820469_Inspection_20190304 (2)

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Facility Number
qt 7
Type of Visit: ?Routine
fiance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: C' f'( Departure Time: i County: Region:
ff
Farm Name: 2--o Z,b Owner Email:
Owner Name: Kj,,,jLAj,J LAI A- Phone:
Mailing Address:
Physical Address:
Facility Contact: i� ��©v'� frs Title:
Onsite Representative: t
Certified Operator: S'
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: . &'.
4
Certification Number:
Certification Number:
Design Current Design 'Curreht
'Wine"Capacity Pop Wet Poulfry Capacity Popy
t
I�
I
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other l: -
DischarL7es and Stream Impacts
_. -Layer
Non -Layer I
Design, `;C VTgn_1
ni-u P __W. v• :("anacity Pon:
Longitude:
3Design �aCuXcent
ti ttle Capacity Po.p�,
airy Cow
y Heifer
Cow
-Dairy
Layers Bee
I Beef Stocker
Non -Layers :.' f Feeder`f:
Pullets f. , Beef Brood Cow c
Turkeys
Turkey Poults
Other
1. Is any discharge observed from any part of the operation?
❑ Yes
❑moo ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field El Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑-A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[—]Yes
[-]No
�A
❑ NE
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)
❑ Yes
❑ No
�A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Q No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Q No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

' Facility Number: - IDate of Ins ection: 'r_\
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [❑ 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): $
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
o
❑ 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
0 No
❑ 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
E3"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
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 �Io ❑ 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): G-9��
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Epxb
❑ NA
❑ NE
15. Does the receiving cropand/or land application site need improvement?
❑ Yes
-I o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0'go
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
©<
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L J�N
® NA
❑ NE
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 To ❑ 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 J No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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?
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)
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?
C41 4-1
S 5 - I - i---
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
®-6. ❑ NA ❑ NE
D'1 o ❑ NA ❑ NE
❑ Yes ED No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes Eg o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes FTKo
❑ Yes Q'1lo
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
6�7e 7— ,�-17 9
Phone: IL
Date:
21412015