430020_routine_20231006

Facility No. Time in (
---- Time Out 1�� I . Date ()
Farm Name_711iniearatw.
Owner I 1 C Site ss:
eNo
rator �
r'sack-up No.
aC� Circle: Genera or NPDES
Wean — Feed
Wean— Finish
Feed Finish
Farrow —.Wean
FREEBOARD: Design 19 16 lit 6 ✓ .
Observed 2 J
Crop Yield
Rain Gaug//e J
11
1 QI 1 VYY - rC
Farrow — Fir
Gilts / Boars
Sludge Survey q 2t'p
Calibration/GPM 904 � p�
Waste Transfers NO cans -ep,
Rain Breaker
Soil Test ' ut-r '
T Wettable Acrds PLAT
Weekly Freeboard �� Daily Rainfall ' 1-in .Inspections s
Spray/Freeboard Drop
Weather Codes I �-� I 120 min Inspections
Waste Analysis:
Date Nitrogen (N) Date Nitrogen (N)
Zh
Iza
fro. 4 a_m, �r �

Division of Water Resources-
Fa6i umbe
t3' N r� � Division of Soil andYWater;Couservation
0 "Others -Agency
Iype of Visit: P Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
season for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: I J(),S6 County: �� ��+ Region:o
Farm Name: �- �Y - Owner Email:
Owner Name: (�iy`' I ul�I I I Cj IC
I V Phone:
Mailing Address:
Physical Address: I
Facility Contact: , W� I �y� p 1 LG Lo I �m
' � Title: Phone:
OnsiteRepresentative: MR_ Integrator• ff'm fl
Certified Operator: L 1 d n 1, `1 ti `7 Certification Number: i M q
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
"
Design Current
Al
Design
Current
Design Current
Swine
Capacity
"""Pop
Wet Poultry
Capacity
Pop
Cattle CapacttyI'op
m
_~,
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
cloo
Dairy Heifer
)(
Farrow to Wean
_
p 2
Design
Current
n
Dry Cow
Farrow to Feeder
Dry Poultry
, : Capaci
Pop
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other P_
Turkey Poults
Other
k
n
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?
Page 1 of 3
❑ Yes IxNo ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
[:]No
kNA
❑ NE
[:]Yes
[:]No
NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
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 ly 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): �-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
'y
❑ 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 �j 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)
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?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 0 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): Cb V 910
13. Soil Type(s): WOOL/
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes E 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 No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tran fers ❑ 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 4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes qNo ❑ NA ❑ NE
Page 2 of 3 511212020 Continued

Facility Number: I 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 ti No
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 LJ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes "q 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 ❑ NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes [!q No ❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
[:]Yes �iNo ❑ NA ❑ NE
V
mments (refer to qu,stion #) w ftplain any YES anjsevers and/or any additions%recommendations or,any other comments.
e`draw,in s`'of facihty='ro betterexplaiasituations (use additional eases as necessarv).
SPtay f'MS w-erp- just
cave r seed d9 n maty.s in
CUf 3 bq i Ied fol-
tne
ho y -rhe N ► S
Reviewer/Inspector Name: �� Q, �b n" of Phone:
Reviewer/Inspector Signature: a0u.) IMeD (Lt.
Date: W
Page 3 of 3 511212020