090073_Inspection_20210518

Type of Visit: Q Compliance 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:
Farm Name:
Arrival Time:
30 1 Departure Time:
Owner Name:
Mailing Address:
Physical Address:
3apm
Owner Email:
Phone:
County: p
Region:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
N.
Title:
Phone:
Latitude:
Integrator: S (
Certification Number:
Certification Number:
Longitude:
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Beef Stocker
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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?
❑ Yes Ergo ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes J-No ❑ NA ❑ NE
❑ Yes �-No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes J2 No ❑ NA ❑ NE
Page 1 of 3
5/12/2020 Continued

Facility Number:
Date of Inspection:
Waste Collection & Treatment
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 Structure 3
3)
❑ Yes ,ErNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
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
❑ Yes ,❑'No ❑ NA ❑ NE
❑ Yes .3-No ❑ NA ❑ NE
7. Do any of the structures need maintenance or improvement? AI Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes M'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 eaNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2rNo ❑ 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): (��Id:��` 1' l/<<ir'f
k,
13. Soil Type(s):
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
❑ Yes ,allo ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes 1:1-No ❑ NA D NE
❑ Yes el:?No ❑ NA ❑ NE
❑ Yes -No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes „Et No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 21'No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections
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 i
Page 2 of 3
box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Soil Analysis ['Waste Transfers ['Weather Code
❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
❑ Yes allo ❑ NA ❑ NE
rrigation equipment? ❑ Yes J2'No ❑ NA ❑ NE
5/12/2020 Continued

Facility Number:
IDate of Inspection: C .1.
g o
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes a4Vo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Y Yes ❑ No ❑ NA 0 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? 0 Yes ,e'No ❑ NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA 0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document 0 Yes J2No ❑ NA 0 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 .rj No ❑ NA 0 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. 0 Yes laNo ❑ NA 0 NE
0 Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 0 Yes ErNo ❑ NA 0 NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? 0 Yes . 'No ❑ NA ❑ NE
0 Yes JNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name: �l
Reviewer/Inspector Signature:
Page 3 of 3 2/4/2015

FACILITY #: G FARM NAME:
FREEBOARD ACTUAL LAGOON LEVEL
PERMIT (#19)
- DUE EVERY 5 YEARS
- EXPERIATION DATE NUMBER OF ANIMALS
- ACTUAL NUMBER OF ANIMAL
- OIC CARD YES OR NO
WASTE UTILIZATION PLAN (WUP) (#20)
SOIL TYPES
CROP TYPES
- THE UTLIZATION PLAN SHOULD HAVE A (-) NEGATIVE NUMBER
- ODOR CONTROL CHECK LIST YES OR NO
Irrigation Plan Maps
WASTE REPORT (#21)
-GOOD FOR 60 DAYS BEFORE OR AFTER
DATE -
EVERY 3 YEARS:
NITROGEN LEVEL
SOIL REPORT (#21)
DATE
- P-I (NO MORE THEN 400) ` 6_ Iii K s
PH (Note if 4 or less)F
- Cu/ZN (NO MORE THEN 3000) CU
(IF PEANUTS NO MORE THEN 300)
MENTAL CHECK OF CROP AND FIELD NUMBERS
ZN
IRR2 (#21)
ZONE ACRES PAN .i CROP TYPE
FLOW RATES [ NITROGEN (N)
120 Min inspection initialed Weather Codes
Commercial Fertilizer
Chicken Litter
CALBRIATION (#24)

- EACH REEL SHOULD BE CALIBRATED
- DATE DUE EVERY TWO YEARS (IC ""I' F, C
- FLOW RATESi'''';'
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
-DUE EVERY YEAR: DATE
0: I', P P: h:
S LUDGF (#21 &25)
611 ;;;),(4
% RATIO OF SLUDGE
OTHER FORMS (#22 AND # 1)
RAIN BREAKER FORM CROP YEILDS " MORTALITY
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