780077_routine_20240718

type or visit: Ix t ompitance inspection U uperation Review U Structure Evaluation O Technical Assistance
Reason for Visit: � Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: '1 i Zt{ Arrival Time:v Departure Time: County: O l
Farm Name: 10 p O k HEi Owner Email:
Owner Name: 90 I O I K Phone:
Mailing Address:
Physical Address:
Region: \ U
Facility Contact: N 1 t -� H M I lJl\ Title:1� I Phone:
Onsite Representative: SQ�'� Integrator• Sol a fl-C I N
p y'
Certified Operator: �� �"C.t ��J Certification Number: Co 4�q�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
DegignA Current f;
Design Current
Design °Cuurrent
Swine
Capacity` Pop.;
WetxPoultry
Capacity ,, Pop
Cattle - Capacity:, Pop''."
Wean to Finish
..ate$
Layer
a
Dairy Cow
Wean to FeederF
Non -Layer
Dairy Calf
Feeder to Finish
'
Dairy Heifer
Farrow to Wean
-
°Design Current
Dry Cow
Farrow to Feeder
Dr 'Poultry
Capacity Pop
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
°
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
77
F e
Turkeys
Other
=
Turkey Pouets
Other
f �
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?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
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
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
0 Yesa�No
❑ NA
❑ NE
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 4 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes io No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 1
Spillway?: NO
Designed Freeboard (in):
Observed Freeboard (in): 4q
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
M 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
FT No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes N 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 ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): CV w N11
13. Soil Type(s): n n 1 ou K W lth (I I -e
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 rM 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 14 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 ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes :� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers 0 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? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA i ❑ NE
Page 2 of 3 511212020 Continued

Facility Number: I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No ❑ 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: l GJ
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes IN No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes N No
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 No
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 No
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 No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
❑ Yes �] No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA 0 NE
❑NA ONE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
:omnients lrefer to question;#) Exolaini,any,"YES answers and/or,any additional recommendations or any other comments:',
Jse dra viri s of fa6ii to better ex'Iain situations use'additional a es as necess'a
or" �e�1ow W-eet IN fleO buff W good vt -.,2imUc�d.
R-evi 2W
1 RAG
Coili utcufl'ON ' f , f 11
P niN�c1�
%&M
PM i N place
Reviewer/Inspector Name: (,I1 ��t1 Phone:
Reviewer/Inspector Signature: ��_�ylvl� l� Date:"
Page 3 of 3 511212020