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820226_INSPECTIONS_20171231
NUH I H LAHULINA Department of Environmental Qual C :� �' L +e �� � �'� � �� S 1 t A.nti9 Type of Visit: C) Compliance Inspection O Operation Review Q Structure Evaluation p Technical Assistance Reason for Visit: "outine 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other [ 0 Denied Access Date of Visit: Arrival Time: Departure Time: c U County: 94 � Region:/ Farm Name:2LOwner Email: r Owner Name: i C— 6 Phone: Mailing Address: Physical Address: Facility Contact: Title: Alf Onsite Representative: Certified Operator: Y Back-up Operator: Location of Farm: K Latitude: Integrator: Phone: Fa Certification Number: 7 2S Certification Number: Longitude: Design Current Design Current Design Current Swine __ Capacity Pap. Wet_Poultry Capacity* .Pop. Cattle Capacity Pop. Wean to Finish Layer Dairy Cow Wean to Feeder I INon-Layer I 6 ". Dairy Calf Feeder to Finish Dairy Heifer Farrow to Wean n Current Dry Cow DPoul Ca acit Po P. Farrow to Feeder Non -Dairy Farrow to Finish La ers Beef Stocker Gilts' Non -La ers Beef Feeder Boars Pullets Beef Brood Cow Qther TurkeyPoults Other Other Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (if yes, notify 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 ®'55- [DNA ❑ NE ❑ Yes ❑ No CJAA ❑ NE ❑ Yes ❑ No ❑.3GA ❑ NE []Yes ❑ No ❑ Yes �No [:]Yes E�KNo dNA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE Page I of 3 21412014 Continued Facility Number: jDate of Inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE 25 'ls the facility out of compliance with permit conditions related to sludge? If yes, check es ❑ NA ❑ NE V ropriate boxes) below. re 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 o ❑ 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 and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: []Yes E fNo []Yes dNo ❑ NA ❑ NE ❑NA ❑NE ❑ Yes dNo ❑ NA ❑ NE ❑ Yes [ffNo ❑ NA ❑ NE 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E]fNo ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes []5 No ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? [:]Yes No ❑ NA ❑ NE Comments (refer -to question #) fiExplaut anyl'E�S'answers:andlor;any4 addittonal reeomnendations or anyRoiercortiment E. .. " r7: Use drawings of facility to better,�explam.situations_.(use additional; al es as necessa P rY µ w C14 (to, oati c Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 0 CA $— 6 0 1 Phone:) Date: 'V 2/4/2015 t ype of visit: U compliance inspection U Uperaaon Keview U structure tvatuanon U I ecnnical Assistance Reason for Visit: 0Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: Arrival Time:rik LIL;Lj Departure Time: County Farm Name:Owner Email: Owner Name: 1 l Phone: Mailing Address: Physical Address: Region: ` 9 Facility Contact: Ltle: Phone: Onsite Representative: f S t Integrator-. Certified Operator: Certification Number: fZ271,5 Back-up Operator: Location of Farm: Latitude: Certification Number: Longitude: Design Current .. Swine Capacity P pit' Design Current Wet Poultry @apacity Design Current le Capacity Pap. Wean to Finish La er Dairy Cow Wean to Feeder Feeder to Finish Farrow to Wean Non -La er Design Current Dairy Calf Dairy Heifer Dry Cow Farrow to Feeder Farrow to Finish 1D . P,onit . Ca aci Po . Layers Non -Dairy Beef Stocker Gilts Non -La ers ! Beef Feeder Boars Pullets Beef Brood Cow Other Turkeys Turkey Poults ii I�Jk �lyi91 1 Other 3A�, .ur�o:uare�ri.,.'+r`',C��wa�wiwa��nusmwurr�aeas Other w� Discharyes and Stream Impacts 1. Is any discharge observed from any part of the operation? ❑ Yes -�o ❑ NA ❑ NE Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? ❑ Yes [] No [DNA ❑ NE b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No k '` 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 Q NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �o ❑ NA ❑ NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Ea"No ❑ NA ❑ NE of the State other than from a discharge? 2 ■ W ■ m ■ Page I of 3 21412015 Continued IFacihiy Number: - Date of Inspection: -� Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes []-No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Ej 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 [D' ❑ 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 lL]-<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 f:rNo ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E] 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 EfNo ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No 0 NA ❑ NE maintenance or improvement? l 1. 