820601_RoutinE InSpEcTion_20230328

iviston of Water Resources
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency.
Type of Visit: E�rCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: --(D-Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
ounty,
Date of Visit: Arrival Time: Departure Time: C
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: tfoelm� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Dischar2es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: F-1 Structure E] Application Field F� 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)?
Phone:
_72 _z9
Region: L9CT-6
Integrator:
Certification Number: a
Certification Number:
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?
Longitude:
E] Yes,4��No E] NA E] NE
E] Yes r-1 No F-1 NA E] NE
0 Yes E] No F-1 NA 0 NE
E] Yes E] No F] NA F_� NE
E] Yes _E�tNo F-1 NA F] NE
F] Yes L211<o F-1 NA E] NE
Page I of 3 511212020 Continued

Facility Number:
Waste Collection & Treatment
I i
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?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Yes e-fff No NA Ej NE
E] Yes E] No F� NA NE
Structure 5 Structure 6
Yes Q"'No F_� NA NE
6. Are there structures on -site which are not properly addressed and/or managed through a
Yes _[allo
F-1 NA
E] NE
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?
[:] Yes 4Z/N o
F-1 NA
F_� NE
8. Do any of the structures lack adequate markers as required by the permit?
E] Yes ._[D�No
F� NA
E] 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 a No
F-1 NA
[:] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes -EfrN o
f__j NA
0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. Yes j F--,,rNo F-1 NA E] NE
F-1 Excessive Ponding F-1 Hydraulic Overload Ej Frozen Ground Heavy Metals (Cu, Zn, etc.)
F_� PAN F-1 PAN> 10%or l0lbs. F-1 Total Phosphorus F-1 Failure to Incorporate Manure/Sludge into Bare Soil
F-1 Outside of Acceptable Crop Window 0 Evidence of Wind Drift F-1 Application Outside of Approved Area
12. Crop Type(s): (24eajz,��' 4,�_e
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
Yes -,E:fNo
F-1 NA
[—] NE
15. Does the receiving crop and/or land application site need improvement?
E] Yes-4ETNo
F-1 NA
0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
Yes L3'-)No
F-] NA
[:] NE
acres determination?
17. Does the facility lack adequate acreage for land application?
E] Yes,-EfrNo
F-1 NA
E] NE
18. Is there a lack of properly operating waste application equipment?
Ej Yes L��No
F_j NA
E] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available9
Yes fnNo
F-1 NA
E] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes [��o
F-1 NA
F-1 NE
the appropriate box.
F_1WUP E]Checklists Design Maps [:] Lease Agreements
ElOther:
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
E] Yes J�J�o
F-1 NA
E] NE
F� Waste Application F_� Weekly Freeboard E] Waste Analysis Ej Soil Analysis
F-] Waste Transfers
Ej Weather
Code
F-1 Rainfall E] Stocking Ej Crop Yield 0 120 Minute Inspections E] Monthly and V Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
Ej Yes,,E]*No
F-] NA
[:] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes _[3-�o
F-1 NA
E] NE
Page 2 of 3
511212020 Continued

Facility Number: I Date of Inspection:j
24. Did the facility fail to calibrate waste application equipment as required by the permit?
E] Yes 'L2-Mo
Ej NA [:] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Ej Yes _2100'No
E] NA E] NE
the appropriate box(es) below.
F� Failure to complete annual sludge survey F'j Failure to develop a POA for sludge levels
F-1 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?
Ej Yes
NA [:] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification9
';'�o
Yes'Z'No
F-1 NA E] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
Yes ;3­Ko
F-1 NA F1 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
NA [:] NE
If yes, contact a regional Air Quality representative immediately.
_��o
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
Yes [3'�o
E] NA Ej NE
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes effN o
NA F-] NE
F-1 Application Field F� Lagoon/Storage Pond Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
E] Yes Ej"No
Ej NA Ej NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
E] Yes L2,1�o
Ej NA E] NE
34. Does the facility require a follow-up visit by the same agency?
Ej Yes J2­1�o
E] NA [:] NE
�) az'j' '-'), 6", a, ""_ ;? , b"
Reviewer/Inspector Name:
C��
Phone: /&-
Reviewer/Inspector Signature: Date:
Page 3 of 3 511212020

., _e /- ") -
FACILITY#: FARM NAME: 13-I'd4i Z;�eZAGOON LEVEL
/P E R M 1;
- DUE EVERY 5 YEARS
- EXPERIATION DATE NUMBER OF ANIMALS
- CURRENT NUMBER OF ANIMAL 9-4
- OIC CARD YES OR NO L/ U
WASTE UTILIZATION PLAN (WUP) (#20)
SOIL TYPES
CROP TYPES
- ODOR CONTROL CHECKLIST YES OR NO
- Irrigation Plan Maps YES OR NO
WASTE REPORT (#21)
-GOOD FOR 60 DAYS BEFORE
OR AFTER
DATE'
NITROGEN LEVEL
DATE
NITROGEN LEVEL -
DATE -7
NITROGEN LEVEL
31
SOIL REPORT (#211
- EVERY 3 YEARS:
DATE
- P-1 (NO MORE THEN 400)
- PH (Note if 4 or less)
- Cu/ZN (NO MORE THEN 8000) CU
(IF PEANUTS NO MORE THEN 300)
Not over PAN
FLOW RATES
Not over PAN
FLOW RATES
CROP TYPES
- ZN_
I RR2 (#21)
NITROGEN (N)
CROP TYPES
NITROGEN (N)
Not over PAN CROP TYPES
FLOW RATES NITROGEN (N)
Not over PAN
FLOW RATES
CROP TYPES
NITROGEN (N)
; I

CALBRIATION (#24)
EACH REEL SHOULD BE C)TRA7ED EVERY OTHER YEAR
DATE OF CALIBRATION
FLOW RATES
RAIN FALL (#21)
-INITIAL AFTER I" RAIN EVENT
-LOOK FOR ANY LEVEL THAT IS LESS THEN THE DESIGNED FREEBORED POA NEEDED.
-D U EVERY YEAR: D�TE T) &41-) SLUDGE (#21 &25)
0: P: % RATIO OF SLUDGE
0: P: % RATIO OF SLUDGE
0- P: % RATIO OF SLUDGE
0: P: % RATIO OF SLUDGE
OTHER FORMS (#22 AND #21)
RAIN BREAKER FORM 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 1 �,t - Ends September 30t',
Small Grain Over seed: Opens October I st - Ends March 31 st
Corn: Opens February I 5t�, - Ends June 30t',
Cotton: Opens March I 5th - Ends August I 3t
Rye: Opens September I st - Ends March 3 1 3t
Oats:- Opens September I il - Ends April 15ffi
Wheat: Opens September I -,t - Ends April 30th
Soybeans: Opens April 13t - Ends September I 5�h
Fescue: Opens August I st - Ends July 31st
Sorghum Hay: Opens March I 5th - Ends August 31 st