260064_routine_20240627

Q Dlvisic
Facility Number =` � r,-© O Divisit'
(Q Other
Iype of Visit: O Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
season for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: : , 5� Departure Time: County: Region:
Farm Name -Pft 6CL S 1 J N U I zi Owner Email:
Owner Name: EA(DN Phone:
Mailing Address:
Physical Address:
Facility Contact: nroil Title: 1e(h S f f,(, Phone:
Onsite Representative: :7 I 1b�j to nd ���i Integrator: l rC JAG
Certified Operator: ` W O N Certification Number: �, � 3 -7 D
Back-up Operator: Certification Number:
Location of Farm: Latitude: - Longitude:
v=
Design Current
x Design
Current
Design Current
Swine -
Capacrty f Pop
Wet Poultry
Capacity
Pop
Cottle
Capacity I'op.
.,:
Wean to Finish
La er:_
y
Dai Cow
ry
Wean to Feeder
Q
Non -Layer
Dairy Calf
b�
Feeder to Finish
Dairy Heifer
Farrow to Wean'
Design
Current
Dry Cow
Farrow to Feeder
Dry P6 ky
Capacity.
• Pop.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
.^.
Boars
Pullets
Beef Brood Cow
"
_
f
Turkeys
Other..
Turkey Puults
-
n_
Other
N
o-
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?
Page 1 of 3
[:]Yes No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
5/1212020 Continued

Facility Number: - Date 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?l 0
Designed Freeboard (in): I�-
Observed Freeboard (in):
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
&] 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
gj 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? hove
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 �j] 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
y �EIWindow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C'�j r S k V V , (0t�fipN
ZEM2�W11111W11\1#1UVM 0111J'S11011
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�j No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
4 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
M.No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
5(] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(4 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 C� 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 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 511212020 Continued

Facility Number: •ol(p - Date 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.
❑ 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: 5�_L
26. Did the facility fail to provide documentation of an actively certified operator in charge?
I] Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes Kj No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 9� 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 I] 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
I] 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
k No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
nQ 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
9No
❑ NA
❑ NE
1 c utawiugsaor-tacuity:to setter.expiam situations Luse-ana tionat pagesas necessary).
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Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
WITur"Impi Mem
Phone: (1�fl
I 2j:f li4
Date: W
511212020