820464_Inspection_20190304 (3)

'V lL -1 l.I M rav- k —1 !J—
' ��ac�ty Number ..
Type of Visit: ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ,• Arrival Time: Departure Time: 777w= County:
Farm Name: v w1_ �� l� Owner Email:
Owner Name: v— Phone:
Mailing Address:
Physical Address:
Facility Contact: j Le,201(ic 5 Title:
T
Onsite Representative: 9
Certified Operator: 0 ►n 111 Y ' vl. J d-(
Back-up Operator:
Location of Farm:
Latitude:
Region: �f
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
'Des gn Current k ' Current 'Design f urgent
z
Capacity P;op
WettPoultry
:Design
Capacity Pop
Cattle : "Capac+Ly Pop
twine
�� 3�-
Layer _
k `
Non Layer
r
bes+gp Current
,.r Dray Poultry
Ca achy Po
'.
i''
i
S
Other:
Wean to Finish
Wean to Feeder
Feeder to Finish
(? �`l�'
O• + "
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Layers
Non -Layers
f
Pullets
�
Turkeys
�
Turkey Pouets
Other
-�
Dairy Cow
Dairy Calf
�
Dairy Heifer
�
D Cow
�
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
'
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Q�❑
NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
Q-A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[]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
❑ No
❑ A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�i5
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
®'No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes d-lQo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0 lA ` ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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
waste management or closure plan?
❑ Yes Q-Vo ❑ NA ❑ NE
[:]Yes 0'<o— ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t reat, 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 6-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 to ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ['- N ❑ 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): C -� _S & V
C Ct'q
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �]<o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ED No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable 0 Yes ErNo 0 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?
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.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes ONo ❑ NA ❑ NE
❑ Yes Ei o ® NA ❑ NE
❑ Yes EDX9 ❑ NA ❑ NE
❑ Yes �nNo ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes u o ❑ NA ❑ NE
❑ Yes fNNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

on
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? El
❑'�Io ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ['llo ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes
❑ Yes
[4(o ❑ NA ❑ NE
EK ❑ NA ❑ NE
❑ Yes &o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes EtNo ❑ NA ❑ NE
❑ Yes �No
❑ Yes ❑ No
❑ Yes ErNo
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
P � 4 1 -:,-7--'7-
/
off: �3�3
Date: ly'
21412015