450007_Inspection_20231213 (4)

4F Division of Water Resources
Facility Number O Division of Soil and Water Conservation
O Other Agency
O Routine O Complaint O Follow-on O Referral O Emereencv O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: R'� County: (t -'A) P-fXilegiom AI —Zs
Farm Name: �7nn/unn/2L( J`fr 01P j> d )A /sr_a OwnerEntail:
Owner Name: Phone: 6LIy' S
Mailing Address: —TsiS7 Rex-HsPB2 jRi-4 r�—_ //Pest � / �
Physical Address: /4(1 Cp I �' fy ifis' lC-4 . / i/ I L ax TI I un< 6 NG 2S7,52
Facility Contact: jffi /.,ta21 � Title: {�/�(v� DIO h-e-IL. Phone: d ?!-�
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
V' rtification Number:
Certification Number:
Latitude: Longitude:
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 DWI)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ❑ No ❑ NA [RNE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ 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 ❑ No ❑ NA &INE
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 I of 511212020 Continued

tut; - 3Y5'
Pacili Number: Dale of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C,No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structu 1 Structure 2 Structure 3 Structure 4
LcUsl 5�
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
``(pp,o
Observed Freeboard (in): 4/?r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(KNo
❑ 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
gNo
❑ 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
KNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
rgNo
❑ 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
Eg No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
FVf NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
UfNE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN> 10%or 101bs. ❑ 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):
13. Soil Type(s):
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
19NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
P_NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
VNE
acres determination?
17, Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
I�.YNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
0 NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
❑ No
❑ NA
�(
Sal HE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
9NE
Etc 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
KNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑Rainfall ❑Stocking ❑Crop Yield ❑ 120 Minute Inspections []Monthly and l" Rainfall Inspections
[]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑Yes
❑ No
❑ NA
NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
XNE
Page 2 of 3
21412015 Continued

✓UCF 3 -5eic
facilit Number:
IDate of Inspection: Z.
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No ❑ NA NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
❑ No ❑ NA VigE
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 noncompliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
❑ No ❑ NA V,NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No ❑ NA LANE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No ❑ NA ONE
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
❑ No ❑ NA
9�( NE
permit? (i.e., discharge, freeboard problems, over -application)
7�
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA [RNE
""7i��
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No ❑ NA aNE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No ❑ NA ['Q<1E
34. Does the facility require a follow-up visit by the same agency?
Yes
❑ No ❑ NA ❑ NE
answers and/or any additional recommendations or any
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Reviewer/Inspector Name: "—nA/� Phone: ZJZq.
Reviewer/Inspector Signature: .^— Date: %7 /y]t "`2-
Page 3 of 51122020