310428_Inspection_20190415

Facility Number -
OVivision of Water Resources
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 Comb ance 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: (1 Arrival Time: () O n Departure Time: 1 _ County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: OeCt4
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
W n to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
Other
Owner Email:
Phone:
Title:
Latitude:
Phone:
Integrator:
Region:
Certification Number: l u
Certification Number:
Design Current. Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry PonUry Canaeity 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 ❑ NA ❑ NE
0 Yes ❑ j NA ❑ NE
[:]Yes ❑ NA [:]NE
❑ Yes [:]No ❑ NA 0 NE
Page I of 3 21412015 Continued

Facility Number: -if Z 56 jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 6 No ❑ 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.)
J
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No ❑ NA
❑ NE
waste management or closure plan?
4-6 immediate health
t DWR
If any of questions were answered yes, and the situation poses an public
or environm
al eat, notify
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ 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
❑ 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
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EfNo ❑ 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
, I�� E] 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
NA
q;N
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yeso
❑ NA
❑ NE
the appropriate box.
❑ W11P ❑ Checklists [:]Design ❑ Maps [:]Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ESNo ❑ 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 ❑
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA Q NE
Page 2 of 3 21412015 Continued

Facility Number: 'Z 1 - �( Z b— I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes Ej No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes [D l�o ❑ NA ❑ NE
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 Q i'�o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No EJINA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ❑-Ro ❑ NA ❑ 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 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 [;[-*go ❑ 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 FJ NW
❑ 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
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes E!fNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes D-Ko ❑ NA ❑ NE
Comments (refer t`o ijiiestion,#t)j=Eg01A"n4anfYES*answers"and/6r any additionaLrecommeu�datiorisoor,anj atliii1 ornmerits. _-__-
-�:._;-ems _...-._-.> ,.
Use ;dr4wings'of &'ility' o better_exp a�n-situations *e additional pages.°as' ne_cessa�y):;°
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone: 7 ^t G % o Y
Date: 5 "
214120I5