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pe of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance 1
ason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
��+� �' ��i /S Departure Time:[s , Y;i County: sg�1L?SQ� Region:' _
to of Visit: Arrival Time: °y
rm Name: Fg,r'Vvt 2-7 O Z. Owner Email:
vner Name: Kalil(
/la itl 3 A 11 (' Phone: 1
ailing Address: 1
1
iysical Address: i
[ditty Contact: ''1fL,L NDv0(s Title: Phone: 3
it Integrator: MI ` ;
mite Representative:
3rtified Operator: Z.-05t 24rou+ - Certification Number: �Go / 28t
Lek-up Operator: 1 Certification Number:
3
)cation of Farm: Latitude: Longitude: 1
1
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)ischarges and Stream Impacts
..Is any discharge observed from any part of the operation? ❑ Yes [e _N 5 D NA ❑ NE
•
Discharge originated at: El Structure El Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No In NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) 0 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 INo ❑ NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 7�No ❑ NA ❑ NE
of the State other than from a discharge?
Pane 1 of 3 2/4/2015 Continued
Facility Number: 2 - 3 I r Date of Inspection: 5-- (2. Zio219
Waste Collection&Treatment •
4.Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes EFNrr[J NA ❑NE
a.If yes,is waste level into the structural freeboard? ❑ Yes ❑ No []-N7 1 ] NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): Li (p
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ 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 t 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 [t ] o ❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes [o ❑ 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 10 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or-compliance alternatives that need ❑ Yes Er\o ❑ 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 QWindow ❑ Evidence of Wind Drift El Application Outside of Approved Area
12.Crop Type(s): C(' ri ,j- e s 0 V4( c
13.Soil Type(s): Grp
14.Do the receiving crops differ from those designated in the CAWMP? ❑ Yes []'No ❑ NA n NE
15.Does the receiving crop and/or land application site need improvement? ❑ Yes [s-No ❑ NA ❑NE
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 [o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? s ❑ Yes No ❑ NA ❑ NE
Required Records &Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes [N ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ['Other:
21.Does record keeping need improvement?If yes,check the appropriate box below. ❑ Yes TKO- ❑ 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 No ❑ NA ❑ NE
23.If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 13 No ❑ NA ❑NE
Page 2 of 3 2/4/2015 Continued -
Facility Number: t9 2' 3t C Date of Inspection: e (L Za2.0
24.Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 111-K; ❑ NA ❑ NE
25.Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes ®'ICrO- ❑ NA ❑ NE
the appropriate box(es)below.
D 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 ❑ NA ❑ NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes [ .Ido❑ NA ❑ NE
Other Issues ❑ NA ❑
28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No 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 LJ 1V o ❑ 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 ±rS o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ NA ❑ NE
3P
3.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes 110 No ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes [No- ❑ NA ❑ NE
Comments(refer to question#) Explam'any YES answers and/or any`additional recommendatrons or any other comments
><Jse draQvmgs of facility_tobefter,_expIam�situahous(use;a�dihonal pages asecessary) , � `` �- �,.r .-�..
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30 G` (o
e (A.-ctco 3 0� 6 g 5 7
Reviewer/Inspector Name: ('\' ()LA[a - Phone jO-La 3`V 33
Reviewer/Inspector Signature: < (A 0 to Date: 12,
2/4/2 5
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