630012_Routine_20230619

D►vision,bf Water Resources 4 a '
Facility Nurizber D►vision,of Soil and Water Conservation
....
Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 'V) Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 23 1 Arrival Time: 6"--� Departure Time: County: M 0 0 re Region: Cyr U
Farm Name: P-1 b b DN- Owner Email:
Owner Name: N 0 PU S i�s l N C Phone:
Mailing Address:
Physical Address:
Facility Contact: d l M®O r Title: Phone:
Onsite Representative: �i �� I '� Integrator: � 11 7
Certified Operator: '� Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design X rreht
._
-"
Resign Cur rent
Design ;Current ' �
sSwine _
Capacity;.` 6 Pop.
Wet Poultry:.,
Capacity Pop
Cattle L w
Caacltyri
Pop.
;
i
=.
nCow
Wean to Finish
Layer
Dairy
Wean to Feeder
Layer
=
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
. ° "' '
' . Design tit nt
Dry Cow
Farrow to Feeder
Dry Poultry"
Capacity Pop.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
I
113oars
Pullets;-
Beef Brood Cow''s'
Turkeys
`
Other9
Turkey Poultsa
z
e
Other
'
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ 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 [Nj 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)
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
❑ Yes No ❑ NA 0 NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
511212020 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:],Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
n
c�
Structure 2 Structure 3 Structure 4 Structure 5
INo ❑ NA ❑ NE
No ❑ NA ❑ NE
Structure 6
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 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?
❑ Yes tj,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 JSLNo ❑ 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 1� 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): feq C,U � �-/
� ' ! "11
13. Soil Type(s): f l ..."F .( ` njee
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 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?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes t],.'No
❑ Yes ❑ No
❑ Yes No
❑' Yes E�No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 'k] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tran fers
❑ 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 kNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � No
Page 2 of 3
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA NEd
❑ NA
5112120

e9upment -Z�
as required by the
permit?
ili outofcompll'atlCe WI��1�1C��1%l`CD��ltldllsl�'%�6C�ev��, 1,,,.a, .
s the fac ty
the appropriate boxes) below.
❑ Failure to complete annual sludge survey [7 ailure to develop a POA fof sludge levels
Qua -compliant sludge levels in any lagoon
List stcnc�l-ks0 and date of first survey indicating non-compliance:
26. Did the facility fail to provide aocumentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
29. 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 Reviewerlinspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow up visit by the same agency?
vo vfg
mgoon IN 9004
0
Reviewer/Inspector
Gorld ICI' D 1V
DYes D No
DYes
4 No
DNA D,
01VA D N�
Yes D No [] NA , NE
Yes q No ❑ NA NE
Yes 6 No NA [] NE
❑ Yes IN No 0 NA 0NE
0 Yes N No 0 NA 0 NE
Yes [),;No NA ONE
0 Yes
1� No
❑ NA
F-1 NE
El Yes
No
❑ NA
[] NE
Yes
No
Ej NA
M NE
CAllbtai�oN �-I'i2'�
uua st-e ; 3 20.23
01 V
91Ud9-e, -'�-i.2:.
P.aiN t-g l l free
Phone
Signature: v 1u I ry" j U-/ I Date: