310178_Structure Evaluation_20181001

II i U Division of Water Resources
4cility Number EZ= - 57-571 O Division of Soil and Water Conservation
O Other Agency
Visit: O Compliance Ins
for Visit O Routine O
Structure Evaluation O Technical Assistance
Referral O Emergency O Other O Denied Access
Date of Visit: =VWArrival Time: Departure Time: County:
Farm Name.
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: (—%ey—.5 1 19 / � / /l/P_�
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
Other
Other
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
IN
Non--
La er
Other
Design Current
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?
Region:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Z No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes FNo
❑ NA ❑ NE
❑Yes ❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
Page I of 21412015 Continued

Facili Number: Date of Inspection: 2 D k-
Wnste 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 I Structure 2 Structure 3 Structure 4
Identifier -
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �1) �� 5
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
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 environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
❑ No ❑ NA
E] wE
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
IE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [—]No ❑ NA
maintenance or improvement? 77
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA
❑ 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 ❑ NEE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [—]No ❑ NA LJ;E
16. Did the facility fad to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA LJ N�
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
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA E Nc
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA C3 NEE
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
❑ 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 ❑ No ❑ NA ❑N79'
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA IE
Page 2 of 3 21412015 Continued

Facili Plumber: jDate of Inspection:
24 Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA [�IE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [-]No ❑ NA DINE
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?
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 fad 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? Ifyes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
❑ No
❑ NA
[g NNE
❑ Yes
❑ No
❑ NA
IE
❑ Yes
❑ No
❑ NA
[ NE
❑ Yes ❑ No ❑ NA
❑ Yes ❑ No ❑ NA LCJ r
❑ Yes ❑ No ❑ NA E PdE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA D'NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA ❑�
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA EINE
Reviewer/Inspector Signature:
Page 3 of 3
P,
Date: 19 S 11K
214,12015