820679_Inspection_20210420

FACILITY #:
FARM NAME:°"`�d��`f
FREEBOARD ACTUAL LAGOON LEVEL
PERMIT (#19)
- DUE EVERY 5 YEARS
( NUMBER OF ANIMALS
- EXPERIAT1914 DATE ; °
- OIC CARD YES OR NO
WASTE UTILIZATION PLAN (WUP) (#20)
SOIL TYPES % 6 "' et) _ '
CROP TYPES ( ..; -. e.,,' % Lti .dn c
THE UTLIZATION PLAN SHOULD HAVE A (-) NEGATIVE NUMBER
ODOR CONTROL CHECK LIST S OR NO
Irrigation Plan Maps V
WASTE REPORT (#21)
-GOOD FOR 60 DAYS BEFORE OR AFTER
DATE NITROGEN LEVEL
SOIL REPORT (#21)
EVERY 3 YEARS: DATE
P-I (NO MORE THEN 400) PH (Note if 4 or less)
Cu/ZN (NO MORE THEN 3000) CU ZN
(IF PEANUTS NO MORE THEN 300) -
MENTAL CHECK OF CROP AND FIELD NUMBERS
I R R 2 (#21)
ZONE , ACRES PAN CROP TYPE
FLOW RATES NITROGEN (N)
120 Min inspection initialed Weather Codes
Commercial Fertilizer Chicken Litter

RAIN BREAKER FORM
CALBRIATION (#24)
- EACH REEL SHOULD BE CALIBRATED
- DATE DUE EVERY TWO YEARS
- FLOW RATES
RAIN FALL (#21)
-INITIAL AFTER 1" RAIN EVENT
-LOOK FOR ANY LEVEL THAT IS LESS THEN THE DESIGNED FREEBORED
-LOOK FOR BIG NUMBER DIFFERENCES SEE THAT THEY MATCH THE IRR2
FORM
SLUDGE (#21 & 25)
-DUE EVERY YEAR: DATE
0: P: % RATIO OF SLUDGE
OTHER FORMS (#22 AND #21)
CROP YEILDS 5--.:' MORTALITY a
VISUAL CHECK
FOUNDATION OR PIT LEAKS PIPE LEAKS LAGOON
SEEPAGE LAGOON BARE AREAS TREES OR GRASS NEED TO
BE REMOVED EROSION DITCHES
WINTER CROP(OVERSEEDED) ALIVE CROP HARVESTED
FIELDS GOOD HEALTHY CORPS CORRECT
CROPS NO PONDING REELS FEED
BINS LAGOON GARBAGE

&4-io 4/63 /Ai
I ca
Type of Visit: .0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ,ei outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time:
A-zz/A.r ei
Departure Time:
IA I. DaPil,
Owner Email:
Phone:
County:
Region:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
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?
❑ Yeso ❑ NA ❑ NE
❑ 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 2rNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes J2''No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
2/4/2015 Continued

ter . Is s i. } r a o-
ail.'" (,1
uc1.i1 o1 ' li.(1; storm `.to1•;ec>(', plus 11..a '4/ rainfall.) less than ;^tf_ir mate?
1,.oji1ii77(l.11):
%- '/es, 1J.-{.`. if ' t into t11'. i.e"Li:'tii°-el 7{(eboarc1?
Structure
l(11•
03
Yes
`its
trti Thu"(' 1 Structure `i
01 1. s' r
f1ff(C' tii i i+E+.it"�(�l'.i �.li�% z .s .lr, ( wv i'i� cr"" i ! i= clil° �� i1 � served?
J
tf, t ? ,Y 1 � � �c stole �1_l1� �, (, _f,1, 1 C Cl
I.._ , 1, - %fees., -%/e 4 y(--r ge tic.)
i_: o there o1, I1+.ttl e'J on -site 1 h,.Ii�F(..t _ 110 r 1 o PC1 l / addressed ns+_ti Ji' managed
Zri`i1(� 1!r =1eit0 t.ilt:_`i1fGi. C € �'01.111 1)y;.2i'P
.. �' C✓I 1, ii�'.
(I(.0 1 rmirt 11a1?C('- or 1i1 ro%, ., .-1C ,..
4_ 1
'
lieu 1'�`:, `�%, i1111rrY°,Pt lr,tl�lr�
1
%.; t '!!', arr./1t,:.",q lit
f_
1
1
1t '�1-0.lr6 �S
!'r
1110 k.';e. 1Di-A
t 0`, 1. 1.E0 11',i,
isoa1C (11 Aceepldhlr_ 'C:t ",l3/I7',,1
..r
1;1 9,'()
(1r.l1!.-[ !.l't;Sl 'the
:iltot1%1,. '<os -in. no
.lao;,: eryes.,tl%. r1;.
;r
;,filrrl'i� ; i-_)o '. below.
•
1(i's dif f er I1ol l do (-he,_ A 7,, I'/lid.
I iit: P .. :� P i, s'.9 `i' t P � CFO") i.121-1t1/ 0,* land t!','s
l .
srf
tl_ 1r1 ,�
1 �.'. i13' ) ,rj%'��±� ( ',� r 1, (. -£(, t'1R �.,}11 ,,�� + _ i i f;i° �i��/+ li. rtl.'1�.. P c it tli s_� ���� � i' �-L ..,
C e teri41 l%It1on?
%. f , i,%(.;' ,••i(.1% 1rl(.(.,I.9(1(t: r?(:tt irk(, 'v° Pi; C! aprdIC.1.11%011
(-'i.iisll.o e
f, l 1?li,`'./ 0111 tii .!:. `4'e, ::ill !., 11-0i.
No
Sit ucturc U
NE
..-...1 N
t.1G. reat, 1. 31 l0 1jj /1..
q No j
e {..
_ m1 .��..? 1\•%1' n R
(' S
"u1,s, y
It‘E ,/v ''JI .,1 ? (OIL /11.,
to t_o6;E1111.?orat( k'
No
'Alf;
1l;
NA
,d s d
1:1,/0 131.'.�(1 1.l.io Lio-
"?i1i,i.:al. _',11 GLt.'.,:(-it; 01 App/(o,'eCt ilVrea
€J,1,)i .? s, P :,, ek f l%.
4 7 ll�•-T\i„
yes ta-Ne ‘!
,.. , -1\l O
it it,7,'
L . l;;;pe i,1 _)i1
4! ,
S_.

Facility Number: -
Date of Inspection: ya/
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
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:
❑ Yes _❑-No ❑ NA ❑ NE
❑ Yes EI)No ❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? 0 Yes ,,.❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes jallo 0 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ,,❑'No ❑ 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 0 Yes c31,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 2 No ❑ NA ❑ NE
❑ 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 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ,'No ❑ NA ❑ NE
Comments (refer to question #): 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).
eer1)-e:d 09--e
trie7A7 _,(;)1/j-eet ixte-4 6.e;e, tut.
.501''-Q t.) 6z/a ateCt.6 v7-1 /-JCrT i4_ ot4471Yi i/1-,�-
10-0(2-( 177-1 /:-Pl-c/J-( +7) _-ea9,4e-im /we/7h kle ‘,/z,iteee
&weei
1
e"teee/e-ece
�- l3-te-vii-eldatvn 604 .;20 �- �1-.icer�-ram_-�
Ai66rece,
Reviewer/Inspector Name:
e
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9/0 F3S -- 5
Date: g/2-53-674
2/4/2015