820150_Compliance Inspection Routine_20210623

Facility Number
SO
Division of Water Resources
0 Division of Soil and Water Conservation
0 Other Agency
Kf NM; co a5
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name: 7---(5-5
Owner Name:
Mailing Address:
Physical Address:
Arrival Time:
ROO
Departure Time:
q:
Owner Email:
Phone:
County:Region:
Facility Contact: a�r�tz��
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title: 7a�� Phone:
Latitude:
Integrator: Z- 7-
Certification Number: / 5 - 2 0
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
zrq
Farrow to Finish
Gilts
Boars
Other
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Layer
Dry Poultr
Design Current
Capacity Pon.
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: ri 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) [1 Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA fl NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters 0 Yes IV No ❑ NA f NE
of the State other than from a discharge?
n Yes
❑NA ❑NE
n Yes
❑ Yes
No ❑NA NE
No ❑NA ❑NE
Page 1 of 3
5/12/2020 Continued

Facility Number: - /, 5? )
Waste Collection & Treatment
Date of Inspection: CO • a�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than
a. If yes, is waste level into the structural freeboard?
Identifier:
Spillway?:
Designed Freeboard (in):
adequate?
❑ Yes jJ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
p5o
N
19
Observed Freeboard (in): ap
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
❑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 threat, notify DWR
7. Do any of the structures need maintenance or improvement?
tyre a.irea,s
8. Do any of the structures lack adequate markers as required by the permit?
(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
maintenance or improvement? fttl
-OSWaste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
Yes ❑ No
❑ Yes No
❑ NA
❑ NA
❑ NE
❑ NE
. Yes ❑ No ❑ NA ❑ NE
❑ Yes XI No ❑ NA ❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E87r1 No ❑ NA ❑ NE
❑ Excessive Ponding El 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
El Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): -/`mot cAd &
13. Soil Type(s): /�p2 / a
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 No ❑ 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 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes RNo
❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes t No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yest-t]No ❑ 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 No ❑ NA ❑ NE
['Waste Application ❑ Weekly Freeboard El Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ 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 rEj No ❑ 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:
L Y0
Date of Inspection: (p.a'2 • a
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
❑ Failure to complete annual sludge survey
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ Yes N No ElNA ❑ NE
❑ Yes IN No ❑ NA ❑ NE
❑ Failure to develop a POA for sludge levels
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:
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
❑ Yes
❑ Yes
❑ Yes
El Yes
El Yes
❑ Yes
P'N1 No
] No
El No
N No
No
Esi No
No
Et No
❑ NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
El NA ❑NE
❑ NA ❑NE
❑ NA ❑NE
❑ NA ❑NE
❑ 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).
recotd S viewed o Ff site.
farm vS2S Sold G-el-
sOkk f\tictic tooK (ool.on fiend ftel4 C w-eg Betmvda
bare qre; on bad of imbon, mbgt
bet l sh4d ded out .
from
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�2 fonnOf
(LK i)r-tuo-t-
Phone:
Date: (p' 22.
2/4/2015