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pe of Visit: ®Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
ason for Visit: 0/Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
to of Visit: r0`y� Arrival Time: ra r3 0 t1 Departure Time:I
6` (2-"•fq p I County: S0 Regionf4Y
rm Name: �crv\ -8'3 ( Owner Email:
vner Name: ° t lkl( / C)Vt,, ',- '"—C Phone:
ailing Address:
ysical Address:
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cility Contact: i�VL 4-e"`r �(`o Of i c
5 Title: Phone: iI
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Integrator: --14 3-- ()A r ' �•. i
'site Representative: I
;rtified Operator: N6 " -- , k (U7 Certification Number: I8ce6 [
tck-up Operator: Certification Number:
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)cation of Farm: Latitude: Longitude:
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Discharges and Stream Impacts
.Is any discharge observed from any part of the operation? ❑ Yes al-1< ❑ NA ❑ NE
•
Discharge originated at: ❑ Structure El 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 0"g1A ❑ 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 Erg.--"A n NE
Z.Is there evidence of a past discharge from any part of the operation? ❑ Yes 1:1 No ❑ NA ❑ NE
3.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?
Page 1 of 3 2/4/2015 Continued
(Facility Number: Z - 6tri Date of Inspection: rk--t51/46
Waste Collection&Treatment
4.Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes ❑ NA ❑NE
a.If yes, is waste level into the structural freeboard? ❑ Yes ❑ No la n-X ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): `D 2-
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [y N ❑ 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 ITI' 10 ❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0'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 to ❑ NA ❑ NE
maintenance or improvement?
Waste Application 10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes 114'e ❑ NA ❑ NE
maintenance or improvement?
11.Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes to ❑ 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): ' °w G
13.Soil Type(s):
14.Do the receiving crops differ from those designated in the CAWMP? ❑'Yes IQ-No ❑ NA ❑ NE
15.Does the receiving crop and/or land application site need improvement? 0 Yes [ 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 E 'Slo ❑ 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&Permifreadily available? ❑ Yes ❑'1<to ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yeso ❑ 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 f 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 Me No ❑ NA ❑ NE
23.If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued
Facility Number: 'e2, - (-k(7 Date of Inspection:
g tz- 'r2v 42-41)
24.Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25.Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes IIMINo ❑ NA ❑ NE
the appropriate box(es)below.
El 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 [fNo ❑ NA ❑ NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes [LPIo ❑ NA ❑ NE
Other Issues
28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 04o (l 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 [N ❑ 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 0 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 InNo ❑ NA ❑ NE
0 Application Field 0 Lagoon/Storage Pond ❑ Other:
32.Were any'additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 3 Vo ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes Q No ❑ NA ❑ NE
34.Does the facility require a follow-up visit by the same agency?. ❑ Yes o ❑ NA ❑ NE
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Reviewer/Inspector Name: at�I �w Phone9(0'v133`333
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Reviewer/Inspector Signature: cQ ,LlR Date:A 4(1 O
TT 2/4/2V11 S
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