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", , te e,3&two" ..{fit z t,,oz.., +_:. .wypy .. :: .s`. -,. - .� .�,L `.,; _ •m pe of Visit: erCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance ason for Visit: tontine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Accessfi rill, to of Visit:F It Arrival Time: ! • , Departure Time:I r l"v '1 County: S�"-i`S0�Region: 1 / Owner Email: rm Name: civil' �0�Je vner Name: A(kAtAi 6(rA,..1. `LL, Phone: 1 tiling Address: 1 i ysical Address: 11 A ; cility Contact: AI KY I• Iv 00f( S Title: Phone: (( r�® j isite Representative: Integrator: h 1 g3 Es rtified Operator: f o b Ael :e V Certification Number: ick-up Operator: Certification Number: q i )cation of Farm: Latitude: Longitude: i 1 • i 1 ,.t.`�.ri '+h.g'i`_xk'j t.:i# . .;a'' r'7.r'«R rr' u' Y' 's '". �'' i` a z--,.-4 g* _Y=3tt„,,, .5... ,.. rv3«' ,,g, Cufrair i s�Z €:� EII�E� ei! * � 3 .� h ' �s rq„as a� .. 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' -_.f__�.,....a )ischarges and Stream Impacts ❑ Yes o r, __/ ❑ NA ❑ NE .Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? ❑ Yes ❑No El 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) 0 Yes ❑ No NA ❑ NE 2.Is there evidence of a past discharge from any part of the operation? ❑ Yes aSlo 0 NA ❑ NE 3.Were there any observable adverse impacts or potential adverse impacts to the waters n Yes No ❑ NA ❑ NE of the State other than from a discharge? 2/4/2015 Continued t PdQe 1 of 3 - Facility Number: - (lc Date of Inspection: Z — o Waste Collection&Treatment • 4.Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes ErNo ❑ NA ❑ NE a.If yes,is waste level into the structural freeboard? ❑ Yes ❑ No [J NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard(in):Observed Freeboard(in): 3 e 5.Are there any immediate threats to the integrity of any of the structures observed? El Yes [ lo ❑ 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 0— ❑ NA ❑ NE waste management or closure plan? If any off 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 Erlo ❑ 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 [ 1Qo ❑ NA ❑ NE maintenance or improvement? Waste Application 10.Are there any required buffers,setbacks, or compliance alternatives that need ❑ Yes. Q'Flo ❑ NA ❑ NE • maintenance or improvement? 11.Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes Eel< ❑ 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 n Evidence of Wind Drift ❑ Application Outside of Approved Area 12,Crop Type(s): 6 C 8 LI s(TO 13.Soil Type(s): rkedr .190ru I/o (✓a. 14.Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [R'F10 ❑ NA El NE 15.Does the receiving crop and/or land application site need improvement? ❑ Yes L_I 1VO ❑ NA ❑ NE 16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ To ❑ NA ❑ NE acres determination? 17.Does the facility lack adequate acreage for land application? ❑ Yes �No El NA ❑ NE 18.Is there a lack of properly operating waste application equipment? El Yes ❑! NNo ❑ NA ❑ NE Required Records&Documents 19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes a59 ❑ NA ❑ NE 20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes LJ No ❑ NA ❑ NE the appropriate box. ❑WUP El Checklists ❑Design ❑Maps ❑ Lease Agreements El Other: 21.Does record keeping need improvement?If yes,check the appropriate box below. El Yes lErNo ❑ NA ❑ NE ['Waste Application El Weekly Freeboard El Waste Analysis ❑Soil Analysis ❑Waste Transfers El Weather Code ❑Rainfall ❑Stocking El Crop Yield El 120 Minute Inspections El Monthly and 1"Rainfall Inspections ❑Sludge Survey 22.Did the facility fail to install and maintain a rain gauge? ❑ Yes ] N ❑o NA ❑ NE 23.If selected,did the facilityfail to install and maintain rainbreakers on irrigation equipment? El Yes o] No ❑ NA ❑ NE Page 2 of 3 2/4/2015 Continued r Facility Number: g 2#- '1 t 'Date of Inspection: g-(2..-- ''0 zt.6) I 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 compliance with permit conditions related to sludge? If yes,check ❑ Yes To ❑ 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 [g'Ro ❑ NA ❑ NE 27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes ['Fro ❑ NA ❑ NE Other Issues 28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yeso ❑ 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 ❑ Yes gel f�O ❑ 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 Q 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 [�No ❑ NA ❑ NE 33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes .[�]N ❑ NA ❑ NE the facilityrequire a follow-upvisit by the same'agency? ❑ Yes 2No ❑ NA D NE 34.Does h q Comments(refer to^question#) Explam any YES answers and/or any,'.additional recommendations or any other comments Use drawings of facility to,better e, Iamfsitnatons.(use additional pagesas necessary} g(w �-1&& Ok, f a (i `r-c' Y v, ah L Col_ li me._ .A. 017 L3 .0* t 11c.". 'ern-t, 9` ..) erC, , c-dt 61(0 - 3®8--6 g s[ III Phone: 1d�' lv�rv`�� ` Reviewer/Inspector Name: kb i IA U Reviewer/Inspector Signature: 1� jfi ��IJ� P Date: lV1r Poop 7 nf 3 2/4/2015