820537_Routinr Indpection_20240123

Arrival Time: ; Departure Time: Q
Mailing Address:
Physical Address:
Facility Contact:
"I l
Onsite Representative: //
Certified Operator: LjAef'V ( 64�<
Back-up Operator:
Location of Farm:
Title:
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?
Phone:
Integrator:
Certification Number: 119145__�
Certification Number:
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)? _
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?
Longitude:
❑ Yes ,'No ❑ NA ❑ NE
❑ Yes Ej No
❑ Yes ❑ No
NA ❑ NE
❑ NA ❑ NE
Yes ❑ No NA ❑ NE
❑ Yes [:;�No NA NE
❑ Yes �,ENo ❑ NA NE
Page 1 of 3 511212020 Continued

Facility Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes .E;? 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:
Spillway?:
Designed Freeboard (in): <�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ,❑'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 -Efl'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 P "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 F__,r�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes -fn'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes _O-T�o
❑ 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 Wiinn(do'w� Ej Evidence of Wind Drift D Application
of Approved Area
12. Crop Type(s) ! ,/JGf//�i�/✓L`��" �G flGy t7h2 U�cvrr
�Outside
(i1�0�
�Q
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes .❑1Qo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ,allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ,L]/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes _E3'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 _EfrNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes Q-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 4D-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
❑ NA
❑ NE
Page 2 of 3
511212020 Continued

Facility Number: Date of Inspection: 2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ,[a'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes J d o ❑ NA ❑ NE
the appropriate boxes) 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 ETNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ,� o ❑ NA [j NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E]"No ❑ 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?
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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
ti
❑ Yes—JE[`&o ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
❑ Yes Z;,No ❑ NA ❑ NE
❑ Yes Ej'No ❑ NA ❑ NE
❑ Yes [�[No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
Phone: q1
Date: /7
511212020