820044_Routine Inspection_20231013

Date of Visit: Arrival Time: Departure Time: aJ�97I 1
Mailing Address:
Physical Address:
Facility Contact: C?CQwI_% Title:
'R
Onsite Representative:
Certified Operator:
Back-up Operator:
/(
Phone:::
Integrator:
Certification Number:
Certification Number:
Location of Farm: 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 'Jallo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes _2�No ❑ NA ❑ NE
❑ Yes Jallo ❑ NA ❑ NE
Page 1 of 3 511212020 Continued

Facility Number: - W jDate of Inspection: !�
,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes Eno
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes J2'No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes E�J-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 PNo
❑ 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 _E]ni to
❑ 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)
e�—
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
_C],No
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J21'No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;3-&o ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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 A,�f
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes 4 f No
❑ Yes �i'No
[j Yes ;]-No
❑ Yes _E2-No
❑ Yes J2-No
❑ NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
❑NA
❑NE
❑NA ❑NE
❑ Yes J2'No ❑ NA ❑ NE
❑ Yes EJ'No ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes f�?No
❑ Yes 12 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 511212020 Continued

Facility Number: -
Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 4Ef No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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 En�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
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?
91 %V
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
❑ Yes oNo ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes E] No ❑ NA ❑ NE
❑ Yes
gNo
❑ NA
❑ NE
❑ Yes
F:::�rNo
❑ NA
❑ NE
❑ Yes
e'No
❑ NA
❑ NE
[:]Yes
[2 No
❑ NA
❑ NE
Phone: lcd/e3�'F7 8�
Date: 1j 131-;L-_4
Page 3 of 3 511212020

i
FACILITY#: �a � FARM NAME: _a� C7 LAGOON LEVEL
P RMIT pne)
- DUE EVERY 5 YEARS
- - EXPERIATION DATE
- CURRENT N BER OF ANIMAL
- OIC CARD ES OR NO
NUMBER OF ANIMALS
WASTE UTILIZATION PLAN (WUP) (#2o)
SOIL TYPES
CROP TYPES
- ODOR CONTROL CHEC4 LIST OR NO
- Irrigation Plan Map ES)DR NO
WASTE REPORT (# i)
-GOOD FOR 60 DAYS BEFORE OR AFTER
DATE `Z(Ado-.3 NITROGEN LEVEL ),25
�' 3
DATE GJ` 911)2- NITROGEN LEVEL
DATE 0 51 I .--3 NITROGEN LEVEL �' �S .2-Co J
G11;�31a-a [,4 /.�5
�l la1 / I * / 1.95,
SOII{ REPORTI#zi)
- EVERY 3YEARS: DATE N,-X- P-3
- P-1 (NO MORE THEN 400)
- PH(Noie 14 or les)
- Cu2N (NO MORE THEN 3000) CU 1 ZN
(IF PEANUTS NO MORE THEN 300)
Not over PAN CROP TYPES
FLOW RA
I RR2 (#2i)
NITROGEN (N)
Not over PAN CROP TYPES
FLOW RATES R )
Not over PAN CROP TYPES
FLOW RATES NITROGEN (N)
Not over PAN CROP TYPES
FLOW RATES NITROGEN (N)

CALBRIATION (#24)
EACH REEL SHOULD BE CA RAT D EVERY OTHER YEAR
DATE OF CALIBRATION /(o ?6-3
FLOW RATES /,_J-
RAIN FALL (ezi)
-INITIAL AFTER 1' RAIN EVENT
-LOOK FOR ANY LEVEL THAT IS LESS THEN THE DESIGNED FREEBORED POA NEEDED.
-DUE EVE Y YEAR: DATE
6!17/,_ LUDGExiszs)
O: P: ui % RATIO OF SLUDGE
0: P: Ui 4 % RATIO OF SLUDGE
0: P: % RATIO OF SLUDGE
0: P: % RATIO OF SLUDGE
OTH ER FORMS (tozz AND 421)
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 1n-Ends September30th
Small Grain Over seed: Opens October 1n-Ends March 31A
Corn: Opens February 15t -Ends June 30*
Cotton: Opens March 15* - Ends August 1�
Rye: Opens September 1k- Ends March 31st
Oats: Opens September 1�t-Ends April 15N
Wheat: Opens September 1st - Ends April 30t
Soybeans: Opens April 1 st- Ends September 15w -
Fescue: Opens August 1 st- Ends July 31 �
Sorghum Hay: Opens March 15* - Ends August 31 st