820642_Routine Inspection_20230907

IM6 "il/
Type of Visit: ,0'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (;Woutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
a
Date of Visit: Arrival Time: Departure Time: O County: Region:
Farm Name: j 4 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
H
Title:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
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 ,01Qb ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes. -[DNo ❑ NA ❑ NE
❑ Yes E]"No ❑ NA ❑ NE
Page I of 3 511212020 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,E�T 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 13-1o ❑ 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 QlNo ❑ 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 [3-No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA
❑ NE
'Ea'No
(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 ff No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ,�rNo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �' o ❑ 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes �No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
.re'Yes ❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes -No
❑ NA
❑ NE
acres determination?
'La
17. Does the facility lack adequate acreage for land application?
❑ Yes J 'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes '�allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes „❑'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes [D"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.
O Yes ❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield �20 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes ,e o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes Lo"No
❑ NA
❑ 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 , D14o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ' '' o ❑ 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 MNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes L2'1Go
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes C7&o
❑ 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 E�'ro
❑ 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 eNo
❑ 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 ,E5 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:
Page 3 of 3
le
Phone:
Date:
511212020

FACILDY#: t FARM NAME: �PLAGOON
' PER
DUE EVERY 5 YEARS
EXPERIATION DATE
CURRENT NUMBER OF ANIMAL
OIC CARD YES OR NO
NUMBER OF ANIMALS
WASTE UTILIZATION PLAN (WUP) (#20)
SOILTYPES
CROP TYPES
ODOR CONTROL CHECK LIST YES OR NO
Irrigation Plan Maps YES OR NO
WASTE REPORT (#21)
-GOOD FOR 60DAYS BEFORE OR AFTER
DATE l ` /Z NITROGEN LEVEL �` s
DATE S C- NITROGEN LEVEL y2
/- !1-41
DATE `j'l - 3b-.2 NITROGEN LEVEL L G
[131 1;L3 �2 •s 7
SOIL REPORT (#21)
- EVERY 3 YEARS: DATE
- P-1 (NO MORE THEN 400)
- PH (Note if 4or leav)
- Cu1ZN (NO MORE THEN 3000) CU ZN
(IF PEANUTS NO MORE THEN 300)
IRR2 (#zi)
Not over PAN CROP TYPES
FLOW
NITROGEN (N)
Not over PAN CROP TYPES
FLOW RATES NITROGEN
Not over PAN CROP TYPES
FLOW RA
NITROGEN (N)
Not over PAN CROP TYPES
FLOW RATES NITROGEN (N)

CALBRIATION (asa)
EACH REEL SHOULD BE CALI ATED EVERY rOTHER YEAR
DATE OF CALIBRATION
FLOW RATES l%D
RAIN FALL (x21)
-INITIAL AFTER 1" RAIN EVENT -
-LOOK FOR ANY LEVEL THAT IS LESS THEN THE DESIGNED FREEBORED PDA NEEDED.
� / SLUDGE (miass)
DU EVERY YEAR: DATE `KJA2
Oj
ls- P: �, 4� % RATIO OF SLUDGE
0; P: % RATIO OF SLUDGE
O: 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
AREASTREES 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 Id- Ends September 30th
Small Grain Over seed: Opens October 1st- Ends March 31st
Corn: Opens February 15t -Ends June 30t
Cotton: Opens March 15t - Ends August Id
Rye: Opens September)-t-Ends March 31st
Oats: Opens September I-f- Ends April 15t -
Wheat: Opens September 1st- Ends April 30t
Soybeans: Opens April 1st- Ends September 15t -
Fescue: Opens August 1st- Ends July 31st
Sorghum Hay: Opens March 15w - Ends August 31 st