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260013_INSPECTIONS_20171231
NUH I H UAHULINA Department of Envimnmental Quaff ►J Hype of visit: wyc ompuance inspection u uperation xeview u structure Evaluation u Ieennlcal Assistance Reason for Visit: �autine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access Date of Visit: Arrival Time: % Departure Time: �O County: '� a Region: �[� Farm Name: C SS+µ' Owner Email: Owner Name: Phone: Mailing Address: Physical Address: Facility Contact: �� Title: Phone: Onsite Representative: � Integrator: Certified Operator: i Certification Number: Back-up Operator: Certification Number: Location of Farm: Latitude: Longitude: Sc —A't'— A� gr19-- Design Cnrrent „' D Current Design Cnrrent Swine Capacity Pap. Wet PoultryzCaN Pop. Cattle Capacity Pop. inish La er DairyCow eeder ,� a OiJ Non -Layer Dairy Calf DairyHeifer Finish ,';'ll" Wean EFF E i� 1�1 ; Design Current D Cow Feeder D . P,[sult . ;;',.;Ca '' aci P.o . Non -Dairy Finish La ers Beef Stocker Nan -La ers Beef Feeder Pullets Beef Brood Cow Turkeys Other Turkey Poults 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 D W R) 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 io ❑ NA ❑ NE ❑ Yes ❑ No [a<A ❑ NE [:]Yes [] No NA [:]NE ❑ Yes ❑ No ❑ Yes 1131io ❑ Yes C],Wo [3VA ❑ NE ❑ NA ❑ NE ❑ NA [:]NE Page I of 3 21412015 Continued Facili umber: 2 - Date of Inspection: au. c Wt{te Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? [3Yes ❑ No EWAB ❑ 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 ©-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 [n::b� ❑ 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 �o ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EJ-1vo ❑ 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 [ oo ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes En -go ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [Z,? foO 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): j e-f wtr{j'gk� R45 i k ^e, _5� 6, 0 r—r � 13. Soil Type(s): 1 (L o 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �Ko ❑ 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 [aN❑ NA ❑ NE ❑ Yes E2/o o ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes l 401 ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E3 o ❑ 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 [�Ko ❑ 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 EVN 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes EdNo ❑ NA ❑ NE ❑ Weather Code ❑ Sludge Survey o ❑ NA ❑ NE ❑ NA ❑ NE Page 2 of 3 21412015 Continued Facili 'Number: -k3 jDate of Inspection: f 24,Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes D-bte- ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes I J 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 [G] o ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 2<o ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes O 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 EE 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 to ❑ 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 [�o ❑ NA ❑ NE ❑ Application Field ❑ Lagoon/storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [rT'No ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [ -96- ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes 6.Ko_ ❑ NA ❑ NE - � - nu L g Reviewer/Inspector Signature: ` (, {Vr Dat Page 3 of 3 214112015 IN ype ui visit: ;Goor—ompnance inspection v tiperatton tceview v anrucnure r vaivaiton tJ i ecnnncat Asststance Reason for Visit: GrIfe—utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: I Arrival Time: Departure Time: „ �� County�c� Region: Farm Name: Mur/i-011 Owner Email: Owner Name:, Phone: Mailing Address: Physical Address: c p Facility Contact: J vuu Title: T /J I Onsite Representative: Certified Operator: C Back-up Operator: Location of Farm: Latitude: Phone: Integrator: Certification Number: 2,0 / [ Certification Number: Longitude: Destgn Current Desi n Current Design CurHnt g Swine Capacity Pe. Wet Poultry Cap city L : ,__. Cattle Capacity Wean to Finish La er DairyCow Wean to Feeder Non -La er DairyCalf Feeder to Finish DesignCtsr er tit Da i Heifer Farrow to Wean Farrow to Feeder D Cow Non -Dairy Farrow to Finish Gilts La ers Non -La ers Pullets Turkeys Beef Stocker - Beef Feeder Beef Brood Cow . Boars Other - Other Turkey Poults Other Discharges and Stream Impacts I. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? 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 a -No ❑ NA ❑ NE ❑ Yes ❑ No []'"NA 0 NE [:]Yes ❑ No [ A ❑ NE [—]Yes [—]No [:]Yes E+No [—]Yes L�rNo Ga"NA ❑ NE ❑ NA ❑ NE ❑ NA D NE Page 1 of 3 21412015 Continued Facilily Number: - f Date of Inspection " Waste Collection & Treatment 4'Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes FL NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No LQ-NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): ( 3 p 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E2rlIo ❑ 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 gl o ❑ 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 EJONo ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes C�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 dNo ❑ 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 [2-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 ^^Dr��ift ❑ Application Outside of Approved Area �� 12. Crop TYPe(s): Pa to U540'�4 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes [r] No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [DNo ❑ 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 Ea"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 ❑'Po ❑ 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 LNo ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [1 Weather Code ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [' No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation"equipment? ❑ Yes L� No ❑ NA ❑ NE Page 2 of 3 21412015 Continued IFacilk Number: 2V - Date of Inspection: k 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E3-15o ❑ NA ❑ NE A 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E?I o ❑ 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 �o ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ET -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 [i]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 [�rN o ❑ 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 [J 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 []T&o ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [!I -No ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes E?fNo ❑ NA ❑ NE Comments (refer to guestton_#) Explain any YES answers and/or any additional recommendations or any. other comments';r s i; -_ Else drawings of facility to better explain situations (use additional pages as :necessary). cor� 7-df Is SG.4,�,r��—� IO-1a-Ib Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 OR - Phone: 3 Date: 2 0 C&k 21412015 R1 Ms r 7 0164\' 14 Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit: Vtoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: �+--F-'�1�Arrival Time: Departure Time: 6A] County: �-kQ-ILW Region: F� Farm Name: iz }dnl 5M 144 Owner Email: Owner Name: �dU1 Phone: Mailing Address: Physical Address: Facility Contact: Ir t SM/�+- Title: Phone: Onsite Representative: ! Integrator: r` 1:7 _ Certified Operator: l Certification Number: 1 4 L43 7 Back-up Operator: Certification Number: a Location of Farm: Catitude: