820214_Routine_20210729

Facility Number
Division of Water Resources
0 Division of Soil and Water Conservation
0 Other Agency 11 t a.
Type of Visit: Q 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:
Farm Name:
Arrival Time:
Departure Time:
Owner Email:
Owner Name: L/i Q fret/-- Fa : Co"ipr--7 Phone:
Mailing Address:
Physical Address:
Facility Contact:
County: ' Region:
Title:
Phone:
Onsite Representative:
Certified Operator: <3 (p� D
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
7�1ft0
(,5D
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Design Current
Wet Poultry 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 ri Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ 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 0 No ❑ NA 0 NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes El No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ No ❑ NA ❑ NE
of the State other than from a discharge?
Yes`"No ❑ NA 0 NE
❑Yes ❑No ❑NA ❑NE
Page 1 of 3
5/12/2020 Continued

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
Structure 3 Structure 4
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 ❑ Yes 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
❑' Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ Yes
Structure 5
0 No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑'KIo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit'? fl Yes ❑rNo 0 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
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground fl Heavy
El No ❑ NA ❑ NE
❑ Yes FrNo ❑ NA ❑ NE
Metals (Cu, Zn, etc.)
❑ PAN ri 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): 2r/`n/tUI 6 v r -�
13. Soil Type(s):
)49 Folk / Ala
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? ❑ Yes
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check fl Yes
the appropriate box.
❑WUP ['Checklists ❑ Design ❑ Maps El Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ri Yes ❑-No ❑ NA 0 NE
fl Waste Application ❑ Weekly Freeboard fl Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections FT Monthly and 1" Rainfall Inspections fl Sludge Survey
1 ? Yes No NA NE
22. Did the facility fail to install and maintain a rare gauge? ❑ ❑ ❑ ❑
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes❑ No ❑ NA ❑ NE
Page 2 of 3 5/12/2020 Continued
❑ Yes ❑1 O ❑ NA ❑ NE
[ Yes No ❑ NA ❑ NE
n Yes ❑No ❑ NA ❑ NE
„-
La No
No
❑ NA
O NA
❑ NE
❑ NE
❑ NA ❑ NE
❑ NA ❑NE
❑ Yes
❑ Yes

Facility Number:- - ( ij
Date 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 I2To ❑ 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?
n Yes ❑ No ❑ NA ❑ NE
n Yes " o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0-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 facility fail to notify the Regional Office of emergency situations as required by the n Yes ®` No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?If yes, check the appropriate box below. nYcs 0 NA ❑NE
❑ 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?
Comments
Use drawiE
k/or any ad
onal pages''
n Yes E No ❑ NA ❑ NE
n Yes 'No ❑ NA ❑ NE
n Yes Er o ❑ NA ❑ NE
stiiome off 1-fS2e JrqE9NIN) �StN)e f'Jq1€s �>pral
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Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
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Phone:
Date:
7-/2 /5/
2/4/2015