660035_Structure Evaluation_20230510

p Division of Water Resources
Facility Number ®- ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Vis' . ompliance Inspection 0 Operation Review Af Structure Evaluation 0 Technical Assistance
Reason for Visit: 96 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Qnr4!qPtAVon: (Fn
Farm Name: ,4M Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address: 3 � 9 G cis i b(D j 1U I' (J?N d 2_ (W— ks a n ) 11? <° .
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
ine
Title: Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to n
Farrow Feeder
Fa w to Finish
9flts
Boars
Other
Non -Layers
Pullets
Turkeys
Turkey Pouets
Other
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Appli ' n Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach w s of the State? (if yes, notify DWR)
c. What is the estim volume that reached waters of the State (gallons)?
d. Does the ' arge bypass the waste management system? (if yes, notify DWR)
2. is there eviden of a past discharge from any part of the operation?
3. Were th any observable adverse impacts or potential adverse impacts to the waters
of t tate other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[]No
❑ NA
❑ NE
Page 1 of 3 511212020 Continued

Facili Number: Date of Inspection: Q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes [—]No ❑ 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: :3 ('6 2�
Spillway?: 1%_0 �l.Q
Designed Freeboard (in):�
Observed Freeboard (in): 1�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(i.e., ge trees, severe erosion, seepage, etc.)
6. Are there ctures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No ❑ NA
waste manage ent or closure plan?
If any of questions were answered yes, and the situation poses an immediate public health or environmental thre , notify DWR
7. Do any of the structure eed maintenance or improvement? ❑ Yes ❑ N ❑ NA ❑ NE
8. Do any of the structures lac dequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, stacks, and/or wet stacks)
9. Does any part of the waste manage t system other than the waste structures require es ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Apmlication
10. Are there any required buffers, setbacks, or c pliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If ye check the appropriate bo elow. ❑ Yes [:]No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload Frozen Ground Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosp orus
❑ Outside of Acceptable Crop Window ❑ Evidence o i
12. Crop Type(s):
13, Soil Type(s): /
Failure to Incorporate Manure/Sludge into Bare Soil
❑ Application Outside of Approved Area
14. Do the receiving crops differ from those designated i the CAWMP? \
15. Does the receiving crop and/or land application s' a need improvement?
16. Did the facility fail to secure and/or operate r the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acrea for land application?
18. Is there a lack of properly operati waste application equipment?
[:]Yes [:]No
❑ Yes [] No
[:]Yes ❑ No
Yes ❑ No
Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
19. Did the l to have a Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does thail to ve all components of the CAWMP readily available? If yes, check
❑ Yes No
[] NA
❑ NE
the apprx.
P ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
/inced
21. Does ren eed improvement? If yes, check the appropriate box below.
❑ Yes ❑ No[]
NA
❑ NE
Waste A❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
Weather Code
Rainfallking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ SI a Survey
22. Did theil 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 ❑ No
❑ NA
❑ NE
Page 2 of 3
511212020 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [—]No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels v lagoon
List structure(s) and date of first surve ' icating non-compliance:
26. Did the facility fail to provide documentation of an ac ' certified operatojin charge9 ❑ Yes ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (P certific' ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 2 _ ours and/or ment
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose odor or air quality concern?
If yes, contact a regional Air Quality repre ative immediately.
30. Did the facility fail to notify the Re ' nal Office of emergency situations as required by the
permit? (i.e., discharge, free b .d problems, over -application)
3 1. Do subsurface tile dra' . exist at the facility? If yes, check the appropriate box below.
❑ Application F' d ❑ Lagoon/Storage Pond ❑ Other:
32. Were any ad itional 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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ 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 additiona pages as necessary).
0 '777777 t.7y�_'7_ cJ4
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
Phone: q/ ! / %/ TdF__�
Date: 116 t'p
6212420