820276_rountine_20201008

Facility Number
vision of Water Resources
Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit: a — Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: '
�L' a=-��;�; �i Arrival Time:
Farm Name: <, �� �. �,� T /,,,
y, r.,
_J
Departure Time:
Owner Name:mi• l,
f -
Mailing Address:
Physical Address:
Facility Contact:
/* =>'< *
Owner Email:
Phone:
County: Region: 17__ j-~\
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Design Current
Capacity Pop.
Wean to Finish
Wean to Feeder
E.eder
to Finish
-i9,c4``tr'
A,;()
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Curre
Poultry Capacity Pop.
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'?
Design Curre
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Q No 0 NA ❑ NE
❑ Yes ❑ No 0 NA ❑ NE
❑ Yes ❑ No ❑ NA 0 NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑o 0 NA 0 NE
0 Yes I 1No ❑ NA ❑ NE
Page 1 of 3
2/4/2015 Continued

Waste Collection & Treatment
Date of Inspection: ,f/-'
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
n Yes ❑''No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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 No ❑ NA ❑ NE
❑ Yes ❑ l\lo ❑ 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?
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?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes []'N�o ❑ NA ❑ NE
❑ Yes El -No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
n Yes r No ❑ NA ❑ NE
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): ,.A, 'malei
13. Soil Type(s):
h(11-2-7--
14. Do the receiving crops differ from those designated in the CAWMP? ❑ YesNo ❑ 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 n Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? El 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 0' No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑°`Yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps Lease Agreements ❑ Other:
❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis IT 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 Q 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
21. Does record keeping need improvement? If yes, check the appropriate box below.

Facility Number: - r 7 4,r
Date of Inspection: f t,-
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 ❑ 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:
❑ Yes
❑ Yes
Ito ❑NA ❑NE
El<o ❑NA ❑NE
26. Did the facility fail provide documentation of an actively certified operator in charge? 0 Yes "No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ago ❑ 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 10 ❑ 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 ❑ Yes IZINo 0 NA 0 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. ❑ Yes [J 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 IZI No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? lades ❑ No ❑ NA ❑ NE
an strop #): Explain anv `YES answer
i;s of facility to better explain situations (use additioi
ny additional recommendations a' any other comments.
Epages as necessary.;
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Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 2/D..31) 3
Date:
/69
2/4/2015