820337_routine_20230817

type of visit: w i ompuance inspection V uperation Keview V Structure Evaluation U Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Aj rdW) -MRM Owner Email:
Owner Name: s h a M 6 ran (f] PRD FOes Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: Gu I_H� Mudd Title: Te(fi Phone:
Onsite Representative: Sa rn� Integrator: w f W
Certified Operator: qu CjU i iV ay Certification Number: l bIl ` q�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
A, 4
Design Currenk
m
r
�. Design
Current
a
Design Current
Swine _` Capacitye Pop
Wet Poultry
Capacity
Pop
Cattle °q Capacity I'op
Wean to Finish
Layer
-
Dairy Cow
Wean to Feeder
Non -Layer
I
Dairy Calf
Feeder to Finish
TORD
1,
Dairy Heifer
Farrow to Wean
Design
Current .i
Dry Cow
-
Farrow to Feeder
Dry'Poultr
:Capacity
z°°Pop.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
°`
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
,,Other.,Turkey
Poults
o.
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?
❑ Yes': No ❑ NA ❑ NE
❑ Yes 40 ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [a No ❑ NA ❑ NE
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 Fo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes r� No ❑ NA ❑ NE
of the State other than from a discharge?
Page I 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:
Spillway?: NO
o
Designed Freeboard (in):
Observed Freeboard (in): of `J 49
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ 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
n 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
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
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
n No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes OQ 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): N�� al rani
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ElYes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
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:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J�] 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 N] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,tQ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 511212020 Continued

Facility Number: I jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes " No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below. `N
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon ,, II //��
List structure(s) and date of first survey indicating non-compliance: ! 0 1/ , pOb I E 2 WY � 2b�
26. Did the facility fail to provide documentation of an actively certified operator in charge? 0 Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 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 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.
❑ Yes NNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes N No ❑ 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 tither comments. , ,
Use drawin s of facili to:,better�ex lain situations use.add tional pages as necessary)."
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Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
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511212020