820727_Inspection_20201124

Facility Number
o'bivision of Water Resources
0 Division of Soil and Water Conservation
0 Other Agency
F4i
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: �� • Arrival Time:
Departure Time:
Farm,Name: %f -7 f t t- .
Owner Name: Al
Mailing Address:
Physical Address:
Facility Contact: Fer,,uiic.(C
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Coun
2m-+r Region: Z)
Title:
% it Ceefil&
Latitude:
Phone:
Integrator: �f4r /�
Certification Number: l/tom
Certification Number:
Longitude:
/ -q5-3
Design Current
:Capacity =Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
yr1 1 9
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other -`
Other
Design Current
Wet Poultry a Capacity ° Pop.°
Layer
Non -Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Cattle,
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
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)?
d. Does the discharge bypass the waste management system? (If yes, 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?
❑ Yes [/]No D NA ❑NE
❑ Yes ❑No D NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑No ❑NA Li NE
No ❑ NA ❑ NE
124 ❑NA ❑NE
Page 1 of 3
2/4/2015 Continued

'Facility Number: 9,— - 7,2-- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
5
Structure 3 Structure 4
❑ Yes eo ❑ NA ❑ NE
❑ Yes ❑No NA El NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 04 ❑ 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 E1 o ❑ 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 [� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D'60 ❑ NA ❑ NE
El Excessive Ponding ❑ Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. El Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence /of Wind Drift ElApplication Outside of Approved Area
ryee(,Prit e'er / % I, /s2/ :: i, -
12. Crop Type(s):
13. Soil Type(s):
70-1
14. Do the receiving crops differfrom those designated in the CAWMP? ❑ Yes ❑ NA ❑ NE
1-5. Does the receiving crop and/or land application site need improvement? ❑ Yes 1To ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable El Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ElTo ❑ 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? El Yes 124o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Flo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists El Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [/] No ❑ NA ❑ NE
El Waste Application ❑ Weekly Freeboard El Waste Analysis ❑ Soil Analysis El Waste Transfers ❑ Weather Code
El Rainfall ❑ Stocking ❑ Crop Yield El 120 Minute Inspections El Monthly and 1" Rainfall Inspections El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 'No El 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 2/4/2015 Continued

Facility Number: V-
Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes Er< ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesNo ❑ 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?
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:
❑ Yes 0No ❑ NA ❑ NE
❑ Yes 12 o ❑ NA ❑ NE
❑ Yes iNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 12I1 o ❑ NA ❑ NE
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
❑ Yes
❑ Yes
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any otifer..comments.
Use drawings of facility fo=better explain situations (use additional pages as necessary).
.// (OG(f )_ i z ©
Reviewer/Inspector Name:
Phone: ,%v5v Q/,�
Reviewer/Inspector Signature: Date: , 7/7 • D
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