820502_routine_20230523

Q.F ivision of Water Resources
Facility Nuzatber q ;� - O Division of Soil and Water Conservation '
0 Other Agency �
Type of Visit: 01tompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: O"Ifo-utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; ` (7 Departure Time: County: Region:
Farm Name: Imo. Owner Email:
Owner Name: _7 7�R 14 Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: V0
Back-up Operator:
Location of Farm:
Design.°_ Current
Swine .Capacity" Pop.'
Wean to Finish
Wean to Feeder
Feeder to Finish ,
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other d°
Latitude:
Phone:
( S 'PAd yj c;k Title:
Integrator:
Certification Number: / 00 719 fQ a
Certification Number:
Design
Current
We't Pouttry
Capacity
Pop."
Layer
Non -Layer
`
Design
Current
Dry Poultry
Capacity
Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
,Design Current_,
Cattle -",a 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?
❑ Yes
EfNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
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?
❑ Yes
Q'l-o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
0 NE
of the State other than from a discharge?
Page I of 3 511212020 Continued

Facility Number: - D jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ to
❑ 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
C; o
❑ 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 or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
E]I<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
QXo
❑ 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
�To
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are 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 Eo ❑ 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)` Gl �u— �� ✓t/� = a+
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
e o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need. improvement?
❑ Yes
❑no
❑ NA
❑ NE
16. bid the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
C2'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
1:31�o
❑ 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 ED No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ o ❑ 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 ❑-10
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [2-No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E3'No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 511212020 Continued

Facility Number: - D;2— 1 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 D-N-o
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑'F!c
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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?
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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes E2-No ❑ NA ❑ NE
❑ Yes ❑'�Vo ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes ETI�o ❑ NA ❑ NE
❑ Yes E3-No
❑ Yes �o
❑ Yes ❑ado
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:j
511212020