310193_Compliance Inspection_20181019

W Division of Water Resources
Facility Ntimber - ® O,Division of Soll and Water Conservation
O Other Agency
(Type of Visit: �O Compl ce Inspection O Operation Review O Structure Evaluation Technical Assistance
Reason for Visit: outine Q Complaint O Follow-up O Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: Q t Arrival Time: p Departure Time: oo County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: / Title:
Onsite Representative: �O' L -n �f e�
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
W to Finish
can to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Latitude:
Phone:
Integrator.
Region:
Certification Number: ( p 23 % 6�
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Discharges and Stream Imoncts
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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes
[7]No
[:]NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Page I of 3 2/412015 Coruinued

IFacWty Number: jDate of Inspection:
Waste Collection & Treatment
4. Is stonigge capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes [ to ❑ 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:
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 Io ❑ 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 environment (rest, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ 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 ❑ 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
ONA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�J No NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Io A
❑ NE
acres determination?17.
Does the facility lack adequate acreage for land application?
❑ YesE�No
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
�No[_]
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
ElYes
NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑LeaseAgreements ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Z] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �❑ NA ❑ NEE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ANo ❑ NA L E
Page 2 of 3 2/4/1015 Continued

Faciti Number: jDate of Inspection:
/
24. Did the facility fail to calibrate waste application equipment as required by the permit?
n
❑Yes
[i]' Imo ❑ 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 ❑-NA—_ffNE
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?
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
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes D_90�❑ NA ❑ NE
❑ Yes D<o ❑ NA ❑ NE
❑ Yes No ❑ NA NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E:P ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewfinspection with an on -site representative?
❑ Yes
o�[� NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
El Yes
e'No ❑ NA
❑ NE
Comments (referao question ff): Explain any YES answers and/or any additional keeommendations or any, other comments.
Use drawings of facility to better explain situations (use arddditional pages as necessary).
5 n +0
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: \ ko 17 � 7-y oLk
Date: 10 If I
21412015