310077_Compliance Inspection_20180424

Division of Water Resources
FeciNy Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Co lance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit�Rouutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Acces
H( s
Date of Visit:� '{/t ��� Arrival Time: Departure Time: Z � County: Region:
Farm Name: �� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: / Title: Phone:
Onsite Representative: Integrator: Q Q
Certified Operator: Certification Number: I 1
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
S 'ne Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish ( 1 11-ayer I I Dairy Cow
Wean to Feeder I jNon-Layer I I I Dairy Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to Feeder Dry Poultry Ca oci Pop. Non-Dairy
Farrow to Finish Layers Beef Stocker
Gilts Non-Layers Beef Feeder
Boars Pullets I lBeefBroodCow
Turkeys
Other Turkey Pouets
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes MNo ❑ 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? ❑ Yes l 1 ❑ 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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Facility Number: - 77 1 Date of Inspection:
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall)less than adequate? [—] Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z
Spillway?:
Designed Freeboard(in):
Observed Freeboard(in): L j�{ ZS-
5.Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EfNo ❑ 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 No ❑ 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 environmenta reat,notify DW R
7.Do any of the structures need maintenance or improvement? ❑ YesrNo
❑ NA ❑ NE
8.Do any of the structures lack adequate markers as required by the permit? [—] Yes ❑ 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 Application
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes 6 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals(Cu,Zn,etc.)
❑ 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 Io Q NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes gNo ❑ NA ❑ NE
Required Records&Documents
19. Did the facility fail to have the Certificate of Coverage& Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes gNo ❑ 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 ffNo ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑Rainfall ❑Stocking ❑Crop Yield ❑120 Minute Inspections ❑Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA IG'vG
Page 2 of 3 21412015 Continued

Facility Number: ZZ ��
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 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 .e"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 EfNo ❑ 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 Io ❑ NA NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes KNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No E
❑NA NE
34.Does the facility require a follow-up visit by the same agency? ❑ Yes Io Q 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 additional pages as necessary).
Reviewer/Inspector Name: a " r �7 Phone: �-1 r6 7F01
Reviewer/Inspector Signature: Date: Zy /t V,
Page 3 of 3 2/4/2075