820196_Routine Inspection_20240613

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t h,Facility Number O Don of Soil and VF'Rter CUnservation
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit:—GIRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival 1Timerogo Departure Time: 'p'% County: _� Region:
Farm Name: (�/�( (rQ1 er- -T_61)IP 1V % Owner Email:
Owner Name: 0jG�t� ljoz " Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
11
Certified Operator: !')'40�7'
Back-up Operator:
Location of Farm:
Latitude:
Phone: �t
Integrator:
Certification Number: dnSa`2
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yess❑ No ❑ NA ❑ NE
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 [—]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
--ffNo,
❑ NA
❑ NE
[—]Yes
I_J No
❑ NA
❑ NE
Page I of 3
511212020 Continued

Facilit Number: - (p Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes �o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Stricture 5 Structure
6
Identifier:
Spillway?:
Designed Freeboard (in): r�
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Q-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 ..TNo
❑ 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 -E114o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes Jallo
❑ 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 2rNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 4ErNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3No ❑ NA
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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): 4t'yv� !*d o 40 //Z 0ZW
13. Soil Type(s): �p
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ETNo ❑ 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 .e o ❑ NA ❑ NE
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
❑ NE
❑ Yes E❑J No ❑ NA ❑ NE
❑ Yes J ' o ❑ NA ❑ NE
❑ Yes _❑`No ❑ NA ❑ NE
❑ Yes E3�No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JNo ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes allo ❑ NA ❑ NE
❑ Yes , 7rNo ❑ NA ❑ NE
Page 2 of 3
511212020 Continued

Facili Number: - Date of Inspection: (�
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 ❑ 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 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 JNo
❑ NA ❑ NE
29. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes_ [-J-No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Ye$,_[3 No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes°-E:rNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes J'Nb
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes E�-No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ,� o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes --0 No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes J:�No
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: 914) 5.3.$ � -295—
Date: 61117-42 y
Page 3 of 3 511212020

racmty No. O� Cgc Time In
Time Out
Farm Name,9a.i
IntegratQks
Owner
Site fiver,
Operator
No.
Sack -up
No.
COC Circle: General , or NPDES
P*KEEBOARD: Design
Ob erved
Crop Yield_
Rain Gauge
Sail Test 1 / Wettable Acres
Weekly Freeboard --/—
Daily Rainfall.__
SpraylFreeboard Drop
Weather Codes --X—
120 min Inspections —
Waste Analysis:
Date
Nitrogen (N)
�a a4
�ali3lai
1.�t
Dare
Sludge Survey."
Calibration/GPM 7 /
Waste Transfers
Rain Breaker
PLAT
1-in Inspections
Date Nitrogen (N)
9