420002_Compliance Evaluation Inspection_20200803

f i . "31
Facility Number -
lDivisiou of Water Resources
0 Division of soil and Water Conservation
0 Other Agency
Type of Visit: -o C w pliance Inspection } Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason Tar Visit: O Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: t , ey Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: -
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
Other
Phone:
Title:
Phone:
Integrator: %n S
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La cr
Non -La er
Pullets
Poults
Design Current
Discharges and Stream Impacts
I - 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)
Region:
Design Current
Cattle Capacity Popes
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes Na ❑ 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 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes r�o NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ No ❑ NA 0 NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: fj Date of Ins ection: 3- �
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes�No
N NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):f
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No 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 No ❑ 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 heat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes N 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes !o 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'A. irr4f f-� j
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes rNo
NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes eN
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [] Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, 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 N NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Trans r ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspectio ❑ Sludge Survey
22. Did the facility fail to instal[ 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: 'Z Date of Ins ection: a - 3 - 2r5
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z(�NoO
; NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes NA ❑ NE
the appropriate box(cs) 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes gNo,,ONA ❑ NE
e
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ 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
❑ No
❑ NA
❑ NE
I Eyes, 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
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tilt drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ 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 to better explain situations (use additional pages as necessary).
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Rev iewerrInspector Name:
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Reviewers Inspector Signature,
Page 3 of 3
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Date: _ _ � 3 A Q
21412015