970003_Inspection_20221123 (2)

Type of Visit:
Reason for Visi
Date of Visit:
Farm Name:
Compliance Inspection 0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Ippoa
aveber( r-o,rs
Arrival Time:
Departure Time:
Owner Email:
County: l t is Region:Ns CIS R.3
Owner Name: rit Ma -his lis Phone: q p4 - mt I b
Mailing Address: Aq W i 1 I S —4Qol I t 1 co 1 n o \ \er ` G U DD 1
Physical Address:
Facility Contact: K.� rV__ / ✓ l�(S
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Title:
Integrator:
Phone:
Certification Number:
Certification Number:
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Latitude:aCbq I 04 tl
Layer
Non -Layer
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
t
Longitude: b&D 6g' Ge
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Da'
Beef Stocker
Beef Feeder
Beef Brood Cow
NTMI
LMEM
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 fNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3
5/12/2020 Continued

Facility Number: a 1 - 0�
Waste Collection & Treatment
Date of Inspection:I ( a -a —
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
S'tyuc re 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I
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.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Structure 6
❑Yes it No ❑NA El NE
El Yes VI No ❑NA ❑NE
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?
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 ❑ Yes
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
❑ 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
12. Crop Type(s):
13. Soil Type(s):
❑ Yes No
❑ Yes ❑ No
❑ Yes No
❑ Application Outside of Approved Area
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No A NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes %No ❑'"tttt NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No y NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes 'No ❑ NA
❑ Yes 'No ❑ NA
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? ❑ 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:
0NA ❑NE
j �y��NA ❑NE
❑C NA ❑ NE
❑ NA ❑ NE
NA ❑NE
21. Does record keeping need improvement?'fie-ap
❑ wisteapplicatien Q W‘delelpFreeboard 0Waste.Aaialysit, [] Sol alysis
17Rainfall ❑ Stocking Crop Yield �42W .inuto-Iespestiens I lil Monthly and 1" Rainfall Inspections ❑-Sludge vey
T22 Did the facility fail to install and maintain a rain gauge? ❑ Yes 14 No ❑ NA ❑ NE
23 If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes ❑ No EA NA ❑ NE
Page 2 of 3 5/12/2020 Continued
❑ NE
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ ]bceat F nsfarsa E Weather -Cede

Facility Number: q 1 - (�3
Date of Inspection: (1 7-31r2C
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 ['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 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ 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 EA No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) T�
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [x No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes �] No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
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 I77X6No El NA ❑NE
ElYes 0 No 54NA ❑ NE
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Reviewer/Inspector Name:
Reviewer/Inspector Signa
Page 3 of 3
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Phone.
Date:
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