670084_Compliance Evaluation Inspection_20230629

- U Division'of Water Resources
Facility Number �1 �4 O Division of Soil and Water Conservation
O Other Agency
rype of visit: (D Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
[Zeason for Visit: @) Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current,
Swine,. Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish 2,�-kQ
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Discharges and Stream Impacts
Phone:
Title: Phone:
Integrator:
Certification Number:
Certification Number:
Latitude:
_'Design
Current
Poultry,
Capacity
• Pop.
Layer
Non -Layer
Design
Current
Dry Poultry
Canacitv
Pon:
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
Region:
44
".Design Current
Cattle• Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes
[6'_ ❑ NA
77
❑ 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
E5,KIC
❑ 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
D NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[TN_
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ N ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 _ 511212020 Continued

Facility Number: Date of Inspection: 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q "' 0 ❑ NA 0 NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E2-KA ❑ 'NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: k
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E 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 n No ❑ NA 0 NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalAhreat, 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 `T ❑ 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 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ffNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Ej No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �To ❑ NA ❑ NE
acres determination? T
17. Does the facility lack adequate acreage for land application? ❑ Yes �To ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes To ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ejef4o ❑ 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 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ZAD
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 511212020 Continued

Facility Number: (� - Date of Inspection: G 2 2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ 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 D<O ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NoEKA ❑ NE
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?
❑ Yes No ❑ NA ❑ NE
❑ Yes ,No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No D40A ❑ NE
❑ Yes
❑ Yes
❑ Yes
[No ❑ NA ❑ NE
❑ NA ❑ NE
W❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: —Ls' 2 3
511212020