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040034_INSPECTIONS_20171231
Type of Visit: ® Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access Date of Visit: Arrival Time: j Departure Time: ��./ County- Farm Name: I %(r-S �Q¢.>rQ1� Owner Email: Owner Name: &4= aIC4- 5; [ C Phone: Mailing Address: Physical Address: Facility Contact: Title: Onsite Representative: I ( T� Certified Operator: 13S4 Al ' Back-up Operator: Phone: Region: r Y_D Integrator: 5•�aP Certification Number: r '97d G 3 Certification Number: Location of Farm: Latitude: Longitude: Design Current Design Current Design Current Swine Capacity' _Pop. Wet Poultry Capacity :i?op. " Cattle Capacity Pap. Wean to Finish Layer Dairy Cow Wean to Feeder Non -Layer Dairy Calf Feeder to Finish Dairy Heifer Farrow to Wean 11-CP 1473 Dry Cow Farrow to Feeder ,, D . Pouit . Ca aci Po Non -Dairy Farrow to Finish Layers Beef Stocker Gilts Non -Layers i Beef Feeder Boars Pullets Beef Brood Cow I Turkeys OtherI ITurkcyPoults Other Other w; a Discharges and Stream Impacts _ 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 No ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes No ❑ Yes [] No 1P NA ❑ NE pqNA ❑NE W NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE Page 1 of 3 21412015 Continued Facili Number: - Date of Inspection: 11 r Waste Collection & Treatment 4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes gg T No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No G;�l NA ❑ NE Structure I 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 P 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 [�JNo ❑ 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 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 No ❑ NA ❑ NE maintenance or improvement? Waste Avelication 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 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 Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop TYpe(s): f �}`3d"y+Es �^^^�^--d i ] " 'S �-Q C — L+_ Soil Type(s): 14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 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 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? ❑ Yes ® No ❑ NA ❑ NE ❑ Yes P 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 [PNo ❑ 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 [� No ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ No 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑NA ❑NE ❑ Weather Code ❑ Sludge Survey ❑ NA ❑ NE ❑ NA ❑ NE Page 2 of 3 21412015 Continued Facili Number: - date of Inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes 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 No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 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 [J] 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 [P 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 0 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 IVNo ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? r] Yes Q9 No ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes CS No ❑ NA ❑ NE (Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. Use drawings of facility to: better, explainSituations (use additional Pages as neccs'sary). Reviewer/Inspector Name: Reviewer/inspector Signature: Page 3 of 3 Phone: '?l ~ �; 76Cp Date: tAw 7 21412015 Type of Visit: ® Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance Reason for Visit: 0 Routine O Complaint O Follow-up Q Referral O Emergency Q Other O Denied Access Date of Visit: 3 Arrival Time: Departure Time: i �County: Region: (— Farm Name: Pt Downer Email: Owner Name: ��` l vC� ' '"'Vt I-. Phone: Mailing Address: Physical Address: Facility Contact: u-f��``-� ]� Title: Phone: Onsite Representative: Lt `70� I "`-�� Integrator: cjh Certified Operator: Certification Number: 7 p6Y Back-up Operator: Certification Number: Location of Farm: Latitude: Longitude: Design Current Swine Capacity Pap. Wean to Finish Design Current Wet Poultry Capacity Pap. Design Current Ca#tle Capacity Pop. La er iNon-Layer I I Dairy Cow Dairy Calf Wean to Feeder I Feeder to Finish 2 ZD 2AW Deg' D , Poul Ca aci P,o Layers Dairy Heifer Dry Cow Non-Dai Beef Stocker Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow Other Turke Poults Other Other Discharges and Stream Imnacts 1. is any discharge observed from any part of the operation? ❑ Yes [ ]0 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 M No ❑ NA ❑ NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes tP No ❑ NA ❑ NE of the State other than from a discharge? Page I of 3 21412014 Continued FaciliVy Number: - Date of Inspection: ' 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 �D 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 0 No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes t] 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 K) No ❑ NA 0 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 14No ❑ 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 W' w 0 Evidence of Wind Drift ❑ Application Outside of Approved Area r Tyr()� 12. Crop e s : R" 13. Soil Type(s): C�r 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�tNo ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes P No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes N No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE Reouired Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [N�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 1P 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 No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes No ❑ NA ❑ NE Page 2 of 3 21412014 Continued FaciliNumber: - Date of Inspection: Aqtj / 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes 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 fast survey indicating non-compliance: 26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [� No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No D NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes 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 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 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 M 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 �g No ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [P No ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes ® No ❑ NA ❑ NE Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 Phone: q/o ^ 33'33C0 Date: 2/4/2 4 type of visit: 0 c:omptiance inspection V operation Heview c ) structure !