110010_Inspection_20201217

4P Division of Water Resources
Facility Number l e l - ® O Division of So➢ and Water Conservation
O Other Agency
aluatio
Type of Visit: Compliance Inspection Operation Review O Structure Evn Q Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
\`
Arrival Time: p//:,,oIIO Departure Time: 1 OQ. County: REtppatLlQgRegion: / 114 /
(eu IQ W S � /V\ Owner Email: t:Lf &j IVIS ( W � (cl b/�.¢.. �('
d3I�P�n ✓i(,♦,J Phone: �L- -t9� 340 S�
o I I l m✓ Cve� aj L P 'cp s7 e 2 0c•. 9'B7 YB
/I
Facility Contact: AkA V ki v� W7 Title:
Onsite Representative: A p ✓ie, as
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone: �Z(j •tY7J3 " �t0 5
Integrator: rt'w', �tl
Certification Number: /TBW��a'-'
Certification Number:
Lungitude:
y T (e�-
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3 y
ptfzl P 4q. Pe
0
1 �- okd 6') ((sv Cretifc yL c
f2/�9� CeasnrL e �, ra A (c
Design Current Design
Current
Design Current
Swine
Capacity Pop. Wet Poultry Capacity
Pop. Cattle
Capacity Pop.
Wean to Finish
Layer
Wean to Feeder
Non -La er
Feeder to Finish
Farrow to Wean
Design
Current
Farrow to Feeder
Dr Poultr Capacity,Po
.
Farrow to Finish
Lz era
Gilts
Non -Layers
_
Boars
_
_
Pullets
_
Turke s
Other
'nuke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part ofthe 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 D WR)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (Ifyes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of3
Dairy Cow
Dairy Calf
Dairy Heifer
D Caw
on -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
_
❑ Yes ❑ No Eg�NA ❑ NE
❑ Yea
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ Na
[4 NA
❑ NE
❑ Yes
❑ Na
CgNA
❑ NE
2/42015 Continuer!

Facili Number: I IDate of Inspection: ZWV
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
KNo
FZNA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
6 NA
❑ NE
Structure 1 Shmeture 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier.
Spillway?: yJ`.es¢
Designed Freeboard (in): o. (f
Observed Freeboard (in): sa it
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZNo
❑ 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
F�r 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 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
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
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
4No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10%or 10 Us. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area / )l.�
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CANo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
U No
NA -
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E4 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
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
&f No
❑ NA
❑ NE
the appropriate box.
❑WDP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
g No
❑ 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
1� No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IY1J No
❑ NA
❑ NE
Page 2of3
21412015 Continued

Facili Number: d jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes IJ I No
the appropriate box(es) below. "1A
❑ 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 MNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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?
❑ Yes I)K No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
rU1 No
LIQk
❑ NA
❑ NE
❑ Yes
Li el Na
❑ NA
❑ NE
❑ Yes
[No
❑ NA
❑ NE
❑ Yes
rU No
❑ NA
❑ NE
❑ Yes
[No
❑ NA
❑ NE
❑ Yes
[VNo
❑ NA
❑ NE
❑ Yes
[$No
❑ NA
❑ NE
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Reviewer/Inspector Name: '<_ �X Phone:
Reviewer/Inspector Signature: /— Date: r /7 1 7-0
Page 3 of 3 21412015