310419_Structure Evaluation_20180926

Number ® - NEI
Inspection
for Visit: O Routine
Division of Water Resources
Division of Soil and Water Conservation
O Other Agency
Assistance
O Referral O Emereencv O Other O Denied Access
Date of Visit: Arrival Time: JQ Departure Time: County:
Farm Name: IM Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: U,/L" Rytjys/(l Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Dry Poultry Capacity Pon -
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
L 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)?
Longitude:
11„ Region: Wt9b
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
XYes ❑ No ❑ NA ❑ NE
❑ Yes
)4 No
❑ NA
❑ NE
❑ Yes
Z5 6
❑ No
❑ NA
❑ NE
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 No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facilitv;l1r Vumbe. - Date of Inspection:
Waste Collection & Treatment
4. Is sto*e capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
1 a. If yes, is waste level into the structural freeboard? K Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.) C q,
6. Are there structures on -site which are not properly address and/or managed through a
waste management or closure plan?
ANo ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA XNE
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? XYes ❑ 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 E
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) V
❑ 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
X NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ 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
❑ No
❑ NA
NE
18. Is there a lack of properly operating waste application equipment?
1
❑ Yes
❑ No
❑ NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
�J NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
NE
NE
the
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA
.I XIM
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield 10 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA PNE
it
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA
Page 2 of 3 21412015 Continued

1
Facili lumber: - Date of Ins ection:
24. Dic ie facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑ No
25. Is th facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the, ppropriate 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 tile drains 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 CAWW?
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?
❑ NA 1KNE
❑ NA 0 NE
❑ Yes [—]No ❑ NA NE
❑ Yes ❑ No ❑ NA 9NE
❑ Yes ❑ No ❑ NA 9NE
❑ Yes ❑ No ❑ NA )�6 NE
❑ Yes gNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA )ONE
❑ Yes ❑ No
❑ NA �6NE
❑ Yes No
❑ NA ❑ NE
R) Yes ❑ No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
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Reviewer/Inspector Name: . /Vv�o!' �t'^ t� 6_7 Phone: q —731
Reviewer/Inspector Signature: 4-A Date: 9
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