960004_Inspection_20221205

eft
, ems /J-1
Facility Number
oy
„ ivision of Water Resources '
:0 Division of Soil and Water Conservation
Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ,a -Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: d Arrival Time:
Farm Name:
Owner Name: c
01/2-e
Departure Time: `0 %d RAFounty:
Owner Email:
Phone:
Mailing Address:
Physical Address:
Facility Contact:, t,/LGU
Onsite Representative:
Region:
Title:
Certified Operator:''
Back-up Operator:
Location of Farm:
Integrator:
Phone:
vela Certification Number: 4
Latitude:
Certification Number:
Longitude:
'(Design Current
at1tyQ.�
Wean to Finish
Wean to Feeder
Feeder to Finish
3790
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
otk
Other
• Design Current
. Wet: 'o ltfry. Capa, r' .. Pop. .ir'Cattle
Layer
Non -Layer
Design Current
Dry' POJ1ltry Caclf,Y Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
• i' • Design Current
S LJ
;y. Capacity "tti►y
Dairy Cow
Dairy Calf
Dairy Heifer r
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) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes »No ❑ NA ❑ NE
of the State other than from a discharge?
❑ Yes 0-No ❑ NA 0 NE
❑ Yes ❑No ❑NA ❑NE
❑ Yes ❑No ❑NA ❑NE
Page 1 of 3
2/4/2015 Continued

I'jacility Number: qcp - Qy
Date of Inspection:/A-/)
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
'S
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
�8-
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
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
❑ Yes ,JNo ❑ NA ❑ NE
❑ Yes No ❑NA ❑NE
Structure 5 Structure 6
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes , No ❑NA ❑NE
❑ Yes No ❑NA ❑NE
❑ Yes Er No ❑ NA ❑ NE
❑ Yes .21No ❑NA ❑NE
❑ Yes ETlo ❑ NA ❑ NE
❑ Yes .12-No ❑ NA ❑ NE
❑ Yes 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):
'4 ; cs
:l 4 C - f
14. Do the receiving crops differ from those designated in the CAWMP? n Yes .2-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Er No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes USio ❑ NA ❑ NE
acres determination?
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 .2-No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ,121(o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ I Ease Agreements ['Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis
❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
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 _❑'l�o ❑NA Li NE
❑ Weather Code
Rainfall Inspections ❑ Sludge Survey
❑ Yes (121'flo ❑ NA ❑ NE
O Yes z.I21 No 0 NA ❑ NE
2/4/2015 Continued

1
,iacllity Number: - g J
Date of InspectioV,/ /' 1
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Yesj71'o ❑NA ❑NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ON° ❑ 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 ,]'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 2'1\To ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes .11••IVo ❑ NA ❑ NE
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 ❑ NE
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. ❑ Yeslo ❑ NA ❑ NE
❑ Application Field El Lagoon/Storage Pond El Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ,❑TNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
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.
Use drawings of facility to better explain situations (use additional pages as necessary)
'4) bu,, Y-e€46' aid
..tee &-gez-71
�vtf� Poz-� ,buc6f toed �in� Ioa/�.chi`A-
�G/ �U �� y /�L •LDv� `�'ozr�g)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: �'f �Q S$ 3$
Date: %.� j5'< ✓Z�
Page 3 of 3 5/12/2020