960161_Inspection_20200819

W Division of Water Resources
Facility Number - O Division of Soil and Water Conservation
0 Other Agency *� _
(Type of Visit: i♦ Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance'����
Reason for Visit: • Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Acce
Date of Visit: Arrival Time: ; Q Departure Time:�� County:
Farm Name: — �%l i' _110'� Ale Owner Email:
Owner Name: Phone:
Mailing Address: /a /��i C f KYz2 �
Physical Address:
Facility Contact:
Title:
Onsite Representative: C-ee Ji.r�C•� rc
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Latitude:
Phone:
Region: tea/
Integrator: PdL
lop -
Certification Number: C7r 'y C� 1-2--
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La cr
? �)I INon-Layer I ]EI
Wean to Finish
Wean to Feeder
1e
Other
Other
Design Current
Dry Poultry Canacitv Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharaes and Stream Imaacts
1. 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)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes E] No
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NI?
❑NA ❑NI
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ Nl�:
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes :No
� o ❑ NA ❑ N I:
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ N I:
of the State other than from a discharge?
Page 1 of 3 21412015 Continued
Discharaes and Stream Imaacts
1. 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)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes E] No
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NI?
❑NA ❑NI
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ Nl�:
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes :No
� o ❑ NA ❑ N I:
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ N I:
of the State other than from a discharge?
Page 1 of 3 21412015 Continued
❑ Yes E] No
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NI?
❑NA ❑NI
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ Nl�:
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes :No
� o ❑ NA ❑ N I:
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ N I:
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: jDate of Inspection:
WWaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 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):
Observed Freeboard (in): 9!
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes U No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen al threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA 0 NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ;No ❑ NA ❑ NF,
(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 Aaalication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NF,
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ON o ❑ NA ❑ N F:
❑ 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): 4C4 1Lp'- _ e
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes [f No ❑ NA ❑ NE
❑ Yes iNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes TNo
o ❑ NA ❑ NE
❑Yes ❑ NA ❑ NE
❑ Other:
❑ Yes dNo ❑ NA ❑ NE
❑ 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 o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ Weather Code
❑ S i udge Survey,
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - / Date of inspection: —
424. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes F o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 7NNo ❑ 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 [No ❑ 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?
ise additional, pages as necessary).
7- /9- i9 = /. #�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[:]Yes [�No ❑ NA ❑ NE
❑ Yes E1 No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
[:]Yes O�No ❑ NA ❑ NE
[:]Yes [7 o ❑ NA ❑ NE
❑ Yes o o ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
Phone: d!-a _ 97S e.
Date: .
/4/2015