820224_routine_20230816

Division of Water Resources
Facility 1�lumber_ O Division of Soil and Water Conservation
-.®
O Other Agency
Type of visit: O Compliance Inspection O 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: • - '7 I Arrival Time: Departure Time: : o (� County: Sam
Farm Name: N m I TI V V U I I' I Owner Email:
Owner Name: Mr) -N_M Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: v vfl� U Title: T Phone:
Onsite Representative: 7 ' '
p � N I{', W Integrator: sm laiM
Certified Operator: 1 1n 1T, W Certification Number: 2� ®�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Design Current Design Current
Swine Capacity, Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Wean to Feeder I INon-Layer
Feeder to Finish -
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Design 'Current
Dry Poultry Canacity . Pnn_
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:
Cattle
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
0
❑ Yes 'Eg,No ❑ NA ❑ NE
0 Yes 'ELNo ❑ NA ❑ NE
❑ Yes Z].No ❑ NA ❑ NE
❑ Yes
�No
❑ NA
❑ NE
El Yes
RNo
❑ NA
❑ NE
❑ Yes
[)No
❑ NA
❑ NE
Page I of 3 5/I212020 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes •KNo ❑ 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): aT
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.) 9
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Q 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 en ironmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? es ❑ NA ❑NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes�No
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 0 Yes N No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes h 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
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.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Ca No
❑ NA
❑ NE
❑ Yes
C,No
❑ NA
❑ NE
❑ Yes
E�'No
❑ NA
❑ NE
❑ Yes
3No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes QNo
❑ 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 N No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes tkNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 511212020 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes M 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:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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:
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
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
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facilityto better explain situations (use additional pages as necessary).
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wvV 4 dQT �
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
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Date: A. 1( P-�_z
511212020