260019_routine_20231113

Division of Water Resources
Facility Number (ti - O Division of Soil and Water Conservation
p Other Agency
of Visit: Q Compliance Inspection Operation Review O Structure Evaluation p Technical Assistance
in for Visit: �) Routine Q Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ►I tj Arrival Time: Departure Time: County:
Farm Name: S Owner Email:
Owner Name: ka nm V u n ef- Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: I A 1 I', I J bI U9
Certified Operator: WOI J N W,
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Other
Title:
Latitude:
Phone:
Integrator: SEV-1rig me)+�dnw�
Certification Number: I V`0�3
Certification Number:
Design Current
Design Current
Capacity Pop.
Wet Poultry Capacity Pop.
La per
Non -Layer
Design Current
Dry Pmdtry Canaritv Pon_
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges 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
❑ 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
o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
ElYes
kNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yeso
❑ NA
❑ NE
of the State other than from a discharge?
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
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: N�
Designed Freeboard (in): 19
Observed Freeboard (in): *3(�_
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?
Structure 5
No ❑ NA ❑ NE
�No ❑ NA ❑ NE
Structure 6
❑ Yes '�No ❑ NA ❑ NE
❑ Yes C3,No ❑ 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? ❑ Yes JNo ❑ 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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
❑ Yes TI No
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 'J�:J'No ❑ NA
❑ 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.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
❑ Yes
❑ Yes
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes Vo
❑ NA
❑ NE
❑ Yes hNo
❑ NA
❑ NE
❑ Yes 't�LNo
❑ NA
❑ NE
❑Other._
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
�
❑ Waste Application ❑ Weekly Freeboard El Waste Analysis ❑Soil Analysis ❑Waste Transfers
❑ Rainfall [—]Stocking ❑ Crop Yield ❑ I20 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes QNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes [�NNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3
511212020 Continued

Date of inspection,
brate waste application equipment as required by the permit? ❑ Yes JNo ❑ NA ❑ NE
Pliance with permit conditions related to sludge? If yes, check ❑ Yes �lo ❑ NA ❑ NE
/9) below.
dlete annual sludge survey ❑ Failure to develop a PDA for sludge levels
font sludge levels in any lagoon
,ure(s) and date of first survey indicating non-compliance:
.tcility fail to provide documentation of an actively certified operator in charge?
,e facility fail to secure a phosphorus loss assessments (PLAT) certification?
Issues
Jid 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?
[:]Yes [3,No
[:]Yes [5,�o
❑NA ❑NE
❑NA ❑NE
❑ Yes ESINo ❑ NA ❑ NE
❑ Yes �tskNo ❑ NA ❑ NE
❑ Yes
`❑ No
❑ NA
❑ NE
[—]Yes
tkNo
[:]NA
❑ NE
❑ Yes
t3,No
❑ NA
❑ NE
❑ Yes
TS�No
❑ NA
❑ NE
❑ Yes
'r_Nj�o
❑ NA
❑ NE
Uomments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
"I( [I 1 Yr) v��j �Iuqo-e 211�2/I
11/1nm l o0d 000d ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: VILP - I I
Date: `� �� 2r�
511,212020