820080_Routine Inspection_20230809

Date of Visit: Arrival Time: ; Departure Time: County: ra Region: leC�
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ��" �� Title:
Onsite Representative: t f
Certified Operator: " �}
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
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?
Phone:
Integrator:
Certification Number: q b % oZ 75
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 �o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes JD-flo ❑ NA ❑ NE
❑ Yes E"f;o ❑ NA ❑ NE
Page I of 3
511212020 Continued

Facility Number: a2- - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes _jD'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: 3 C
Spillway?:
n
Designed Freeboard (in): -;t4rl17C7
Observed Freeboard (in): 1 _ q /
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes E�'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 E] 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?
J2AVk� Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 4�1No
❑ 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 E[No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes L2-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 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
12. Crop Type(s): �iet..�
j
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
E6Ycs 12 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [J-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
'Lg-No
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 -D-No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes _E3-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes �Q-No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
El 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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes -_0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes -S No
❑ NA
❑ NE
Page 2 of 3
511212020 Continued

Faciliq Number: FDate of Inspection:
�
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes - ff No NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes -Q-No NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a PDA 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 .e No NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Yes `E]-No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
Yes e"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 f"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 ''-No 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
e No
Ej NA
NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
J-No
❑ NA
NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
E-No
❑ NA
NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E�No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: %`U F35
Date: � //?/"
511212020
Page 3 of 3

FACILITY#: G FARM NAME: � LAGOON
PERMIT gns/
- DUE EVERY 5 YEARS
- EXPERIATION DATE NUMBER OF ANIMALS
- CURRENT NUMBER OF ANIMAL
- OIC CARD YES OR NO
WASTE UTILIZATION PLAN (WUP) (#20)
SOILTYPES
CROP TYPES
- ODOR CONTROL CHECK LIST YES OR NO
- Irrigation Plan Maps YES OR NO
�jjam�� / // WASTE�2
dd &RT (s i) R5 /, kg
-GOOD F6/f�$17)1h,M BEFORE OR AFTER d2 / /V
DATE NITROGEN LEVELO
DATE ,�/"6/ �3 NITROGEN LEVEL
DATE `(/y `�-e�- NITROGEN LEVEL �' ` ��/s �, ?6
EVERY 3 YEARS:
P-I (NO MORE THEN 400)
- PH (Nate lt4ar iesv)
Cu/ZN (NO MORE THEN 3000)
(IF PEANUTS NO MORE THEN 9D0)
SOIL REPORT c +l
DATE Ab/N[j-a
Not over PAN CROP TYPES
FLOW RATES
Not over PAN CROP TYPES
FLOW RATES
IRR2 (s21)
NITROGEN (N)
NITROGEN (N)
Not over PAN CROP TYPES
FLOW RATES NITROGEN (N)
Not over PAN CROP TYPES
FLOW RATES NITROGEN (N)
U"
3�
PUT,- 3(,-7 IC
333 /13
3�S 1�
3SS1 f15
5ss 1F

CALBRIATION (u24)
EACH REEL SHOULD BE CALIB%RA_TP EVERY OTHER EAR
DATE OF CALIBRATION F— o26Sv�avc�c.r/o
FLOW RATES
RAIN FALL (#21)
-INITIALAFTER I"RAIN EVENT
-LOOK FOR ANY LEVEL THAT IS LESS THEN THE DESIGNED FREEBORED PDA NEEDED.
SLUDGE (#21 a2s)
-DUE EVERY YEAR:
DATE
4 1
O: P:
,.
% RATIO OF SLUDGE
a
0:P:
0127
%RATIO OF SLUDGE
135-
3
O: , I P:
% RATIO OF SLUDGE
1.3s
I
O:Y P:
3.�/�-%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
4 s
,9-6111
1
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 30th
Small Grain Over seed: Opens October I st- Ends March 31 It
Corn: Opens February 151n - Ends June 30*
Cotton: Opens March 15N - Ends August 1st
Rye: Opens September I Ends March 31,t
Oats: Opens September I - Ends April 15t
Wheat: Opens September 1st- Ends April 30i
Soybeans: Opens April 1 st- Ends September 15th
Fescue: Opens August 1st- Ends July 31 st
Sorghum Hay: Opens March 15th - Ends August 31 st