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Division of Water Resources 61 MS S. L+ .Facility Number O Division of Soil and Water Conservation . O' Other Agency Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access Date of Visit: Arrival Time: Departure Time: County: Farm Name: kmakd 2"kPfScrn arm 4z Owner Email: Owner Name: R[r(lui Ca we1(sm Phone: Mailing Address: Physical Address: Region: t__F10 Facility Contact: Ronald Fhye rsm Title: ()I j),r p - Phone: Onsite Representative: Sa Integrator: �{P�VLa Q1P.� Certified Operator: so%mz Certification Number: Back-up Operator: Location of Farm: Latitude: Certification Number: Longitude: Design Current Design Current Swine Capacity Pop. Wet'Pooltry Capacity Pop. Cattle, Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Boars Other Layer Non -Layer Design Current Dry Poultry Canacitv Pon. Layers Non -Layers Pullets Turkeys Turkey Poults Other Discharees 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? Page I of 3 Design Current Capacity Pop. Dairy Cow Dairy Calf Dairy Heifer Dry Cow Non -Dairy Beef Stocker Beef Feeder Beef Brood Cow ❑ Yes EQ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes 0 No ❑ NA ❑ NE ❑ Yes N No ❑ NA r \� S/1212020 Facility Number: - Date of Inspection: Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes K] 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? ❑ Yes No ❑ 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 No ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health o mental 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 CaNo ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes N No ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes N 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 Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): &K MU d % oyey 5e1' CA 13. Soil Type(s): Au'{,Ol u I j z 1— �, wok 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ 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 N No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [n No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes N 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. 0 Yes NLNo ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code ❑ Rainfall 0 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? ❑ Yes No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE Page 2 of 3 511212020 Continued /1"- Facility Number: jDate of inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ 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: 6 Iy 26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®No ❑ 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 EQ 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? ❑ Yes ® No ❑ NA ❑ NE Co ntnents (refereto qutestion #}t Explain, any YES.answers and/or any additional'recommendatians br ;ahy atli r comments Use diraw ngs of facility toc,betterexplain situations (use additional pitgees as necessary)- N©k, "rite_ anaig5�5 neect AD be lad &At wovvl ov\ boye areas M 1ac�i� {-arrn chid add top �0 0 Reviewer/Inspector Name: Phone: Reviewer/Inspector Signature: Date: Page 3 of 3 511212020