310312_Structure Evaluation_20181003

Division of Water Resources
Facility Number r� - ® O Division of Soil and Water Conservation
O Other Agency
Type of Visit: O Compliance Inspection 0 Operation Review AStructure Evaluation Technical Assistance
Reason for Visit: O Routine O Complaint A Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
Arrival Time: Tb_�Departure Time: ®
County:
Regionv-ILIEI�)
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: + rAy_ Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
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
Design Current
Dry Pnultry Canacitv Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Pouets
Other
Discharges and Stream Impacts
I. 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?
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 ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes TVIVN No
❑ Yes LIN No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes X No ❑ 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):l
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 1p"-d' 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
N 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?
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 apphration 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
NE
❑ Yes
❑ No
❑ NA
NE
❑ Yes
❑ No
❑ NA
42A NE
❑ Yes
❑ No
❑ NA
�q NE
❑ Yes
❑ No
❑ NA
_JZ NE
❑ Yes ❑ No
❑ Yes []No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a ram gauge?
23. If selected, did the facility fail to install and maintain rambreakers on irrigation equipment?
❑ Yes ❑ No
[—]Yes [—]No
❑ NA NNE
❑ NA ® NE
❑ NA NNE
❑ Weather Code
❑ Sludge Survey
❑ NA NE
❑ NA NE
Page 2 of 3 21412015 Continued

Facill Number: Date of Inspection: 0 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
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 fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drams exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other.
32. Were any additional problems noted which cause non-compliance of the permit or CAWivfP?
33. Did the Reviewer/Inspector fail to discuss review/mspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA 01NE
❑ NA NE
❑ Yes
❑ No
❑ NA
4 NE
❑ Yes
❑ No
❑ NA
ZNE
❑ Yes ❑ No ❑ NA ^154 NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes ;Q No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA X NE
❑ Yes f?] No
❑ NA ❑ NE
❑ Yes No
❑ NA ❑ NE
❑ Yes No
❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawines of facility to better explain situations (use additional paees as necessary).
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Reviewer/Inspector Name:
Reviewer/Inspector
Page 3 of 3
Phone:
Date:
21412015