630008_routine_20230619

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Reason for Visit: )D Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I S Arrival Time: Departure Time: County:
Farm Name: 1 1 M b1 I, S Owner Email:
Owner Name: N q VOW Phone:
Mailing Address:
Physical Address:
Facility Contact: ®N MDOM Title:
Onsite Representative: SkLe
Certified Operator: _ �W Vi/ E Y chi/ N
Back-up Operator:
Location of Farm:
Latitude:
Region: -fro
Phone:
Integrator: 6 V `9 PUNK —
Certification
Number:
Certification Number:
Longitude:
�-
�. Design Current
Design
Current
Design Current
Swine . , 'Capacity 'Top:,
Y8'et Poultry
Capacity
I'ap.
Cattle � Capacity
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
I I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Weans
r=
Design
Current
Dry Cow
Farrow to Feeder
Dry Poultry :
Capaci
:Pop.,
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys_
°
r
Turkey Poults,.-
Other
_
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 �Q No ❑ NA ❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes o 0 NA ❑ NE
❑ Yes [� o ❑ NA ❑ NE
Page 1 of 3 511212020 Continued

Facility Number: jDate of Inspection:
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: Lr
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):� j q
5. Are there any immediate threats to the integrity off any of the structures observed? E]Yes E ❑ 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
I 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
EN�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
NNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
C�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes NNo ❑ 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 n ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
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.
❑ Yes
ElNo
—Cj,k4o
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
CqNo
❑ NA
❑ NE
❑ Yes E , o ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes [D,-�o ❑ NA ❑ NE
❑ Yes �\No ❑ NA ❑ NE
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes b] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [_!jNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes NNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 511212020 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes n 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 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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
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 the 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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes t No ❑ NA ❑ NE
0 Yes �No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes t No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
h] No
❑ NA
❑ NE
Reviewer/Inspector Signature: `\� JU(, — �(lf �( ` Date:
Page 3 of 3 511212020