820271_routine_20220411

Type of Visit: ____0lCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: icrRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time:
Departure Time:
Owner Email:
Phone:
County:
Region:
42€/
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Integrator:
Phone:
t f rg/
Certification Number:
Latitude:
Certification Number:
Longitude:
Design Current
Capacity Pop. Wet 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? ❑ Yes \No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes NNo ❑ NA 0 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 0 NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes alo ❑ 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?
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
0 Yes IN,No 0 NA ❑ NE
Page 1 of 3
5/12/2020 Continued

Date of Inspection: / / /,
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?
Structure 1 Structure 2
Identifier: :.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4
❑ Yes
❑ Yes
Structure 5
No El NA ❑NE
No ❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ 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
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
No ❑ NA ❑ NE
7. Do any of the structures need maintenance or improvement? ❑ Yes No 0 NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes NEI 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
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
❑ Yes
❑ Yes
❑ 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
❑NA ❑NE
No ❑ NA ❑ NE
❑NA El NE
❑ Outside of Acceptable Crop Window
12. Crop Type(s):
13. Soil Type(s):
❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
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 f] Maps ❑ Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Weekly Freeboard
Waste Analysis n Soil Analysis
❑ Rainfall ❑ Stocking n Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 2 of 3
❑ Yes m No ❑ NA ❑ NE
n Yes No ❑ NA ❑ NE
❑ Yes INo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yesq\\No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA [l NE
['Other:
❑ Yes No ❑ NA ❑ NE
❑ Waste Transfers ❑ Weather Code
❑ Sludge Survey
No ❑ NA ❑ NE
❑ Yes i No ❑ NA ❑ NE
5/12/2020 Continued

Facility Number: 'ems°".; - _-- 7 77
r
Date of Inspection:'//i 71:__
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
n Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
n Yes
❑ Yes
No ❑NA ❑NE
No ❑ NA ❑ NE
26. Did the facility fail to 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 ❑ Yes
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? n Yes
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
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [] Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? n Yes
❑ Yes 1E1 No ❑ NA ❑ NE
❑Yes IC No El NA ❑NE
9No El NA LINE
No ❑NA ❑NE
�No ❑NA El NE
No ❑NA ❑NE
No
�No
No
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ 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).
5i vdge due b/ «- 3/ .
lagoon ►ooKed -Ftn€
ccilibtation
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
/6Mtna- Date:
5/12/2020