820235_Routine Inspection_20230410

i ype of v isit: %c�,-ruompnance inspection v uperation Review U Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
yl'
Date of Visit: Arrival Time: I Y!/T Departure Time: ,/Couno3 .
Farm Name: lOwner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
If
Certified Operator:
Back-up Operator:
Location of Farm:
!<
Latitude:
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?
Region: /�/<G
Phone:
Integrator:
Certification Number:
Certification Number:
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?
Longitude:
❑ Yes --Eno ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes [—]No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes _L�rNo ❑ NA ❑ NE
❑ Yes L;I)No ❑ NA ❑ NE
Page 1 of 3 511212020 Continued

Facility Number: �- Date of Inspection: G
11
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes,,E'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: v�
Spillway?:
Designed Freeboard (in): y �%
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Q-No
❑ 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 0-No
❑ NA
❑ 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 ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
'EFNo
9. Does any part of the waste management system other than the waste structures require
❑ Yes D No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes c�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes _Ea - 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--EfrNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes,,f�no
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes Ea$4o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes _D No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ,ETNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes E]-No
0 NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes Z]-No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes �o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes E No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes Ej>No
❑ NA
❑ NE
Page 2 of 3
511212020 Continued

Facility Number: - a, Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
',J�'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�J'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? ❑ Yes _[2-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes J:J�No ❑ 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?
❑ Yes _lEit"No
❑ 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
_allo
❑ 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
EDINo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ 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
�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
J:�No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:10
Date:
51 2,12020

FACILITY # �/ FARM NAME: l�,/
6/`- LAGOON LEVEL
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 CHE "S S R NO
- Irrigation Plan Map ES R NO
WASTE REPORT (#21)
-GOOD FOR 60 DAYS BEFORE OR AFTER
DATE / NITROGEN LEVEL /
DATE /fLC
NITROGEN LEVEL ) " v d
C1
DATE /
NITROGEN LEVEL 1 t 44
SOIL REPORT
- EVERY 3 YEARS:
DATE
- P-I (NO MORE THEN 400)
- PH (Note if 4 or less)
- Cu/ZN (NO MORE THEN 3000) CU
(IF PEANUTS NO MORE THEN 300)
l R R2 (#21 )
Not over PAN CROP TYPES
FLOW RATES
Not over PAN CROP TYPES
FLOW RATES
Not over PAN
FLOW RATES
Not over PAN
FLOW RATES
NITROGEN (N)
NITROGEN (N)
CROP TYPES
NITROGEN (N)
CROP TYPES
NITROGEN (N)

CALBRIATION (#za)
- EACH REEL S.HOULD BE CALIBRATED EVERY OTHER YEAR
DATE OF CALIBRATION
FLOW RATES
RAIN FALL (#21)
-INITIAL AFTER 1" RAIN EVENT
-LOOK FOR ANY LEVEL THAT IS LESS THEN THE DESIGNED FREEBORED POA NEEDED.
SLUDGE (#21 &25�
-DUE EVERY YEAR: DATE � �/��'
0: Ij P: % RATIO OF SLUDGE
0: P: , L % RATIO OF SLUDGE 3 3
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 st -Ends September 30th
Small Grain. Over seed: Opens October 1st- Ends March 31 st
Corn: Opens February 15th - Ends June 30t,
Cotton: Opens March 15th - Ends August 1st
Rye: Opens September 1 st- Ends March 31 st
Oats:- Opens September 1 - Ends April 1511,
Wheat: Opens September 1st- Ends April 30th
Soybeans: Opens April 1st- Ends September 15th
Fescue: Opens August 1 st- Ends July 31 st
Sorghum Hay: Opens March 15th - Ends August 31 st
166