820663_Routine Inspection_20220222 (4)

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Type of Visit: ,EfCompliance 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:
21941A-
Mailing Address:
Physical Address:
Arrival Time:
if 6-Dm
Departure Time:
Owner Email:
Phone:
County:
Region:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
//
Phone:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Capaci
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
acc��
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Cattle
Design
Capacity
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Design Curren
Poultry Capacity Pop.
Layer
Non -Layer
Design Current
D Poultr Ca ' ac
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 ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ,No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes]allo ❑ NA ❑ NE
of the State other than from a discharge?
❑ Yes JNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Page 1 of 3
2/4/2015 Continued

Facility Number: I)._ - / ( 3
Date of Inspection: a/ .- /)J
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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
/g 015-"/
1
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 , to El NA ❑NE
❑ Yes ❑No ❑NA ❑NE
Structure 5 Structure 6
O Yes
4E-go
❑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.
❑ Yes . No ❑ NA ❑ NE
❑ Yes a -No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
n Yes ❑rNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ,�No 0 NA 0 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs.
❑ Outside of Acceptable Crop Window
12. Crop Type(s): &5L/YI i lA'//)11 rt.)
i, Gtrn�L
d
13. Soil Type(s): P.4)."
❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
5Zer2Set
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 ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 0-No ❑ NA ❑ NE
❑ Yes .,.2-No 0 NA ❑ NE
❑ Yes ErNo ❑ NA ❑ NE
n Yes .E1--No 0 NA ❑ NE
❑ Yes __ErNo ❑ NA ❑ NE
❑ Yes -Er No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
,Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield 2120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes _.❑--No ❑ NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,E`No ❑ NA 0 NE
2/4/2015 Continued
Page 2 of 3

Facility Number: 5/02__ - 663
Date of Inspection;/a,%
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes .®'-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ..-Er 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 � P� � �����
List structure(s) and date of first survey indicating non-compliance: , _ G yez,..,
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes . No ❑ NA 0 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? ❑ YesNo ❑ 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 0 Yes , rNo ❑ 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. ❑ YesNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond n Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes .�No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Jallo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ,-No ❑ NA ❑ NE
r to question ): Explain any YES answers and/or any additional
acility to better explain situations (use additional pages as necessa
onimendationa
comments.
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Reviewer/Inspector Name:
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Reviewer/Inspector Signature:
Phone: 9/6 3as--?xs--
Date: 02 id'?/9
Page 3 of 3 2/4/2015

CALBRIATION (#24)
EACH REEL SHOULD BE CALIBRATED EVERY OTHER YEAR
DATE OF CALIBRATIONS -/
- FLOW RATES
- INITIAL AFTER 1" RAIN EVENT
-LOOK FOR ANY LEVEL THAT IS LESS THEN THE DESIGNED FREEBORED POA NEEDED.
RAIN FALL (#21)
- DUE EVERY YEAR: DATE
JI I 9I3,I SLUDGE (#21 &25)
O: Li 4.) P: 3 T i'l % RATIO OF SLUDGE a � -2
0: a I i) P: ) ' . % RATIO OF SLUDGE 6
0: P: % RATIO OF SLUDGE
0: P: % RATIO OF SLUDGE
RAIN BREAKER FORM
OTHER FORMS (#22 AND #21)
CROP YEILDS
MORTALITY !.
*If fields are grazed there will be no crop yields
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) HARVESTED FIELDS GOOD HEALTHY CORPS CORRECT
CROPS NO PONDING REELS FEED BINS LAGOON GARBAGE
Bermuda grass: Opens March 1st - Ends September 30th
Small Grain Over seed: Opens October 1st- Ends March 31 st
Corn: Opens February 15th - Ends June 30th
Cotton: Opens March 15th - Ends August 1st
Rye: Opens September 1st - Ends March 31 st
Oats: Opens September 1st - Ends April 15th
Wheat: Opens September 1st - Ends April 30th
Soybeans: Opens April 1st - Ends September 15th
Fescue: Opens August 1st- Ends July 31st
Sorghum Hay: Opens March 15th - Ends August 31 st

FACILITY #ff()I(3 FARM NAME:
PERMIT (t,e)
DUE EVERY 5 YEARS �?/Z / 2L
EXPERIATION DATE / + -3 / NUMBER OF ANIMALS
- CURRENT NUMBER OF ANIMAL .?—
OIC CARD YES OR NO
LAGOON LEVEL
WASTE UTILIZATION PLAN (WUP) (#20)
SOIL TYPES
CROP TYPES
- ODOR CONTROL CHECK LIST ES R NO
Irrigation Plan Maps YES OR NO
WASTE REPORT (#21)
-GOOD FOR 60 DAYS BEFORE OR AFTER
DATE 015 ! NITROGEN LEVEL
DATE 7l % G NITROGEN LEVEL
DATE NITROGEN LEVEL
SOIL REPORT (#21)
EVERY 3 YEARS: DATE 1/O /(7
P-I (NO MORE THEN 400)
PH (Note if 4 or less)
Cu/ZN (NO MORE THEN 3000) CU 76716(ZN
(IF PEANUTS NO MORE THEN 300)
IRR2 (#21)
Not over PAN CROP TYPES
FLOW RATES NITROGEN (N)
Not over PAN CROP TYPES
FLOW RATES NITROGEN (N)
Not over PAN CROP TYPES
FLOW RATES NITROGEN (N)
Not over PAN CROP TYPES
FLOW RATES NITROGEN (N)
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