✓valuation U I eclimCal Assistance Reason for Visit: 0 Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access Date of Visit: 13 1 Arrival Time: lo: Sci.ti Departure Time: Countyt Farm Name: �OL�LnrK.,S Owner Email: Owner Name: �`�G�L$�u�� Phone: Mailing Address: Physical Address: Facility Contact: Title: Onsite Representative: t , T6 S�?VW CVL✓ Integrator: Phone: t Certified Operator- &A Certification Number: Back-up Operator: Location of Farm: Latitude: Certification Number: Longitude: Region: KR-D - _ Design Current Design Curren# Design Current $wine Capacity Pap. �5 Wet Poultry Layer Non -La er Capacity I Pop. Cattle Capacity Pop. Dai Cow lf DairyHeifer Dry Cow Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean 22-00 [1 0,p Farrow to Feeder D . P,oult . Ea aci PoINon-Dairy ILayers Non -Layers Pullets Turkeys Beef Stocker Beef Feeder Beef Brood Cow Farrow to Finish Gilts Boars Other_ :� TurkeyPoults Other Other 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 DWQ) c. What is the estimated volume that reached waters of the State (gallons)? ❑ Yes Pq No ❑ NA ❑ NE ❑ Yes [] No ® NA ❑ NE ❑ Yes ❑ No NA ❑ NE d. Does the discharge bypass the waste management system? (If yes, notify DWQ) 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 ❑ No [] Yes No ❑ Yes 9 No �NA ❑NE ❑ NA [] NE ❑ NA ❑ NE Page l of 3 21412011 Continued fteility Number: - Date of Inspection: Z Z Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes a. If yes, is waste level into the structural freeboard? ❑ Yes Structure I Structure 2 Structure 3 Structure 4 Structure 5 Identifier: No ❑ NA ❑ NE ❑ No NA ❑ NE Structure 6 Spillway?: Designed Freeboard (in): Observed Freeboard (in): r 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 DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes f" No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [� 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 [ No ❑ 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 M No ❑ NA ❑ 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 l ❑cEvidence of /W�in_d Drift ❑ Application Outside of Approved Area �eSC 12. Crop Type(s): t,,.,Q � S J, C /tits-ot [Truk$ ❑ NE 13. Soil Type(s): C"_aj 4100-r 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 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 No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ 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 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 ® No ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers E] 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 No 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE ❑ Weather Code ❑ Sludge Survey ❑ NA ❑ NE ❑ NA ❑ NE Page 2 of 3 214/2411 Continued Facifi Number: - Date of Inspection: Z 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes PtNo ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes r%No ❑ NA ❑ NE the appropriate box(es) below. TT ❑ 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 fast survey indicating non-compliance: 26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes O No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE Other Issues 28. Did the facility fait to properly dispose of dead animals with 24 hours and/or document ❑ Yes 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? 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: ❑ Yes b!j No ❑ Yes No [:]Yes [�)No ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Ir 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 a follow-up visit by the same agency? ❑ Yes No 0 NA ❑ NE Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. Use drawings of facility to better explain situations (use additional pages as necessary). Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 UM Phone: �6 �7> 17t?0V_ Date: '2 di-.2 21412011 4-4-rZ (Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access l0It0 Date of Visit: I c fl Arrival Time Departure Time: / i County: Region: C20 Farm Name: WI/« � gbc�- F;L""W^X_S Owner Email: Owner Name: W�, _ 12f;4M LL-G Phone: Mailing Address: Physical Address: Facility Contact: 221U� lS¢/ Title: Phone: Onsite Representative: Integrator: s.Jv� � Certified Operator: j�2+ Back-up Operator: Location of Farm: Latitude: �q o Certification Number: Certification Number: Longitude: Design Current Swine Capacity Pop. Wean to Finish Design Current Wet Poultry Cspecify Pop. I Layer Design C•unrent Cattle Capacity Pop. Dairy Cow Wean to Feeder Non -La er I airy Calf Feeder to Finish Dairy Heifer Farrow to Wean Farrow to Feeder Design Current Dr, P,oult , Ca aci P,o , Dry Cow Non -Dairy Farrow to Finish Layers Beef Stocker Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow OtherI Other I Turke s ITurkeyPoults 10ther 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 DWQ) ❑ Yes P No ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes ❑ No NA ❑ NE 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 DWQ) ❑ Yes ❑ No NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �] No ❑ NA ❑ NE of the State other than from a discharge? Page I of 3 21412011 Continued Facility Number: -5qDate of Ins ection: L4 f.;;- 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): 47 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.) 7T' 6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes P 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 DWQ 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 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 EP No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes §a No ❑ NA ❑ NE maintenance or improvement? 11. is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes W 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 Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): 13. Soil Type(s):—k'PP�.tJlVn08-/ 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [� 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 No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ 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 ® No T® ❑ 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. T ❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes '� No ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE ❑ Weather Code ❑ Sludge Survey ❑ NA ❑ NE ❑ NA ❑ NE Page 2 of 3 21412011 Continued Paciii Number: - Date of Inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [FbNo ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE the appropriate box(es) below. T ❑ 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? 