820262_Routine_20230718

type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
leason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 7Arrival Time: I J,T70 Departure Time: ,' County• l �— Region: i
Farm Name:TOwner Email:
Owner Name: Agj'-fiT,-L. T/- ot_4 Phone:
Mailing Address:
Physical Address:
Facility Contact: f j��5 Title: / Phone:
Onsite Representative: 5.��.,�-t_ Integrator:
Certified Operator: ,��� Certification Number:
0
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Il`esigri ' Current
Desagn +( urxent
Swine
Capacity Pmp
Wet,p6ultry, , Capacity Pop
; �.
Cattle Capacity a Pop
Wean to Finish
Layer'
�;
Dairy Cow"
Wean to Feeder
%
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current„
,
Dry Cow
Farrow to Feeder
Dry,Poultry:' °'Ca pacity P®"
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
JBeef Feeder
Boars
Pullets
jBeef Brood Cow
Turkeys
�°
Other
Turkey Poults
Other
Discharges and Stream Impacts
L'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?
❑ Yes �o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes
D<O
❑ NA
❑ NE
❑ Yes
<0
❑ NA
❑ NE
Page I of 3 511212020 Continued

Facility Number: - Date 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
ITV V
❑ 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
[�Jo
❑ 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?
- Ye'
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Elw
❑ 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. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑-N-b-_
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes . ' o ❑ 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) :G2l//
13. Soil Type(s): p AdZ'W j _
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
es
❑ 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?
❑ Yes
Ea No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�lo
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ado
❑ 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
Q'l o
❑ NA 0 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" 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 rainbreakers on irrigation equipment?
❑ Yes
0-15_o_�
❑ NA ❑ NE
Page 2 of 3 511212020 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Io
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
E3 1Vo
❑ 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
[]No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�10
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E3<o
❑ NA ❑ NE
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
/
E3-Ko
❑ NA ❑ NE
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
/
[3'No
❑ NA ❑ NE
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
[;]-110
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E] o
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes61<0'
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[]-T4o
❑ NA ❑ NE
(Comments (refer to question #}; Explain any YES answers�and/orAny additional recomniendations or any other comments.
Use draw ngs,of facility,,#o betteraexplain situations (use additional napes as-necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �/O �©lcJ f
Date:
511212020