310229_Compliance Inspection_20180227

U Division of Water Resources
Facility Number © Z Z 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Co ance 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 ,
Date of Visit: Arrival Time: 01!-r Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
to I
r to
to
Other
Other
Veze— ff e,•
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 1 n 0/ S/ z
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
2,10 N
Non--
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?
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 F?N-5�EI NA ❑ NE
[:]Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ Nofo
❑ NA ❑ NE
El Yes
�� NA ❑ NE
❑ Yes �❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - 22 q jDate of Inspection: 2_ z 7
Waste Colidctlon & Treatment
4. Is'storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ETNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3
Identifier.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes o ❑ NA ❑ NE
❑ Yes 0-1q'o' ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t reat, 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
ffNo ❑ 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
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ 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 equipments
❑ Yes
��No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
rNo
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes❑
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 2<0 ❑ 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 ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EyNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: n, jDate of Inspection: f Z
24. Did the'facility fail to calibrate waste application equipment as required by the permit?
❑Yes
o ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
es
^P-l-+o ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a PDA for sludge levels
on compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: S (s PO/-
0132
"1 M- 12-A //7
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 IA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ZINO ❑ 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 concem?
❑ Yes
PNo, ❑ 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
ErNo ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Doo surface tile drains exist at the facility? If yes, check the appropriate box below.
Yes
� vO ❑ NA
❑ NE
U Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ Yes
❑ Yes
�NO ❑ NA ❑ NE
No NA ❑ NE
No ❑ NA ❑ NE
Reviewer/Inspector Signature:Date:
Page 3 of 3 21412015