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? ❑ Yes No ❑ NA ❑ NE ❑ Yes ❑ No [NJ NA ❑ NE ❑ Yes E� No ❑ NA []NE ❑ Yes [p No ❑ NA ❑ NE ❑ Yes M No ❑ NA ❑ NE ❑ Yes [P No ❑ NA ❑ NE ❑ Yes `" No ❑ Yes q No ❑ Yes ® No ❑ NA ❑ NE ❑ NA ❑ NE ❑NA ❑NE Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. Use drawings of facility to better explain situations (use additional pages as necessarv). Reviewer/Inspector Name: +`'" ".0 Reviewer/]nspector Signature: 1: Page 3 of 3 Phone: 19(fl 1` 1'5^33CO Date: q - r -;L- 2141201I Type of Visit • Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance Reason for Visit G Routine O Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access Date of Visit: ,, N�Arrival Time: t Departure Time: � County: Region: Farm Name: W& FCWM S Owner Email: Owner Name: Li t -k &4_ s LLC _ _ Phone: Mailing Address: Physical Address: Facility Contact: I :l� T U V->W /'` Title: Phone No: Onsite Representative. �f Integrator: b I-OkGt I UCC Certified Operator: a+ Operator Certification Number: �U I Back-up Operator: Back-up Certification Number: Location of Farm: Latitude: = o = I = u Longitude: 0 ° = 1 ET .. Design :� Swine -a SO Cprrent Design Current Design Current Population �'�'et Poultry Capacity Population Cattle Capacity Population ❑ Wean to Finish ❑ Layer ❑ DairyCow ❑ Wean to Feeder -Layer Dairy Calf ❑ Feeder to Finish Dry Poultry ❑ Layers El Non-Layers DairyHeifer Farrow to Wean i 2c0 ❑ Dry Cow ❑ Farrow to Feeder I ElNon-Dairy El Stocker ❑ Farrow to Finish ❑ Gilts ElBeef Feeder El El Pullets ❑ Turkeys ❑ Boars Other 2 * M: ❑ Other ❑ Beef Brood Co Number of Structures: ❑Turke Poults ❑Other Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? ❑ Yes 99 No ❑ NA ❑ NE Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? ❑ Yes ❑ No ONA ❑ NE b. Did the discharge reach waters of the State'? (If yes, notify DWQ) ❑ Yes ❑ No M NA ❑ NE c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No P NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 1P No ❑ NA ❑ NE 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes P No ❑ NA ❑ NE other than from a discharge? Page I of 3 12128104 Continued Facility Number: — Date of Inspection if Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P 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): v2 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JgNo ElNA ElNE (ie/ large trees, severe erosion, seepage, etc.) yy 6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 'g No ❑ NA ❑ NE through a 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 DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes PgNo ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes M 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 )9 No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 6No ❑ NA ❑ NE maintenance/improvement? IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 10 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 Crop Window ❑ Evidence of Wind Drift Application Outside of Area %r' to P PR 12. Crop type(s) c 13. Soil type(s) C�4 eJ 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes IpNo ❑ 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 acre determination?❑ Yes No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes Q No ❑ NA ❑ NE Reviewer/Inspector Name vQwUe Phone: /O' 33-3 W Reviewer/Inspector Signature: Date: 28 �/ Page 2 of 3 12128104 Continued Facility Number: — Date of inspection Reauired Records & Documents 19. Did the facility tail to have Certificate of Coverage & Permit readily available? 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check the appropirate box. ❑ WUP ❑ Checklists ❑ Design g ❑ Maps El Other ❑ Yes dFNo ❑ NA ❑ NE ❑ Yes 8 No ❑ NA ❑ NE 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes B No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 24. Did the facility fail to calibrate waste application equipment as required by the permit? 25. Did the facility fail to conduct a sludge survey as required by the permit? 26. Did the facility fail to have an actively certified operator in charge? 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document and report the mortality rates that were higher than normal? 30. 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 31. Did the facility fail to notify the regional office of emergency situations as required by General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative? 33_ Does facility require a follow-up visit by same agency? ❑ Yes N No ❑ NA ❑ NE ❑ Yes ❑ No PEJ NA ❑ NE ❑ Yes MNo ❑ NA ❑ NE ❑ Yes (5 No ❑ NA ❑ NE ❑ Yes [7?No ❑ NA ❑ NE El Yes ®No El NA ONE ❑ Yes PNo ❑ NA ❑ NE ❑ Yes PNo ❑ NA ❑ NE ❑ Yes RNo ❑ NA ❑ NE ❑ Yes )@ No ❑ NA ❑ NE ❑ Yes 21No ❑ NA ❑ NE ❑ Yes 19 No ❑ NA ❑ NE Page 3 of 3 12128104 Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: r Arrival Time: lj2 : eparture Time: ounty: ��� Region: Farm Name: j� Y7Jyl v 7�N strn �/+�. Owner Email: Owner Name: � / Q�^�S°Y` Phone: ,, ,t �p Mailing Address: �� � '� r" Y AAf d9M Physical Address: Facility Contact: 11_1� Title: Phone No: Onsite Representative: ;eA Integrator: Ms " ., — Certified Operator: Operator Certification Number: Back-up Operator: Back-up Certification Number: Location of Farm: Latitude: [= o = = Longitude: [� o [� L = i{ Design Current Swine Capacity Population an to Finish Design Current Wet Poultry Capacity Population ❑ La er Design Current C►attle C►apathy Population ❑ Dai Cow an to Feeder ❑ Non -La er ❑ Dai Calf der to Finish 0 � FrEE]Farrow ❑ Dai Heifer row to Wean ❑ D Cow to Feeder ElNon-Dairy El Farrow to Finish ElN Layers El Beef Stocker ❑ Gilts ❑on -La Non -Layers ❑Beef Feeder ❑ Boars El Fullers ❑ Beef Brood Cowi ❑ Turkeys Outer ❑ Other ❑ Turkey Poults ❑Other Number of Structures: Dischart=_es & 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 DWQ) c. What is the estimated volume that reached waters of the State (gallons)'? d. Does discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'? ❑ Yes lso ❑ NA ❑ NE ❑Yes ❑No P< ❑NE ❑ Yes ❑ No Eil< ❑ NE ❑ Yes No OlA El NE El Yes ,❑--,, E140 NA ❑ NE ❑ Yes No ❑ NA ❑ NE Page 1 of 3 12128104 Continued Date of Inspection WiAo Facility Number: — 3 Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes `� Noo El NA [I NE a. If yes, is waste level into the structural freeboard? El Yes , LtPi!o ❑ 