Longitude: Discharees and Stream Impacts 1. Is any discharge observed from any part of the operation? ❑ Yes Eno ❑ NA ❑ NE Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? ❑ Yes ❑ No /J NA ❑ NE b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No Eg'I�A ❑ 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 [ 1N' o ❑ NA ❑ NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes dNo ❑ NA ❑ NE of the State other than from a discharge? Page I of 3 21412014 Continued. Facility Number: Z 6- Date of inspection: �� ;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 l Structure 2 Structure 3 Structure 4 Structure 5 Identifier: Spillway?: Designed Freeboard (in): _ Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? (i.e., large trees, severe erosion, seepage, etc.) No ❑ NA ❑ NE ❑ No C&lqA ❑ NE Structure 6 ❑ Yes 2No ❑ NA ❑ NE 6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes I B 1"o ❑ 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 o ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ENo ❑ 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 M No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes gD"No ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes UrNo ❑ 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): 1349-4,A k K4', rqp Al"We 13. Soil Type(s): 0 14, Do the receiving crops differ from those designated in the CAWMP? [:]Yes ; �o ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2r*No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes EB14o ❑ 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 [ffNo ❑ NA ❑ NE ❑ Yes [DNo ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [Z�No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE the appropriate box. ❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [!J'No ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EfNo 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2f No ❑ NA ❑ NE ❑ Weather Code ❑ Sludge Survey ❑NA ❑NE ❑ NA ❑ NE Page 2 of 3 21412014 Continued Facilitj Number: - Date of Inspection: 1' 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 [Z'&o ❑ 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 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 [?rNo ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E�r`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 Cj"'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 dNo ❑ 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 dNo ❑ NA ❑ NE ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ONo ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �7 'No ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? r] Yes L No ❑ NA ❑ NE Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments Use drawings of facifity.to better explainsituations (use additional pages asmecessary) C4.l�C�t, 40-1 S'� ( v- �� 3. o 0 j i g -� qu o Reviewer/Inspector Name: m TNPhone: J3 1 Reviewer/Inspector Signature: Date: Page 3 of 21412014 S 3 r� aypc va rfau: V0'%-UjUPL1HHVV wapccuvu v vpCrauun 1cCvKCW V aLiuUwic r vuaunuvu V iCl'ullll'xl tsa,�aLxul'C Reason for Visit: (94outine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access Date of Visit: Arrival Time: 0 Departure Time: Q County _ Farm Name: ��Owner Email: Owner Name: �(�t4 Phone: Mailing Address: Physical Address: Facility Contact: .t d� Title: Onsite Representative: r Certified Operator: Back-up Operator: Location of Farm: Latitude: Region: Phone: Integrator: �q. 6 Certification Number: Certification Number: Longitude: - Swine Design Current Capacity Pap. Wet PoWtry Design Capacity Carrent Pop. Design Gnrrent Cattle Capacity Pop. Wean to Finish Layer Dairy Cow Wean to Feeder gatiQ Non -Layer Dairy Calf Dairy Heifer Feeder to Finish D Ro. Design ('Current Ca ac' _Po _. Farrow to Wean Farrow to Feeder Dry Cow Non -Dairy Farrow to Finish Layers Beef Stocker Gilts Non -Layers Beef Feeder NJ Boars Pullets Beef Brood Cow Othe Other Turkeys F Turkey Poults 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 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 LJ < ❑ NE [:]Yes ❑ No ED�NA ❑ NE ❑ Yes [:]No [;[>A ❑ NE ❑ Yes ®moo ❑ NA ❑ NE [] Yes Ea"'No ❑ NA ❑ NE Page I of 3 21412014 Continued Ir FaciU Number: - Date of inspection: 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 1 Structure 2 Structure 3 Structure 4 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): _c'9-1 S. Are there any immediate threats to the integrity of any of the structures observed? (i.e., large 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? [;< ❑NAB❑NE ❑ No E ►NA ❑ NE Structure 5 Structure 6 ❑ Yes g.Pd' ❑ NA ❑ NE ❑ Yes IJ"o ❑ NA ❑ NE 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 ImoN-o ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 10 ❑ 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 ff No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0.9 ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence 9f 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): Se"AL0 {, J S"k 0tv, A'VE*4 13. Soil Type(s): 9_4'*11 U-0 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LE�qPo ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes E? <io ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes ffNo ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes 640 ❑ 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 ❑ 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 o ❑ 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 acili Number: - Date of Ins ection- . 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes a ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes III "'o ❑ 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 to provide documentation of an actively certified operator in charge? ❑ Yes e No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E No ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [5-Ro ❑ 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 [IrNo ❑ 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 []r Po ❑ 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 [ErNo ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes Q No ❑ NA ❑ NE Comments (refer to questiion'#): Explain any YES answers -and/dr any=additional recommendations oraanyother-comments`- Use drawings of facility to better explain situations (use additional pages as necessar_y). c.L r+ � (jr, &fi'� M_- -t'� - I � Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 -4j- z o k,6b o p1,Qr I ,S.a0 kfl Phone: - V 33 Date: K_A_ I S 21412014 Type of Visit: (D.-C6mpliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance Reason for Visit: �utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other 0 Denied Access Date of Visit: 3-1 -/ Arrival Time: Departure Time: County: Region: Farm Name: i-C ply Owner Email: Owner Name: L Phone: Mailing Address: Physical Address: Facility Contact: i T ., Title: Phone: Onsite Representative: Integrator: jT'i ✓✓� �✓ �� Certified Operator: Certification Number: Back-up Operator: Certification Number: Location of Farm: Latitude: Longitude: Design Current Design Current Swine Capacity Pop. Wet Poultry Capacity Pop. Wean to Finish fl 3 -90 Layer Desigu Current C►attie Capacity Fop. Dairy Cow Wean to Feeder Non -La er Dairy Calf Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish = = +�� Design D , P,oWtr, Ca aci P,o Layers Dairy Heifer. Ehy Cow Non -Dairy Beef Stocker Beef Feeder Beef Brood Cow Gilts Non -Layers Boars Pullets Other OtherI Turkeys Turkey Poults 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) 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) 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 5�.No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE [::]Yes ❑ No ❑ Yes No [::]Yes ® No ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE Page I of 3 21412011 Continued Facility Number: - / Date of Inspection: Waste Collection & Treatment i 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C.