820052_Routine Inspection_20240917

for Visit:
0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: dad Departure Time: pd Countyc-+/ Region:
Farm Name: Owner Email:
Owner Name: Inez Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: '12 �b
Certification Number:
Longitude:
pitoil
t
Wean to Finish
Layer
Dairy Cow �#
! Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
7
Dairy Heifer
vt Farrow to Wean
NJ
a6tg,
`I�'
i
! a
i
Dry Cow
Farrow to Feeder
�
Non -Dairy
Farrow to Finish
j
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
jPullets
Beef Brood Cow
d t s tip, ,a ,
Turkeyst
Turkey Points
Other
t ;i S 13 t'4IYIt
£.
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 EJ-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0'No
❑ NA
❑ NE
❑ Yes
—ff No
❑ NA
❑ NE
Page I of 3
511212020 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ly5
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): A
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 4❑jNo
❑ 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 J2'1<0
❑ 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 eE] No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes
❑ NA ❑ NE
"E2-No
(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 -Eno
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L,® No
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes _, e-No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ 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): � ucGecr /. S //4ce QS i 11 66)
i
13. Soil Type(s): 4 )3d6
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 r® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes r❑'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �o
❑ 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 ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking []Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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 ❑'No
❑ Yes EjNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 511212020 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
A No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
2�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
.E' No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
F�;'Ro
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E�`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
Ej No
❑ 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
Q 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
dNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
El"No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E2'No
❑ NA
❑ NE
lti 1 :� °� ' • E �' �E�
'�tl� r
l
Reviewer/Inspector Name: �✓1` 4 /I
Phone:
'Y1y
Reviewer/Inspector Signature:
Date:
Page 3 of 3
511212020

racimy NO, d
Time In
Time Out _
4a�
inlegrafa
Farm Name l�7�
Site Re;.
OWnef
Operator
No. _
lack up
No. _
cOC
Circle: General ,
or NPDES
Dare
Design
Current
Design Current
Wean - Feed
Farrow - Feed
Wean. -Finish
Farrow -Finish
Feed _Finish
Gilts /Boars
Farrow -.Wean
I I Ofherz
FREEBOARD: Design
Observed
Crop Yield
Rain Gauge
Soil Test � Wettable Acres
Weekly Freeboard _� Daily Rainfall L-,-'_
SpraylFreeboar� Drop
Weather Codes 120 min Inspections —
Waste Analysis:
Date Nitrogen (N)
Sludge Survey a�/�3 ' y'2'
Calibration/GPM &&4Z Po i y
Waste Transfers
Rain Breaker
PLAT
1-in Inspections
Date Nitrogen (N)
2/iA/�3., l7