310011_Structure Evaluation_20181016

Division of Water Resources
Facility Number I - O Division of Soil and Water Conservation
Other Agency
Type of Visit: O Compliance Inspection 0 Operation Review 'tructure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine O Complaint Follow-up 0 Referral O Emergency 0 Other ///0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: bal — Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
T�►,
Onsite Representative: W UA 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 I jLaver I I Dairn Coy%
Wean to Feeder I jNon-[_avet Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder Dry Poultry capacity Pop. Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets Bccf Brood Co��
Turkeys
Other Turkey Pouets
Other Other
Discharges and Stream Impacts �j
1. Is any discharge observed from any part of the operation? ❑ Yes �u I No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: ''���CCCCC
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? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
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Facili Number: - jDate of Inspection:
Waste Collection&Treatment
4.Is storage capacity(structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [XNo ❑ 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:
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in):
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 VNo ❑ 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 ❑ No ❑ NA E
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 AnoGcation
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes ❑ No ❑ NA d�E
maintenance or improvement? p
11. Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes ❑ No ❑ NA /I NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.) 7�
❑ 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):
13. Soil Type(s):
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 ❑ 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
Reauired 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 ❑ No ❑ NANE
❑Waste Application ❑ er Cod Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weathe
❑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 NE
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Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NAJNE
E
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes ❑ No ❑ NA
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 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? ❑ Yes ❑ No ❑ NA NE
Other Issues y,�
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA I N/NE
and report mortality rates that were higher than normal? �C
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA �E
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 i i,�qE
El Application Field ElLagoon/Storage Pond ❑ Other: `
32.Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA Of NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments(refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations(use additional pages as necessary).
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Reviewer/Inspector Name: IVY 12- Phone: 1 10 — 1q(e ^73y
Reviewer/Inspector Signature: Date:
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