780076_Routine_20240829

Division of Water Resources �
Facility Number -� 0 Division of Soil and Water Conservation
Other Agency
type of visit: P Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
[teason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0.Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: �� County:
Farm Name:�� �� ���4 i��i.Owner Email:
Owner Name: Tcylisi (Nc Phone:
Mailing Address:
Region:_
Physical Address:
Facility Contact: ���� �� Title Phone:
Onsite Representative: �� Integrator:
Certified Operator: JCertification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Design Current Design Current
Swine Capacity Pop. ° Wet Poultry -Capacity Pop.
Wean to Finish
Wean to Feeder
�J Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Layer
Non -Layer
Design Current
Dry Poultry °Capacty Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
1
❑ Yes No ❑ NA ❑ NE
❑ Yes "'E�o ❑ NA ❑ NE
❑ Yes JS;�No ❑ NA ❑ NE
❑ Yes T�QNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 511212020 Continued

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Facility Number: I jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 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:
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? ❑YesTo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �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 0 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 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 ❑`No ❑ NA ❑ NE
❑ Application Field ElLagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Q No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 'E] No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 0 No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additionalpages as necessary).
Reviewer/Inspector Name: �OL/ U Phone: 11 q %j
a
Reviewer/Inspector Signature: 1 ,�, Date:
Page 3 of 3 511212020