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 )Wodow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? 15. Does the receiving crop and/or land application site need improvement? 16. Did the facility fail to secure and/or operate per the irrigation design or wettable 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 ["No ❑ NA ❑ NE ❑ Yes CTNo ❑ NA ❑ NE ❑ Yes Q'No ❑ NA ❑ NE ❑ Yes [ No ❑ NA ❑ NE ❑ Yes �'o ❑ NA ❑ NE ❑ Yes E3--No ❑ NA ❑ NE ❑ Yes Q'1�Io ❑ NA ❑ NE ❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes ffNo ❑ 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 [XNo 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes F(No ❑NA ❑NE ❑ Weather Code ❑ Sludge Survey ❑ NA ❑ NE ❑ NA ❑ NE Page 2 of 3 21412015 Continued Fac!k Number: 9,9, Date of Inspection: i ?��Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [9- o❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []jfiTffo ❑ 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 6_150 ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? 34. Does the facility require a follow-up visit by the same agency? []Yes ❑-Ado ❑ NA ❑ NE ❑ Yes rnNa- ❑ NA ❑ NE ❑ Yes [�o' ❑ NA ❑ NE ❑ Yes U 1 o ❑ NA ❑ NE ❑ Yes �10 ❑ Yes []moo ❑ Yes No ❑ NA ❑ NE ❑NA ❑NE ❑ NA ❑ NE Comments {refer o!qu(st,on #) Explain any�YESAanspwers,afidVorianyxad`drtronal ricdfiig mendations r aAy other cl agents. 'F*ir A' - 44 �:a!16mR-' '^° "i+.'i. f� "�k' " '^ - T yk Use awings of faciLtyto better ezplam situations {use additionalipages_as necessary) ,;, C_44 6( Z I V —,' q 4 CCU Reviewer/Inspector Name: Reviewer/Inspector Signatur Page 3 of 3 Phone:T61-� 4 , 3V, Date: / — / p 21412015 krrt3 Type of Visit: eJCompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance Reason for Visit: tine Q Complaint Q Follow-up O Referral O Emergency O Other O Denied Access Date of Visit: Arrival Time: Departure Time: County: Farm Name: &,1106U tLe ' r1�,� Owner Email: Owner Name: 4c5tca I C ✓� it6C* rk- Phone: Mailing Address: Physical Address: 6A—P11 Regiont7 � Facility Contact: t'{. ����` 1✓`'`1 Title: Phone: Onsite Representative: i Integrator: Certified Operator: Y Certilcation Number:` L S Back-up Operator: Certification Number: Location of Farm: Latitude: Longitude: Design Current Design Current = Design Current Swine Capacity Pop Vet Poultry Capacftty�Pop Cattle Capacity Pap. Wean to Finish Layer Dai Cow Wean to Feeder Non -La er Dai Calf Feeder to Finish Dai Heifer Farrow to Wean rDesign Current D Cow Farrow to Feeder D . P,outt . t Pn '., -Dairy Farrow to Finish Layers Beef Stocker Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow Turkeys *�* �Ih Other Turkey Pouets } 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 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 Lam o ❑ NA ❑ NE ❑ Yes ❑ No Zj_�LA ❑ NE ❑ Yes ❑ No [ ❑ NE ❑ Yes ❑ No ❑ Yes Ea -No ❑ Yes [!T No [2t<A ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE Page I of 3 21412015 Continued iFacili Number: Date of Ins ection: Waste Collection & Treatment 4. )s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ej� ❑ NA ❑ NE a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No � ❑ NE Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spi I lway9: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [(]-IQo ❑ 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 El"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 If threat, notify DWR [ 7.�o any of the structures need maintenance or improvement? es ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EffNo ❑ 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 [201; o ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE maintenance or improvement? 