820719_Inspection_20210520

Type of Visit: c 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:
Owner Name: \
Arrival Time:
Departure Time:
Mailing Address:
Physical Address:
Facility Contact:
0110
Owner Email:
Phone:
County t+1
l:A1
Region:
Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
�l!�hI, ,
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
H 3+t4Y
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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 NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ YesNo ❑ NA ❑ NE
❑ Yes '" '�INo ❑NA ❑NE
El Yes ❑ NA ❑ NE
El Yes 'hNo ❑ NA ❑ NE
Page I of 3
5/12/2020 Continued

Facility Number:', . - I f ' 1
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?
Date of Inspection: t7IRom
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes
❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
No ❑ NA ❑ NE
No ❑ NA ❑ NE
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 ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an rrim��mediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? B \ C Ul € IC 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
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):
❑ Yes t]No ❑NA ❑NE
cr.}1
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? eq. Yes No ❑ NA 0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or dtf21P
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? ❑ 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
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra fers ❑ 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 No ❑ NA ❑ NE
Page 2 of 3 5/12/2020 Continued
❑Yes No ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yesp No ❑ NA ❑ NE

IFacility Number: 1r"; i -
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L ❑ 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:
Date of Inspection: ,Z'jlj'd.
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes
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 0...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 5No ❑ 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 Io ❑ NA ❑ NE
El Application Field El Lagoon/Storage Pond El Other:
❑ Yes No El NA ❑ NE
❑ Yes o ❑ NA ❑ NE
No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes0 NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No 0 NA ❑ NE
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Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
cI7175

FACILITY#: 9,2 %/q'/ FARM NAME: Soxrierna Sne- _ ze ' LI- e
FREEBOARD ACTUAL LAGOON LEVEL
PERMIT (#1s)
DUE EVERY 5 YEARS L'/3 a y NUMBER OF ANIMALS �o 96
- EXPERIATION DATE
- ACTUAL NUMBER OF ANIMAL
- OIC CARD YES OR NO
�99 WASTE UTILIZATION PLAN (WUP) (#20)
SOIL TYPES /vi
CROP TYPES
- THE UTLIZATION PLAN SHOLD HAVE A (-) NGATIVE NUMBER
- ODOR CONTROL CHECK LIST
Irrigation Plan Maps x
OR NO
WASTE REPORT (#21)
-GOOD FOR 60 DAYS BEFORE OR AFTER
DATE1'� thth NITROGEN LEVEL l 430 a
SOIL REPORT
xi)
EVERY 3 YEARS: DATE a S/at oboa / .et% Igewi t
- P-I (NO MORE THEN 400) t`-624X-
- PH (Note if 4 or less) I-Oza
- Cu/ZN (NO MORE THEN 3000) CU LEW ZN 1-02tr
(IF PEANUTS NO MORE THEN 300)
- MENTAL CHECK OF CROP AND FIELD NUMBERS
IRR2 (#21)
ZONE ACRES PAN /52 CROP TYPE //4%�ic�./
FLOW RATES o2O( J ?0l NITROGEN (N) /r el3 / (ifi
120 Min inspection initialed )(/ Weather Codes X
Commercial Fertilizer Chicken Litter
CALBRIATION (#24)

- EACH REEL SHOULD BE CALIBRATED
- DATE DUE EVERY TWO YEARS /o1/,3 /d.O p.n
- FLOW RATES l"60S/ /C'5, ?651
RAIN FALL (#21)
-INITIAL AFTER 1" RAIN EVENT Pr
-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 l0774//2-02'0
O: P: �` . /4/ % RATIO OF SLUDGE 4),W
OTHER FORMS (#22 AND #21)
RAIN BREAKER FORM CROP YEILDS MORTALITY L�
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