820733_Routine_20220825

015ivision of Water Resources
0 Division of Soil and Water Conservation
Q Other Agency
L�F•�ts���z
Lf e'9I ,122
Type of Visit: atroinpliance 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: : Arrival Time: /air Departure Time:
Farm Name:
Owner Name: W).75 j,"
Mailing Address:
Physical Address:
8rLi 1 c � Owner Email: la 3
Phone:
County:- Region: l V
Facility Contact: ss L1 Title:� G►�C Phone:
57P0/4/7--/e1
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop. _•;
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Poo
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Design Current
Wet Poultry Capacity Pop. Cattle
Layer
Non -Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
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 [ No ❑ NA ❑ NE
O Yes ❑ No ❑ NA ❑ NE
❑ Yes No El NA El NE
❑ Yes ❑ No 0 NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes o El NA El NE
Page 1 of 3
5/12/2020 Continued

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23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
22. Did the facility fail to install and maintain a rain gauge?
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Facility Number: -
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 ❑ 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:
❑ Yes 3 No ❑ NA ❑ NE
❑ Yes NA NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o ❑ NA
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 124o ❑ 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 To ❑ 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 Er< ❑ 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 do ❑ NA ❑ NE
❑ 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
❑ Yes
❑ Yes
❑ NE
❑ NE
No ❑ NA ❑ NE
Erv� ❑NA ❑NE
No ❑ 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).
j )1. 6cd'r ,/% y r-s �— ��'Q5% �-�- 7/5. �°
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
fornot
i<culAdq-crity
Phone: 902 --o3-0/37
Date:f%-
5/12/2020