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Type of Visit: )Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine Complaint Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:( 10 :IS-0. Departure Time: \k..•30+... I County: 6 Region:K.S
Farm Name: Own er Email:
Owner Name: 16Ye f'-k )►/ Phone: 5� bk°1 I
Mailing Address: `2'1-11 tY 3A* r\)fttYj 0 . , gam s.VY 1\l� 2-131 6
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Physical Address: �/
Facility Contact: 2iYe V�I leSi--Jr Title: Phone:/ ' ?'-1— �11S
Onsite Representative: I Integrator: �UYVIS
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: ' '- (j 1 '2(-)il Longitude: 'iq b SS 1 4111
US Hwy 14 ') ® NIL H1 4' n 7 CD0411A+- CArlyn VA.
n > — ,: -i*
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Wean to Finish Layer Dairy Cow
Wean to Feeder Non Laver Dairy Calf
Feeder to Finish tJ '��i Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder _' Non-Dairy
Farrow to Finish : _ Beef Stocker
Gilts .Non-La ers Beef Feeder
Boars Pullets -- Beef Brood Cow
4 '. -`•
: Turke Pouets
Other •Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes V No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State?(If yes,notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
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) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes K No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [I No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2015 Continued
Facility Number: "I h - I \ (Date of Inspection:1 QI 2A\IC\
Waste Collection&Treatment
4. Is storage capacity(structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes igtNo ❑ 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: \copr �� (Y\c fl
Spillway?: V
Ll
Designed Freeboard(in):
I,1. • 1. u
Observed Freeboard(in): y �' 6
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 isidNo ❑ 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 NI No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 23 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 73 Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.Are there any required buffers,setbacks,or compliance alternatives that need ❑ Yes IANo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application?If yes,check the appropriate box below. ❑ Yes 'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground El 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): c-6cue,1e, 1 y i e1 ! ,U Q, \a
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 'f No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Y"K' No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes it No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes IA No ❑ NA ❑ NE
Required Records& Documents
19. Did the facility fail to have the Certificate of Coverage&Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available?If yes,check ❑ Yes No ❑ NA El NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ['Other:
21. Does record keeping need improvement? , -.-.:._ ::: :: ' . : . ❑ Yes 'No ❑ NA ❑ NE
Waste Application Weekly Freeboard El Waste Analysis 1:1 Soil Analysis ficiWaste Transfers 154Weather Code
4Rainfall MStocking%Crop Yield 14120 Minute Inspections lj Monthly and 1" Rainfall Inspections DisjSludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0,No ❑ NA ❑ NE
23. If selected,did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes El No ANA El NE
Page 2 of 3 2/4/2015 Continued
'Facility Number: -1. - `r 'Date of Inspection: VA a', `\
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes A No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes,check ❑ Yes IA No ❑ 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 provide documentation of an actively certified operator in charge? ❑ Yes tIcl No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments(PLAT)certification? ❑ Yes Dif No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 4 No ❑ NA ❑ NE
and report mortality rates that were higher than normal? I✓uM1
29.At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes T 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 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 ixtNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes N No ElNA ElNE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes x No ❑ NA ❑ NE
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Reviewer/Inspector Name: Phone: b Tit, "c{-10.!
Reviewer/Inspector Sign Da3te31-
-35-4 aafu at-i(;
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