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 9<o ❑ NA ❑ NE (iel large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed El,— Yes , L o<o ❑ NA ❑ NE through a 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 DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes D-Ko ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 04o ❑ 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 LL�o`_ ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes ❑4(ro ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 4. Xo ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) []PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area 12. Crop type(s) (.:r1ll./ C Iel-I 13. Soil type(s) Z_-'U , 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 520�o ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes ErNo ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes U�,Ko ❑ NA El NE 17. Does the facility lack adequate acreage for land application? ❑ Yes 9�,No NA ElNE 18. Is there a lack of properly operating waste application equipment? ElYes Eq o LJ NA ❑ NE Reviewer/Inspector Name „fi„ /�_ry .' Phone: ` ZO Z ReviewerfInspector Sign Date: /d Ak, =j Page 2 of 3 12129104 Continued Facility Number: 07 — Date of Inspection !� Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [P o ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAW -MP readily available? If yes, check ❑ Yes M o ❑ NA ❑ NE the appropriate box. ❑ Wup ❑ Checklists El Design ❑Maps El Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes UK ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ,_,_�o ❑ NA El NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes o�K. ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P4o ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes E N ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? El Yes 4k1VV ElNA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes EK ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document and report the mortality rates that were higher than normal? 30. 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 3 1 . Did the facility fail to notify the regional office of emergency situations as required by General Permit? (ie/ discharge, Freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? 33. Does facility require a follow-up visit by same agency? Comments and/or Drawings: ❑ Yes LCd'No ❑ NA ❑ NE ❑ Yes M o ❑ NA ❑ NE ❑ Yes E;k&o [INA ❑ NE ElB Yes o ❑ NA ❑ NE ❑Yes 63No El NA El NE ❑ Yes E&? o ❑ NA ❑ NE Page 3 of 3 12128104 i . - -- -- � Division of Water Quality !Facility Nutttber Division of Sail and Water Conservation MO Agency Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: 3 0 ArrivalT,ime: 0 Departure Time: i County: Farm Name: ��' Owner Email: Owner Name: 1062'K_ dt`' 4'&20!:t� 149S Phone: Mailing Address: Physical Address: Facility Contact: axu, uw_ Title: Onsite Representative: 40 Certified Operator: Back-up Operator: Region: Phone No: Integrator• —ko t^r� Operator Certification Number: O6 r Back-up Certification Number: Location of Farm: Latitude: E--] e E__1 ' ❑ u Longitude: ❑ o = I ❑ u Design Current Design C*urren# Design C•nrrent Swine Capacity Population Wet Poultry Capacity Populatian Cattle Capacity Population ❑ Wean to Finish ❑ La er ❑Dai Cow ❑ an to Feeder ❑ Non -Layer ❑Dai Calf ❑ Feeder to Finish El Dairy Heifer p� y Poultry [I Dry Cow Farrow to Wean El Farrow to Feeder E]Non-Dairy ❑ La ers ❑ Beef Stocker ElFarrow to Finish on -La ersPullets ❑Beef Feeder Gilts PE113oars ❑ Turkeys ❑ Beef Brood Cowl Other ❑ Other ElTurkey Pouits ❑ Other I�lumber of Structures: Discharges & Stream Im acts 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 DWQ) c- What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PNo ❑ NA ❑ NE ❑ Yes ❑ No [;RNA ❑ NE ❑ Yes ❑ No NA ❑ NE �RbNA ❑ NE ❑ Yes ❑ No ❑ Yes ;&No ❑ NA ❑ NE ❑ Yes )jNo ❑ NA ❑ NE Page I of 3 12128104 Continued Facility Number: -=3�p Date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No PINA [I NE S cture I 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 Mo ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or ruanaged ❑ Yes ?PNo ❑ NA ❑ NE through a 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 DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes RNo ❑ NA [I NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes II No ❑ NA El NE (Not applicable to roofed pits, dry stacks and/or wet stacks) I 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 ONo ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or t0 tbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crgp Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 12. Crop types) — %S CO J UtIMVI-a 13. Soil type(s) lints_- ini[/lt 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 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 acre determination ? ❑ Yes No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes @ No ❑ NA ❑ NE Reviewer/inspector Name I � Phone: D Re-dewer/Inspector Signature: gyp,, Date: 3 O Page 2 of 3 r- 12128104 Continued • Facility Number: — Date of Inspection Required Records & Documents 19. Did the facility fail to have 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 ❑ NE the appropriate box. ❑ WUP El Checklists El Design ❑Maps El Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ I20 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes No ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE 27_ Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No J�bNA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes IF No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes q§No ❑ NA ❑ NE and report the mortality rates that were higher than normal? 30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [PNo ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately 31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ElNE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [%No ElNA [INE 33. Does facility require a follow-up visit by same agency? ❑ Yes tpNo ❑ NA ❑ NE Comments and/or Drawings: Page 3 of 3 12128104 Type of Visit 0 Compliance Inspection (D Operation Review 0 Structure Evaluation O Technical Assistance Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: I 51 ) Arrival Time: �+`��Q►k Departure Time: D�%- y� County: 50A Region: )WO Farm Name: PKv 0r__ _ d _ f-Uewi 5 _ Owner Email: Owner Name: r-IDVxyd W. &W n's- Phone: Mailing Address: Physical Address: ti Facility Contact: I e U aW m e -Title: Phone No: Onsite Representative: Integrator: � � -" Ynw LA Certified Operator: N Operator Certification Number: Back-up Operator.