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Type of Visit: 7 ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: _()-Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: dJ /3 Arrival Time: Departure Time: //D/37,7 County:
Farm Name: /� yr �r� LCGG2. Owner Email:
Owner Name: /(/�' 0Lcyj Phone:
Mailing Address:
Physical Address:
Region: Flel)
Facility Contact: / azL ,LB pCi�N Title: Phone:
Onsite Representative: t Integrator: p /L
Certified Operator: l Certification Number: yd 3 g' ✓
Back-up Operator: Certification Number:
Location of Farm: 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 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 DWR)
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 e'NTo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
4�:rNo
❑ NA
❑ NE
❑ Yes
f�No
❑ NA
❑ NE
Page I of 3 511212020 Continued
Facility Number: - Date of Ins ection: , a'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes oNo ❑ 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: t
Spillway?:
Designed Freeboard (in): J�
Observed Freeboard (in): 040
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ZNo
❑ 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 �io
❑ 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 E� No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes _E3'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 ,2-No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes _.. o
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes E3-No
❑ NA ❑ NE
❑ Excessive Pending ❑ 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): , (�,9L'e, , ciGR �5; Y , tj
4"
13. Soil Type(s): * . F h
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes f No ❑ 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 _[allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes .E]"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes _allo
❑ 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 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 ...®'No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes 2] No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes E�'No
❑ NA
❑ NE
Page 2 of 3
511212020 Continued
Facility Number: Date of Inspection: d
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ErNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E]"No
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 .,EI—No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes -E]'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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes 4�f[No ❑ NA ❑ NE
❑ Yes frNo ❑ NA ❑ NE
❑ Yes iE5No ❑ NA ❑ NE
❑ Yes •e No
❑ Yes •e"No
❑ Yes 4ErNo
❑ Yes -EE-No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
r /I /Su i� Phone: %�(� �,3s' �J �S'
Date: 3�as—/a V
511212020
t-801MY NO. 9d-_/g1 ITime In rI'luu
n? Time Out /00)6y1"" Dace
Farm Name __ A2+1.) ;kcGuy
Iniegraar
Owner
Site Ra^
Uperator
No.
Back-up
No.
COC
FREEBOAKU: Design `7
/Observed 9-7
Crop Yield N
-- Circle: General or NPDES
Rain Gauge
Soil Test/ / a-, Wettable Acres
Weekly Freeboard Daily Rainfall h`
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis
Date Nitrogen (N)
I� sr/ s3 3 3
Sludge Survey J r e7
Calibration/GPM
Waste Transfers
Rain Breaker
PLAT
1-in Inspections
Date Nitrogen (N)
L is j