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 Ug-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 Eff-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 D5,No ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes [ o ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes allo ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes [8-No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or l 0 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): � S.r..rr�,-� It LAI� f / yz,:- 7rm d., IA9,VG/' x-r 13. Soil Type(s): T%E Z a l eq L 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [K No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes p"o ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes (allo ❑ 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 allo ❑ NA ❑ NE D Yes [Z No ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes allo ❑ 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. ❑W11P [—]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 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 21412011 Continued • Facility Number: Z& - 3 Date of Inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? [-]Yes [&No 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E&No the appropriate box(es) below. ❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels ❑ Non -compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes allo 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [RNo 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? ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes [&No ❑ NA ❑ NE [:]Yes allo ❑ NA ❑ NE ❑ Yes [3,No [] NA ❑ NE ❑ Yes rU No ❑ NA ❑ NE ❑ Yes [e No ❑ Yes � No ❑ Yes ED-No ❑ NA ❑ NE ❑NA ❑NE ❑ 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 panes as necessary). Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 Phone: 9149 —1123-532� Date: 21412011 Map -et /3-P6-&� a5- �J tvis10n of Wa#er Quality �Y Facility Ngut mber ®- 0 ® Division of Soil and Water Conservation 9 Other Agency Type of Visit: omp lance Inspection 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 Date of Visit: .J_— j 1 Arrival Time: ; p O Departure Time: ') County: G'1 +. �a.+ci Region: Farm Name: Owner Email: Owner Name: i �}'y S7-rt ; �''i�— _ Phone: Mailing Address: Physical Address: Facility Contact: ; 6 1.�:r 'Sn4 r'r/k, Title: &&4')11 tr •'� Phone: Onsite Representative: fcrc.c� Certified Operator: �.•--� Back-up Operator: Location of Farm: Latitude: Integrator: rvr��y Certification Number: Certification Number: Longitude: Design Current _ Design Current ::. Design Current Swine Capacity Pop. Wetlp'd t P.op. Cattie Capacity Pop. ,Capacity v- Finish [Layer Da Cow Feeder 5 D Non -La er :;k�Dai DairyCalf Heifer FFeederFinish o WeanD Cow o Feeder fi`+ D 'foal Ca aci P,o Non -Dairy Farrow to Finish Layers Beef Stocker Gilts Non -Layers Beef Feeder Boars Pullets Teske s urkey Poults Beef Brood Cow Othe NJ 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 [Z No ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes [:]No ❑NA ❑NE ❑NA ❑NE 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 1 of 3 21412011 Continued Faciti Number: (v - Date of Ins ection: Waste Collection & Treatment ' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes � No [DNA ❑ 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:jry�; Spillway?: Designed Freeboard (in): J `) f `l Observed Freeboard (in): p'Z.S� 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes to 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 ® No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0 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 ® 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 ❑/ E/vidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): 1��"md,, Ze_c izL! w -A-- A_ �S[ �vr,�./�, 13. Soil Type(s): / u> 14. Do the receiving crops differ from those designated in the CA WMP? ❑ 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 25 No ❑ NA ❑ NE ❑ 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. J71 Yes ❑ No ❑ Waste Application ❑ Weekly Freeboard []Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E] No 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE Weather Code ❑ Sludge Survey ❑ NA ❑ NE ❑ NA NE Page 2 of 3 21412011 Continued ' Facility Number: - Date of Ins ection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? y Yes eNo ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes (A 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 to provide documentation of an actively certified operator in charge? ❑ Yes M No [] NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE Other lssues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Icy 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) 3 1. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes C&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 ® 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 ❑ NA ❑ NE Comments'(refer to question #): 7 Explain any YES answers and/or any additional recominendations or any other coinments'�" .,x w Use drawin s-of facility to better explain situations use additional pages as sary Reviewer/Inspector Name: J � Phone: �flf '�%3J 3Jya Reviewer/Inspector Signature: Date:~' r Page 3 of 3 21412011 14. I Type of Visit: 19-Ilance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: Arrival Time: y �Departure Time: County: Region: Farm Name: j� 4 �� y jj'yJ NL�i3�/ y Owner Email: Owner Name: G k y c5 "7 Phone: Mailing Address: Physical Address: Facility Contact: � ( _fr ; /-A Title: Phone: Onsite Representative: Certified Operator: Back-up Operator: Location of Farm: Latitude: Integrator: Certification Number: Z92Z7 Certification Number: Longitude: Design Current Swine Capacity Pop. Wean to Finish Design Current Design Current WetlPoUltry . Capacity Pop. Cattle Capacity Pop. Layer Dairy Cow can to Feeder D Non -La er I Dairy Calf Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish D P,oult o Layers Dairy Heifer Design Current Dry Cow Ca grit P,o Non -Dairy Beef Stocker Gilts Non -Layers Beef Feeder Boars Pullets Turkeys Beef Brood Cow Other Other Turke Poults 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)? _ 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 g�;_No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes [:]No NA ❑ NE [:]Yes [:]No ❑ Yes 0 No ❑ Yes 0 No ❑ NA ❑ NE ❑NA ❑NE ❑NA ❑NE Page 1 of 3 21412011 Continued 4 Facili Number: - Date of Inspection: /y Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C3 No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): jq Observed Freeboard (in):� 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 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 EL No 0 NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? [—]Yes 0 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 [g 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 (4 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): ,n 13. Soil Type(s): `T w a 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R] 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 tj� No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? 