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Operation Review Reason for Visit: Q'Routfne 0 Complaint 0 Follow-up 0 Referral 0 Emerge Date of Visit: Arrival Time: 0 Departure Time: ZUR): Farm Name: G %/�(Y1 Owner Email: Owner Name: jy�,m ®i' (..LO Phone: Mailing Address: Physical Address: Facility Contact: / Z)4e!-i.Cl� 6'ei_ Title: le Onsite Representative: Certified Operator: (jrGrD AA& Back-up Operator: Location of Farm: 0 Other 0 Denied Access Region: t a)CO Phone: Integrator: Certification Number: 'qoc)� Certification Number: Latitude: Longitude: 4#4##ix*4', ii &ttBliR•-#%#t$�f#40# pyy UNt 44##A4#b6A k4 Ft V}ti#Nttb'/4�fy *i#}k4d##d•Nb##46##fig': &FE#ba3iY•, 0414.4,RS4kssk R%A4kaW wa*za saaas:Ra�pa t$'�.sa #e#sxlroamaa aaaa'a�.ga * aurae r,.sw¢rewL ast a,#m! *va ssagagmylx a xs arvx §g�X'q$rix g'4## 49##a �'kitd ikh$M4..b6Pt tit ^^ddtryypp/�'ppRR,, 44 #u§'Ch Yt AYt Yt 4 g i kaS$ 'kNM 9kd N'#NB•$H#+Rpy#Ab Pba{# 5 4i d}sg..y#h yCB 5R34 µp"A;8n4`�1 kaa¢ b aY E�fnRg $.$x+4.�#g. i5r?t## aid dqt �3+#+�IMF p kR 3§R&W A ##4tlS$l�nR AEi#�'ftR b# a4&$# r i }y,,,y�t gg;;�yy;;,,4'-0 725�#yq�-#yp, g�$�yyr��g6(+RkekR a�B d��#£�t N x4, S4 $k to � 04# b'8a toot k�# IDr�3a$ni�+9@�'st'���'�q¥a. 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Wit.. ge ys as €+am a. 6 .�' Rase�yx I }' Wean to Finish ¢ *41 ILayer I jDairy Cowgg { Wean to Feeder Feeder to Finish s, Non-La er I dt Dairy Calf I (,r Dairy Heifer a3 "�� % t Dry Cow I `F � i i f %;)'.1 I' Non -Dairy %#t Farrow to Wean s FINO arrow to Feeder Farrow to Finish .011 Layers ?I# Beef Stocker too g" 3 Gilts 6§Y Non -La ersA Beef Feeder *# Boars �� Pullets •ea'= Beef Brood Cow •to & C •Yx, Ra+nxsar5,wn>waaxniaa;, psi *tto-a#tNRfiRffi$h #}%k R'}Sa m*sx:*33 a t a%irwmtl ##{ Xi d 93 &.4SY#u. §ikrr of{R#b+ p #AS4N*Pasfy %�,n. taka a'SR4#aRk#§##&&##i mws ��4'2*m Turkeys '°* Rs ;a 'aaa aaaAs sR:exa Rxx"a m.to qxa tsNorv@a. 1a as ea+s +x gqmaa "`m ad*aam#s(#,%+ra $g*a r# a $. t*Rd$&1S#^g £4 9t4'4'£a#Rk# #'x tr'&A48§'i'##'#b*44S'# *,r��#. a$e k#, erRzsa iii Aua4 Ira$' x**k .§va# s Turke Poults *a' aRxx ua staaat axt'§ it at§�+s+a awaaas x1, a Other $ nta i a is94 a 6 "No No a *i i&p s tttt:N#Skro#': @�$Y : -.m. mm48#b '. aYt.:#9. •• Ali AEtA 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 .,�o ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE [—]Yes [:]No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE ❑ Yes Q�No ❑ NA ❑ NE Page I of 3 511212020 Continued Facili Number: Date of Inspection: % Waste Collection & Treatment 4. Is storage capacity (structural heavy less plus storm storage plus rainfall) than adequate? ❑ Yes .f:rNo ❑ 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 _e'1qo ❑ 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 J:;�o ❑ 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? j2r'�es ❑ No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes .Eno ❑ 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 Q"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 f_!j No ❑ 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): 13. Soil Type(s): 14. Do the receiving crops differ from those 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? ❑ Yes -f5 No ❑ Yes E:fNo ❑ Yes 2"No ❑ NA ❑ NA ❑ NA :56� ❑ NE ❑ NE ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes &No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes ;�eNo ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? []Yes �I o ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 6 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 1" Rainfall Inspections ❑ Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes &No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E3-�o ❑ NA ❑ NE Page 2 of 3 511212020 Continued Facility Number: Date of Inspection: �} a 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes /f:j'No ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 4�frNo ❑ 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 ZN o ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes WNo ❑ NA ❑ NE 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: ❑ Yes E�rNo ❑ NA ❑ NE ❑ Yes E�No ❑ NA ❑ NE ❑ Yes [R'�Io ❑ NA ❑ NE ❑ Yes dNo ❑ Yes ❑'No ❑ Yes Qo ❑ Yes f rNo ❑NA ❑NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE Phone: 9`U/0 3S—C7�5 Date: Page 3 of 3 511212020 racwty No.Time In Time Out _ — Farm Name ���, � ' Integraw Owner Site Rep. Operator No. — Back up No. — COC Circfe: General , or NPDES Data Des' n Current I uesi n wrreu� Feed Farrow — Feed Finish #Farrow Farrow — Firiist: Finish Gilts / Boars —,Wean ( Imo= FREEBOARD: Design Observed Crap Yield Rain Gauge Soil Test 202�,2= Wettable Acres Weekly Freeboard Daily Rainfall Spray/Freeboard Drop �Neather Codes 120 min Inspections _ Waste Analysis: Date Nitrogen (N) 9j, VO4 W Sludge Survey L I �, Calibration/GPM 96 � )2: Waste Transfers Rain Breaker PLAT 1-in Inspections Date Nitrogen(N)