630012_Inspection_20200206

Facility Number: jDate of Inspection:
a v
Waste Collection & Treatment
•4. Is storage capacity (structural storm storage heavy less than
Yes
/
plus plus rainfall) adequate?
❑
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No [g-Nk-
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C
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
E jXo ❑ 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
D—Xb ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Lg-Ko ❑ 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
D-RG E j NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
D-N'6- ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M 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): (7,5 COY A e.4
13. Soil Type(s): 11-1 go S K 4L(11 V1 E.-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes I_�J o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [q"l-0 0 NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes []"moo ❑ 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?
❑ Yes
L No
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E[ o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [—]Yes D-IIo ❑ 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
❑ 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 [2 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �Io
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection: 0
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑-Xio" ❑ 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 D o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes MN6' ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
L -N'o ❑ NA
❑ NE
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?
❑ Yes
l D No ❑ NA
❑ NE
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
❑ Yes
0 ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[]'l o— ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
To ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®Ko❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[ No ❑ NA
❑ NE
Comments (refer to question#); Explain any YES answers and/or any additional recommendations or any other. comments:
Use drawings of'facility fo better explain situations (use additional pagesas necessary).
%
Reviewer/Inspector Name: `l
Reviewer/Inspector Signature:
Page 3 of 3
Phone:![ ip�? "4
Date:
21412015

(Mvision of Water Resources
Facility Namber 3 O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Como iance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (z�'Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ; ? Departure Time: CC7 1 County: '9A_r c rc, Region:t4
Farm Name: tG ft� `�I Owner Email:
Owner Name: �cj '�'('LV5 Phone:
Mailing Address:
Physical Address:
Facility Contact: f"gLt ri'�co Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: �u. L 5
Certification Number: 1764iF
Certification Number:
Longitude:
— Design , Currei&
Design
Current
Design Current .
Swine :Capacity :Pop,
Wet Poultry
Capacity
Pop.
Cattle a Capacity,`;.:I'op.
Wean to Finish
Layer
�.
a
Dairy Cow
.. 4�
Wean to Feeder
j �3�
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
ffoDesign
Current
Dry Cow
Farrow to Feeder
;Dry Poultry,
Capacity aci
Pop.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
x o
Turkeys
-
Other , �,'
Turkey Poults
=
Other
Other
Discharees and Stream Imuacts
1. Is any discharge observed from any part of the operation?
0 Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
�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
[5NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ET/No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued