770006_routine_20240612

I jPc vi v,au: v wu,puauce iuspecuoii v vperauuu review v Structure r vamation V i ecnnicai Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: IZI 2A Arrival Time: Departure Time: ' County: Region: �b
Farm Name: �r��, U 1�� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: fT ��r`e Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
DPhone11
Integrator: 1V �S
Certification Number:
Certification Number:
Longitude:
Design Current
'Design
Current° E Design hCurrent
Swine Capacity 5 1'op
Wet Poultry
;Capacity
;Pop Cattle °° Capacity Pop
a .
Wean to Finish
Layer
`3`
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dry Poultry °;.
,Capacity,
P®
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
T
Turkeys
Ot�ier
Turkey Poults
v� .
s,
Other
e .-
Discharees and Stream Imuacts
1. Is any discharge observed from any part of the operation? ❑ Yes N 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts. or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
No ❑ NA
❑ NE
0 Yes
No ❑ NA
❑ NE
0 Yes
No ❑ NA
❑ NE
Page 1 of 3 511212020 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Flo ❑ NA ❑ NE
Structure 1 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? ❑ YeZ"-S�o ❑ 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 ❑ Ye s�o ❑ 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 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ 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? NNIII
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 Acceptable Crop Window pEj 1E�viidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYPe(s): �Y/" r f-e�yb I � 11 1 t
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 *ipment?
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 qo
❑ NA
❑ NE
❑ Yes � o
❑ NA
❑ NE
❑ ,Yeso
❑ NA
❑ NE
❑ Yes `No
❑ NA
❑ NE
❑ Ye �o
❑ NA
❑ NE
El Yes o
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Trans s ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" 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 o NA, 0 NE
❑ aN-
❑ Yes ❑ NA ❑ NE
Page 2 of 3 511212020 Continued

Facility Number: ' - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Y �No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check El 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 "EkNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ej�4o
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑\o
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 &0
If yes, contact a regional Air Quality representative immediately.
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes &�No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[:]Yes ENo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 'MNo
❑ 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
Comments (refer to question )> Explain `any YES answers and/or any additional 'recommendations or any other comments.:
6
Use drawings of facility to better explain-Mtnations (use additional pages as:necessary),
Reviewer/Inspector Name: K,
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
511212020