820019_Routine Inspection_20231017

Date of Visit: (J %'7 Arrival
Time: d Departure Time: County:5
Farm Name: /`�Gr �liin Owner Email:
Owner Name: �� ��� Phone:
Mailing Address:
Physical Address:
Facility Contact: -'/��Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Region:
Integrator: ��� t
Certification Number: fGU7397
Certification Number:
Latitude: Longitude:
Discharges and Stream Impacts
Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes E3 &o ❑ NA ❑ NE
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 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] o ❑ NA ❑ NE
❑ Yes .'No ❑ NA ❑ NE
Page I of 3 511212020 Continued

Facility Number: - / Date of Ins ection: 3
7 A2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes _12-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):
yi
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes __[gNo
❑ 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 _❑ fVo
❑ 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?
Z Yes o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes inNo
❑ 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 ENo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes f rNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ 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): c aa&.",916e� 644.40
13. Soil Type(s): /J0 6 ; %op (g
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q-Vo ❑ 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 Q No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 2'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes .❑"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes e-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes J:�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 ,❑'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 2 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 0 No
❑ NA
❑ NE
Page 2 of 3
511212020 Continued

Facilit Number: - /
Date of inspection: 7 / ,�-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �❑/' No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ,D-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?
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:
r
❑ Yes
Ea -No
❑ NA
❑ NE
[-]Yes
;],No
❑ NA
❑ NE
❑ Yes
J2-No
❑ NA
❑ NE
❑ Yes -No ❑ NA ❑ NE
❑ Yes ErNo ❑ NA ❑ NE
[-]Yes
❑"No
❑ NA
❑ NE
❑ Yes
�2'No
❑ NA
❑ NE
❑ Yes
E[ [No
❑ NA
❑ NE
❑ Yes
❑yNo
❑ NA
❑ NE
Phone: /? o
Date: 101% 7 4,i^-3
Page 3 of 3 511212020

FACILITY#: " 11 /V FARM NAME: f 1 tLAGOON
DUE EVERY 5 YEARS
EXPERIATION DATE
CURRENT NUMBER OF ANIMAL
OIC CARD YES OR NO
PERMIT (:na)
NUMBER OF ANIMALS
WASTE UTILIZATION PLAN (WUP) (#20)
SOIL TYPES
CROP TYPES
- ODOR CONTROL CHECKLIST YES OR NO
- Irrigation Plan Maps YES OR NO
WASTE REPORT (#zi)
-GOOD FOR 6p DAYS BEFORE OR AFTER O
DATE �b 3 NITROGEN LEVEL �) U
DATE COJ �l�-.3 NITROGEN LEVEL
DATE 2 I aJ NITROGEN LEVEL /, .3 %
161d& 120r
OIL REPORT (#24)
�L l EVERY 3 YEARS: DATE �3
P-1 (NO MORE THEN 400)
PH (Nate it4o, I.)
Cu1ZN (NO MORE THEN 3000) CU ZN
(IF PEANUTS NO MORE THEN 300)
Not over PAN CROP TYPES
FLOW RATES
IRR2 (#21)
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 (a24)
EACH REEL SHOULD BE CAL17AT913 EVERY OTHER YEAR
DATE OF CALIBRATION 76L! S�/J-1
FLOW RATES art"
> RAIN FALL(a q
-INITIAL AFTER I" RAIN EVENT ?
-LOOK FOR ANY LEVEL THAT IS LESS THEN THE DESIGNED FREEBORED PDA NEEDED.
SLUDGE (= a2sl
-DUE EVERY YEAR: DATE 7 %�/i�'2
O: .5-, o P: % RATIO OF SLUDGE
O: P: % RATIO OF SLUDGE
O: P: % RATIO OF SLUDGE
0: P: % RATIO OF SLUDGE
OTHER FORMS (422AND 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
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�- Ends September 30th
Small Grain Over seed: Opens October 1-t-Ends March 31A
Corn: Opens February 15N - Ends June 30t
Cotton: Opens March 15� - Ends August 1 �
Rye: Opens September in- Ends March 31A
Oats: Opens September 1�t- Ends April 15t^
Wheat Opens September 1st - Ends April 303
Soybeans: Opens April 1st- Ends September 15t
Fescue: Opens August 1st- Ends July 31 st
Sorghum Hay: Opens March 15*n - Ends August 31 st