820043_Routine Inspection_20240305

Date of Visit: Arrival Time: Q Departure Time: ) County:
Farm Name: Ay )c Owner Email:
Owner Name: �p�Q j /Cjr/jPhone:
Mailing Address:
Physical Address:
Facility Contact: 1)1 ,Z ., �C Ca�A� Title:
OnsiteRepresentative: /f
Certified Operator: /t
Back-up Operator:
Region: I/26
Phone:
Integrator:
Certification Number: / 79d 5g
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 PrNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ,❑"No ❑ NA ❑ NE
❑ Yes ,Q'I�o ❑ NA ❑ NE
Page I of 3 511212020 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes _E;°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?:
q
Designed Freeboard (in): /
Observed Freeboard (in): 22
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes EyNo
❑ 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 E7-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 ZNo
❑ 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 E�J`No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes E�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 CropWindow ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): 6&17r Z/> O 65
&i�%Ct9��
13.Soil Type(s): 6g P
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes _EEj`No ❑ 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 ONo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
d No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Qo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes gE'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes .❑'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 eE]'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ErNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes _E�No ❑ NA ❑ NE
Page 2 of 3 511212020 Continued

Facilit Number:
Date of inspection: SJ
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑-No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes "�o
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 12rNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes _ENo
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
❑ NA ❑ NE
❑ NA ❑ NE
[—]Yes 4 No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
❑ Yes -E�No
[:]Yes El"No
❑ Yes [2-No
(—]Yes ❑-No
❑ Yes JZNo
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:
Page 3 of 3 511212020

FACILITY #: (/�_ `, FARM NAME: LAGOON
PERMIT (#is)
DUE EVERY 5 YEARS
EXPERIATION DATE
CURRENT BER OF ANIMAL
OIC CARWYES OR NO
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 (#21)
-GOOD FOR -60 DAYS BEFORE OR AFTER
DATE NITROGEN NITROGEN LEVEL
DATE Z-///1112-3 NITROGEN LEVEL 3!�
DATE / 4 4" ?-3
NITROGEN LEVEL I. 7U
101�/�2 3
l d
SOIL REPORT (#zi)
- EVERY 3 YEARS:
DATE
- P-1 (NO MORE THEN 400)
- PH (Note if4or less) [\ L
- Cu/ZN (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)
:z 11y/a-y
,3 is

CALBRIATION Imal
- EACH REEL SHOULD BE CALIBRATED EVERY OTHER YEAR
DATE OF CALIBRATION /! Sao/a. $ //Laa /, 3
FLOW RATES aan
RAIN FALL (#21)
-INITIAL AFTER 1" RAIN EVENT
-LOOK FOR ANY LEVEL THAT IS LESS THEN THE DESIGNED FREEBORED POA NEEDED.
.,�/pS UDGE(mi&2e)
-DUE EVERY YEAR: DATE a'
O: s a P: eI % RATIO OF SLUDGE
O: P: % RATIO OF SLUDGE
O: P: % RATIO OF SLUDGE
O: P: % RATIO OF SLUDGE
OTHER FORMS (n22 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 30th
Small Grain Over seed: Opens October 1st- Ends March 31A
Corn: Opens February 15th - Ends June 30u
Cotton: Opens March 15th - Ends August 1st
Rye: Opens September 1st- Ends March 31 st
Oats: Opens September 1�t- Ends April 15t
Wheat: Opens September 1st- Ends April 30m
.Soybeans: Opens April 1st -Ends September 15th
Fescue: Opens August 1st- Ends July 31st
Sorghum Hay: Opens March 15th - Ends August 31 st