1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 13< ❑ 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 ft ❑Application Outside of Approved Area 12. Crop Type(s): SGv ij�L 13. Soil Type(s): AN Q` 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ENo ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes [!f No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑/ NNo ❑ 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 [ to ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [6No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Fj"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 Z"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 ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LJ 1 o ❑ NA ❑ NE Page 2 of 3 21412015 Continued Aj FaciliNumber: - Date of Ins ection: Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ ❑ 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 � ❑ 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 F71Tdo 0 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 21To 0 NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [no ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require [:]Yes [ o ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes [ o ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes QJ'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 0 Application Outside of Approved Area 12. Crop Type(s): CAcn, 13. Soil Type(s): �^-�4-- / b 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L2rfNo ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes O No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [f No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? 18. Is there a lack of properly operating waste application equipment? Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check the appropriate box. ❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Yes [3'Ro ❑ NA ❑ NE ❑ Yes [?"No ❑ NA ❑ NE ❑ Yes EfNo ❑ NA ❑ NE [:]Yes ][fNo ❑ NA- ❑ NE ❑ Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�No ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections [—]Yes [](No ❑ Yes []'No 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? ❑ NA ❑ NE ❑ Weather Code ❑ Sludge Survey ❑ NA ❑ NE ❑NA ❑NE Page 2 of 3 21412014 Continued )F'icili Number: - �.� Date of inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes fo ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [f*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 EfNo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [;1Qo 0 NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? 34. Does the facility require a follow-up visit by the same agency? ❑ Yes [ZO'No ❑ NA ❑ NE ❑ Yes 13fNo ❑ NA ❑ NE ❑ Yes ['] No ❑ NA ❑ NE ❑ Yes !�No ❑ NA ❑ NE ❑ Yes [2fNo ❑ NA ❑ NE ❑ Yes E06 ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE Comments (refer,to,questioa ft Explain any YES answers and/or any additional. recommendati n or any other comments: Use drawings of facility to better explainsituations (use additional pages�as necessary). 4. e �. 0 1-9 'j,6 "(' " - G(. - 61'�t Reviewer/Inspector Name: 3 V 1-01 Reviewer/Inspector Signature: Page 3 of 3 Phone: _j �3 Date: irl 21412014 type or visit: (.7 c:ompuance inspection v uperation meview V asruccure r valuation V l ecnnicat Assistance Reason for Visit: (20koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: Arrival Time: Departure Time: County: S `14 Farm Name: Qe Owner Email: Owner Name: Phone: Mailing Address: Physical Address: Facility Contact:e Title: Onsite Representative: t { Certified Operator: t{ Back-up Operator: � � '� T 4- 'A", Location of Farm: Region: l Phone: Integrator:Py� k :4 Certification Number: -7 �S Certification Number: 3 Latitude: Longitude: Swine Wean to Finish Design Current Capacity Pop. Wet Poultry Layer Design Current Capacity Pop. Design Current Cattle Capacity Pop. DairyCow Wean to Feeder Non -La er DairyCalf Feeder to Finish -]l (� D . P,oul Layers Design Current Ca aci P,o Da' Heifer Farrow to Wean Farrow to Feeder row to Finish D Cow Non -Dairy Beef Stocker ts P Non -La ers Beef Feeder Beef Brood Cow ars Pullets Turkeys Turke Poults Other 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 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 2 ❑ NA ❑ NE ❑ Yes [:]No ❑'NA ❑ NE ❑ Yes [:]No �A ❑ NE [:]Yes [:]No ❑ Yes lawo [:]Yes QrNo [IGA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE Page I of 3 21412014 Continued Facili ~Number: jDate of inspection: Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q-Al.