260003_ROUTINE_20240627

type of visit: p Uompliance Inspection V Operation Review U Structure Evaluation p Technical Assistance I
Reason 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: �� �� I V Owner Email:
Owner Name: � , n �I Ili �� MON Phone:
Mailing Address:
Physical Address:
C m Q O%IRegion:�
Facility Contact: i ( Title: (h Phone:
Onsite Representative: Integrator•
Certified Operator: Lou Pawn Certification Number:
Back-up Operator:
Location of Farm:
ter.
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Latitude:
Certification Number:
Longitude:
,sign Current °Design Current 3 Design Current
)acity Pop . Wet I?oultry g ;Capacity= Pops= , Cattle Capacity pop.
Ea
Layer
Non -Layer
Design ¢ Current
Q P' 'pd"Po
ouwp
Layers
Non -Layers
Pullets
Discharges and Stream Imuacts
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
s Turkeys
Turkey Poults x` _
Other -
e,
0
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
bb•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
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?
Pagel of 3 511212020 Continued

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Facility Number: - 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 Xj No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes nj 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 ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
[:]Yes 'gj No ❑ NA ❑ NE
❑ Yes tq No ❑ NA ❑ NE
❑ Yes & No ❑ NA ❑ NE
[:]Yes bo No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes : No ❑ NA ❑ NE
Reviewer/Inspector Signature: D'l A A ! (�v I Date: —
Page 3 of 3 511212020