310128_Structure Evaluation_20181009

O-v­1'r
Facility Number
0 Division of Water Resources
(T O'Division of Soil and Water Conservation
O Other Agency
Type of Visit: O Compliance Inspection 0 Opera on Review Structure Evaluation Technical Assistance
Reason for Visit: O Routine O Complaint Follow-up Q Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: 7-%y%Pl2 D 1,5�*rao7 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to I
Wean to I
Feederto
Farrow to
Farrow to
Other
Other
Phone:
Title:
Latitude:
Phone:
Integrator: {% e i f
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
NNon--
La er
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?
Longitude:
Region:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
b. Did the discharge reach waters of the State? Of yes, notify DWR)
ElYes
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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ YesrN
El
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes❑
NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili ,Number: JZFDate of Inspection: tr
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N ❑ NA
5No
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
07No 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
ZNo ❑ 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 at, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application /
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes [—]No ❑ NA I^�,"'L',
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 CropWindow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 13e Y Al h 64�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes ❑ No ❑ NA
❑ Yes ❑ No ❑ NA gN.22�_
❑ Yes ❑ No ❑ NA 2 NE
❑ Yes ❑ No ❑ NA
❑ Yes ❑ No ❑ NA NE
g��
❑ Yes ❑ No ❑ NA
❑ Yes ❑ No ❑ NA NE
❑ 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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a min gauge? ❑ Yes [:]No ❑ NA ; t ;
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA NE
Page 2 of 3 21412015 Continued

Facili Number: Date of inspection: O —(*y
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA [ZN
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification9 ❑ Yes ❑ No ❑ NANF
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA E
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 file 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.
Use drawings of facility to better explain
)I situations ('use additional pages as necessary).
5 prier T� 5l2fil, 3�
Reviewer/Inspector Name:
Phone: ! / � % g/ t% Zw
Reviewer/InspectorSignature: i3ClSTAt rellI�5/ 232 (ZZZ>
Date: �b
Page 3 of 1/4/2015