18. Is there a lack of properly operating waste application equipment? Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? 20. Does the facility fail to have all components of the CAWMP readily available? if yes, check the appropriate box. ❑ Yes 10 No ❑ Yes CKNo [:]Yes ® No ❑ Yes No ❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes KNo ❑ 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 ONE ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ Weather Code ❑ Sludge Survey ❑ NA ❑ NE ❑ NA ❑ NE Page 2 of 3 21412011 Continued I� Facili Number: - %3 Date of Ins ection: /.;Z— 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � No 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes " No the appropriate box(es) below. ❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels ❑ Non -compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes MI No 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No 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? ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes Eg No ❑ NA ❑ NE ❑ Yes g No ❑ NA ❑ NE ❑ Yes E] No ❑ NA ❑ NE ❑ Yes ®No ❑ NA ❑ NE ❑ Yes ®No ❑ Yes ® No ❑ Yes � No ❑ NA ❑ NE ❑ NA ❑ NE ❑ 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: r/ti! /,--- Phone: 9Q-41-73 3300 Reviewer/Inspector Signature: Date:"''�i_ Page 3 of 3 21412011 t IN Type of Visit JG�Co-mpliance 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: Arrival Time: C / Departure Time: r� County Region: Farm Name: r l Owner Email: Owner Name: Phone: Mailing Address: Physical Address: Facility Contact: Title: 4�G( Pov"' J Phone No: /iTL/i"L?�1 Onsite Representative: _a-t-�— Integrator: Certified Operator: Operator Certification Number: Back-up Operator: Back-up Certification Number: Location of Farm: Latitude: = o = I = u Longitude: = ° =' = u w ,Des' n �Cnrrent 00 - =�Desi 'u� Current Design Current SwineCapa%tty Population Wet PouItryCapacityPopulation Cattle Capacity Population ❑ Wean to Finish ❑ La er ❑ Da' Cow 1QLWean to Feeder ❑Non -La er ❑Dai Calf Feeder to Finish y 17 airy Heifer w ❑ D Cow ❑ Farrow to Wean ry -- ❑ Non -Dairy ❑ La ers ❑ Beef Stocker ❑ Farrow to Feeder ❑ Farrow to Finish ElGilts ❑Non -La ers Pullets ❑Turke s PEE, ❑ Beef Feeder ❑ Beef Brood Co Boars Other �> TurkeyPoults ❑ Other ❑ Other Number of Structures: 3"r��s::+++ •+..tR .,. -..� -.sue-- — ... Discharges & Stream Impacts I . Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? 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 RNo ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes 0,No ❑ NA ❑ NE ❑ Yes MNO ❑ NA ❑ NE Page 1 of 3 12128104 Continued Facility Number: — 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 Structure 3 Structure 4 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): pZg ! 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ large 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? ❑ Yes ® No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE Structure 5 Structure 6 ❑ Yes 0 No ❑ NA ❑ NE ❑ Yes ,O No ❑ NA ❑ NE 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 ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes Lallo ❑ 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 )allo ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,ENO ❑ 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) B /yJ ' rS :'4� 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CgNo ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3 No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes C4No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes E.No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes 19INo ❑ NA ❑ NE Reviewer/Inspector Name f Phone; 01 Reviewer/Inspector Signature: Date: Page Z of 3 12128/U4 Continued Facility Number: — Date of Inspection 12=LL l Rectuired Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes D} No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [RNo ❑ NA ❑ NE the appropirate box. ❑ WUP ❑ Checklists ❑ Desig n 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 ❑ Stacking ❑ 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 E[No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,Z No ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JR 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 14 No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes f,No ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Jallo ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes [,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 ER 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 ERNo ❑ 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 N No ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes ® No ❑ NA ❑ NE (Additional Comments and/or DrawRngs,�a Page 3 of 3 12128104 A T..// r2 . . Type of Visit O-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access Date of Visit: 17 9- /0 Arrival Time: ! 1VS_ Departure Time: County: _ LujKbtrf.rlatr Region: +� *A Alas �•� Owner Email: Farm Name: � `` �l ✓�� Owner Name: K'lGei. s+%N4 Phone: Mailing Address: Physical Address: r Facility Contact: Title: �A.h� Phone No: Onsite Representative: Certified Operator: Back-up Operator: Integrator /y%i� Ara, / Operator Certification Number - Back -up Certification Number: G"2o Location of Farm: Latitude: = o = I =" Longitude: = o = f = u Design C►anent Swine Capacity Population Design Current Wet Poultn' Capacity Population Design Cattle Capacity Current Population ❑ can to Finish ❑ Layer ❑ DairyCow Wean to Feeder Z ❑ Non -Layer Dry Poultry ❑ Layers La ❑ N Nets ers ❑ Pullets ❑ Turkeys ❑Turke Poults ❑ Other ❑ DairyCalf ❑ DairyHeifer ❑ D Cow ❑ Non -Dairy El Beef Stocker El Beef Feeder ElBeef Brood Co Number of Structures: i ❑ Feeder to Finish ❑ Farrow to Wean ❑ Farrow to Feeder ❑ Farrow to Finish ❑ Gilts ❑ Boars Other. ❑ Other Discharges & 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 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 [!I No ❑ NA ❑ NE ❑ Yes ❑ No El NE El Yes El No ,_,[�iA [R NA ❑ NE LTNA ❑ NE ❑ Yes ❑ No ❑ Yes No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE Page 1 of 3 12178104 Continued Facility Number:,?& - Date of Inspection 7-/ - )o 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 1 Structure 2 Structure 3 Structure 4 Identifier: /- Sr -,.'AZ- Z- Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ large 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? ❑ Yes B_, NNoo El Yes 9 o Structure 5 ❑NA El NE ❑ NA ❑ NE Structure 6 ❑ Yes No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE 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 ETNo ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2 o ❑ 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 ElYes No ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes LBNo ❑ 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 ❑ EvidenceofWind Drift Application Outside of Area 12. Q❑_ Crop type(S) Ste.,ati, r ✓ Gfrn171/W 13, Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Ej<o ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0<o ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes Er No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes El NA El NE 18. Is there a lack of properly operating waste application equipment? El Yes BINo L7 No ❑ NA ❑ NE �.F� ,.mana. ��iF �� a4 <Comments (refer to question #): Eicplain any YES answers and/or arty recommendations or anv other comments Use drawings of facility to better explain situations (use additional pages as necessary) AL Reviewer/Inspector Name tC Q,e Phone: ReviewertInspector Signature: u- Date: 7- /IV- 00/0 12128104 Continued Facility Number: 2le— __Y Date of Inspection 7-! Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 13"No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Io ❑ NA ❑ NE the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes kd'No ❑ 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 E] Weather Code 22. Did the facility fail to install and maintain a rain gauge? [IYes IE� N��o El NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes 13<0 ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes <o ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes L'f No ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes t Ko ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes B No ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes L�7, Noo [I NA El NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El Yes E3<o❑ 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? ElB Yes o ❑ 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 El Yes B o ❑ 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 01 o ❑ NA ❑ NE its and/or Page 3 of 3 12178104 ru 3SwtS 4e.,.r,�Q,-mod /o -d2 -Zoo y evision of water Quality Facility Number (p /3 0 Division of Soil and Water Conservation 0 Other Agency Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access d Date of Visit: Arrival Time: p /Lt " County: /'Zg-09 er% C4�itc Departure Time: Farm Name: cG1rC Ss - �cySr.y Owner Email: Owner Name: ni Phone: Mailing Address: Physical Address: Facility Contact: ` 1CV 5; -4; 4 Title: Phone No: Onsite Representative: SivW4 Integrator: 4 �4Z-e "`w Certified Operator: Operator Certification Number: Back-up Operator: Back-up Certification Number: Location of Farm: Latitude: = v ❑ I = ,, Longitude: ❑ ° ❑ 1 ❑ u Swine Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Other ❑ Other Design Current Design Current Capacity Population Wet Poultry Capacity Population ❑ Layer 52J/0 3700110 Non-Layet Dry Poultry ❑ Layers ❑ Non -Layers ❑ Pullets ❑ Turkeys ❑ Turkey Poults ❑ Other Discharees & 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) Design Current Cattle Capacity .upulation r ❑ Dairy Cow ❑ Dairy Calf ❑ Dairy Heifei ❑ Dry Cow ❑ Non -Dairy ❑ Beef Stocker ❑ Beef Feeder ❑ Beef Brood Co c. What is the estimated volume that reached waters of the State (gallons)? Number of Structures::. F. 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? J ❑ Yes B o ❑ NA ❑ NE ❑ Yes ❑ No A El NE El Yes El No LT1vA ❑ NE 9'l A El NE ElYes El No ❑ Yes o ❑ NA ❑ NE [:]Yes 91v o ❑ NA ❑ NE 12128104 Continued ! a Facility Number: Date of Inspection %- - D 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? Structur StructurO Structure 3 Structure 4 Identifier: J cxkvx i 4— Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ large 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? ❑ Yes No ❑ NA ❑ NE ❑ Yes 9K(0) ❑ NA ❑ NE Structure 5 Structure 6 El Yes Bl o El NA ❑NE ❑ Yes D o ❑ NA ❑ NE If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalthreat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes ,L,_T► o ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? El Yes L'1 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 ETNo ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3 o ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ 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 ❑ Evidence of Wind Drift ❑ Application Outside of Area 12. Crop type(s) Avova4 AAA../Ls 13, Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes B<o ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes o ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes �B 13No ❑ 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 G rc ,�?c�v✓ _ ReviewerlInspector Name ice. R--eveli J Phone: 91,0, � 33._?_33 o Reviewer/inspector Signature: Date: `i- Z S —ZDD 9 Page 2 of 3 12128104 Continued Facility Number: Date of Inspection Records & Documents _Required 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L`' < ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ETNo ❑ NA ❑ NE the appropriate box. ❑ WUP ❑ 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? ElFlo]Yes 3 ❑ NA ❑ NE - 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ��� ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ,B ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ,LhNo NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ,L—S, �No�❑ 0-N-b ❑ NA ❑ NE Other Issues Ergo Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Tr Yes No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document [ 1 Yes ISNo ❑ 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 ,�� LSNo ❑ 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 3 o ❑ 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 LTNo0❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes [1ANo ❑ NA ❑ NE 12128104 Division of Water Quality ! Facility Number O Division of Soil and Water Conservation O Other Agency 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: Farm Name: Owner Name: Mailing Address: Physical Address: Departure Time: County: Owner Email: Phone: Facility Contact: '�`� 1'Y► t Title: �� Phone No: 1 Onsite Representative: Integrator: Certified Operator: 1 Operator Certification Number: Back-up Operator: Back-up Certification Number: 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 Region:' v- ' Latitude: [= e = 0 Longitude: [= ° = f Design Current Design Current Capacity Population Wet Poultry Capacity Population ❑ La er I❑ Non -Layer Dry Poultry ❑ Layers ❑ Non -Layers ❑ Pullets ❑ Turke s ElTurke 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? b. Did the discharge reach waters of the State? (If yes, notify DWQ) Design Current Cattle Capacity Population ❑ Dairy Cow ❑ Dairy Calf ❑ Dairy Heifej ❑ Da Cow ❑ Non -Dairy ❑ Beef Stocker ❑ Beef Feeder ❑ Beef Brood Cow, c. What is the estimated volume that reached waters of the State (gallons)? Number of Structures: 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 fV No El NA El NE ❑ Yes ❑ No 0 NA ❑ NE ❑ Yes ❑ No ,I NA ❑ NE ❑ Yes ❑ No *1 NA ❑ NE ❑ Yes 1P No ❑ NA ❑ NE ❑ Yes KNo ❑ NA ❑ NE 12128104 Continued • Facility Number:Z-11 I Date of Inspection 400 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 frceboard? ❑ Yes MNo ❑ 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 )Z 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 [X-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 KNo ❑ 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 �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/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 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable CropWindow❑ Evidence of Wind Drift ElApplication Outside of Area 12. Crop type(s) �U.Yhr i' HYIr, k of n4f (�r,ns6j.(ti V M - Sm C-11, 0! 5 13. Soil type(s) Tr w o 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes KNo ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes N3 No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes MNo El 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 EpNo ❑ 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): Reviewer/Inspector Name C_j4 U Phone:n 104A:.