780084_routine_20240306

Date of Visit: Arrival Time: f ` Departure Time: ( County:
Farm Name: pQ�f f arN Owner Email:
Owner Name: j V {" nj P" Phone:
Mailing Address:
Physical Address:
Facility Contact: ddveld moeoA Title: Phone:
Onsite Representative: Integrator:
Region:
Certified Operator: Certification Number: 18M
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design` °Cn`rrent
Design' Cur"77,rent Design Current
Swine Capacity<9 Pop.,
op
Wet Poultry
Capacity Pop Cattle Capael Pap
.
Wean to Finish'
Layer'
,
m
Dairy Cow
,
Wean to Feeder
°
Non -Layer
-
Dairy Calf
Feeder to Finish
E `°._
m'°�
.
Dairy Heifer
Farrow to Wean
-Design ",,Cu' rrent.", °
Dry Cow
Farrow to Feeder
D: ; Foultx, �°
'Ca aci' �.Pop;,Non-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Othex °
Turkey Poults
Otherx
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
_ o
❑ 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)
\deuce
❑ Yes
NA
NE
of a past discharge from any part of the operation?
❑ YesNo
kNo
❑ NA
❑NE
observable adverse impacts or potential adverse impacts to the waters
❑ Yeso
❑ NA
❑ NE
than from a discharge?
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 �Zo
o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes � ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a G
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 CY
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 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 Acce1pt,,a'bleCCrop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C,► V�1► bD 13. Soil Type(s): W` l = � `f I q 11 Y q� "'
v
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 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? ❑ Yes No ❑ 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 No ❑ NA ❑ NE
\20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
ioes record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
,te Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tr sfers ❑ Weather Code
\ll ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspection [:]Sludge Survey
facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
511212020 Continued

Facility Number: jDate 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 No
27. Did the facilityfail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
El Yes'. No
❑ NA ❑ NE
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?
-' 0 Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify theyRegional Office of emergency situations as required by the
❑ Yes '�o
❑ NA ❑ NE
permit? (i.e., discharge, freeboaM problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes o
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑\No
❑ NA ❑ NE
Commenis.(refer to=queshona #) Explain any YES answers: and/or any additional recommendations or any other"comet_ ents.
U'se drawings of % ility,to better explain situations (use additional pages as necessary).
fwA mW good
�X A SlvAge DAY-eAl b_qDj_Q de(
ver/Inspector Name: jKk�
ver/Inspector Signature:
\3 of 3
Phone:
Date: `,