780092_Follow Up_20230925

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Reason for Visit: 0 Routine Complaint 16 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Gj 5 Arrival Time: C` Departure Time: O(° County:
Farm Name: � M Owner Email:
Owner Name: ffflffiu�2 i .ON Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone: r_
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:
Design Curren
Design :Cur°renf
Designurrent,N`
Swine Capacity,' ° Pap
Wet Poultry
n
'Capacity ' Pop
Cattle Capacity .-Pop.
a
-F
�.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
4Dairy
Heifer
Farrow to Wean
A
Design Current
Dry Cow
Farrow to Feeder
4 Dry Poultry
Capacit ,.' Pop.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other, 4�'
Turkey Pouets
Other
A= in
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA hl I NE
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)
❑ Yes
❑ No
❑ NA NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
❑ NA NE
of the State other than from a discharge?
Page 1 of 3 511212020 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
IN No ❑ NA ❑ NE
No ❑ NA ❑ NE
Structure 6
Yes ❑ No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
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? A
Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) /l�
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 'A
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 [:]No ❑ NA l 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? ❑ Yes ❑ No
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [:]No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes ❑ No
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ 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 ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
Page 2 of 3
❑ NA %NENA
❑ NA
❑ NA NE
❑ NA NE
❑ NA �q NE
❑ NA ❑\ E
❑ NA jg NE
❑ Weather C de
❑ Sludge Sur ey
❑ NA ❑�tE
❑ NA NINE
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 ❑ 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 Q No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �i I 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 XNE
❑ NA )� NE
DNA ONE
❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes '] No ❑ NA ❑ NE
❑ Yes I \I No ❑ NA ❑ NE
❑ Yes �V No ❑ NA ❑ NE
❑ Yes �No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
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Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
W1,11
Phone: q I qjI y
Date:
511212020