630001_Inspection_20200206

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
0 Yes
[q'No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
`fl
7
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): % C/ 67
th
`tothe
5. Are there any immediate threats i—ntegrity of any of the structures observed?
❑ Yes
[yg-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
[DN
❑ 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
rTL.No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�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
[Z[—Ncf
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
©,K'o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D-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): t ( 4c;j SG
.r
13. Soil Type(s):��C�Z�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
G[ Ko
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
©No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
g No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ej<o
❑ 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
❑'�To
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E[Ko❑
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
E 6 :X'6
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
0 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
[fl<o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[D
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facility Number: - Date of Inspection: fo,( C/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Quo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E�-�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 0 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑IIo ❑ 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?
Use drawings of facility to better explain situations (useaddi
0
c-("(( 1 (0--� r) �-- � g s 1
Reviewer/Inspector Name: t u �) '(f
Reviewer/Inspector Signature:
Page 3 of 3
any additio
paces as na
❑ Yes [,No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes -1� o ❑ NA ❑ NE
❑ Yes F3-No ❑ NA ❑ NE
❑ Yes No
❑ Yes [? No
❑ Yes Q No
any
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date: r_-7 �!
21412015

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 040-utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: --t ` `Arrival Time: Departure Time: ( C S County:
Farm Name: ®�� 1 `( .C� Owner Email:
Owner Name: -PWIVL`r Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: �(
Back-up Operator: ,4, f&-,
Location of Farm:
Latitude:
(1LZ0o6W_ Region:(
Phone:
Integrator:
Certification Number: 176
Certification Number: U
Longitude:
Ar
ADesnureut DesIgu Current Dcsign Ce�reaat
Svunne - Capacity' fop Wet Po,rltry Opacity°oi CattXe Capacity )Pop
Wean to Finish
Layer
=-
Dairy Cow_
Wean to Feeder
=
Non -Layer
Dairy Calf
N3 Feeder to Finish
=
Design Current=
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Di poetltt ,.,,.Caoacitim,ftp
Non -Dairy
y Farrow to Finish
ILayers
Beef Stocker
Gilts
-
Non -Layers
_
Beef Feeder
3ry i:-
Boars
Pullets
Beef Brood Cow
Turkeys
Ot ,�Turkey
Poults
-
MIR
Other
Other
„
_
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0-5-o- ❑ NA 0 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 O<lA ❑ 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 DlA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes VNo
N ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued