820158_Inspection_20181211

Date of Visit: U Arrival Time: f 'l Departure Time: i ��� County:
Farm Name: C&vv Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: L
c
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
- z
Design Cui rent ' De
f,
Capacity P°op ei, oultry Cap
Wean to Finishm
Wean to Feeder
Feeder to Finish
'
Farrow to Wean
q1
Farrow to Feeder
Farrow to Finish
Gilts
Boars 11
1 -1
Other
Layer
Non -Layer
Dry4Poultry Ca
Region: / -E--
Phone:
Integrator:
Certification Number: S 3
Certification Number:
Layers
Non -Layers
s
Pullets
4
d`
Turkeys
Turkey Poults
Other
DischarLyes 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)?
Longitude:
Dairy Cow
'
Dairy Calf
Dairy Heifer
Dry Cow
g
Non -Dairy
k
Beef Stocker
'
Beef Feeder
`
Beef Brood Cow
❑ Yes ❑-No 0 NA ❑ NE
❑ Yes ❑ No Lg-TqXr' ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [:]No ffNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes %N-o ❑ 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: Qr
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q'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?:
Designed Freeboard (in):
Observed Freeboard (in): V
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ i ❑ 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 Ua<o ❑ 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 O� No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Q'N ❑ 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 ,, No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ j o ❑ 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):
e.
13. Soil Type(s): �b vLt 9
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
IS. Does the receiving crop and/or land application site need improvement? ❑ Yes El" o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
© 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
❑2"N' o
❑ 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 [2rNo
❑ 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 R No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

' Facilify Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z2-No- ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ETNo ❑ 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 Signatui
Page 3 of 3
❑ Yes
❑ Yes
❑NA ❑NE
F go' ❑ NA ❑ NE
[:]Yes �No
❑ Yes �No
[:]Yes ®No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
[:]Yes [Z No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
[:]Yes 0 )qo ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
Phone:\ I
1
Date: l I' QXE'i- `t
21412015