820262_Inspection_20210505

eea,, ,,,,e6L37,
FACILITY #: �� "1;16;2- FARM NAME:
FREEBOARD / IG? ACTUAL LAGOON LEVEL
PERMIT (#19)
DUE EVERY 5 YEARS
EXPERIATIO�DI--QATE / 6 0� 7 NUMBER OF ANIMALS
nor cnRrvSrF�nR NO
OIC CAR E OR NO
WASTE UTILIZATION PLAN (WUP) (#20)
SOIL TYPES L .>r: ;,�'
CROP TYPES efrtzt4 POI d�-ed
- THE UTLIZATION PLAN SHOULD HAVE A (-) NEGATIVE NUMBER
- ODOR CONTROL CHECK LISTS OR NO ,Y
- Irrigation Plan Maps
WASTE REPORT (#21)
- GOOD FOR 60 DAYS BEFORE OR AFTER
DATE -ll5'12- / NITROGEN LEVEL ‘2 . 3(
9
SOIL REPORT (#21)
EVERY 3 YEARS: ink 1iDATE c2 I / i �% _ c .�.�.tc' l�-�3i/X
RE THEN 400 PH Note if 4 or Tess b " S / l`'``si�.•
P I (NO MORE ) -3c� � ( ) /
Cu/ZN (NO MORE THEN 3000) CU `1), : 7 .),), 373 ZN / /4,e/ L/c./ / 3L
(IF PEANUTS NO MORE THEN 300)
MENTAL CHECK OF CROP AND FIELD NUMBERS
IRR2 (#21)
ZONE ACRES PAN CROP TYPE
FLOW RATES / %-' NITROGEN (N) /06
120 Min inspection initialed Weather Codes
Commercial Fertilizer Chicken Litter L-

CALBRIATION (#24)
EACH REEL SHOULD BE CALIBRATED /s-th
DATE DUE EVERY TWO YEARS
FLOW RATES / 1. :
/ems
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 it/A(4/ /
O: 1 - 4, 1 P: 2, % RATIO OF SLUDGE :) ,
RAIN BREAKER FORM
r (l 7
OTHER FORMS (#22 AND #21)
CROP YEILDS 1 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

Facility Number
,0-Division of Water Resources
0Division of Soil and Water Conservation
0 Other Agency
Type of Visit: O 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:
Owner Email:
Phone:
County:
Region:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Integrator:
Phone:
Certification Number:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
Wean to Finish
Wean to Feeder
54`2
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Wet Poultry
Design Current
Capacity Pop.
Layer
Non -Layer
Design Current
Dry ,Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Cattle
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer'
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
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) ❑ 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 0 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Et'-No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 'No ❑ NA ❑ NE
of the State other than from a discharge?
❑ Yes o ❑ NA 0 NE
El Yes El No El NA ❑NE
Page Iof3
2/4/2015 Continued

Facility Number:
Waste Collection & Treatment
Date of Inspection:
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):
❑ Yes
❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
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
'No ❑ NA ❑ NE
❑No ❑NA El NE
Structure 6
7. Do any of the structures need maintenance or improvement'?
❑ Yes J No ❑ NA ❑ NE
❑ Yes 11] -No ❑ NA ❑ NE
r,Yes ❑ No ❑ NA n 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 VrNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN n PAN > 10% or 10 lbs. ❑ Total Phosphorus n Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift n 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?
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 El Checklists ❑ Design ❑ Maps ❑ Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis n Soil Analysis ❑ Waste Transfers
❑ Rainfall n Stocking ❑ Crop Yield 7 120 Minute Inspections ❑ Monthly and 1" Rainfall 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 irrigation equipment?
Page 2 of 3
❑ Yes ,No
❑ Y• es ,Eif No
❑ NA
❑ NA
❑ NE
7 NE
❑ Y• es Et No ❑ NA ❑ NE
n Y• es ❑-No
n Yes ❑' No
❑ Yes ❑'No
❑ Yes [ 'No
❑ NA
❑ NA
❑ NA
n NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ Other:
❑ Yes ❑No ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[1] Yes ❑No E NA El NE
❑ Yes ❑'TIo ❑ NA ❑ N E
2/4/2015 Continued

Facility Number: -,�-
Date of Inspection: f 471. - i
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:
0 Yes ,Z4No ❑ NA ❑ NE
❑ Yes AE'No ❑ NA ❑ NE
zAA / is- /
v
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ,;,.❑''No 0 NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 YesNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes PrNo ❑ 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? 0 Yes JNo 0 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 ErNo 0 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 la1Vo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes -ENo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes „ONo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes _12-'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).
C..,61 aA-rhel Visa0 f1-6-7*
1 - . fci -e
je--4-e-e4
497,_(
/ 3i /.20,2-1
r � G TZ /e
2-o do
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
ID ✓LCZ� jUlt?2
Phone: /6) «3
Date: j k/ji
Page 3 of 3 2/4/2015