260021_Routine Inspection_20240715

for Visit: 4"Routine O
Referral O Emergency O Other O Denied Access
Date of Visit: 7 7s� Arrival Time: f Departure Timer County: �gion: F46
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: k_Llt�' Title: Phone:
Onsite Representative: Integrator:
Certified Operator: i Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish HID
p /�
i` 1{
�'r
Dairy Heifer
Farrow to Wean
€
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
4
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
fib
•�
'��-.{
Turkeys
,+I
R
#i�{t`
TurkeyPoults
r13f1�niE
il,
t eSiti
tp,:4
�ikY t rr
it!61ii6
N !i� f( ,Ei.
Discharges and Stream bonnets
1. Is any discharge observed from any part of the operation? ❑ Yes Z�'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
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
4E]I;o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ENo
❑ 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 ,,E]rNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): n/
Observed Freeboard (in): _ate
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Q'f\To
❑ 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 fffNNo
❑ 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 c�]`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 ..�Io
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
/E]_Ro
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Pilo ❑ 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 f❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
pt�
12. Crop Type(s): 0 r Gli4a-ro w / 4-t OS S-6 v
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 �No
❑ NA
❑ NE
❑ Yes ,�7rNo
❑ NA
❑ NE
❑ Yes Ae o
❑ NA
❑ NE
❑ Yes 1::rNo ❑ NA ❑ NE
❑ Yes .e No ❑ NA ❑ NE
❑ Yes E3'&o ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
[—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑/ �No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
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 13 No
❑ Yes ❑i �No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 511212020 Continued

Facili Number: - Date of Inspection: / "S
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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes A0rNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes —Er-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?
❑ Yes _Eallo
❑ NA
❑ NE
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
❑ Yes f TNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes E]No
❑ 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 jfNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes /[D-No
❑ NA
❑ NE
i
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
H
Phone:
Date: 5 ��
511212020

raauty NO, is P V � � Time In
Time Out
Farm Name
Owner Integrato,
Operator Site Red
Sack -up No.
No.
COC Circle: General or NPDES
FREEBOARD: Design
Observed
Crop Yield
Rain Gauge
Soil Test Wettable Acres
Weekly Freeboard Daily Rainfall
Spray/Freeboar� Drop
Weather Codes 120 min inspections
Waste Analysis;
Date Nitrogen (N)
Dare
Sludge Survey
CaiibrationlGPM g a
Waste Transfers
Rain Breaker
PLAT
1-in Inspectto
Date Nitrogen (N)