310286_Inspection_20191029

Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator:
Location of Farm:
Design C
Swine Capacity
Wean to Finish
Wean to Feeder 0® C,
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars I l
Other
Other
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Layers
Non -Layers
Pullets
Turkeys
TurkeyPoults
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?
Longitude:
Cy ow
Cy alf
Hy eifer
Cow
❑ Yes f 2-7 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
12<
[:]NA
❑ NE
❑ Yes
FLWoo
tr-
❑ NA
❑ NE
21412015 Continued
Page I of 3

F 1' Number - Date of Ins ection:
aci i
Waste Collection & Treatment
storage plus heavy rainfall) less than adequate?
4. Is storage capacity (structural plus storm
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): —77
Observed Freeboard (in): OK
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
t mana ement or closure plan?
[]Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
Structure 5 Structure 6
❑ Yes .C3Xo ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
was e g
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 [D I - ❑ 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 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application ❑ NE
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yeso ❑ NA
maintenance or improvement? �❑ NA ❑ NE
�
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
Yes L` o
❑
❑ 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?
El Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
°
00-Nb
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�.PQo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑ Yes
�jQb
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes
o
❑ NA
❑ NE
the appropriate box.
❑WUp ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Analysis ❑ Soil Analysis
❑ Yes
❑ Waste Transfers
❑
❑ Weather Code
❑ Waste Application ❑ Weekly Freeboard
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge
Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ yes
�.Pd'o
❑ NA
❑ NE
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�\
2/4/ZO15 Continued
Page 2 of 3

ccC.
Facili Number: -a AC., jDate of Inspection: l'
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [q10 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�Koo ❑ 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 E[?a ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No E3 A ❑ 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?
❑ Yes [;Ko ❑ NA ❑ NE
❑ Yes EJ Ko ❑ NA ❑ NE
❑ Yes ❑,Ko' ❑ NA ❑ NE
❑ Yes JEJNo ❑ NA ❑ NE
❑ Yes DIo
❑ Yes E]No
❑ Yes E94o
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
[Comments,( refer to question ft Explain any YES answers and/or any additionot t . ea . i s or any outer eo
Iran drumYnaa aifsniiity #n hattar "ninin niiaatinna tn"e additional naves as neceasarvi '
�ta"�s2
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: �d �� 313
Date:
21412015