820337_structural evaluation_20230901

Date of Visit:
J
A rrival Time:
Departure Time: 0 County: �my
Farm Name:
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RKn `"j (,n
Owner Email:
Owner Name:
sh o m
mo n c I
Phone:
Mailing Address:
Physical Address:
h
Region: - \` 9
Facility Contact: C V
I (i M I w K
K
Title: -rhrl q,-",(,(!J- T
Phone:
OnsiteRepresentative:
Cllmt
Integrator:
31111Ififfe,14
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
I ifiuli
�kl �41i
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to FinishME
DairyHeifer
Farrow to Wean
D Cow I;
Farrow to Feeder
Non-Dairyr,
a Farrow to Finish
Layers
Beef StockerI'
Gilts
Non -Layers
Beef Feeder
is Boars
Pullets
Beef Brood Cow
:�uTu
Turkeys
�$ �'!
i
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)?
❑ Yes U No ❑ NA ❑ NE
❑ Yes"& No ❑ NA ❑ NE
❑ Yes &ZNo ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes JKNo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes L] No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes qNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 511212020 Continued

Facility Number: - Date of Inspection: j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes [—]No ❑ 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): L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [4 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 ® No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) ( 4
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 [—]No ❑ NA NE
maintenance or improvement? CR
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA N 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
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [:]No
❑ Waste Application El 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 ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes [—]No
❑ NA �NE
❑ NA NE
❑ NA C�NE
❑ NA ' NE
❑ NA NE
❑ NAPNE
NE
❑ NA
❑ NA NE
❑ Weather &dc
❑ Sludge Survey
❑ NA NNE
❑ NA [NNE
Page 2 o. f 3 511212020 Continued

Facility Number: Date 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 ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA 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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
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?
❑ NA �NE
❑ NA NE
❑ NA
❑ NA
❑ Yes ❑ No ❑ NA
❑ Yes ❑ No ❑ NA
❑ Yes ❑ No ❑ NA
❑ Yes ❑ No ❑ NA
NE
NE
N NE
NE
NE
NE
❑ Yes
[]No
❑ NA
'P NE
❑ Yes
❑ No
❑ NA
t�] NE
❑ Yes
❑ No
❑ NA
N NE
k-CM Rgbii-el a high free bong] on f�(�5ij27 affe p, a
n(Am c,l (�tOrr e,v on 5�te checw)(l on +he
Cat itvt> of Moon.
f,Oilbvv ywf- 5 d(jj Poft ft� IcigCoN :k:
Reviewer/Inspector Name: (M�o y�� `�/I �-}�n / Phone: '11j . 91F' . M�1
Reviewer/Inspector Signature: �. J U 1 � (.uf Date: I L L�
Page 3 of 3 511212020