310830_Inspection_20180628

_0 Division of Water Resources
Facility lumber ©- c3 V 0 Division of Soilland Water Conservation
0 Other Agency
Type of Visit: 0 Compliance Inspection 0 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: QArrival Time: �'� Departure Time: LFLI�CLI County: Region:
Farm Name: y Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: 1,
Facility Contact: ` L f4"k-(. loved Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to I
Wean to I
Feederto
Farrow to
Farrow to
Other
Other
Integrator:
Phone:
Certification Number:
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
nry Pmdtry Canaelty Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
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 ®No ❑ NA ❑ NE
[—]Yes
❑ No
� NA
❑ NE
❑ Yes
[]No
y NA
❑ NE
❑ Yes [—]No
❑ Yes {�No
ElYes ;No
E� NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 \
G,
2/4/2015 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4 Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 31 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �b NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier. ftiO.1
Spillway?:
Designed Freeboard (in): °I'!�
Observed Freeboard (in): ab
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E�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
Wo
❑ 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
C� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[0 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
E4 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�}'jNo
❑ NA
❑ NE
maintenance or improvement?
77`"'
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
tStNo
❑ NA
❑ NE
❑ Excessive Pending ❑ 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 Windows ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s): e r M\+
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? '
❑ Yes
Qj No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement9
Tt Yes
W No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
F�yNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
JX No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE ,
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
T
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other.
'
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ No
❑ NA
❑ NE
El Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
Otte
Lftte Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a ram gauge?
❑ Yes
;g No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
V NE
Page 2 of 3
21412015 Continued

Facie Number: 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 PDA 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 Dg�`No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No ❑ NA r\—^E
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ❑ No ❑ NA Rr 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 concern?
❑ Yes CSVFJo ❑ 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 [)rNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? Ifyes, check the appropriate box below.
❑ Yes W No ❑ NA ❑ NE
ElApplication Field ElLagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ZrNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewtinspection with an on -site representative?
❑ Yes V No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [A No ❑ NA ❑ NE
Comments (refer to question t/): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional vaees as necessarv).
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Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of
711CWV
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Phone: 91072L0
Date: (0 2 �a
2/4l2075