090040_Routine Inspection_20240206

Date of Visit: P217 Arrival Time: Departure Time: T177UP—M County: A',�j,�
Farm
Owner
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
uC/�GJiLsaO Title:
air— —
l/
l/
Latitude:
Email:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: Structure Application Field Other:
a. Was the conveyance man-made?
Region:
Phone:
Integrator:
Certification Number:
Certification Number:
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 -PE-Ko NA NE
Ej Yes Ej No
Yes No
NA NE
NA NE
Yes No NA NE
Ej Yes �No Ej NA NE
❑ Yes []/No NA Ej NE
Page I of 3 511212020 Continued

Facility Number: 0 1 - Date of Inspection: a-va-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes gNo ❑ 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): w
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes _J�jNo ❑ 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 4E]'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 „®'No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes „ 2-No ❑ 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 �o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ❑'No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes p '&o ❑ 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): cc%� 6 , ���
05
13. Soil Type(s): NU 14 �YYI e�zlq
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 4�:rNo ❑ 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 J ]'No ❑ NA ❑ NE
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.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes 'allo
❑ Yes ,❑-No
❑ Yes �No
❑ Yes 10-No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �EJ'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? []Yes 0N0
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes &No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ 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 `0No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes .4�No
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:
❑NA ❑NE
❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes FJ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
P No
❑ 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
2' 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
Z—.VNo
❑ 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
[3-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
D No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[3'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[3/No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date:
Page 3 of 3 511212020

FACILITY* Jq�O. FARM NAME:% r�:/ � F LAGOON LEVEL
PERMIT (ne)
- DUE EVERY 5 YEARS
- EXPERIATION DATE NUMBER OF ANIMALS
- CURRENT NUMBER OF ANIMAL
- OIC CARD YES OR NO
WASTE UTILIZATION PLAN (WUP) (#20)
SOIL TYPES
CROP TYPES
- ODOR CONTROL CHECKLIST YES OR NO
- Irrigation Plan Maps YES OR NO
WASTE REPORT (u21)
-GOOD FOR 60 DAYS BEFORE OR AFTER
DATE a ! ` �"
DATE /'�' '3
DATE 0/19/ a" 3
NITROGEN LEVEL o�a UU
NITROGEN LEVEL 3. o 2
NITROGEN LEVEL • a-
-
- EVERY 3YEARS:
- P-1(NO MORE THEN 400)
SOIL REPORT (#21)
DATE
��Ln
0
(� u
- PH (Note if4 or less)
- Cu/ZN (NO MORE THEN 8000)
A
CU _.___ZN
Q
(IF PEANUTS
NO MORE THEN 300)
IRR2 (#21)
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 (x24) /',,/�J/''
EACH REEL SHOULD BE CALIBRATED EVERY OTHER YEARR j � s!'
DATE OF CALIBRATION
FLOW RATES
RAIN FALL xi)
-INITIAL AFTER 1" RAIN EVENT
-LOOK FOR ANY LEVEL THAT IS L SS THEN THE DESIGNED FREEBORED PDA NEEDED.
-DUE EVERY YEAR: DATE '1/ 81LUDGE (x21 a2s) f/
O: 3. Ce P: �"� % RATIO OF SLUDGE `t
0: P: % RATIO OF SLUDGE
O: P: % RATIO OF SLUDGE
O: P: % RATIO OF SLUDGE
OTHER FORMS (s22 AND #21)
RAIN BREAKER FORM ____CROP YEILDS X' 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 1st- Ends September 30t
Small Grain Over seed: Opens October 1st- Ends March 31st
Corn: Opens February 15* - Ends June 30u
Cotton: Opens March 15w- Ends August 1st
Rye: Opens September 1st - Ends March 31 st
Oats: Opens September i-t- Ends April 15w
Wheat: Opens September 1st- Ends April 300
Soybeans: Opens April 1st -Ends September 15t .
Fescue: Opens August 1st- Ends July 31 st
Sorghum Hay: Opens March 15w - Ends August 31 st