630003_Inspection_20200206

Facility Number: - `� Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural heavy less
plus storm storage plus rainfall) than adequate?
❑ Yes
E3'No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
E3-I'A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1 °L�( J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E]I�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],
❑ 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
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
L3 o
❑ 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
0-N�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
QNo
❑ 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): t1� a
13. Soil Type(s): -e- L9cl l�
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
[v]-N-o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[D-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0-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
2No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
q �_o ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2-56
❑ 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 I " Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
[] No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 1, q - Date of Inspection: L OC2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [41-Pdi�'_ ❑ 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 �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes R]'<o ❑ NA ❑ 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?
e//d''rawings of facility to=better explain situat
H Jo
Vks I � 101/k
e�j( qib
Reviewer/Inspector Name: i I
t ".7
Reviewer/Inspector Signature:
Page 3 of 3
Mr, any
as
10�LrL +_uV^ r o v>
❑ Yes P--Ko ❑ NA ❑ NE
❑ Yes LEI- ❑ NA ❑ NE
0 Yes No ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
❑ Yes EKo
0 Yes E No
❑ Yes 2 <0
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone: (Aytq' 31�'
Date: I �-L� �,v
21412015

"ivision of Water Resources
.Facility Number _ �i ivision of Soan,?t?atCon
servation",
oservation ,
Dild
—
_._,
Aa
O Other Agency �.
r
type of Visit: O-Omnpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
[2eason for Visit: critoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: JbF4, -7 1)1 Arrival Time: ` L Departure Time: County:
Farm Name: 0 C Owner Email:
Owner Name: 14
Phone:
Mailing Address:
Physical Address:
Facility Contact: �,dy ���^-� Title:
Onsite Representative: 1 I
Certified Operator:
Back-up Operator: ✓� �n� d t (escs
Location of Farm:
Latitude:
Region:
Phone:
Integrator: L k(f
Certification Number: f 7 6 g V
Certification Number: _7770E 1
Longitude:
Design,Current-•
Design
Current,
Design Currenf
c Swine
=Capacity- POP4,
Wet Poultry'
° Capacity
Po1e.
Cattle Capacity"
°Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
ofy Poultry
Capacity
Pop.'
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other ��'
Turkeys
,
Turkey Poults
F—TO—ther
=
Other
Discharges and Stream Impacts
/
1. Is any discharge observed from any part of the operation?
[-]Yes
QUO
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
F.
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑-N7V-
❑ 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
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
0 Yes
e 5;
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
EErNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued