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Factltt 1 umbber �/& 0 Drnsmu of Soil and Water Conservation
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Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 7 7,—Arrival Time: /4'-5- Departure Time: / 2'./0 County: -r-..-%- Region: f (D
Farm Name: — p-'277 Owner Email:
Owner Name: ///f Gg(,-( 7-5 -i-I/mt<- - Phone:
Mailing Address:
Physical Address:
FacilityContact: r,� ��„��� , Title: Q�gin Phone:
Onsite Representative: _.:'1c Integrator: 4,32/F .r6�PJ`
Certified Operator: Jd.— Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current 4 Design Current �g Design Current
Swme Capacity Pop Wet Poultry Capacity Pope' Cattle ` �gCaaci P
L
i
Wean to Finish Layer Dairy Cow
1* Wean to Feeder �lfpa ,27,j Non Layer Dairy Calf
-f. Feeder to Finish [ Dairy Heifer
Farrow to WeanDesign Current Dry Cow
Farrow to Feeder ;, Dn Ponitr Ca sad Poi" __Non-Dairy
Farrow to Finish '''''NEE �� a Beef Stocker
Gilts a •Non-La ers Beef Feeder
Boars •Pullets Beef Brood Cow
EallM' < - s'-a-as -�
Other 'a : Vile'' , •Turke Poults
Other .Other -- ?. ,,j $
Discharges and Stream Impacts
1.Is any discharge observed from any part of the operation? ❑ Yes ®'No • ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ 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 ❑ NA ❑ NE
2.Is there evidence of a past discharge from any part of the operation? ❑ Yes [✓]�No ❑ NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes <o ❑ NA ❑ NE
of the State other than from a discharge?
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4:7
Facility Number: - Date of Inspection: 7--a-0
,710
Waste Collection&Treatment
4.Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? ❑ Yes 6 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): �Q
Observed Freeboard(in): 3 4
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q 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 lallo ❑ 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? s ❑ No ❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ J'1c ❑ 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 io ❑ 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):
13. Soil Type(s): 6 0ff/M2!!
14.Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15.Does the receiving crop and/or land application site need improvement? ❑ Yes [-11 ❑ NA ❑ NE
16.Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17.Does the facility lack adequate acreage for land application? ❑ Yes Q-11-6--- ❑ NA ❑ NE
18.Is there a lack of properly operating waste application equipment? ❑ Yes 0 ❑ NA ❑ NE
Required Records&Documents
19.Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes E< ❑ NA ❑ NE
20.Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes Erg.c .
❑ 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 lEr< ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑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 No ❑ NA ❑ NE
23.If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes I2 1VO ❑ NA ❑ NE
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Facility Number: © p_ Date of Inspection:
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 �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 1210 ❑ NA ❑ NE
27.Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28.Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 10 ❑ 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 2 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 lageg ❑ 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 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 E No ❑ NA ❑ NE
33.Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes Arlo 0 NA ❑ NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes Er< ❑ 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).
Reviewer/Inspector Name: .S/ et"-e_ Phone: i71,
Reviewer/Inspector Signature: Date: ‘7`�7-7:59'4
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