670041_Compliance Evaluation Inspection_20210203

/J
Division of Water Resources
Facility Number - ® O Division of Soil and Water Conservation
O Other Agency
Type of Visit: ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Q Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: a SS Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: ��5 5 ` C. i..— Title:
Onsite Representative: �y �L %� Vl C l Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone: (l 10 3 Li © GkO -7
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
Dry Pnultry Canacity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
Design Current
Cattle 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?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
l NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑DNA
❑ 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
EJNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
<XNoo
❑ NE
3. Were there an observable adverse impacts or potential adverse impacts to the waters
Y P
❑ Yes
NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatments
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes E '40 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes , No ❑ NA ONE
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4 Structure 5 Structure 6
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 nNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental hfeat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesVNo,
❑ 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 0 Yes / ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes OXNo ❑ NA ❑ NE
i
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):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes'
EfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
l Yes
❑/No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
/ c
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ENo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNoo
❑ NA
❑ NE
the appropriate box.
❑ W JP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other: I ,
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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 Inspectio;No
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑rNA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No l ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate 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
es
❑ No ❑ NA
❑ NE
the appropriate box(es) below.
❑ Fajure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
-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
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No lA
❑ NE
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
If yes, contact a regional Air Quality representative immediately.
30. Did the facilityfail to notify the Regional Office of emergency situations as required by the ❑ Yes ` No ❑ NA ❑ NE
�' g
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 7 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes DIM ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes to ❑ NA ❑ NE
Comments (refer to question ft 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).
l0o — d.f_ �:..
b
r>
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
NCS-4uJ
\'rje_1
(qfo �7c)
Phone: C p
Date:
2/4 5115