630007_Inspection_20190225

." _ ivision of Water Resources
Facility Number 4 1J - 0 Division of Soil and Water Conservation
Y.
0 Other Agency
Type of Visit: �plia ce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ` Departure Time: t1 ' County: Kc-e nc—
Farm Name: Owner Email:
Owner Name: L% Phone:
Mailing Address:
Physical Address:
Facility Contact: I C I'll
Onsite Representative:
Certified Operator: — 6 CvL``
Back-up Operator:
Location of Farm:
Latitude:
Region: �-
Phone:
Integrator: I UVULS7
Certification Number: T 7
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder �
Farrow to Finish
Gilts
Boars
Other
Layer
Non -Layer
Design Current
Dry Poultry Capacity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey 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?
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Da'
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Q ❑ NA ❑ NE
❑ Yes ❑ No [7 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
L_Lj 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
M`NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
,[TTNO
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
E�No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Fac' 'ty Number: '' jDate of inspection: ?
Waste Collection & Treatment
°4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ 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?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑-??o ❑ 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
®�lo - ❑ 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
E5N ❑ 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
❑ ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2-go ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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): I C 1- S L
13. Soil Type(s):
14. Do the receiving crops differ from
designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
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
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes Ij',IVO
❑ 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 No
❑ 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?
❑ Yes LEE(No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ZNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 63 jDate of Inspection: ,5
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q_Ni(j�- ❑ NA ❑ NE
91
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E]-N`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?
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 Signatur
❑ Yes 0-N_o__❑ NA ❑ NE
❑ Yes E__No ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes r No ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
❑ Yes LJi i;o ❑ NA ❑ NE
❑ Yes
0'N10
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
©Ilo
❑ NA
❑ NE
Page 3 of 3
21412015