820132_Routine Inspection_20230718

6 //W,5 .7 /r 0, / -�-_3
r ype of visit: U t-ompiiance inspection V operation tceview U Ntructure revaluation U l ecnnical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
—
Farm Name: �(� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: (�fTitle:
Onsite Representative:
Certified Operator: I Z
Back-up Operator:
Location of Farm:
Latitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
❑ Yes _,[E'No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑NA ❑NE
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 Q-No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes -4EI No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: Date of Inspection:f ,:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes �No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: l
Spillway?:
Designed Freeboard (in): `
Observed Freeboard (in):�p
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes-,E]"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 _Q'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 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes . ]-Wo
❑ 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 ,❑"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes _Q No
0 NA
0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes__LD-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 Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
a
d'
13. Soil Type(s): a
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,�_=FNo ❑ NA ❑ 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 ,_LQ-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes,-Q No
❑ 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 ❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ❑ No
❑ 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 ❑ No ❑ 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 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ No DNA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes PNo
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 to provide documentation of an actively certified operator in charge? ❑ Yes_e No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes f No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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?
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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
/ n'
v
5-113
/g 9
Reviewer/Inspector Name: e_
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes -ETNo ❑ NA ❑ NE
❑ Yes -L_j No ❑ NA ❑ NE
❑ Yes EfrNo ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
❑ Yes ,,EfrNo ❑ NA ❑ NE
❑ Yes 'EJ-No ❑ NA ❑ NE
❑ Yes 4D'T to ❑ NA ❑ NE
Phone: Gjl� 6,357'i.7�
Date: L ,�3
511212020