190020_NOD-2019-PC-0075_20190325

;, o
Facility Number -
W=D= 2 d(b ILI - F _On
Q)TIvision of Water Resources
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: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
DateofVisit:O= Arrival Timer Departure Time: © County: Region:
Farm Name: _ /7 j, Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Jew L - ^ 1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er I I A
Dry routtry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Longitude:
6-1
Design Current
Cattle Capacity Pop.
Dairy Cow I7
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes y" ❑ NA ❑ NE
❑ YesRfx [] NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes No ❑YA 0 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)
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?
❑ Yesoo
❑ Yes Wo
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 214/2015 Corttinned

Facility Number: - Date of Inspection: 3 2 5 / 1
❑ Yes
[N ❑ NA
❑ NE
Waste Collection & Treatment
Does the receiving crop and/or land application site need improvement?
❑ Yes❑
NA
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yeso
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure
5
Structure 6
17.
Identifier:
E]Yes
❑ NA
❑ NE
Spillway?:
Is there a lack of properly operating waste application equipment?
❑ Yes
No [ NA
Designed Freeboard (in):
Required
Records & Documents
Observed Freeboard (in):
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No[:]
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
E]Yes/No❑
NA
❑ NE
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
o ❑ 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? ❑ Yes01N.;- ❑ NA ❑ NE
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 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑YesVNo
❑ NA [:]NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below. [E::] Yes❑ 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): Cry -r] / % PSS , '5I 'q rA, ', 5-
13.
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[N ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes❑
NA
❑ NE
16.
Did the facility fail to secure andlor operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
E]Yes
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No [ 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 ofthe CAWMP readily available? Ifyes, check
E]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 ❑ NA ❑ NE
[;Kaste Application ❑ Weekly Freeboard ante Analysis ❑ Soil Analysis ❑ Waste Transfers Q Weather Code
❑ Rainfall E] Stocking ❑ Crop Yield F]120 Minute Inspections ❑ Monthly and V Rainfall InspectioNo
tGJge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: - Date of Inspection: '3/75'/137
❑ Yes ❑ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
0 YesVNo
E:] NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? 1 ryes, check
❑ Yes❑
NA
❑ NE
the appropriate box(es) below.
❑ Yes ❑ No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Yes ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Non-compliant sludge levels in any lagoon
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
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?
❑ YesFe
❑ NA
r�No
[:]NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ 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 ❑ 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 ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ No ❑ NA ❑ 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.
Usedrawings of facility to better explain situations (use additional pages as necessary).
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Reviewer/Inspector Name:
Reviewer/Inspector Signature: 7 G $ 4 ow :.v e
Page 3 of 3
Phone: "7C1 I - 1/ 7-C70
Date: r/ Z ] / f 9
2/4/2015