090198_Inspection_20210520

Type of Visit: ,Q-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: altoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
Arrival Time:4, ,i) I Departure Time:
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Mailing Address:
Physical Address:
Facility Contact: (j ner
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
County: t9/4j Region: Teo
Title:
i/
Phone:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
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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?
❑ Yer No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yews
❑ Yes
❑ Yes
❑NA ❑NE
No ❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Na ❑NA ❑NE
Pagel of 3
5/12/2020 Continued

Facility Number: Gc/ - /Q 9
Waste Collection & Treatment
Date of Inspection: S< /✓2/
12. Crop Type(s):
13. Soil Type(s):
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
N
❑ Yes No ❑ NA ❑ NE
❑ Yeso ❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
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 ❑ Ye o ❑ 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? ❑ Ye:I:1�Ip ❑ 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 ❑ Ye?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 ❑ Evir ence of Wind Drift Appli ation 0 side of Approved Area
PCN) gin a �1IP]
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Yes ❑NA ❑NE
El Yes 13.V..2 ❑NA ❑NE
❑ Yes No ❑ NA 0 NE
❑ Yes fNo ❑ NA ❑ NE
❑Yes '-'` ❑NA ❑NE
El Yes o ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Other:
❑ Yes No ❑ NA ❑ NE
❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 2 of 3
❑ Yes
❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
5/12/2020 Continued

!Facility Number: 01 - / 9 0
Date of Inspection: C,,/62-d %a-/ 1
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
❑ NA
❑ yesIEIZIo
❑ NE
❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ ‘' No ❑ 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 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 "� o El NA ❑ NE
If yes, contact a regional Air Quality representative immediately. —vN
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes fl 4o ❑ 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_IRANo ❑ 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? ❑ Ye. \ o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes"No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
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Phone:
Date: 640 %0 02 /
2/4/2015

FACILITY #: 09 — /' 9' FARM NAME: Pe hoot & c-tr-
FREEBOARD 1 GI ACTUAL LAGOON LEVEL
PERMIT (#ie)
- DUE EVERY 5 YEARS p
EXPERIATION DATE l /36/ 9-4(
- ACTUAL NUMBER OF ANIMAL
- OIC CARD YES OR NO
SOIL TYPES
CROP TYPES
THE UTLIZATION PLAN SHOULO'HAVE A (-) NEGATIVE NUMBER
- ODOR CONTROL CHECK LIST YES OR NO
Irrigation Plan Maps 1.
d pO cs7o%eam4,
Fe4,--F-er,
NUMBER OF ANIMALS !�a
L/V&2 ft0/ eid —GJ
4244 /30
WASTE UTILIZATION PLAN (WUP) (#20)
WASTE REPORT (#21)
-GOOD FOR 60 DAYS BEFORE OR AFTER
DATE Via-/ NITROGEN LEVEL ` 30
ff6
SOIL REPORT (i)
- EVERY 3 YEARS: DATE WM/(##2X�
P-I (NO MORE THEN 400) 5/4/
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
3 4e 1,(o9 IRR2(#2i)
ZONE` 3,V ACRES / OS" PAN aS' CROP TYPE
FLOW RATES / 7 2 NITROGEN (N)
120 Min inspection initialed K Weather Codes
Commercial Fertilizer Chicken Litter
CALBRIATION (#24)

-DUE EVERY YEAR: DATE CM3
o: 3 (a l P: 3,91
- EACH REEL SHOULD BE CALIBRATED !L rl I75 , / o 1 V95
- DATE DUE EVERY TWO YEARS
- FLOW RATES l(,5 /737 /(05--
RAIN FALL (#21)
-INITIAL AFTER 1" RAIN EVENT r/
-LOOK FOR ANY LEVEL THAT IS LESS THEN THE DESIGNED FREEBORED
-LOOK FOR BIG NUMBER DIFFERENCES SEE THAT THEY MATCH THE IRR2
FORM
/01/ /2-d,d
SUDGE (#21 & 25)
old
% RATIO OF SLUDGE
OTHER FORMS (#22 AND #21)
,V5-
RAIN BREAKER FORM CROP YEILDS r/ MORTALITY 'V
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