440036_Inspection_20231205 (2)

Date of Visit: Arrival Time: , cD ,Departure Time:
County: Region: ' �%
Farm Name:—^'-(-�-fl kf btl( R-" rj]jr IpI y, � 'O er t�� �.
Owner Name: V� J �..//Q�(r,,,t.V1 K3 _-POh�one: 32A� s�/�_/
Mailing Address: Lge?5� 1/ro4<- �� v CIC tiL-
Physical Address:
G
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Certification Number:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes tVNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ 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 D WR) ❑ 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 D WR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
PgZo
❑ NA
❑ NE
Page 1 of 511212020 Continued

Facility Number: - Date of —inspection: f)--A72,,szy
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
tru� Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?: 7 s�
Designed Freeboard (in):
e-r
Observed Freeboard (in): c�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
9�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Arethere structures on-sitewhich are notproperly addressed and/ormanaged through a
❑Yes
[Ne
❑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
tANo
❑ 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
JA—No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA
maintenance or improvement? 14
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc77777.))'"''''"
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside ofAcceptable
eCCrop Window ❑ Evidence of Wind Drift ❑ Application O/utsidee ofApprovedArea
p
12. Crop TYpe(s): L.�" /.%/nJ � /�FC. ZGLiZ / IrY' / /ts/'/ 10 1)4 V-t, -
❑ NE
❑ NE
13.SoilType(s):
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes VI No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �91 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 15e,,((No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VfNo ❑ 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
❑ Yea 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 ViNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes (OLNo
❑ NA
❑ NE
Page 2 of
21412019 Continued

Facility Number: Zf IDatoof Inspection:
Tom'
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yea
A No
❑ NA ❑ NE
25. Is the facility out of compliance with per conditions related to sludge? If yes, check ❑ Yes
EgNo
❑ 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 structures) and date of first survey indicating noncompliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes
l7`1 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
ONO
❑ NA ❑ NE
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?
Ifyes, 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)
3 L 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 ofthe 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?
❑ Yes F�f No ❑ NA ❑ NE
❑ Yes? No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 0No ❑ NA ❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
[g No
❑ NA
❑ NE
❑ Yes
giNo
❑ NA
❑ NE
1a uapnems p'eref m queYnan nJ: GXprmn any xrsa answers analor any opmponal recommeaaatlons or any other comments.
Use drawings of facility to better explain situations fuse additional pages as necessatvl.
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ReviewerQnspectar Nzme: - ec( q==yti Phone:
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Reviewer/Inspector Signature: J >� Date: I? �l 2EE?=Ej
Page 3 of 3 511212020