470027_Routine_20210823

Facility Number
Division of Water Resources
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Farm Name: \
Arrival Time:
t--(1 t
Departure Time:
Owner Email:
Owner Name: k
Mailing Address:
Physical Address:
Facility Contact:
Phone:
County:
Region:
Title:
Phone:
Onsite Representative: ' f Integrator:,
Certified Operator. ", �f � �' r t �`
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
Wean to Finish
can to Feeder
Feeder to Finish
Farrow to Wean
_t 1
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Layer
Dry Poultry
Design Current
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)
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 [ N ❑ NA ❑ NE
❑ Yes N• ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3
5/12/2020 Continued

Facility Number: 91 - a 1-
Date of Inspectio
?).
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):
❑ Yes
❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
669
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ 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
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
No
❑ NA
No ❑ NA
Structure 6
0 NE
❑ NE
❑ Yes ❑ NA ❑ NE
,_ p Type(s)c,0(1C;ta.)3i-rn LJcI dj a4-1
13Soil ,pe,=, BatNei j vrY��ydl�
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? ❑ Yes
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes
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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ 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
No ❑NA ❑NE
No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
ludge Survey

Facility Number: -
Date of Inspection:
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:
❑ Ycs
❑ Yes
f
Io 0 NA 0 NE
No ❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E P ❑ 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 0 Yes NJ ❑ 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 ❑ N ❑ 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 Li 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. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
/
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ to ❑ NA ❑ NE
❑ Yes 0 No 0 NA ❑ NE
❑ Yes ❑ No 0 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).
{
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
2/4/2015

FACILITY #: 99' gi FARM NAME: 3 � I I
FREEBOARD ACTUAL LAGOON LEVEL
PERMIT (#19)
DUE EVERY 5 YEARS,
EXPERIATION DATE I �a 4�� NUMBER OF ANIMALS �1�a
ACTUAL NUMBER OF A IMAL
OIC CA'. � � OR NO
SOIL TYPES
CROP TYPES
THE UTLIZATION PLAN SHOULD HAVE A (-) NEGATIVE NUMBER
ODOR CONTROL CHECK LIST YES OR NO
Irrigation Plan Maps
WASTE UTILIZATION PLAN (WUP) (#20)
WASTE REPORT (#21)
-GOOD FOR 60 DAYS BEFORE OR AFTER
DATE1130 1 a l NITROGEN LEVELO{-C)'/
SOIL REPORT (#21)
EVERY 3 YEARS: DATE/971
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
IRR2 (#21)
ZONE ACRES PAN a J� CROP TYPE CPD
FLOW RATES � NITROGEN (N) 2) , g.bg
120 Min inspection initialed Weather Codes
Commercial Fertilizer Chicken Litter
CALBRIATION (#24)

RAIN BREAKER FORM
Ci tu)ici..rtck' A
EACH REEL SHOULD BE CALIBRATE
DATE DUE EVEYTWO YEARS c
FLOW RATES 1'4;
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: P: % RATIO OF SLUDGE
THER FORMS (#22 AND #21)
CROP YEILDS MORTALITY
SLUDGE (#21 & 25)
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