960063_Inspection_20201008

Facility Number
(3
40 Division of Water Resources
0 Division of Soil and Water Conservation
0 Other Agency
he
Type of Visit: ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: W -r at!
Farm Name:
Arrival Time:
Departure Time:
Owner Name: `�[ - S� I.CQa
64tA—A
Mailing Address:
Owner Email:
Phone:
Coun
Region: 4t/4/�
f/9--77- F517
Physical Address: 73 ' ,Z
Facility Contact: %,Z/ Title: Phone:
Onsite Representative:
A
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: —1$4-
Certification Number: /9'
,72-a-3--
Certification Number:
Longitude:
Swine`
Design Current
Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
ATP
Soy%
Farrow to Feeder
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Layer
414-1
Dry Poultr
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Capacity ° Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
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 4No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page l of 3
2/4/2015 Continued

Facility Number: T/ -
Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
❑ Yes
./
© No ❑NA ❑NE
❑ No ❑NA ❑NE
Structure 5 Structure 6
❑ Yes
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes
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
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes
(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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
❑ 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
dNo ❑ NA ❑ NE
No ❑NA ❑NE
12. Crop Type(s):
13. Soil Type(s):
No ❑ NA ❑ NE
No ❑ NA ❑ NE
[� No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
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 ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
n Yes No ❑ NA ❑ NE
❑ Yes 14 No ❑ NA ❑ NE
n Yes [ No ❑ NA ❑ NE
❑ Yes ® No
❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspection
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 2 of 3
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
No ❑ NA ❑ NE
2/4/2015 Continued

Use drawings of facility to better explain situations (use additional pages as necessary).
Facility Number:
Date of Inspection: / (J
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
❑ Failure to complete annual sludge survey
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ Yes [7rNo
❑ Yes L<o
n Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes
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
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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. n Yes
❑ 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?
❑ Yes
❑ Yes
❑ Yes
No ❑ NA
/[�No ❑ NA
�No
reNo
❑ NE
❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑NE
❑ NA ❑ NE
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
"`mments (refer . question #):Ex lain anyYES answers and/or anyadditional recommendations or any other com
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ents.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: s,p
Grel T aav,
Date:
2/4/2015