670076_Compliance Evaluation Inspection_20220105

n Division of.WaterResources
Tacility Nttmbeir - n O Division of Sod'and WaterLCdnservatiou' .
., O Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: O 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: ` IL ���"� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: S V�`%v� Title:
o.
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone: q'1( O 3 S-i 2 5Ct 3
Integrator:
Certification Number:
Certification Number:
' liesign Current " 'Design : •Cukrenta
Swine . ".. Capacity A Top.'Wet Poultry Capacity Pop,
Wean to Finish
Wean to Feeder 0
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other ...
Layer
Non -Layer
Design a Current
Dry Poultry Canaeity- - -Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
A .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
Z No
0 NA
0 NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[�A
❑ 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
❑ Np
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Z N
❑ 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?
Page I of 3 511212020 Continued

Facility Number: (0-1- 6 1 jDate of Inspection: i
Waste Collection & Treatment
11
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No EP4-AEJNE
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?
E Yes
No ❑ NA
❑ NE
(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
o ❑ 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 environmenta
threat, 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?
❑ Yes
V.No ❑ 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 0 /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1 to ❑ 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
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes [3No ❑ NA ❑ NE
❑ Yes E� No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes EJ�❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Other:
❑ Yes EkNlo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Inspections
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 2 of 3
❑ Yes ❑ No
❑ Weather Code
❑ Sludge Survey
❑ NA VNE
E
❑ NA
511212020 Continued

Facility Number: Date of Inspection: 4 1,5 1 'L�L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ONE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ej'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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NoF:a-'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
❑ Yes
o
❑ 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.
❑ Yes
❑ No
❑ NA
E2--I�E
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0'-No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ZNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
&No
❑ NA
❑ NE
Reviewer/Inspector Signature:, Date:
Page 3 of 3 511212020