040003_Routine Inspection_20221025

Facility Number
Division of Water Resources
Q Division of Soil and Water Conservation
Q Other Agency
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: /' /,»/� j�` Arrival Time:
Farm Name: 7
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Departure Time:
Owner Email:
Phone:
;+bounty:
/6.).r;/) Region: lid
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
•
J'L6 L'
Title:
Latitude:
Integrator:
Phone:
Certification Number:
Certification Number:
Longitude:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -Layer
L'LJ
0
Design Curren
Dry Poultry Capacity Pap,
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) ❑ Yes ❑ No ❑ NA ❑ 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 ❑ NE
2. Is there evidence of a past discharge from any part of the operation? n Yes ❑ No ©DNA ❑ 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?
❑ Yes ❑ No laiCIA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Page 1 of 3
2/4/2015 Continued

Date of Inspection: E/Z,,2.��//
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? „j- Yes ❑ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site wl*1, are not properly addressed and/or managed through a ❑ Yes Eg.No ❑ NA ❑ NE
waste ffiuriagtc :' __ jiosure 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 ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? .ErYes ❑ No ❑ NA n 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 .❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No aNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. n Yes ❑ No ,F1 NA ❑ NE
❑ Excessive Ponding n 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 n Application Outside of Approved Area
12. Crop Type(s): '-6e
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? n Yes ❑ No - ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No _DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No _❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No [ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? n Yes ❑ No ❑ NA ❑ NE
Required Records & Documents
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 n Yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists in Design n Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. n Yes ❑ No -17/NA ❑ NE
Waste Application WeeklyFreeboard Waste Analysis Soil Analysis Waste Transfers Bather Code
❑ pp ❑ ❑ y I —I y� ' I -I
n Rainfall ❑ Stocking n Crop Yield n 120 Minute Inspections n Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No _E 1VA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No p=NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: C'` 1 a Date of Inspection: /a/,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No LINA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ..(NA ❑ 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 ❑ No 12-11\1A ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 2'lA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ► A ❑ 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 12'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 El No .❑"NA ❑ NE
0 Yes ❑ No NA ❑ NE
❑ Yes ' 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).
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Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
xike Sort)
Phone: CilG)
Date: 4/big /i;L
5/12/2020