• Back-up Certification Number: Location of Farm: Latitude: = e = i = Longitude: 0 ° 0 6 = it h Des' n esign Current Desigu Current Swine Capaci Populatton Wet Pou�tr>y Cap ty aci Po ulation h p Cattle _ x Ca achy Population p �t � ❑ Wean to Finish ❑ Layer ❑ Dairy Cow ❑ Wean to Feeder ❑ Non -Layer ❑ Dairy Calf 2 ❑ Feeder to Finish El Dairy Heifer Farrow to Wean _ 97Sb Dry Poultry __ El Dry Cow El Farrow to Feeder x ElNon-Dairy El Farrow to Finish ❑ La ers ❑ Beef Stocker ❑ Gilts ❑ Non -La ers ❑ Beef Feeder ❑ Boars Pullets; ❑ Beef Brood Cow __— Turkeys _ -- Other ' - :.• -�� ❑ Turkey Points ❑ Other ❑ Other Number ofEStr�uctures: Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? ❑ Yes *No ❑ NA ❑ NE Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? ❑ Yes ❑ No 1P NA ❑ NE b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No EPNA ❑ NE c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 9) No ❑ NA ❑ N E 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes �No [I NA El NE other than from a discharge? Page l of 3 12128104 Continued Date of inspection I Facility Number: — 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 (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes IN No ❑ NA ❑ NE through a 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 DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes 19 No ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �9 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 04No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required butlers, setbacks, or compliance alternatives that need ❑ Yes J9No ❑ NA ❑ NE maintenance/improvement? 11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 71 No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 12. Crop type(s) 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes 49 No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes i] No ❑ NA ❑ NE Reviewer/Inspector Name "_F� W Phone: O—t 3'3.3O Reviewer/Inspector Signature: Date: Page 2 of 3 12128104 Continued f . Facility Number: Date of Inspection Required Records & Documents 19. Did the facility fail to have 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 ❑ NE the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps p ElOther 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �&No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 19 No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes I'No ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes J'No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes b No ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes W No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes [PNo ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �?No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes 19No ❑ NA ❑ NE and report the mortality rates that were higher than normal? 30. 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 31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes [SNo ❑ NA ❑ NE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �jNo ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes ®No ❑ NA ❑ NE * Pe (-a j jrAbt.b r. we w v-cel ASAPIO Ae C4 a &t-.w`I 6v,rC'ce S Page 3 of 3 12128104 Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit f Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: 3 i Q$ Arrival Ti TZ : k2At Departure Time: County:Farm Name: zfaG L fl C fQ�i"'1 S Owner Email: Owner Name: e f! O M -e Phone: Mailing Address: Physical Address: (� Facility Contact: �ry A211 ArVofr-P _'ritle• Onsite Representative: M Certified Operator: Back-up Operator: Region: Phone No: Integrator: iWRE AWAI I%Wk- Operator Certification Number: Back-up Certification Number: Location of Farm: Latitude: a o ❑ ' = Longitude: = o =, = « Design Current Design Current _ Design Current Swine C•apaFREE"opulation �- let Poultry Capacity Population Cat#Ie C•apacity Population ❑ Wean to Finish ❑ La er ❑Dai Cow ❑ Wean to Feeder ❑Non -La er ❑ Dairy Calf ❑ Feeder to Finish ` -: El Dairy Heifer Farrow to Wean e� O Dr Poult ❑ D Cow to Feeder La ers❑ ❑ Non-Dairy ow to Finish Beef Stocker ❑ Non -Lavers ❑ Beef Feeder kOFarrow rs ❑Pullets❑Beef Brood Cow Turkc s ❑ Turkev Poults r El Other Wumber of Structures: Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation'? ❑ Yes F No ❑ NA ❑ NE Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made'? ❑ Yes ❑ No V? NA ❑ NE b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No FNA ❑ NE c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ yes ❑ No NA ❑ NE ?. is there evidence of a past discharge from any part of the operation'? ❑ Yes �] No ❑ NA ❑ NE 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes � No ❑ NA ❑ NE other than from a discharge? Page 1 of 3 12/28/04 Continued Y Facility Number: — Date of Inspection O� Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CPNo ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E5iNA ❑ NE Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): 2r 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes rANo ❑ NA ❑ NE through a 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 DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes 9No ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 29No ❑ 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 5 No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [PNo ❑ NA ❑ NE maintenance/improvement? It, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [4No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,Ln, etc.) ❑ PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind rift El Application Outside of Area 12. Crop type(s) {TUiryt t "-5 S� 67 e e-5 ;k��) 13. Soil type(s) ' 1 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 8 No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes O No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes M No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application'? ❑ Yes RNo ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes JP No ❑ NA ❑ NE Comments{refer to question=#): Explain :an3 YES.ansrvers and/or any recommendations or any other comments s„ Use drawings of facility to better explain situations. (use additional pages as necessary) Reviewer/Inspector Name �� Phone: ID� `l33`33eb Reviewer/Inspector Signature: Elate: 3 / Page 2 of 3 12128104 Continued Facility Number: — Date of Inspection ReQuired Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [P No ❑ NA ❑ NE the appropriate box. ❑ wup ❑ Checklists ❑ Desigm El Maps El Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 6No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 24. Did the facility fail to calibrate waste application equipment as required by the permit? 