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Type of Visit: 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:
7 tc 2a-
Arrival Time:
Farm Name: ?Age, fawn
n
Owner Name: Toni cage
Mailing Address:
Physical Address:
Facility Contact:
Departure Time:
Owner Email:
Phone:
County:
EORT&n: Pro
FICHE
JUL 21 2022
LEQ79yifdf Worms
r. rr. LL: REGPONA, OFFICE
Guirilc, haYw i cK Title:179,c f P.
Onsite Representative: Same
Phone:
Integrator: Cjl 1 1 i�il f I d
Certified Operator: Certification Number: 1 n`"Jdt
Back-up Operator:
Location of Farm:
Certification Number:
Latitude:
Longitude:
NO Con l R-Ci LE-
ND pigs
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tsa x.ti.4 ti v. ba'
1116:: 'Ta:11g
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
APO
;d
Layer
Non -Layer
Non -Layers
Pullets
Turkeys
Turke Poults
Other
Dairy Cow
Dairy Calf
Dairy He
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
e*:et n ur
CA NtOttYgg
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)
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 7 No ❑ NA ❑ NE
❑ Yes J No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3
5/12/2020 Continued
Facility Number: t r2 -
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?
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes
❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
No
I9
9)a
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?
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Structure 6
El Yes t,;IINo ❑NA ❑NE
''
❑ Yes Tx I No ❑ 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? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 Y/ I No ❑ NA ❑ NE
maintenance or improvement? 777CCC
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IP No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes if 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 Crop7��Windowo/}(❑''�� //Evidence doff Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): CDQ `.�i U Mum() 11 �4 U% l/v {I RN e
13. Soil Type(s): gQ2
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes itl No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? lt41 Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes `t'c' No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes 50� No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 7t' No ❑ NA ❑ NE
Required Records & Documents T`
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ['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 Tra sfers ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 2 of 3
❑ Yes
❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
5/12/2020 Continued
Facility Number:
-PG I
Date of Inspection:
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
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
El Yes XNo ❑NA ❑NE
❑Yes 1pNo ❑NA ❑NE
❑ Failure to develop a POA for sludge levels
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
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?
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:
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ' No ❑ NA ❑ NE
❑ Yes ] No ❑ NA ❑ NE
❑ Yes TJ No ❑ NA ❑ NE
❑ Yes EpNo ❑NA ❑NE
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?
barn burnt- no pigs
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Reviewer/Inspector Name:
<Qtt- e ftnWnvt
Reviewer/Inspector Signature: \ ,Qi tOMW "� Date: 1, ' I 2
Page 3 of 3 11
Phone: 9ii b* q1!G
5/12/2020