260025_routine_20230724

ivision of WaterResources
Facility Number - 0 Division of Soil and Water Conservation
0Otther Agency W `
Type of Visit: Q-eMpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q<outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: ;J�J—L'I��,t�G�'1ryt� Owner Email:
�T r�
Owner Name:i,(S� f ('�� f / C� pFj //I S Phone:
Mailing Address:
Physical Address:
Facility Contact: P22� Title:
Onsite Representative:
Certified Operator: 1-: ` :
Back-up Operator:
Location of Farm:
Design Current t
:.P aw ne k apaciry ,rop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Latitude:
Phone:
Integrator:
Certification Number: /M�
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
i)ry Pooltry Canaeity Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
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)
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?
Longitude:
Design Current
Cattle .. Capacity : ;T
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow 11
eef Stocker
eef Feeder
eef Brood Cow
❑ Yes [3110 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA,, ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
El No
❑ NA
❑ NE
❑ Yes
To
❑ NA
❑ NE
Page 1 of 3 511212020 Continued

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Facility Number: (o - Date of Inspection: —'
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ No Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 01G' ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ErNo ❑ NA ❑ NE
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?
❑ Yes
To
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ (o
❑ NA
❑ NE
❑ Yes
Io
❑ NA
❑ NE
❑ Yes 2-No
❑ Yes Q_Tq10'
❑ Yes EKO
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comrnenfs"(refer to question, Explain ,any YES'answers and/or:any additionaE 'ecommendations or any oti er eomments ' ;° >
Use drav*ings of facihty`;to better explain situations (use additional, pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 19�__5�D3 ` 61-5-7
Date:
511212020