040010_Routine_20210908

Facility Number
Division of Water Resources
0 Division of Soil and Water Conservation
0 Other Agency
CMS
Kf-
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:
Fo,) a1
Arrival Time:
LcA Nt\i'Ve
Departure Time:
Owner Name: Lt'\IC UJ 1 I V t t e
Mailing Address:
Physical Address:
Facility Contact:
VIC
Owner Email:
Phone:
County:
�J
Region: V
km i tAM WW-e
Onsite Representative: CAI I IBC,
Certified Operator:
Back-up Operator:
Location of Farm:
'AN
Title: Lv,.,1\1 Phone:
Latitude:
Integrator: ✓ 11 Irt
)i
Certification Number:
Certification Number:
Longitude:
Design Current
Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
D Poultr Ca + aci Po . .
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?
❑ Yes )allo ❑ NA ❑ NE
❑ Yes .1allo ❑ NA 0 NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ YesNo ❑ 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 ❑ NA 0 NE
2. Is there evidence of a past discharge from any part of the operation? El YesNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ,No El NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
2/4/2015 Continued

Facility Number: -
0
❑ Yes No ❑ NA ❑ NE
❑ Yes NNo ❑ NA ❑ NE
Structure 5 Structure 6
1\Yes ❑ No
❑ YesN&L No
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 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
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?
Strructure 1 Structure 2 Structure 3
1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
r�o
i9
ya
Structure 4
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
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(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
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes LNo
❑ Yes ELNo
❑ Yes No
❑ Yes 1N.,No
❑ Yes &o
❑ NA ❑NE
❑ NA ❑NE
❑ NA
❑ NA
❑ NE
❑ NE
❑ NA ❑NE
❑ NA ❑ NE
❑ 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): 61 be Uri, °II fe cun 6Urnu (la) e
13. Soil Type(s): \r\' V eig t )lre j ,i
OtSW
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.
❑ Yes "No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
❑ Yes Iccl,,No ❑ NA ❑ NE
❑ Yes "SI,No ❑ NA ❑ NE
❑ Yes NNo ❑ NA ❑ NE
n Yes No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
n Other:
❑ Yes 1No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers ❑ Weather Code
❑ Sludge Survey
❑ Yes "ELNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
2/4/2015 Continued

Facility Number: "-i - j Q,
Date of Inspection: 9 ei/�C
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 n 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 EI,No 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes 1SINNo 0 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? 0 Yes 1S‘No 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 ISLNo ❑ 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 ISNo 0 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 [�No ❑ NA ❑ NE
O Yes RNo ❑ NA ❑ NE
❑ Yes ISL.No ❑ NA ❑ NE
❑ Yes `1No ❑ NA ❑ NE
❑ Yes 1SI%No ❑ NA 0 NE
tgs
ditional recommendations or any other comments.
al pry s necessary).
rrneve ttees from cUvuN jO' N.
cuf qri for hcj'l SODN..
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with
Reviewer/Inspector Name:
a4fi�e hcUjnN
Reviewer/Inspector Signature: /
Page 3 of 3
Phone: 9 1, ;' �� 911
Date: I (?):.�
2/4/2015

FACILITY #: FARM NAME: \ij\j\(, UNII,FJ
FREEBOARD ACTUAL LAGOON LEVEL
PERMIT (#19)
- DUE EVERY 5 YEARS .�y,
- EXPERIATION DATE NUMBER OFANIMALS'J✓
ACTUAL NUMBER OF ANIMAL
- OtC CAR NO
WASTE UTILIZATION PLAN (WUP) (#20)
SOIL TYPES gitt2 5t-tA,
N\IsttL
CROP TYPES COfN
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 91 Iaii NITROGEN LEVEL
SOIL REPORT (#21)
EVERY 3 YEARS:
P-I (NO MORE THEN 400) 1 I 114'
J
PH (Note if 4 or less) C.b� ' 1
Cu/ZN (NO MORE THEN 3000) CU I.)
10
(IF PEANUTS NO MORE THEN 300)
MENTAL CHECK OF CROP AND FIELD NUMBERS
DATE G I1 14 Pt -al
ZONE ACRES PAN
FLOW RATES 1Ql
120 Min inspection initialed
ZN (yi1; 1, f 1-3 I I
IRR2 (#21)
t c
CROP TYPE DU4Pd
'
�`�� i
NITROGEN (N) - l`
Weather Codes *-Cs
Commercial Fertilizer Chicken Litter
CALBRIATION (#24)