090128_Routine_20240416

Facility Number = - 'LS
K) Division of Water Resources
O Division of Soil and Water Conservation
O Other Agency
Type of Visit: 9 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 12) Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: LI Arrival Time: C; ( Departure Time: County: en
Farm Name: ?`&�'� an m 1}-m Owner Email:
Owner Name: U Z MC Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Kew
Iv lj I�G 1 I t V VL I ,�
Certified Operator: some
Back-up Operator:
Location of Farm:
Swine
Title:
Latitude:
Phone:
Integrator: -ZIIP0 z�
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
1 i•
Design Current
Dry Poultry Canacitv Pon.
Layers
Non -Layers
Pullets
Turkeys
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?
Longitude:
Region: flu
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes y No ❑ NA ❑ NE
❑ Yes t4] No ❑ NA ❑ NF
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
[ ] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
01 No
❑ NA
❑ NF
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
t] No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 511212020 Continued

Facility Number: C1 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
�] No
❑ NA
❑ NE
Structure I 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
❑ 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
n No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
4 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?
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E] No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ I leavy 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 �j❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): V A 1112 A D
13. Soil Type(s): RVRll DC., oUfl-1 %&Qyo- ftirhunm
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes sal ] No ❑ NA ❑ NE
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 detennination?
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 ❑LeaseAgreements
❑ Yes P No ❑ NA ❑ NE
❑ Yes [Z] No ❑ NA ❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes � No
❑ NA
❑ NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes [� No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 2 of 3 511212020 Continued

Facili Number - J2
Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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
E]NA ❑NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
EQ No
❑ NA
❑ NE
El Yes
� No
❑ NA
❑ NE
❑ Yes )0 No ❑ NA ❑ NE
❑ Yes 14
No ❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
7K] No
❑ NA
❑ NE
❑ Yes
K] No
❑ NA
❑ NE
❑ Yes
Ej No
❑ NA
❑ NE
Reviewer/Inspector Signature: T\UOC&-V-- 71 l/)\4(4 ILM Date:
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