100005_Structure Evaluation_20180806 (53)

Division of Water Resources
Facility Number - O Division of Soil and Water Conservation /
O Other Agency V
Type of Visit: O Compliance Inspection 0 Operation Review^Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral xEmergency O Other O Denied Access y��/�
Date of Visit: 1"" (�� lAnr'rival Time" I Departure Timer County: /1,f F'.1// gion: tv V
Farm Name: (!I e.{^y Y a,r I c,t,w Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish ]Layer Dairy Coati
Wean to Feeder I INon-Layer I 1 1 Dairy Calf
Feeder to Finish d Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder Dry Poultry Ca aci Pop. Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets I jBeef Brood Cow
Turkeys
Other Turkey Puuets
Other Other
Discharges and Stream Impacts
1.Is any discharge observed from any part of the operation? [:] Yes KNo ❑ 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) ❑ Yes ❑ No ❑ NA ❑ NE
2.Is there evidence of a past discharge from any part of the operation? 0 Yes ❑ No ❑ NA ❑ NE
3.Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Vq No ❑ NA ❑ NE
of the State other than from a discharge?
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