100005_Structure Evaluation_20180806

Facili Number: - Date of Inspection:
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? I
Yes ❑ 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: I
Spillway?:
Designed Freeboard(in):
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Observed Freeboard(in):
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes I X� No ❑ NA ❑ NE
(i.e.,large trees,severe erosion,seepage,etc.) T�
6.Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes 9No ❑ 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 ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ 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 ❑ No ❑ NA KNE
maintenance or improvement?
Waste Application
10.Are there any required buffers, setbacks,or compliance alternatives that need ❑ Yes ❑ No ❑ NA X NE
maintenance or improvement?
11. Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes ❑ No ❑ NA �NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ PAN ❑ PAN> 10%or 101bs. ❑ 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 designated in the CAWMP? ❑ Yes ❑ No ❑ NA NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA XNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA I�NE
acres determination?
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17.Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NAE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA
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 ❑ 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 K
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 ❑ No ❑ NA NE
Page 2 of 3 21412015 Continued

Faci6- 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 provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA E
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes ❑ No ❑ NA INE
Otherlssues
28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA [XNE
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 ANE
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 ❑ 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 jk;/
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA
N
34.Does the facility require a follow-up visit by the same agency? Yes No ❑ NA ❑ NE
Comments(refer to question#):Explain any YES answers and/or any additional recommendations or any other comments.
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Reviewer/Inspector Name: (�a�� 1� 00 /I Phone:
Reviewer/Inspector Signature: Date: 0
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