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pe of Visit: Geeompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
ason for Visit: Cfrx``outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
VDeparture County: S(�MPS011 Region: �-
to of Visit:��12(?K'� � Arrival Time:l g,0 � Time:amen
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rm Name: rail'yak ZO Z-6 Owner Email:
vner Name: Wt i t yA '3 r h 1 LLG
Phone:
ailing Address:
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ysical Address: rr (�r
cility Contact: I i i(,'\&'e.t I�Cb rr i 5 Title: Phone:,
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'site Representative: Integrator: wi j .. S K.l`c'l ,
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;rtified Operator: A q,j. .,Z.Ct.i" P 4 rn•e t v Certification Number: !D zb Si
ick-up Operator: Certification Number:
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cation of Farm: Latitude: Longitude:
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III Wean to Finish La er
■Dal Cow e '+•Wean to Feeder ill Non La er _Ill Dai Calf
El Feeder to Finish '4 Dai Heifer11 ,
Farrow to Wean 4 � .. ' ' e. e� D Cow ,
s -, „` Non-Dai J
.FarrowtoFeeder +'t -> ' --x � rY
Farrow to Finish .La ers <�Beef Stocker
L. •Non-La ers , _I.Beef Feeder
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■ U Pullets ...I.Beef Brood Cow
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)ischarges and Stream Impacts
.I$any discharge observed from any part of the operation? ❑ Yes [(,NZ ❑ NA ❑ NE
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Discharge originated at: ❑ Structure El Application Field El Other:
a. Was the conveyance man-made? ❑ Yes ❑ No , IR@A ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes ❑ No [ I 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 ❑ NorNA ❑ NE
2.Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑-Go ❑ NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Q'i‘ ❑ NA ❑ NE
of the State other than from a discharge?
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Facility Number: Fj 2 - I. Date of Inspection: g,'—(Z. Zo tO
Waste Collection&Treatment
4.Is storage capacity(structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a.If yes,is waste level into the structural freeboard? ❑ Yes ❑ No [ f]%PdA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): el
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [1'51-o ❑ 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 EK ❑ 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 11.-No ❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes [4o ❑ 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 ❑'Flo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes arr\lo ❑ NA ❑ NE
maintenance or improvement?
11.Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes ❑ 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
❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12.Crop Type(s): C g HeJ'P s6.0 c4)6
13.Soil Type(s): fb
14.Do the receiving crops differ from those designated in the CAWMP? ❑ Yes El-No ❑ NA n 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 [}< 0 NA ❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes Er< ❑ 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 It< ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes EiJ (o ❑ 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 [ !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 z❑Sludge Survey
22.Did the facility fail to install and maintain a rain gauge? - ❑ Yes ENo ❑ NA ❑ NE
23.If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Eo ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued
Facility Number: $ 2,-e/``L Date of Inspection: 0— f 2. '21)24.Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 4To ❑ NA ❑'NE
25.Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes 12ro ❑ 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'No ❑ NA ❑ NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes to ❑ NA ❑ NE
Other Issues
28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [26To ❑ 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 Quo ❑ 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 [a-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 [I No ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes t- o . ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes . L 7< 0 NA ❑ NE
Com nenls(refer to_questtom(#) Explarn any YES answers aud(o.r any adclta ill reconmiendations or any ether comments.
Use drawings of facility to_;better egpIarn�srtuahons,(use;addittonal a e5,as necessary}. n_;�_t ,. „� ,. _..__ ._ _:: ..._-:�_ �._.. .. -
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e4 °t 30% --(0c85 (Reviewer/Inspector Name: e t `` '`'''A 4 ap Phone:G 10' L l3 3°33 (
Reviewer/Inspector Signature: LJ 2 1-") Date: (a,.( / 0 2v
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