean l�Design Curi ent Dry Cow ,a.
Farrow to Feeder A PPoult :C,a`i aci P.o Non-Dairy
• Farrow to Finish -',MI 1222MME - Beef Stocker
,, Gilts Non-La ers Beef Feeder -
• Boars _�� Pullets Beef Brood Cow
,� Other
r
a o wu m Turke Points . t - sue 3 a °fw €Other Other Discharges and Stream Impacts
1.Is any discharge observed from any part of the operation? ❑ Yes <o ❑ 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 ❑ NA ❑ NE
2.Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑No ❑ NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑N ❑ NA ❑ NE
of the State other than from a discharge?
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Facility Number: 9 -- Date 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? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in): /9-
Observed Freeboard(in): 3to
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ergo ❑ 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 IZI 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 IZ N ❑ 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.)
❑ PAN ❑ PAN> 10%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidencej of Wind Drift El Application 0 ide of Approved Area
12.Crop Type(s): / � /® i�d
13. Soil Type(s): pit
14.Do the receiving crops differ from those designated in the CAWMP? 0 Yes No ❑ NA ❑ NE
15.Does the receiving crop and/or land application site need improvement? s ❑ No ❑ NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes la o ❑ NA ❑ NE
acres determination? I
17.Does the facility lack adequate acreage for land application? ❑ Yes ❑ NA ❑ NE
18.Is there a lack of properly operating waste application equipment? a<s ❑ No ❑ NA ❑ NE
Required Records&Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes No ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes To ❑ NA ❑ NE
the appropriate box.
❑WUP ['Checklists ❑Design ❑Maps ❑Lease Agreements El Other:
21.Does record keeping need improvement?If yes,check the appropriate box below. ❑ Yes la o ❑ NA ❑ NE
❑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 �l0 0 NA ❑ NE
23.If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Er5o ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued
Facility Number: B9„--- /D— . Date of Inspection . 9 -5- .
24.Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes To ❑ NA ❑ NE
25.Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes E J lac ❑ 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 El< ❑ NA ❑ NE
27.Did the facility fail to secure-a phosphorus loss assessments(PLAT)certification? ❑ Yes ❑ago ❑ 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 . 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 0 Yes [�1 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 To ❑ NA ❑ NE
LI Application Field ❑ Lagoon/Storage Pond.. ❑ Other: _
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [KNo= ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes 0 N ❑ NA ❑ NE
.34.Does the facility require a follow-up visit by the same agency? ❑ Yes ENo ❑ NA ❑ NE
Comments(refer to question#).Explain any',YES answers and/or any additional recommendations or:anyother comments I_
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Reviewer/Inspector Name: -U-C— Phone: 97�,ja3----,e9
Reviewer/Inspector Signature: e< Date: 9 - 37- 7-4
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