820491_Routine_20220519

Facility Number
0 Division of Water Resources
0 Division of Soil and Water Conservation
0 Other Agency
rims
Type of Visit: 0 Compliance Inspection 0
Reason for Visit: 0 Routine 0 Complaint
Operation Review 0 Structure Evaluation 0 Technical Assistance
0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
9`
Ar
rival
c''k to2
Evan \Qt1Ng
Mailing Address:
Physical Address:
Facility Contact:
Departure Time:
Owner Email:
Phone:
County:
Region:
ENTERED TO
LASERFICHE
MAY 2 9 2022
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
DEQ/DWR WQROS
Title: FAYEgff j LE REGIONAL OFFICE
(rrQ
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Wet Poultry
Design Current
Capacity Pop.
Layer
Non -Layer
Dry Poultry
Design Current
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 ❑ 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?
❑ Yes
❑ NA ❑ NE
❑ Yes
❑ Yes
No ❑ NA ❑ NE
NA ❑NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Page 1 of 3
5/12/2020 Continued

Facility Number:
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 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
39)
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?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
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
❑ 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): (MIA) �1\)4V'ij\
❑ Yes
❑ Yes
Structure 5
No ❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
13. Soil Type(s): Nt\t(*
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.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA 0 NE
or environmental threat, notify DWR
❑ Yes � No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
['Other:
No ❑ NA
No ❑ NA
No ❑ NA
'yNo ❑NA
No ❑NA
No ❑ NA
No ❑ NA
❑ NA ❑ NE
No ❑ NA ❑ NE
❑ NA ❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ Yes
❑ Waste Trar
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 2 of 3
❑ Yes
❑ Yes
No ❑ NA ❑ NE
fers ❑ Weather Code
❑ Sludge Survey
No El NA ❑NE
No ❑NA ❑NE
5/12/2020 Continued

Facility Number:
Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes R.,No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes quNo ElNA ❑ 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 ta No ❑ NA D NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ YesNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 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 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. ❑ Yes \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 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? El Yes o ❑ NA ❑ 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).
CN\# OV)Gp off fl),/(1C
-MI6'
Reviewer/Inspector Name: \?JJ1t
Reviewer/Inspector Signature:
Phone:
Date:
Page 3 of 3 5/12/2020