670066_Compliance Evaluation Inspection_20220106

40) Division of Water,Resources
Fa_ cility'Nuinber . ®` - 1 GG O Division �of'Soil and Water Conservations .-
0 Other'Ageney
Cype of Visit: ® Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
treason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: '' County:
Farm Name: \/ �(/� �� d'+^-� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
r V-ti �- A-"--c) 'J Title:
Phone:
Integrator:
Region:
Phone: %3 3 Z A 3 O zz
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
�Des�gn � Current, � Desigin Current ` � � `Design Current-
Capacity- 'Pop.: WefPoultry Capacity Pop: ` °° Cattle ;. Capaacity Pop.`
Wean to Finish
Wean to Feeder
Feeder to Finish
®
0
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
'Other
Layer
Non -Layer
Design' Curie' ntr
Drv' Poultry Canacity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
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
A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
ETA
❑ 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
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ YesgNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 511212020 Continued

Facility Number: jDate of Inspection: Z�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
❑ Yes
No ❑ NA
❑ No [�NA
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): )
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes❑'�io ❑ NA
(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 No ❑ NA
waste management or closure plan?
❑ NE
❑ NE
❑ NE
❑ 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? . [:]Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ❑.3qO ❑ 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 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ffNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes o ❑ 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?
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?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps [:]Lease Agreements
❑ Yes
_0 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[/No ,.
❑ NA
❑ NE
/
❑ Yes
Q
❑ NA
❑ NE
❑ Yes
[ ] No
❑ NA
❑ NE
❑ Yes
, No
❑ NA
❑ NE
❑ Yes
©'No
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ 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 Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA YNE
Page 2 of 3 511212020 Continued

Facility Number: - >ty jDate of Inspection: f "j Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [—]No
❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes6,-No ❑ 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 to provide documentation of an actively certified operator in charge? ❑ Yes D o r-NAA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes oo 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 [ a o ❑ 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
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 [ To ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA rE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
©No - ❑ NA ❑ NE
�zo ❑ NA ❑ NE
IComments (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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
54212020