800010_Inspection_20230517

Division of Water Resources
Facility Number ®- O Division of Soil and Water Conservation
O Other Agency
Type of Visit *Compliance Inspection 0 Operation Review O Structure Evaluation O'Technical Assistance
Reason for Visit O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
-19 • Z
Arrival Time: 12W
Departure Time: I $w
County: Qc" .
Farm Name:
V)Crgy„+
grp*ra ]76:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title: Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Wean to Feeder
I Nan -La yer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Other Turkey Pouets
Other
Diacharees and Stream house s
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 Sure other than from a discharge?
Region: M20
Design Current
Cattle Capacity Pop.
Darry Cow
Dairy Calf
Dairy Heifer
/b
1
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Bret Brood Co,
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes [—]No [:]NA [—]NE
[:]Yes
[:]No
[:]NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 51122020 Continued

Facill Number: I jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy minfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: Q,,a I I- PW4 3
SpillwayR: Yes cs OJD
Designed Freeboard (in): K V_ 1%
Observed Freeboard (in): 0 24-
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?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®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 q 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 ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Am there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No
❑ NA
❑FIE
❑ Excessive Pending ❑ 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): S`
Ire.,
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ®No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes K No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the iffigation design or wettable ❑ Yes [N No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is them a lack of properly operating waste application equipment?
❑ Yes
[4 No
❑ NA
❑ NE
Reauired 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
❑ Yes
® 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
Co No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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 minbreakers on irrigation equipment?
❑ Yes
❑ No
Lra-fNA
❑ NE
Page 2 of 3
511212020 Continued

[Facility Number: I jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
P No
the appropriate boxes) 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 noncompliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[3 No
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
© No
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
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
C@ No
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
®No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
DNA
ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
rymenta (refer to question 4): Explain any YES answers and/or any additional recommendations or any other comments.
(facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: T
Reviewer/Inspector Signature:
Page 3 of
Phone:
Date: 5'-P -73
51122021)