670011_Inspection_20181109 (2)

Division of Water Resources /
Facility Number G7 - © O Division of Soil and Water Conservation V/
. O Other Agency
Type of Visit: O Compliance Inspection 0 Operation Review tructure Evaluation Technical Assistance
Reason for Visit: O Routine O Complaint 6/Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: �/ Arrival Time: ® Departure Time: J 20o County:
Farm Name: K4 01 e74A ( Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: D�2q (sq,b Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
to
Other
Other
Latitude:
Phone:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
$ Non -La er
Poults
Design Current
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:
Region:
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
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 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
P No
❑ 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):
/L
Observed Freeboard (in): 27
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
gNo
❑ 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
l] 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
W No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[B 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
FR No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[yNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application If yes, check the appropriate box below.
❑ Yes
[U No
❑ NA
❑ 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?
❑ Yes
❑ No
❑ NA
lg 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?
❑ Yes
❑ No
❑ NA
[� NE
_Required Records & Documents
19. Did the facility fad 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.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ N
ElWaste 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 fad to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
❑ Yes ❑ No
o
❑ NA P NE
❑ Weather Code
❑ Sludge Survey
❑ NA lal NE
❑ NA Q NE
21412015 Continued
Page 2 of 3

Facili Number: Date of Inspection: ./
240 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? ❑ 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)
3 L 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 CAWMP?
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 Pa NE
❑ NA [gNE
❑NA NE
❑NA NE
❑ Yes ❑ No ❑ NA [f'NE
❑ Yes ❑ No ❑ NA 2 NE
[—]Yes �TNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ® NE
❑ Yes ❑ No
❑ Yes �U No
❑ Yes U No
❑ NA [,tRNE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question tl): 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).
I✓ol w L4�ODn
q9r) 6 esac/,2y '.
27
Reviewer/Inspector Name:
Reviewer/Inspector Signature:���_
Page 3 of 3
Phone: �129
Date:
21412015

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