� Reviewer/Inspector Signature: Date: a 12128104 Continued Facility Number: (p — [3 Date of inspection 5 }a Required Records & Documents t9. Did the facility fail 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 ❑ Desi gn ❑Maps ❑Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ YesNo ❑ 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? 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? Comments and/or Drawings: — (1l(jj� VY-Car C 5 . - c-k e do NV-C. 5 +C' c a, ()A S ISO(Vcl � ViY ❑ Yes iA No ❑ NA ❑ NE ❑ Yes PfNo ❑ NA ❑ NE ❑ Yes ,®.No ❑ NA ❑ NE ❑ Yes ❑ No O NA ❑ NE ❑ Yes �&No ❑ NA ❑ NE ❑ Yes 19 No ❑ NA ❑ NE ❑ Yes b No NA ❑ NE El Yes El No bb❑,, I] NA ❑ NE ❑ Yes allo ❑ NA ❑ NE ❑ Yes P�No ❑ NA ❑ NE ❑ Yes ;9 No ❑ NA ❑ NE ❑ Yes P No ❑ NA ❑ NE ❑ Yes W, No ❑ NA ❑ NE ❑ Yes Q No ❑ NA ❑ NE 12128104 Facility No. Chi � ` l 2 Time In Time Farm Name �� Owner +C Operator � Back-up )ut Date 5jo Integrator Site Rep r� No. p�1` No. f r9 COC Circle: General or NPDES Design Current Design Current Wean - Feed ' 4V Farrow - Feed Farrow - Finish Feed - Finish Gilts / Boars Farrow - Wean - Others FREEBOARD: Design Sludge Survey Observed I Calibration/GPM 1 Crop Yield Waste Transfers Rain Gauge L� Rain Breaker Soil Test �A Wettable Acres PLAT Weekly Freeboard ----- 4L,,,- Daily Rainfall I Spray/Freeboard Drop Weather Codes 120 min Inspections Waste Analysis: Date Nitrogen (N) 14 In ro � L .Z --I 1-in Inspections �% Date Nitrogen (N) '3 Z(D 1_ 1,33 39q \Vca l7 9, 1 Pull/Fiend Soil Crop Pan Window w >4 a - N �� �� - ��,• �U G t� I:t1' `*Division of Water Quality C)A 1 i w Facility Number 0 Division of Soil and Water Conservation _n 0 Other Agency C 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: Time: Departure Time: 1 � _ County: Region: Farm Name:JjArrival e- N) lJl Dr Owner Email: S 1`Sm vi Tl' ®i n+m, Soar, N [4 Owner Name: t Phone: (:110 F,3133 — �,oa $ Mailing Address: Physical Address: Facility Contact: ' �J�`�Y � Title: c VJY1w Phone No: i � �� -m Onsite Representative: ' Sln, Integrator: MQVVIt ��' Certified Operator: Operator Certification Nt er: Back-up Operator: Back-up Certification Number: Location of Farm: Latitude: ❑ . ❑ tl Longitude: = ° ❑ 1 Swine Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Other ❑ Other Design Current Design Current Capacity Population Wet Poultry Capacity Population ❑ Layer ❑ Non -Layer Dry Poultry ❑ Layers ❑ Non -Layers ❑ Pullets ❑ Turkeys ❑ Turkey Pouits ❑ Other Discharzes & 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) Design Current Cattle Capacity. Population ❑ Dairy Cow ❑ Dai Calf ❑ Dairy Heifer ❑ Dry Cow ❑ Non-PILry ❑ Beef Stocker ❑ Beef Feeder ❑ Beef Brood Co c. What is the estimated volume that reached waters of the State (gallons)? Number of Structures: 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'? El Yes *o El NA El NE ❑ Yes ❑ No K)qA ❑ NE ❑ Yes ❑ No O�YA ❑ NE ❑ Yes Cl No 34)NA ❑ NE ❑ Yes fo ElNA ElNE ElYes �TNo ❑ NA ❑ NE 12128104 Continued iFacilih \`ufnber• �� Date of Inspection Waste Collection & Treatment 4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No % iA ElNE Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: i Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? ElYesNo ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) NN 6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �j 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 [ No ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ❑ 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 P No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes allo El NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes )RNo ❑ 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 12. Croptype(s) CPf V1 -0,tQ• r ,�]�1 5 :&rnj0L—Q-'1f0.t2 c'xi`i�Jr Olt, . SULMMu 4 U444 13. Soil type(s) 7TY, W � 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 fallo ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes UO No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes 19� No El NA [I NE 18. Is there a lack of properly operating waste application equipment? El Yes No ❑ 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): Reviewer/Inspector Name Reviewer/Inspector Signature:Date: { 1 a13 12128104 i I Continued Facility Number: —Oj Date of Inspection �0 Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PkNo ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps p ❑ 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 )1120 Minute Inspections ❑ Monthly and 1" Rain Inspections eather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ANo ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes El No CUNA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? Yrulk es ❑ No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? )Ayes ❑ 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 4 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 R 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 tkN0 ❑ 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 ❑ NE General Permit? (ie/ discharge, freeboard problems, over application) 11'"' 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? ICJ Yes No ❑ NA ❑ NE lAdditional Comments and/or Drawings: I�t k) S4 key C'X)'T re.r,-� Vj0sJ'L.e a-VICLI V ML d. Uod" „-e. A to orriaasa_rn U r% - oVe-t -,,-,"k d;L-6 . 'Rq_c_zrcnx r SvAp . ��A c4Le 5 v'z� SAP PQ CIA O �14 ' 10V JV�i.o.- f S�KC,T/ S4-( W,v 0.Ye �OvnOle-Y"L D Q 1 12128104 Facility No.` ut "0 Ti e InTime Out - Date Farm Name chi N Integrator ' ' _ !p Owner, r' Site Rep Operator No. o-1, ..-. M Circle: Genera or NPDES Design ---Current Design Current can =Feed �ZZ O 4 '7 Farrow - Feed Wean - mis Farrow -Finish Feed Finish Gilts / Boars Farrow - Wean Others -` FREEBOARD: Sludge Surrey Design Ll 0 rop Yield al�Rain Gauge�ias„ 1 Soil Test Weekly Freeboard Observed Caiib£atien!GPM Waste Transfers 1� Rain Breaker. '� PLAT Daily Rainfa" \K� Waste Analysis: Date Nitrogen (N) Date Nitrogen (N) MMVMM e > r`lsion of Water Quality < Fadtity�Number f O Division of Sod and Water.Consenration ` O, Other Agency _ P Type of Visit 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: 13--?D:4 Arrival Time: '. Q Departure Time: fl County: Region: Farm Name: ,^ Owner Email: Owner Name: — G t'7 ��Jf�j Phone: Mailing Address: Phvsical Address: Facility Contact: G —z L�5]i" Title: On site Representative:+ LY cS77��` Certified Operator: S11-7 ; 7!n _ 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 /%7t�✓d+5! Operator Certification Number: k4/3 Back-up Certification Number: Latitude: = c = 6 Longitude: = ° = ` = Design. Current Design Current Capacity Population Wet Poultry Capacity Population ❑ Layer Cj70t� I❑ Non -La et Dry Poultry ❑ Layers ❑ Non -Layers ❑ Pullets ❑ Turkeys ❑ Turkey Poults ❑ Other Disc_ h� & Stream Impacts I. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? Design Current Cattle Capacity Population ❑ Dairy Cow ❑ Dairy Calf ❑ DaiEy Heifer CFDry Cow ❑ Non -Dairy ❑ Beef Stocker ❑ Beef Feeder ❑ Beef Brood Cow Number of Structures: ®l 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 KNo ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes 4 No ❑ NA ❑ NE ❑ Yes [LNo ❑ NA ❑ NE 12128104 Continued Facility Number: L— Date of Inspection 13-—_3pF--b4. Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes KNo ❑ NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): 3 L 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE (iel large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® 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 RNo ❑ 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 0 No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes f!