820271_Routine Inspection_20230220

type of Visit: 40Tompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
teason for Visit:_-C�Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; 3019M I Departure Time: :30 County:'' Region:�6
Farm Name:, Owner Email:
Owner Name: r Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
/Il/ Title:
f�
Latitude:
Phone:
Integrator: /�
Certification Number: l �-&t 1 -7
Certification Number:
Longitude:
Design ;Current
Design
Current
Design
Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop,
Cattle Capacity
Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
7S1� o270
Desiew:Current
Dry Cow
Farrow to Feeder
Dry Poultry
Ca ace
Pop.,:::,
Farrow to Finish
Layers
-.Non-Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkeyPoults
F
Other
Other
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 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes tD- o ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - % C Date of Inspection:,,2, 4'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes -El"No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure
6
Identifier: A 10-J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [�!rNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes No
0 NA
❑ NE
waste management or closure plan?
',E�f
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 ,e'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ,D"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 ErNo
❑ NA
ONE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ._E]'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q 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
12. Crop TYPe(s): �� �.� �� �
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes,,f�rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes E]'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes,ff:rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes `.ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes a'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ETNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes J"No
❑ NA
❑ N E
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes L2,No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes ,E!j No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes c.�No
❑ NA
0 NE
Page 2 of 3
21412015 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q-I�o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes _E5"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?
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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
17f /Y�/�WIso/0
❑ Yes -En'No
❑ NA
❑ NE
❑ Yes . n- o
❑ NA
❑ NE
❑ Yes -Efr-No
❑ NA
❑ NE
]Yes fNo ❑NA ❑NE
❑ Yes E] No ❑ NA ❑ NE
❑ Yes '2 No ❑ NA ❑ NE
❑ Yes EI No
❑ Yes Q-No
❑ Yes _1�]�o
9eo ao r�-
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Phone: C-7%6 �?3 S
Date: t,
511212020

FACILITY#: C/y _ " ARM NAME: LAGOON LEVEL
�� 3
PERMIT
- DUE EVERY 5 YEARS
- EXPERIATION DATE
- CURRENT NUMBER OF ANIMAL
- OIC CARD YES OR NO
NUMBER OF ANIMALS
WASTE UTILIZATION PLAN (WUP) (#20)
SOIL TYPES
CROP TYPES
- ODOR CONTROL CHECK LIST YES OR NO
- Irrigation Plan Maps YES OR NO
WASTE REPORT (#21)
-GOOD FOR 60 DAYS BEFORE OR AFTER
DATE �-! �"% .�—
G
NITROGEN LEVEL ° �o
DATE �' �"
NITROGEN LEVEL
DATE g` ��"
NITROGEN LEVEL
- EVERY 3 YEARS:
SOIL REPORT
DATE
- P-1 (NO MORE THEN 400)
- PH (Note if 4 or less)
- Cu/ZN (NO MORE THEN 3000) CU ZN
(IF PEANUTS NO MORE THEN 300)
IRR2 (#2,)
Not over PAN CROP TYPES
FLOW RATES NITROGEN (N)
Not over PAN CROP TYPES
FLOW RATES NITROG )
Not over PAN CROP TYPES
FLOW RATES NITROGEN (N)
Not over PAN CROP TYPES
FLOW RATES NITROGEN (N)

CALBRIATION (#24) Q ! a yl
- EACH REEL SHOULD BE CAL! RATED EVERY OTHER YEAR r ,1
DATE OF CALIBRATION
- FLOW RATES l k6
RAIN FALL (#21)
-INITIAL AFTER 1" RAIN EVENT
-LOOK FOR ANY LEVEL THAT IS LESS THEN THE DESIGNED FREEBORED POA NEEDED.
DUE EVERY YEAR: DA
0:
P:
0:
P:
0:
P:
0:
P:
SLUDGE (#21 &26)
% RATIO OF SLUDGE
• RATIO OF SLUDGE
• RATIO OF SLUDGE
% RATIO OF SLUDGE
OTHER FORMS (#22AND #21)
RAIN BREAKER FORM X 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 st - Ends September 30th
Small Grain Over seed: Opens October 1st- Ends March 31st
Corn: Opens February 15th - Ends June 30th
Cotton: Opens March 15th - Ends August 13t
Rye: Opens September 1st -Ends March 31A
Oats:- Opens September 1 st'— 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