310813_Inspection_20180412

II r QO Division of Water Resources
F�zility dumber F3 17 - ® 0 Division of Soil and Water Conservation
Other Agency
Type of Visit: (j� Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time:®®
Departure Time: L County: Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: 'Te �� � COLMC Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Z3gI
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Other
Other
Latitude:
Phone: q�'37��
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
NNon--
La er
Design Current
Discharees 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 D WR)
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 [V]'No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes [—]No
❑ Yes ❑ No
❑ Yes & 'No
❑ Yes g'<o
g-NA ❑ NE
ffNA ❑NE
QUA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412015 Continued

Factli Number:
JDate of Inspection: !!,T1
171
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 fieeboard?
❑ Yes
❑ No
© NA
❑ NE
Structure Stru t Structure 3 Structure 4
5 kN
Structure 5
Structure 6
Identifier:
AWOUV
Spillway?.
Designed Freeboard (in): ICl . S 1r rs
Observed Freeboard (in): S Zo
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Sa 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?
1�1 Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[]F 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
E} No
❑ NA
❑ NE
maintenance or improvement?
WasteAm cation
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 '1�] No ❑ NA ❑ NE
❑ Excessive Pondmg ❑ 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): �����r y
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2 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?
❑ Yes
E No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Fh] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes n No ❑ NA ❑ NE
the appropriate box. T
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements El Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [�g No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA [55NE
Page 2 of 3 21412015 Continued

Faeili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [R No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes T `f' 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? ❑ Yes �] No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
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.
01 Application Field ❑ Lagoon/Storage Pond ❑ Other
32. Were any additional problems noted which cause non-compliance of the permit or CAWNP?
33. Did the Reviewer/Inspector fail to discuss reviewfinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA 5] NE
❑ Yes ❑ No ❑ NA 9 NE
❑ Yes E� No ❑ NA ❑ NE
❑ Yes 5 No ❑ NA ❑ NE
RI Yes
❑ No
❑ NA
❑ NE
❑ Yes
[�`C] No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Icommenrs treter to question;;): axpram any T r;S answers and/or any additional recommendations or any other comments. q 1 I
Use drawings of fh�llity to better explain situations (use additional pages as necessarv).
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Reviewer/Inspector Name:t SU Phone:
Reviewer/Inspector Signature: Date: Z
Page 3 of 3 21412015