820178_Routine Inspection_20230815

for Visit: 0 Routine
0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County::52 Region:
Farm Name: ��.D Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: e'(_ Title:
Onsite Representative: tf
Certified Operator: it,
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: PA�
Certification Number: 026 /
Certification Number:
Longitude:
/--/40
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Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[—]Yes E:I.Nb
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA
❑ NE
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 O�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes -fTNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 511212020 Continued

Facility Number: % Date of Inspection: t5
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes,,,Ei rNo
❑ 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes „�o
❑ 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 �P_0�o
❑ 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 ®"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 J:],1<Io
❑ NA
❑ NE
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 Z3�No
❑ NA
❑ NE
❑ Excessive Pending ❑ 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
fir❑
12. Crop Type(s): /%
CAI��, r+�/QDS� tt.� ,
p
q_
13. Soil Type(s): %A,� 1146, )L, L n 1V o 6
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes fNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 43-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ,® o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes E°No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes C]Ao
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes L2^No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ,❑'fo
❑ 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 ®-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 .®'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®'No ❑ NA ❑ NE
Page 2 of 511212020 Continued

Facility Number: 7 Date of Inspection: 77
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0"No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes n No ❑ NA ❑ NE
the appropriate box(es) below. T
❑ 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
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
❑ Yes _[2,No ❑ NA ❑ NE
❑ Yes E] No ❑ NA ❑ NE
❑ Yes ,�No ❑ NA ❑ NE
❑ Yes _E24o ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes ,E]"No ❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 9/o V.35 - 5?2 5—
Date:
511212020

"I /
FACILITY#. /�V FARM NAME: /'' LAGOON
PERMIT ns
- DUE EVERY 5 YEARS
- B(PERIATION DATE NUMBER OF ANIMALS
- CURRENT NUMBER OF ANIMAL
- OIC CARD YES OR NO
WASTE UTILIZATION PLAN (WUP) (R20)
SOIL TYPES -
CROP TYPES
- ODOR CONTROL CHECKLIST YES OR NO
- Irrigation Plan Maps YES OR NO
WASTE REPORT (#21)
-GOOD FOUR 6004 DAYS BEFORE OR AFTER
DATE 21 � ®a/ NITROGEN LEVEL__./
DATE 01 NITROGEN LEVEL
DATE NITROGEN LEVEL
SOIL REPORT (#21)
- EVERY 3 YEARS: DATE
- P-I (NO MORETHEN 400)
PH (Note if 4 or I..)
- Cu/ZN (NO MORE THEN 3000) CLI ZN
(IFPE NI S NO MORETHEN 300)
IRR2 (n21)
Not over PAN CROP TYPES
FLOW RATES I I 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)

CALBRIATION (nza)
EACH REEL SHOULD BE CALI RAT EVERY OTHER YEAR
DATE OF CALIBRATI � �
FLOW RATES!
.. RAIN FALL p2i)
-INITIAL AFTER I"RAIN EVENT
-LOOK FOR ANY LEVEL THAT IS LESS THEN THE DESIGNED FREEBORED POA NEEDED. (uzi
G&- ' L2-SLUDGE az� _—
-DUE VERY YEAR: DATE �<
O: P: ?.7 % RATIO OF SLUDGE / by
O: P: % RATIO OF SLUDGE
O: P: % RATIO OF SLUDGE
O: P. % RATIO OF SLUDGE
OTHER FORMS (#zz AND 921)
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
AREASTREES OR GRASS NEED TO BE REMOVED EROSION DITCHES
WINTER CROP(OVERSEEDED) HARVESTED FIELDSGOOD HEALTHY CORPS_ CORRECT
CROPS NO PONDING REELS_ FEED BINS LAGOON GARBAGE
Bermuda grass: Opens March 1-t- Ends September 30+
Small Grain. Over seed: Opens October 1�- Ends March 31st -
Corn: Opens February 15t - Ends June 30th 15
Cotton: Opens March 15N- Ends August 1st
Rye: Opens September 1� - Ends March 31A
Oats: Opens September 1�t- Ends April 15'^ -
Wheat: Opens September 1st- Ends April 30+
Soybeans: Opens April 1st- Ends September 15w
Fescue: Opens August 1st- Ends July 31 st
Sorghum Hay: Opens March 15i - Ends August 31st