310253_Structure Evaluation_20181017

Division of Water Resources
"Facility Number - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: U Compliance Inspection U Operation Review AStructure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint gi,Follow-up O Referral O Emergency O Other O Denied Access Date of Visit: FRO Arrival Time: LLl—l� Departure Time: try County: �� I Ir1 Region: W
Ito
Farm Name: —17(ruo Y Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: I /l., l lt�_
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
to Feeder
- to Finish
Phone:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
A IN
Non--
La er
Design Current
Other
Other
Dischames and Stream Impacts
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? Of yes, notify DWR)
❑ Yes
❑ 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
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412015 Continued

Facili Neimber, jDate of Inspection:
Waste Collection & Treatment
�j
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes IXI No
///"❑CCC
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
kf
❑ 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
❑ Yesi`:�/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
8. Do any of the structures lack adequate markers as required by the permit? E]Yes E]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 t FNE
maintenance or improvement? %
Waste Application ,,��,,....,,``�-
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E] No ❑ NA E
maintenance or improvement? T
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. Sod 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.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes ❑ No ❑ NA
❑ Yes ❑ No ❑ NA E
❑ Yes ❑ No ❑ NA E
❑ Yes ❑ No ❑ NA
❑ Yes ❑ No ❑ NA NE
❑ Yes ❑ No ❑ NA E
❑ Yes ❑ No ❑ NA E
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ N
Page 2 of 3
o

Facili Narmber: Date of —Inspection.
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No ❑ 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 1
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No ❑ NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ❑ No ❑ NA gNE
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 X 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 9NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ No ❑ NA XNE
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 9): Explain any YES answers and/or any additional ucommendations,or any other comments.
Use drawings of,facility to better explaiu,situations (use additional pates as neces�erv).
- 37
It
�" - 2� r,
Mupj "l 9II Ilif
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: D
21412015