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FORWARD IANDFILL <br />DALLY PRE -APPLICATION INSPECTION FORM <br />Waste Discharge Requirements Order No. R5-2014-0006 <br />Weather conditions: 6 0 <br />Temperature: <br />Wind direction: - Wind speed: �- <br />Other relevant field conditions: <br />Evidence of erosion .............. <br />s- ca =1'ir-a <br />Soil saturation......... <br />Ponding--------•------•---- <br />............................................................. ef No ...............................o Yes <br />............................................................. it Good ......................... o Needs attention <br />............................................................. N�o.............................. ❑ Yes <br />-•...................................•---....-----.......................... Cf N o Yes <br />Potential runoff to off-site areas............................................................. <br />Potential discharge to surface water ....:................................................ <br />Actual discharge to surface water..........................................................No <br />Accumulation of organic solids.............................................................. <br />Soil clogging .................. <br />Odors that have the potential to be objectionable at or <br />Ed No .............................. <br />Ct Nc .............................. <br />.............................. <br />No ------------------------------ <br />❑/No.............................. <br />o Yes <br />❑ Yes <br />o Yes <br />❑ Yes <br />o Yes <br />beyond the property boundary ............................................................... <br />o No o............................ <br />o Yes <br />Vectors (insects, rodents)....................................................................... <br />No ............................... <br />❑ Yes <br />Documented observations requiring corrective action and corrective action taken (if applicable): <br />Note: No valves are required as part of the land application operation. <br />Date/time: jelLLI ?. l @ 1: to Signature: Ao64 Title: Operations Manager <br />Ruben Ramirez <br />n <br />C7 <br />