820698_Structure Evaluation Inspection_20180925

Structure Evaluation Inspection
Facility Number: -- Date: --/
Qf �r
Time in: 3 Time out: 3`. vcf)
Farm Name: / ! w G , Farm 911 address:
Owner Name: Phone
Facility Contact:
Onsite Representative: Integrator:
Certified Operator: Cert. Number
Is storage capacity less than adequate? Yes No
If yes is waste level into the structural freeboard? Yes No
Was non-compliant level reported to DWR POA received
Structure: 1 2 3 4 5 6
Identifier:
Spillway?
Designed Freeboard (in.):
Observed Freeboard (in.): "I
Are there any immediate threats to the integrity of any of t le structures
observed? Yes No
Do any structures lack adequate markers as required by the permit? Yes _ No_
Does any part of the waste.management system need repair Yes No
Condition of field's is
Condition of receiving crop
Comments: :671ri tie,1 Ui(A144
we/6 %7.