630002_Routine Inspection_20240513

Arrival Time: veJ Departure Time: / pJ County: Region: /I:n
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
/I
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Discharges and Stream Impacts
I. 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: e�cd
Certification Number: fJ"7 t3
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 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?
Longitude:
❑ Yes �TNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
4�:[No
❑ NA
❑ NE
Page I of 3
5/12/2020 Continued

Facility Number: Date of Inspection: / y
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes .-Ef �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: 4� 0 / q
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): � �/ 31
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 El -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 nNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ,allo
❑ 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 P7rN0
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes tNo
❑ 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): C�7/YI �DL� 1�
/
13. Soil Type(s): .t iJi C7 O /if 4 B
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑ Yes -°No
❑ NA
❑ NE
❑ Yes ..Pr No
❑ NA
❑ NE
❑ Yes _Iallo
❑ NA
❑ NE
❑ Yes 0 No
❑ NA
❑ NE
❑ Yes J2 No
❑ NA
❑ NE
❑ Yes ..❑ No
❑ Yes ❑-No
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 0-Yes ❑ N
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield �120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ['No
❑NA ❑NE
❑ NA ❑ NE
o ❑NA ❑NE
Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 511212020 Continued

Facifi Number: ' � - Date of Inspection: U
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 Jallo ❑ NA ❑ NE
the a r t b b I
pp onapa ox(es) a ow.
❑ 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 JgNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
J2 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?
❑ 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 ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
,f:[No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑'No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
j°No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
LyNo
❑ NA ❑ NE
P
%7
Reviewer/Inspector Name: kl l a n -C
Reviewer/Inspector Signature:
Page 3 of 3
Phone: gl0
Date: S—A3 A
511212020

racmry NO. (O�— 6 Time In
Time Out
Farm Name
Integrat<y
Owner —
Operator • Site Re;.
lack -up No.
No.
COC Circle: General , or NPDES
FREEBOARD: Design
Observed
Crop Yield
Rain Gauge
Soil Test Wettable Acres
Weekly Freeboard ._ Daily Rainfall
Spray/Freeboard, Drop
Weather Codes 120 min Inspections
Waste Analysis: ,� )e' /o �y /2
Date Nit or gen (N) 7
02 rrr ay 1 Vi Lys / yj , /3 _
Sludge Survey
Date
Calibration/GPM lrS74-3 2 `0 y
Waste Transfers
Rain Breaker
PLAT
1-in Inspections
Date Nitrogen (N)