550001_Compliance Evaluation Inspection_20200316

acil#y`Number
5
Division of Water Resources
O Division of Soil and Water Conservation
O Other'Agency
Type of Visit: @'Com s liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: C: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ? -(‘-
Farm Name:
Owner Name:
Arrival Time:
r0o0
Departure Time:
Mailing Address:
Physical Address:
Facility Contact:
120
Owner Email:
Phone:
County: Region:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
/ 1 r
Title: Phone:
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
Other
Design Current
Wet Poultry Capacity Pop. Cattle
Layer
Non -Layer
Design Current
Dry Poultry Capacity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design- Current
Capacityy Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
'too
.2_
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 iNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA D NE
❑ Yes ❑No NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes lErNo ❑ NA ❑ NE
❑ Yes /"No ❑NA ❑NE ,
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2/4/2015 Continued

Facility Number: f-S-
Date of Inspection: 3 - ((2, -Zo2O
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 to ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA D NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
3�'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes eNo ❑ 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 11No ❑ 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 environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 11rNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA El 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 [1 'No El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No El 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? ❑ Yes MiNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? El Yes [YNo ❑ NA ❑ NE
-16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ No ❑ NA El NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes 10 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? El Yes [L]rNo El NA El NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? El Yes IIKTo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes IEKlo El NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements El Other:
❑ Yes J j No El NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
El Waste Application ❑ Weekly Freeboard El Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
D Rainfall El Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections El 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?
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❑ Yes 131V O ❑ NA ❑ NE
❑ Yes El No El NA
NE
2/4/2015 Continued

Facility Number: j S - /
Date of Inspection: 3 -
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 'No ❑ NA 0 NE
▪ Yes El No [ NA ❑NE
26. Did the facility fail provide documentation of an actively certified operator in charge? 0 Yes Ei<lo 0 NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No IIKIA 0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [114�lo ❑ 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 al 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 �NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes IRio ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? 0 Yes [I/No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA 0 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).
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Reviewer/Inspector Name: Mr r cl' l 1 ' (e_l (`-p ez'
Reviewer/Inspector Signature:
Phone:
Date:
764'_23s 2/6 3
3,/C-2p2O
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2/4/2015