670080_Inspection_20190411

?l , Division of Water Resources
Facility Number - ® Division ,of Soil and Water' Conservation
0 Other Agency
(Type of Visit: 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: �D Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: fr I kl I Vj I Arrival Time: Departure Time:
Farm Name: ` Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative:
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:
County: C Region:
Phone:
Integrator: f
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design `-Current
Dry Poultry Ca aci Pop.
Layers
Non -Layers
Pullets
Turkeys
,Turkey Poults
Other
Longitude:
_ Design,_ Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
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)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
bdNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
14
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

' Facility Number: jDate of Inspection:
{
Waste Collection & Treatment
NZ
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
jjj❑0
❑ 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):_
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?
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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 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?
there evidence of incorrect land application? If yes, check the appropriate box below.
QS
KYes ❑ 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
d
12. Crop Type(s): o
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ 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
v
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 19No
❑ 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.
!�
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste 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 rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0
No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesNo❑ NA ❑ NE
1
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes W1 No ❑ NA ❑ NE
the appropriate box(es) below. /--N
❑ 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 ZVNo ❑]NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No �%��/NA ❑ NE
Other Issues �/' �"
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes I iXl No ❑ NA ❑ NE
and report mortality rates that were higher than normal? %C
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ 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 No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes ❑ No ❑ NA ❑ NE
4 Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA ❑ NE
i
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ( No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes VNo ❑ NA ❑ NE
Conu►ieiits (refer to, question #): Explain any YES answers and/or any additional recommendations or an other' comments. -
Use drawingslof facility to better explain situations (use additional pages as necessary).
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Reviewer/Inspector Name: V loll GU
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q (Ly7q &/ 3 ff 7
Date: 1 O
242015