090081_Routine Inspection_20240827

Date of Visit: a Arrival Time: / :fJ Departure Time: County: Z Region: —1?54
Farm Name: — o Owner Email:
Owner Name: As A ��� j t✓ (� Phone:
Mailing Address:
Physical Address: /
Facility Contact: L�2 Ate+ %�[girse�Cci-YL Title: Phone:
Onsite Representative:
Certified Operator: lC,Y�U��� Y/"4'.
Back-up Operator:
Location of Farm:
Latitude:
Integrator: �ZCw e
Certification Number: 5OG
6__Z
Certification Number:
Longitude:
Discharges and Stream Impacts �/
No ❑ NA ❑ NE
1. Is any discharge observed from any part of the operation? ❑ I
Discharge originated at: El Structure ❑ Yes 3iT 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 ETNo ❑ NA ❑ NE
❑ Yes L�No ❑ NA ❑ NE
Page 1 of 3 511212020 Continued

Facility Number: Date of Inspection: /a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C2/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I 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 4�1 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
waste
❑ Yes No
❑ NA ❑ NE
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 ETNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 21�o
❑ 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
❑ NA ❑ NE
maintenance or improvement?
,❑'No
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[]Yes ❑`No
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes )❑ o ❑ 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 CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ��Z� �LCc/ 2 x G r ;., i / /le i iic //;, ...., , .,1i_
13. Soil Type(s):
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 El Design ❑ Maps ❑ Lease Agreements
❑ Yes ET —No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes
;�No
❑ NA
❑ NE
❑ Yes
P-No
❑ NA
❑ NE
❑ Yes
"No
❑ NA
❑ NE
❑ Yes
;ErNo
❑ NA
❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes D�No
❑ 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 ZNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F,]No
Page 2 of 3
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
511212020 Continued

Facility Number: &09- Date of Ins ection: (2 ,1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes .[�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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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)
DNA ONE
DNA ❑NE
❑ Yes ' No ❑ NA ❑ NE
❑ Yes Ea No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes �2No ❑ NA ❑ NE
❑ Yes J'No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [j Yes _E]No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW? ❑ Yes JZNo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 'FerNo
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 'C2filo
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone: '/CI e-
Date: g'la 7
511212020

racmcy NO. — Time in
-----__ Time Out
Farm Name ---
Owner integrate'
Operator Site Rep,
Back-up
COC
FREEBOARD: Design
Observed
Crop Yield
Rain Gauge
Soil Test Del
Circle; General
Wettable Acres
Weekly Freeboard t/ Daily Rainfall
Spray/Freeboarc,, Drag _
Weather Codes L--�
Waste Analysis:
120 min Inspections
Date Nitrogen(N)
�arl�y �OF
No.
No._
OrNPDES
Dace
Sludge Survey //`7/l;L-?
Calibration/GPM
Waste Transfers
Rain Breaker
PLAT
1-in Inspections
Date Nitrogen (N)
-7
I