25. Did the facility fail to conduct a sludge survey as required by the permit? 25. Did the facility fail to have an actively certified operator in charge? 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? Other Issues 29. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document and report the mortality rates that were higher than normal? 30_ 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 31. Did the facility fail to notify the regional office of emergency situations as required by General Permit? (ie/ discharge, freeboard problems, aver application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? 33. Does facility require a follow-up visit by same agency? ❑ Yes ® No ❑ NA ❑ NE ❑ Yes E] No ❑ NA ❑ NE ❑ Yes ® No ❑ NA ❑ NE ❑ Yes BNo ❑ NA ❑ NE ❑ Yes N No ❑ NA ❑ NE ❑ Yes 09 No ❑ NA ❑ NE ❑ Yes ® No ❑ NA ❑ NE ❑ Yes P9 No ❑ NA ❑ NE ❑ Yes 19 No ❑ NA ❑ NE El Yes WNo ❑NA ❑NE ❑ Yes ® No ❑ NA ❑ NE Additional .C.omme& and/or Drawings k Page 3 of 3 12128104 It 1 0 Division of Water Quality Facility Number �1 34 O Division of Soil and Water Conservation O Other Agency Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: .3 Q 1 Arrival Time: ����i QM Departure Time: fl: � rr. County: � Region: FRO Farm Name: Otr I►'Ls Owner Email: 4,)��7a--7S Owner Name: _ m!„ �� ko �"� Phone: b 0 Mailing Address: Physical Address: Q Facility Contact: It �I I Brame _ Title: tl Onsite Representative: Certified Operator: li Back-up Operator: Location of Farm: Swine Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Boars Other ❑ Other Phone No: lntegrater: Operator Certification Number: Back-up Certification Number: ❑o ❑, [= g ❑o �g ❑" Latitude: Longitude: Design Current Design Current Capacity Population Wet Poultry Capacity Population ❑ La er I❑ Non -La er Dry Poultry ❑ Layers ❑ Non -Layers ❑ Pullets ❑ Turkeys ❑ Turkev Poults ❑ Other Discharges & 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? Design Current.; Cattle Capacity Population ❑ Dairy Cow ❑ Dairy Calf ❑ Dairy Heifer ❑ Dry Cow ❑ Non -Dairy ❑ Beef Stockei ❑ Beef Feeder ❑ Beef Brood Co Number of Structures: 5' b. Did the discharge reach waters of the State? (If yes. notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'? ❑ Yes X No ❑ NA ❑ NE ❑ Yes ❑ No §9 NA ❑ NE ❑ Yes ❑ No 'N NA ❑ NE ® NA ❑ NE ❑ Yes ❑ No ❑ Yes �iNo ❑ NA ❑ NE ❑ Yes [9 No ❑ NA ❑ NE 12128104 Continued Facility Number: — ,3 Date of Inspection3 f� Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [A No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No J�PNA ❑ NE Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): pp Observed Freeboard (in): -1 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IsNo ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes EBNo ❑ NA ❑ NE through a 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 DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? [--]Yes N3No ❑ 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 ElYes V No ElNA ❑ NE maintenance or improvement? Waste Anplication 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EIND ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 12. Crop type(s) 13. Soil type(s) I 1 1 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [d No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes 91 No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes [ANo ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes ® No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes CgNo ❑ NA ❑ NE Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. Use drawings of facility to better explain situations. (use additional pages as necessary): @Q� SLS� 3jLf-- 2 Reviewer/Inspector Name -�- Phone: /0 -33CO Reviewer/Inspector Signature: Date: 37),3 12126104 t,onttnuea . Facility Number: 44— Date of Inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 7ZNo ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes f9 No ❑ NA ❑ NE the appropriate box. ❑ WUP El Checklists ❑Design El maps ❑Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;, No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes F No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:1 No U�NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �&No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes V] No ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes P No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes 6 No ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ,,��qq �,y, No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes 1J No ❑ NA ❑ NE and report the mortality rates that were higher than normal? 30. 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 31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes M No ❑ NA ❑ NE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ® No ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes 59No ❑ NA ❑ NE Additional Comments and/or. Drawings Page 3 of 3 12128104 t-- Type of Visit ®'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access Date of Visit: Arrival Time: 0rr; L1� Departure Time: ` '1TD County: Jr Region: Farm Name: Prrr!" 0/`eJ!400 Jti I_e?em-5 _ Owner Email: Owner Name: Mailing Address: Physical Address G . leek -/ /l r // Facility Contact: /'YI ;' ;ftY�! ` 4109 Title: Onsite Representative: Certified Operator: ,fll� Back-up Operator: Location of Farm: Swine Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Boars Other ❑ Other Phone No: Integrator: Operator Certification Number: Back-up Certification Number: Latitude: ❑ o E ❑ u Longitude: = ° ❑ ❑ u Design Current Design Current Capacity Population Wet Poultry Capacity Population ❑ Layer �Ih ❑ Non -Layer Dry Poultry ❑ Layers ❑ Non -Layers ❑ Pullets ❑ Turkeys ❑ Turkey Poults ❑ Other Discharges & 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'? Design Current Cattle Capacity Population ❑ Dairy Cow ❑ Dairy Calf ❑ Dairy I-leifei ❑ Dry Cow ❑ Non -Dairy ❑ Beef Stocker ❑ Beef Feeder ❑ Beef Brood Co Number of Structures: E] b. Did the discharge reach waters of the State'? (if yes. notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'? ❑ Yes LgNo ❑ NA ❑ NE ❑ Yes O\No ❑ NA ❑ NE ❑ Yes M No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes O-No ❑ Yes 0 No ❑ NA ❑ NE ❑ Yes M No ❑ NA El NE 12128104 Continued Facility Number: — l Date of Inspection Waste Collection & Treatment 4" Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes, is waste level into the structural freeboard? Structure I Structure 2 Identifier: Spillway?: 'PS Designed Freeboard (in): Observed Freeboard (in): d?l� Structure 3 Structure 4 ❑ Yes [4 No ❑ Yes Q No Structure 5 El NA ❑NE ❑ NA ❑ NE Structure 6 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IQ No ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes CZ No ❑ NA ❑ NE through a 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 DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes 7W No ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® 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 EgNo ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 Ibs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 12" Crop type(s) �sS'ry r , a T,L_nc o% -4117if i 4eA tT 13. Soil type(s) /' err �C Z&f &Sir, ZGrr 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RNo ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? � Yes El No El NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[:] Yes ;gNo ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes [9 No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes JR No ❑ NA ❑ NE .�% �L"�7 � 4� �� �SCuZ- jc.�`rr�,� �'%��if1�s"� ✓17r��re��C���f /8 ` ���t�� Ar.-c cc D F- Reviewer/Inspector Name Reviewer/Inspector Signature: Phone: Date: 12178104 Continued Facility Number: kyDate of InspectionG- Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [-]Yes KNo ❑ NA ❑ NE the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 14 No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes CKNo ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CK No ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE 25- Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 4 No ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes (KNo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No JKNA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ® No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes EZNo ❑ NA ❑ NE and report the mortality rates that were higher than normal? 30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 9Q No ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately 31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes 9 No ❑ NA ❑ NE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes � No ElNA El NE 33. Does facility require a follow-up visit by same agency? ❑ Yes 54 No ❑ NA ❑ NE 12128104 .: a,�'•r � a „.-..�,-. _-.....x.z, x. : ,.=:�.--....._, 1.,.-s..,. - a ra�:.E`W.- '�,.. ... _.< -ems. :r::r,v .« •i �. ,z.-..:-.-- ..,. .. .... ».--<-�:.-.:�- __«.-, r-- Type of Visit ® Compliance Inspection O Operation Review 0 Lagoon EValuation Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access Facilitv Number Date of Visit: Time: LJ ro not O erational 0 Below Threshold ® Permitted ® Certified ❑ Conditionalh' Certified ❑ Registered Date Last Operated or -Above Threshold: Farrn Name: r Q t-f- C J r6-r, Counn•: 1F fZD Owner Name: M; i rf-"E./f Af'oQ Phone No: Mailing Address., OA Vq 2 ccl' -k Al _28123 Facility Contact: Title: Phone No: Onsite Representative: M..i-[ C'f,f i3„Cd-0 "a- Integrator: __ C6 i`c, It 10 Certified Operator: L3d-Q-D Operator Certification Number: Location of Farm: ®Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 14 0 ` Longitude ' • 0 Design Current Swine C'anneity Pnnulation ❑ Wean to Feeder ❑ Feeder to Finish ® Farrow to Wean oo ici JD ❑ Farrow to Feeder ❑ Farrow to Finish ❑ Gilts ❑ Boars Design Current Design Current Pouhry Ca acitF Population Cattle Ca aciity Poriulation ❑ Laver 1 1 10 Dairy Non -Laver I I ❑ Non-Dain ❑ Other Total Design Capacity Total SSLW Number of Lagoons 0 ❑ Subsurface Drains Present jjE1EaeoonAre3 ❑ S ray Field -Area Holding Ponds / Solid Traps ❑ No Liquid Waste Management Svstem Discharges S Stream Impacts 1- Is any discharge observed from any part of the operation? Dischar;e originated at: ❑ Lagoon ❑ SDrav Field ❑ Other a. If discharge is observed, was the conveyance man-made? b. If discharge is observed, did it reach Water of the State? (If yes, notifi' DWQ) c. If discharge is observed, what is the estimated flow in Qal/min? d. Does discharge bypass a lagoon system? (If yes, notify DWQ) 2. Is there a Adence of past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? Waste Collection 8- Treatment 4. Is storage capacity (freeboard plus storm storage) less than adequate? ® Spillwav Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Identifier: Freeboard (inches): 05IV3101 ❑ Yes [�LNo ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes (5No ❑ Yes [53 No ❑ Yes ®,No Structure 6 — Continued Facility Number: 4 — 3 Date of Inspection 2 0 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or closure plan? (If any of questions 4-6 was answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ) 7. Do any of the structures need maintenance/improvement? ❑ Yes Wo ❑ Yes [XNo ❑ Yes [F No 8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes (RNo 9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level elevation markings? ❑ Yes PNo Waste Anolication 10. Are there any buffers that need maintenance/improvement? ❑ Yes [ No 11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ERNo 12. Crop type {—e_ Ke, w 4— fr�L"_r%&, (?,- -- — -- 13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes C& No 14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No b) Does the facility need a wettable acre determination? ❑ Yes ❑ No c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No t5. Does the receiving crop need improvement? ❑ Yes ® No 16. Is there a lack of adcgiu waste application equipment? ❑ Yes RNo Required Records & Documents 17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes CQ No 18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? (ie/ WUP, checklists, design, maps, etc.) ❑ Yes 9[No 19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes P] No 20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Q No 21. Did the facility fail to have a actively certified operator in charge? ❑ Yes (,No 22. Fail to notify regional DWQ of emergency situations as required by General Permit? ❑ Yes M No (ie/ discharge, freeboard problems, over application) 23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes &No 24. Does facility require a follow-up visit by same agency? ❑ Yes BNo 25- Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 0 No 10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. 