310294_Inspection_20191018

LaL
Arrival Time: Departure Time: County:
Date of Visit:
Farm Name: �� Owner Email:
Owner Name: ��S,t, ` il' n Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Integrator:
Onsite Representative:
Certification Number:
Certified Operator:
Certification Number:
Back-up Operator:
Location of Farm:
Latitude: Longitude:
Design curmt
Swine capacity, Pop.
Wean to Finish
Wean to Feeder
I Kin
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La ers
Non -La ers
Pullets
Turke s
Turke 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?
Page I of 3
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
Region:
❑ Yes PX0 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes M�W< ❑ NA ❑ NE
❑ Yes NA ❑ NE
21412015 Continued

Facili Number: - � Date of Ins ection:
Waste Collection & Treatment ❑ NA ❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ oNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z J-- 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 0
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
1 re Ian?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
waste management or c osu p
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
❑ Yes ETNo ❑ NA ❑ NE
7. Do any of the structures need maintenance or improvement? ❑
NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes �No ❑ NA
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ Yes ❑.,No ❑ NA ❑ NE
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application ° ❑ NA ❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [
maintenance or improvement? ❑ ❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes o NA
❑ 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):
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
❑ Yes
o
o
❑ NA
❑ NA
❑ NE
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Fes"_
(,E-frNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
❑ Yes
o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑Yes
�� o
❑ NA
❑ NE
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?
❑
n N
KNo%
❑ NA
❑ NA
❑ NE
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
the appropriate box.
❑Ch klists ❑Design ❑Maps ❑Lease Agreements
Other:
❑ WUP ec
❑ Yes hIo ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑Monthly and 1
❑ Rainfall ❑Stocking ❑Crop Yield ❑ 120 Minute Inspections " Rainfall Inspections ❑Sludge Survey
❑ Yes ❑,Ko' NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge? ❑ ❑ ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? Yes No NA
Page 2 of 3
21412015 Continued

Facili Number: 31 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ©tf ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ 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:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes F;] Flo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No LI4IA ❑ NE
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 tile 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?
Comments (refer to question #): Ezpls a Vw YES a ers aaei/or , additl
s of
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes To ❑ NA ❑ NE
[:]Yes 10 ❑ NA ❑ NE
❑ Yes CJfiio ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
❑ Yes [DNo ❑ NA ❑ NE
❑ Yes [:JNo ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Phone �7; If
Date: L�
21412015