�No ❑ 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 ] 0 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) L. r m u kt, G 7,n S, C.� vt �li 9 rah r. � / SLf iyfm 13. Soil type(s) �=1I a-') 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? Z[Yes Rio ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes 5&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 16-- C&;l iHar ld.%Kd- &?N De rmu-eleL >-arrm wad 3 -- 0,�— Reviewer/inspector Name �`` - " yam✓ w'Phone: Reviewer/inspector Signature: Date: IZZZ&U4 uonnnuea Facility Number: — Date of inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ERNo ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWW readily available? If yes, check ❑ Yes X No ❑ NA ❑ NE the appropirate box. ❑ WUP El Checklists El Design El maps ❑Other 21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE Waste Application Dd Weekly Freeboard ® Waste Analysis ® Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking WCropYield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code 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 [ZNA ❑ 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 (ZNo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No IVNA ❑ 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 El 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 El 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 �0 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 50 No ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes CKNo ❑ NA ❑ NE Addrt�onal;Coinments'aod/or,Dra�vEngs: o? 1, K rY f C_tDV0y ; r Lals ;L 404�p �7�cu rrr. t5�; L lfla ��✓ ! i, w L 00o -,5 ePt-, IV'#Ie a,1 C � T royv� a A eoj X: k R t d' oP-/ rn r Dr y,' t "�� �'D r,z•l �' F,-) Yei ve d 12128104 11 x:. s^ i. _ ._` .y- :_ �� a Sri_ -' - - '� .. - _ _ _ , ... _ .. __- ;M_w = _--- _ M. _- =11 Type of Visit ® Compliance Inspection O Operation review O Lagoon Evaluation Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Emergency Notification O Other ❑ Denied Access Facilitt- Number Date of Visit: % ! D Time: rO Not O erational Below Threshold ® Permitted ® Certified M Conditionally Certified 0 Registered Date Last Operated or Above Threshold Farm Name: _ 0Z.i Ccl _ Stv.iy' hIW S C-['!. Count: �r1a►� �+ 1 � — Owner Name: rt ,cl" 'a Phone No: of t�I' - tt -3 Mailing Address: _ 3110 �• !1�_G r.1 !�� ci S� 1 „__ 1/LD�e�_��'. G Facility Contact: _r' 1, n ig., S+ni Title: Onsite Representative: e Certified Operator: A� llr_�_ C..�..�- Location of Farm: Phone No: Integrator: Operator Certification Number: ® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' 0 w Longitude ' �• K Design Current Swine rAngrity Pnnnlatinn ® Wean to Feeder n ❑ Feeder to Finish ❑ Farrow to A`ean ❑ Farrow to Feeder ❑ Farrow to Finish ❑ Gilts ❑ Boars Design Current Design Current Poultry Capacity Po Motion Cattle Capacity Population ❑ Laver I I::::� Fo Dairy ❑ Non -Laver ]von-Dair ❑ Other Total Design Capacity Total SSLW Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area Holding Ponds / Solid Traps 10 No Liquid Waste Management System t Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? 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 Water of the State? (If yes, notify- DWQ) c. if discharge is observed. what is the estimated flow in gaUmin? d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) 2. Is there evidence 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? Wa a Collection A - Treatment 4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Structure 1 Structure 2 Structure 3 Structure 4 Structure Identifier: Z Freeboard (ittcbes): 05103101 ❑ Yes 1 1$.No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes [`p No ❑ Yes [ANo ❑ Yes ❑ No Structtre 6 Continued Facility Plumber: 2L — Date of Inspection O 5. Are there any immediate threats to the integrity of any of the structures observed?.(ie/ trees, severe erosion, ❑ Yes 99 No seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or closure plan? El Yes `tom No (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 No 8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No 9. Do any stuctures lack adequate, gauged markers with required maximum and minimum Iiquid level elevation markings? ❑ Yes ® No Waste Application 10. Are there any buffers that need maintenance/improvement? ❑ Yes L,,j No 11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes E� No 12. Crop type Cory.,, lL3 hec�t . Sa ,��c.h r 1Zud I e-SC[,a L�!'i!_t 13. Do the receiving crops differ with those designated intheCertified Animal Waste Management Plan (CAWMP)? I4. a) Does the facility lack adequate acreage for land application? b) Does the facility need a wettable acre determination? c) This facility is pended for a wettable acre determination? 15. Does the receiving crop need improvement? 16. is there a lack of adequate waste application equipment? Required Records & Documents 17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? 18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? (ie/ WUP, checklists, design, maps, etc.) 19- Does record keeping need improvement? (ie/ irrigation. freeboard, waste analysis & soil sample reports) 20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? 21. Did the facility fail to have a actively certified operator in charge? 22. Fail to notify regional DWQ of emergency situations as required by General Permit? 00 discharge, freeboard problems, over application) 23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? 24. Does €acility require a follow-up visit by same agency? 25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [!A No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes 0 No ❑ Yes [p No ❑ Yes No ❑ Yes 11� No ❑ Yes No ❑ Yes No ❑ Yes [ No ❑ Yes Wo ❑ Yes P No ❑ Yes ip No ❑ Yes fjdNo 113 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit. Camentsire#er to question #) 'Ezpiam any YES_aasrrers°and/or-any reeotri�iuns or any.otiterr coomments: UsewadMonalteirtittBs:pages as necessary) Field Cotry Final Note., a SnLt SG. p`a. it e7 p'-Ck'C4 cs 4 .4 � Reviewer/Inspector Name A, Reviewer/Inspector Signature: r Date: I G 05103101 Continued Facility ]umber: 4, - 13 Date of Inspection C O Odor Issues _ 26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor bcio%&- ❑ 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 ® No 28, is there an,,- evidence of A•ind drift during land application? (i.e. residue on neighboring vegetation, asphalt. ❑ Yes ® No roads, building structure. and/or public property) A Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes W No 30. '%ere anv 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 ® No 31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes EZ No 32. Do the flush tanks lack a submerged fill pipe or a permanent+temporary covcr? ❑ Yes ❑ No Additional Comments and/or Drawings: A. 05103101 Site Requires Immediate Attention: NO Facility No. 2& - 13 DIVISION OF ENVIRONMENTAL MANAGEMENT ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD DATE: A%t5us+ z , 1995 Time: / 3 : 10 Farm Name/Owner: _ ja v & Q' S /Ju r s cr _ r3; c ka., S . Mailing Address: R+ 1 &x 3& seboro NC. z s3 u z County: Cum be"".j - - Integrator: Afu�a4 rvM./4 r-1 r-b $6 Phone: On Site Representative: , �5m;Wn Phone: 1910531-5'39 / Physical Address/Location: Type of Operation: Swine ✓ Poultry Cattle Design Capacity: -z (,oa . Number of Animals on Site: - Z !