820481_Routine Inspection_20210930

Type of Visit: ,_Q-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:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time:
Departure Time: �` , ,�C oun
gc,a7-1
Owner Email:
Phone:
Region:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title: �
Latitude:
Phone:
Integrator:
Certification Number: / 7 O-rr
Certification Number:
Longitude:
Design Current
Capacity Pop.
Wean to Finish
Wean to Feeder
//feeder to Finish
Farrow to Wean
2-0
Farrow to Feeder
Farrow to Finish
Gilts
Boars
f
Other
Wet Po
Design Curren
Capacity Pop.
Layer
Non -Layer
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 .,0'Ro 0 NA ❑ NE
❑ Yes 0 No ❑ NA 0 NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes eNo 0 NA ❑ NE
❑ Yes ErSlo ❑ NA ❑ NE
Page 1 of 3
2/4/2015 Continued

Facility Number:
Date of Inspection: 62/3e/ ,-t
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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?
Structure 1 Structure 2 Structure 3 Structure 4
l
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 ❑No ❑NA ❑NE
Structure 5 Structure 6
❑ Yes erNo ❑ NA ❑ NE
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.
❑ Yesio ❑ NA ❑ NE
.1EfrYes ❑ No
❑ Yes ,-No
❑ Yes No
❑ Yes .-No
❑ Yes No
❑ NA
❑ NA
❑ NE
❑ NE
❑ NA El NE
❑NA ❑NE
❑ NA 0 NE
❑ Excessive Ponding ❑ Hydraulic Overload D 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):
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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
❑ Yes 10 ❑ NA ❑ NE
fYes ._12'fVo ❑NA ❑NE
❑ Yes .io ❑ NA ❑ NE
❑ Yes ,,,0—No ❑NA ❑NE
❑ Yes 'No 0 NA ❑ NE
n Yes LI,No ❑ NA ❑ NE
n Yes ,,®' No ❑ NA ❑ NE
n Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. „❑'Yes ❑ No ❑ NA ❑ NE
n Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking jaerop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes j'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes „ONO ❑ NA ❑ NE
2/4/2015 Continued
Page 2 of 3

Facility Number:
Date of Inspection:
60ib-/
24. Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes 10 D NA ❑ NE
Th:#1&
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 12"No ❑ 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:
26. Did the facility fail to 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
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?
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 0 Yes 6,0No ❑ 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 D 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
❑ Yes No ❑ NA ❑ NE
❑ Yes .,1No ❑ NA ❑ NE
❑ Yes No ❑ NA 0 NE
❑ YesNo ❑ NA 0 NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ,'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).
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Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
Ad/4/
5/12/2020

FACILITY #:
FARM NAME:
r;'
FREEBOARD ACTUAL LAGOON LEVEL
PERMIT (#19)
- DUE EVERY 5 YEARS
- EXPERIATION DATE NUMBER OF ANIMALS
- OIC CARD YES OR NO
WASTE UTILIZATION PLAN (WUP) (#20)
SOIL TYPES
CROP TYPES
- THE UTLIZATION PLAN SHOULD:IAVE A (-) NEGATIVE NUMBER
- ODOR CONTROL CHECK LIST{YESR NO
- Irrigation Plan Maps
WASTE REPORT (#21)
-GOOD FOR 60 DAYS BEFORE OR AFTER
DATE %/ /141 NITROGEN LEVEL
�(1/
- EVERY 3 YEARS:
P-I (NO MORE THEN 40
CUIZN (NO MORE TH i0) CU ZN
(IF PEANUTS NO MORE THEN 300)
MENTAL CHECK OF CROP AND FIELD NUMBERS
SOIL REPORT (#21)
ATE
PH (Note if 4 or less)
IRR2 (#21)
ZONE ACRES PAN 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 //3-6//
- FLOW RATES r�
RAIN FALL (#21)
-INITIAL AFTER 1" RAIN EVENT 9
-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 /) 1; "-1)-6
0: ! /,; P: /1,6 % RATIO OF SLUDGE '
RAIN BREAKER FORM
OTHER FORMS (#22 AND #21)
CROP YEILDS
VISUAL CHECK
MORTALITY
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