820038_routine_20240905

.; °� , a � � ,<I7►ivisio� of Water Re�ourcesr
Facile Number T;rvision gof Soil and Water Conservatton
'i��Is� J Other A envy':
n ,
Type of Visit: Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: F-j Arrival Time: Departure Time: County:
Farm Name: �'I� V i �4 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region: Wl
Facility Contact: o mi Title: te)j { Phone:
Onsite Representative: �1 ll Integrator: (l°,�rpj (1
1i �I NS Certification Number:
Certified Operator: 1
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design Current
; p i)esign Current
Capacity I'op
Wet Poultry Capacity Pap
Cattle Capacafy p. Po
Swine
Wean to Finish<;
Layer
Dairy Cow
-`-
[]
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design ` Current'
Dry Cow
Farrow to Feeder
DryPoaltr `'Cad ac t. r Po �
Non -Dairy
Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
�"
Pullets
-
Beef Brood Cow
IT
Other
TurkeyPoults
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?
❑ Yes N No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes ' No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 511212020 Continued

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Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes] No ❑ NA ❑ NE
r
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 I-
11
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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?
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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
a
❑ Yes No ❑ NA ❑ NE
❑ Yes ` , \ No DNA ❑ NE
❑ Yes '❑/ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
i
❑ YesNo ❑ NA ❑ NE
i
c
❑ Yes rV1 No ❑ NA ❑ NE
r.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
/ No
PP11
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
n No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
n No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations orany other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: r
Dater I
511212020