44&6_ x i . . _ s3I iComments. (refer tt►queshon € Explain airy YES answers andlor.any1recommetidattons or siiy other comments. - =sexi '.�fe� #e ».e - ab } €6"mtx C3d:�=� (Use drawrngs�of facili , to+better explain situations. (use addtUonal,pdya3g�es�,aiTeeessaryj r- ❑Field Copy ❑Final Notes :.".IK fu.'v. ..r4.s�•,{...�Y.w" qFk� .Ili'"'AIiT�ne+�n:�iani!:9AFd'aRMlf�aea �G✓ ^^/ �- re C' ' d., Reviewer/inspector Name Reviewer/Inspector Signature: ' Date: 2 3 0 05103101 Continued Facility lumber: 4 - 3 4 Date of Inspection Odor Issues 26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No liquid level of lagoon or storage pond with no agitation? 27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes LA No 28. Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt, ❑ Yes [& No roads, building structure. and/or public property) 29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes jJ No 30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 9 No 31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Q No 32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover? ❑ Yes ❑ No ,Additional Comments andlor.Drawings: 05103101 3 ❑Division of Soil and Water Conservation D Other Agency I s� Quality °°'� of Water Q9P ns, yp,xw'`iy'iyu �FF':,� 10 Routine 0 Comnlaint O Follow-up of DNVO inspection O Follow-ut) of DSWC review O Other ! Date ofinspection 1-/O Facility Dumber - ��ff Time of Inspection Q : ao 24 hr. (hh:mm) ©Registered Certified © Applied for Permit $ermitted ❑ Not Operational Date Last Operated: ....................,_ Farm Name: I'eC�,r...��r5; — .fL_ r1".:1 ................................ County: ....elso^—...._................................................. ..... . Owner Name: , �e rr'.., ......... ...... Phone No: Facility Contact: .-5., r. .►rl......h. en. ............... Title:.. Q„ L ............................... Phone No: Mailing Address: Pi ................ _....W��i�!���.!J ! r..�. W......... ,�.1/..../ 7 �-1 Onsite Representative:.. Mr.......1�0.' � T ..._....................... ..,,...... Integrator: ...._..---- ...„.. Certified Operator-,___... _.. Operator Certification Number; Location of Farm: Latitude Longitude a , Design„`: 'Current ° :Design w :Current" Desioi :Current -: Swore , °Capaeity, Population ".Potiltiy Capacity'Population 'w Gattle s ¢ Ca iscity ........0 Wean to Feeder '❑ Layer ❑ Dairy ❑ Feeder to Finish I0 Non -Layer I ❑ Non -Dairy ❑ Farrow to Wean ❑ Farrow to Feeder ❑ Other"ri ❑ Farrow to Finish p. Total Design Capacity,, ❑ Gilts n rx. ` ❑ Boars '' Total SSLW Number of Lagoons I Holding Ponds ❑Subsurface Drains Present ❑Lagoon Area Spray Field Area ❑ No Liquid Waste Management System General 1. Are there any buffers that need maintenance/improvement? ❑ Yes ANo 2. Is any discharge observed from any part of the operation? ❑ Yes �No Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other a. if discharge is observed, was the conveyance man-made? b. If discharge is observed, did it reach Surface. Water? (If yes, notify DWQ) c. If discharge is observed, what is the estimated flow in gal/min? d. Does discharrc bypass a lagoon system'? (If ycs, notify DWQ) 3. Is there evidence of past discharge from any part of the operation? 4. Were there any adverse impacts to the waters of the State other than from a discharge? 5. Does any part of the waste management system (other than lagoons/holding ponds) require Mai ntenancelimprovement? 5. is facility not in compliance with any applicable setback criteria in effect at the time of design? 7. Did the facility fail to have a certified operator in responsible charge? 7/25147 ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes No ❑ Yes No ❑ Yes P(No ❑ Yes No ❑ Yes ❑ No Continued on back Fa Tty Number: Q 6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? 7. Did the facility fail to have a certified operator in responsible charge? 8. Are there lagoons or storage ponds on site which need to be properly closed? S-tructures fLa#Qons and/or Nold_ingPonds) 9. Is storage capacity (freeboard plus storm storage) less than adequate? Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 I0. Is seepage observed from any of the structures? 11. Is erosion, or any other threats to the integrity of any of the structures observed? 12. Do any of the structures need maintenance/improvement? (If any of questions 9-12 was answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ) 13. Do any of the structures lack adequate minimum or maximum liquid level markers? Waste Anplicatign 14. Is there physical evidence of over application? (If in excess of WMP, or runoff entering waters of the State, notify DWQ) IS. Crop type ❑ Yes JK No ❑ Yes ❑ No ❑ Yes 0 No ❑ Yes ❑ No Structure S Structure 6 16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? I7. Does the facility have a lack of adequate acreage for land application? I.B. Does the receiving crop need improvement? 19. Is there a lack of available waste application equipment? 20. Does facility require a follow-up visit by same agency? 21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? EStI SergfiSd Facilities Only 22. Does the facility fail to have a copy of the Animal Waste Management PIan readily available? 23. Were any additional problems noted which cause noncompliance of the Certified AWMP? 24. Does record keeping need improvement? ❑ Yes J� No ❑ Yes KNo ❑ Yes YNo ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes X No ❑ Yes A No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Comments (refer to question # ): Explain any YES answers and/or any recommendations or any other comments. : Use drawings of facility to better explain situations. (use additional pages ,as necessary): hde r co Ks-Frue ^t' con�Diciih�- cti1aS �iJe� 4here ujo s AO JcLj ! +' r,e J t�lSr yej sla�e hoc f • Ma-�eria.�� c.>4ick is na+ sae rpc�CJ IS Ntc�+ert�rc,&iaveJ lrmvo^~ w;l! !ate iinF� w�--�wej,.e �hc es e-F "b�•ll �-Aiow't-c-�c�.� pet' 7�.e �.►spe�.-�rr 44n-6 -H•ere 'rs Reviewer/Inspector Name ' - Y CZ ° �=i r � s ' 4N40 ; ',. :v 3 ' `v 't^n� Reviewer/Inspector Signature: Date: %% Z I— TT�'^' - cc. Division of Water Quality ater Quality Section, Facility ksesfment Unit A 17A/nA7