820580_Routine Inspection_20231102

for Visit:
Referral
Other O Denied Access
Date of Visit: -3 Arrival Time: Departure Time: i 0 County Region: c;�?fo
Farm Name: %`Ccriir7 Owner Email:
Owner Name: /y Phone:
Mailing Address:
Physical Address:
Facility Contact: ��/1, (jam-, Title.
Onsite Representative: �r
Certified Operator:,Da-r
Back-up Operator:
Location of Farm:
Latitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
�3
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)?
Phone:
Integrator:
Certification Number:�
Certification Number:
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 '240
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [].No ❑ NA ❑ NE
❑ Yes J:?No ❑ NA ❑ NE
Page I of 3 511212020 Continuer!

[Facility Number: Date of Ins ection: 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ 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: F124�
Spillway?:
Designed Freeboard (in): &
Observed Freeboard (in): r-151 y "
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
LD'Ko
❑ 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
O 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?
❑ Yes
eNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EeNo
❑ 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
�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
,5No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
J�fNo
❑ 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): clle�6 C OS
11'f4l
13. Soil Type(s): 6J41,13
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E1540
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ 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?
17. Does the facility lack adequate acreage for land application?
❑ Yes
En'�TNo
❑ 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
Q 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. ❑ Yes ErNo ❑ 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 oNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E24�o ❑ NA ❑ NE
Page 2 of 3 511212020 Continued

Facility Number: - Date of Inspection: a'
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ,,allo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
ONo
❑ 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
f� No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
_0No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ErNo
❑ 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
❑-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
E3'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
1✓J No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[]Yes
.2 No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require afollow-up visit by the same agency?
❑Yes
,.f�o
❑ NA ❑ NE
Se- 52C� .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: d�?6 835 -'F2,s—
Date:
511212020 3
Page 3 of 3

FACILITY#:5�2 Sy FARM NAME: LAGOON LEVEL
4PERMITM9)
- DUE EVERY 5 YEARS
- EXPERIATIONDATE_
- CURRENT NUMBER OF
- 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 (uzi)
-GOOD FOR 6Q DAYS BEFORE OR AFTER
DATE I �.1-.�
NITROGEN LEVEL W
. 66
DATEZ712-3 y
NITROGEN LEVEL
DATE 1 ('A/
NITROGEN LEVEL A�-
/�� 3
C)
SOIL FFEP/ORT
- EVERY 3 YEARS:
DATE
- P-1 (NO MORE THEN 400)
- PH(Note if 4o, 1..)
- Cu2N (NO MORE THEN 3000) CU ZN
(IF PEANUTS NO MORE THEN 300)
I RR2 (a -H
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)
Not over PAN CROP TYPES
FLOW RATES NITROGEN (N)

CALBRIATION pz4)
- EACH REEL SHOULD BE CALIBRAT D EVERY OTHER YEAR
DATE OF CALIBRATION
FLOW RATES
RAIN FALL(#21)
-INITIAL AFTER 1" RAIN EVENT
-LOOK FOR ANY LEVEL THAT IS LESS THEN THE DESIGNED FREEBORED PDA NEEDED.
SLUDGE pm azs)
-DUE EVERY YEAR: DATE
O: 1- �y'`/— P: �^, d� % RATIO OF SLUDGE
O: P: e2.3 % RATIO OF SLUDGE
0: 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
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 September30*
Small Grain Over seed: Opens October 1-t- Ends March 31 A
Corn: Opens February 15t - Ends June 30t
Cotton: Opens March 15N-Ends August1A
Rye: Opens September 15t-Ends March 31A
Oats: Opens September IA- Ends April 15t -
Wheat Opens September 1 st - Ends April 3P
Soybeans: Opens April I-t - Ends September 15t
Fescue: Opens August 1 st- Ends July 31 A
Sorghum Hay: Opens March 15w - Ends August 31 st