820323_Routine Inspection_20231116

Type of Visit: .Q'Compliance Inspection 0 Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit:-04outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: /ty Arrival Time: y Departure Time: ® County:c//v/rrIJGYm
Farm Name: /✓,1 /ji ��yy,� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region:��
Facility Contact: �/,;Ca�7d'l�(� Title: Phone:
Onsite Representative: Integrator:'�%�.�tvr�
Certified Operator: G W� Certification Number: �Od
Back-up Operator: Certification Number:
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:
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?
Longitude:
[—]Yes /O No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes Le-tNo ❑ NA ❑ NE
[—]Yes ENo ❑ NA ❑ NE
Page I of 3 511212020 Continued

Facility Number: - 3 T3 jDate of Inspection: Z 1 tp
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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes ❑ 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 �❑-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?
12rYesTo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes _2No
❑ 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 Aoolicafion
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 42-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes J2-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):
13. Soil Type(s):
14. Do the receiving crops differ from those d signated in the CAWMP?
❑ Yes_" o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes -4allo
❑ 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 �❑irNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [:I -No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes —f!:rNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes,,ffNo
❑ 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" j 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 `' 7No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rambreakers on irrigation equipment?
❑ Yes .Q/No
❑ NA
❑ NE
Page 2 of 3
511212020 Continued

Facility Number: - . ,9
Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes _Q'No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �IQo
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:
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes .❑No ❑ NA ❑ NE
❑ Yes _ No ❑ NA ❑ NE
❑ Yes 2TNo ❑ NA ❑ NE
❑ Yes J:�No ❑ NA ❑ NE
❑ Yes -E[No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes No
❑ Yes Q'No
❑ Yes -[D"No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Phone:
Date:
Page 3 of 3 511212020

FACILITY Av� FARM NAME: LAGOON
- DUE EVERY 5 YEARS
- EXPERIATION DATE
- CURRENT NUMBER OF ANIMAL
- OIC CARD YES OR NO
SOIL TYPES
PERMIT pw!,)
NUMBER OF ANIMALS
WASTE UTILIZATION PLAN (WUP) (#20)
CROP TYPES
- ODOR CONTROL CHECKLIST YES OR NO
- Irrigation Plan Maps YES OR NO
26
A111,__3
WASTE REPORT (m1)
eI
-GOOD FOR 60 DAYS BEFORE OR AFTER �� 7
DATE�/ ')-.3
DATE ` �����"
NITROGEN LEVEL/ -
NITROGEN LEVEL �
DATE X g'e2
NITROGEN LEVEL ' 7k
SOIL REPORT
- EVERY 3 YEARS: DATE
- P-1 (NO MORE THEN 400)
- PH(Note U4or less) OI71T
- Cu2N (NO MORE THEN 3000) CU
(IF PEANUTS NO MORE THEN 300)
Not over PAN CROP TYPES
FLOW RA
Not over PAN CROP TYPES
IRR2 (uzI)
NITROGEN (N)
FLOW RATES NITROGEN (N)
Not over PAN CROP TYPES
FLOW RATES NITROGEN (N)
Not over PAN CROP TYPES
FLOW RATES NITROGEN (N)

CALBRIATION (+a<)
EACH REEL SHOULD BE CALIBRATED EVERY OTHER YEAR
DATE OF CALIBRATION
FLOW RATES Jr?) (
RAIN FALL hrrl
-INITIAL AFTER 1" RAIN EVENT
-LOOK FOR ANY LEVEL THAT IS LESS THEN THE DESIGNED FREEBORED POA NEEDED.
SLUDGE lvt a25)
-DUE fy.ERY YEAR: DATE %��a2(4/a )-
0: P: jr67- % RATIO OF SLUDGE
0: P: % 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 1st- Ends September 30t
Small Grain Over seed: Opens October 1�-Ends March 31�
Corn: Opens February 15� - Ends June 30*
Cotton: Opens March 15w - Ends August 1 #
Rye: Opens September In- Ends March 31A
Oats: Opens September 1-t- Ends April 15th
Wheat-, Opens September 1 st - Ends April 30th
Soybeans: Opens April 1st -Ends September 15t -
Fescue: Opens August i st - Ends July 31 A
Sorghum Hay: Opens March I SN - Ends August 31 st