� DD DEM Certification Number: ACE DEM Certification Number: ACNEW Latitude: Longitude: , Circle Yes or No Does the Animal Waste Lagoon ' have sufficient freeboard of 1 Foot + 25 year 24 hour storm event (approximately 1 Foot + 7 inches) t�or No Actual Freeboard: Z Ft. Inches Was any seepage observed from the lagoon(s)? Yes or(IP Was any erosion observed? Yes oiQT9D Is adequate land available for spray? (Vj_s�br No Is the cover crop adequate? �t or No Crop(s) being utilized: Coos Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No 100 Feet from Wells? tTiPor No Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or® Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or ice` Is animal waste discharged into water of the state by man-made ditch, flushing system, or other similar man-made devices? Yes or0 If Yes, Please Explain. Does the facility maintain adequate waste management records (volumes of manure, land applied, spray irrigated on specific acreage with cover crop)? er No Additional Comments: 9, c-k,� RCV � ' Inspector Name Signature cc: Facility Assessment Unit Use Attachments if Needed. Site Requires Immediate Attention: 40 Facility No. z.6- /4 DMSION OF ENVIRONMENTAL MANAGEMENT ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD DATE: IQugusf- z , 1995 Time: 1 z : 59 Farm Name/Owner: �, �, S w• A vs e,-,, / i�, k, Sw+i J Mailing Address: 94 / Sox 3& i2osc �o.o NG County: 5io.*M D sv..i Integrator: Muvp! 6 r-A fir...... _ Phone: On Site Representative. cky 5�u� Ls Phone: (Ved -5-31 - 14.3 / Physical Address/Location:_ TT6!•= _Z/0 .1_ Cr AV6 f:z -Alga 4S- Type of Operation: Swine _Z Poultry Cattle Design Capacity: Z j &0v Nurs< _! Number of Animals on Site: z &Qn DEM Certification Number: ACE DEM Certification Number: ACNEW Latitude: Longitude: Circle Yes or No Does the Animal Waste Lagoon have sufficient freeboard of i Foot + 25 year 24 hour storm event (approximately 1 Foot + 7 inches) Y� or No Actual Freeboard: * Ft. 0 Inches Was any seepage observed from the lagoon(s)? Yes or(S? Was any erosion observed? Yes or I� aIs adequate land available for spray? No Is the cover crop adequate? �or No 'Crop(s) being utilized: Cori Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? dPol 100 Feet from Wells? /jg6r No Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orK0 No Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes oK15D Is animal waste discharged into waset of the state by man-made ditch, flushing system, or other similar man-made devices? Yes o6i� If Yes, Please Explain. Does the facility maintain adequate waste management records (volumes of manure, land applied, spray irrigated on specific acreage with cover crop)? <!FcT,76r No Additional Comments: R". e1s &4"_e Inspector Name Signature cc: Facility Assessment Unit Use Attachments if Needed. ❑ DSWC Animal Feedlot Operation Review > "Mk3 r� V DWQ Animal Feedlot Operation Site Inspection ry . 0 Routine 0 Complaint 0 Follow-up of DIVQ inspection 0 Follow-up of DSWC review 0 Other Date of Inspection Facility Number Time of Inspection �� 24 hr. (hh:mm) 0 Registered [3 Certified [3 Applied for Permit 13 Permitted E3 Not Operational Date Last Operated:..„.....- ` ................ Farm Name .......................... Owner Name:........ ... S�'?r r� Phone No: ���� ^.K7 71............ ........................................................................ ............ J/ Facility Contact: ��-.✓ .4� Phone No: ......................lg................................... Title:.................---...................................................................................... MailingAddress:........��.....�...� ��f�..� ��, �.��- .. �rap� ..J- ,G e...................................................... .......................... Onsite Representative:.....1.R.,....r?✓..-....//,--!r ............................. Integrator: ... %%%r".!�rP............. `4':..y......e,� Certified Operator............. :- � ..... --........................ I........ ------------ Operator Certification Number:...................... ------•----------. Location of Farris: Latitude ' 1 44 Longitude • 6 44 Design _:Current Design Current Design Current Swine Capacity Population "Poultry Capacity Population. Cattle, G` Capactty 3`Populattaa Wean to Feeder �d ❑ Layer ❑ Dairy ❑ Feeder to Finish ILI Non -Layer JE1 Non -Dairy ❑ Farrow to Wean K ❑ Farrow to Feeder JEI Other ❑ Farrow to Finish Total Design Capacity ❑ Gilts ❑ Boars -Total SSLW Number of Lagoons./ Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area ❑ No Liquid Waste Management System { General 1. Are there any buffers that need maintenance/improvement? 2. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other a. if discharge is observed, was [he 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 discharge bypass a lagoon system? (li-yes, 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 ]agoons/holding ponds) require maintenance/improvement`! 6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes j No ❑ Yes No ❑ Yes ® No ❑ Yes JU No ❑ Yes 9No ❑ Yes l5 No ❑ Yes X[ No ❑ Yes 0 No ❑ Yes No ❑ Yes (] No 7. Did the facility fail to have a certified operator in responsible charge? 7/25/97 Continued on back Facility Number: ,21. 8. Are there lagoons or storage ponds on site which need to be properly closed? Structures (Lagoons,Haldine Ponds. Flush Pits, etc.) 9. Is itorage capacity (freeboard plus storm storage) less than adequate? Structure I Structure ? Structure 3 Structure 4 ❑ Yes KNo ❑ Yes �WNo Structure 5 Structure 6 Identifier: Freeboardft ........................................................................................................................................... 10. Is seepage observed from any of the structures? ❑ Yes [KNo ]I. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes J�FNo 12. Do any of the structures need maintenance/improvement! 'P(Yes ❑ No (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? ❑ Yes $I No Waste Application 14. Is there physical evidence of over application? ❑ Yes KNo (If in excess of WNW, or runoff entering waters of the State, notify DWQ) 15. Crop type ...... C. PRY-)................................................................................................................................................................................................................. 16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ❑ NoO 17. Does the facility have a lack of adequate acreage for land application? ❑ Yes JM No 18. Does the receiving crop need improvement? ❑ Yes No 19. Is there a lack of available waste application equipment? ❑ Yes No 20. Does facility require a follow-up visit by same agency? ❑ Yes VNo 21. Did ReviewerAnspector fail to discuss review/inspection with on -site representative? ❑ Yes RNo 22. Does record keeping need improvement? XYes ❑ No For Certified or Permitted Faciliit , Qnly 23. Does the facility fait to have a copy of the Animal Waste Management Plan readily available? ❑ Yes PqNo 24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes N No 25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes J4 No ®- No.vialations'or deftciencies-were•noted-during this:visit.- .Yoit.wi11 receive -no farther. corrt'spondehce about this'.visit: /Z • /%?�. S,.•�,� r' �a e�G�r�Eo-� yea�d /i�a� �.E�,� 01 s, •�a� vJJJ�cU.c. � ,�SGcJG �/�3���f7 Lv� �G.g�a�.!'T�V,G •r fnit �i�. /.� C��/��� /c.c%r/"�/�%�/•-iJ fi�� 7/25/9 Reviewer/Inspector Namei a-h � Reviewer/Inspector Signature: �w�� Date: ;Z7 9