--Q NE Structure 1 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): - Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ 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 ❑ 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 1- 1`5 ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? (not applicable to roofed pits, dry stacks, and/or wet stacks) ❑ Yes [3-bla' ❑ NA ❑ NE 9. Does any part of the waste management system other than the waste structures require ❑ Yes []-W ❑ NA ❑ NE maintenance or improvement? Waste Anolication 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE maintenance or improvement? I I.1s there evidence of incorrect land application? If yes, check the appropriate box below. - [:]Yes No ❑ NA ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑/-Evidence of WinVID 'R ❑ Application Outside of Approved Area 12. Crop Type(s): oftyg, L -& 0 �� � s* 6et-L-c ❑ NE 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 No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes Io ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes No NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check the appropriate box. ❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Yes ❑ Yes ❑ Other:_ tT Vo- ❑ NA ❑ NE ❑ No ❑ NA ❑ NE 21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes_L],No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q-No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE Page 2 of 3 21412014 Continued Facili Number: ALI Date of Ins ection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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: "No ❑ NA ❑ NE 0416--❑ NA ❑ NE 26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes LTN5 ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o ❑ NA ❑ NE Otherlssues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 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? 0 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 E'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 �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 Ea'lgo ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes -No ❑ NA ❑ NE Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 Date: 2a2i.�( C 21412014 t ype of visit: &.Corn ance inspecnon U Uperanon Keview U Structure rlvaivatton U technical Assistance Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access Date of Visit: Arrival Time: Departure Time: /, County: Regiony Farm Name: s ✓' �' Owner Email: T^ Owner Name: Phone: Mailing Address: Physical Address: Facility Contact: k '1/ej t le: Phone: Onsite Representative: It Integrator: Certified Operator: b Certification Number: ` `J Back-up Operator: Certification Number: Location of Farm: Latitude: Longitude: Design, Current DestgnCnrrent Swine Capacity Pop _ Wet Poultry °:: Cap city+ Pop. Design Current Cattle Capacity Pap. Wean to Finish Layer Dai Cow Wean to Feeder = Nan -La er Dai Calf Feeder to FinishRUE; `, Da Heifer Farrow to Wean Farrow to Feeder Farrow to Finish Vesig "MCnrrent +D . Pout Cam ci Po , Layers Non -Layers Cow Non-Dai Beef Stocker Gilts Beef Feeder Boars Pullets jBeef Brood Co — Turkeys Outer 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 DWQ) c. What is the estimated volume that reached waters of the State (gallons)? ❑ Yes [ZL>1u--n NA ❑ NE ❑ Yes ❑ No [] Yes [:]No le _ A ❑ NE E]NA ❑ NE d. Does the discharge bypass the waste management system? (if yes, notify DWQ) L] Yes U No LffNA LJ NE 2- Is there evidence of a past discharge from any part of the operation? [:]Yes L7'"" ❑ NA ❑ NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes [INo ❑ NA ❑ NE of the State other than from a discharge? Page I of 3 2/4/20II Continued Faci i Number: - Date of Inspection: be .Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No 1=l i A ❑ 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? (i.e., large trees, severe erosion, seepage, etc.) ❑ Yes �� ❑ NA ❑ NE 6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ NDI ❑ 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 E l4o ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [3-1166 ❑ 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 []FKo ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ 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 Accepta&crok"A^ p Window ❑ Evidence of Wind Drift ❑cApplication Outside of Approved Area 12.Cro T e s : V^ f J IA) P Yr () C. �t 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? 15. Does the receiving crop and/or land application site need improvement? 16. Did the facility fail to secure and/or operate per the irrigation design or wettable 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 ❑ Yes ElrNo ❑ NA ❑ NE ❑ Yes [:g o ❑ NA ❑ NE ❑ Yes [3t< ❑ NA ❑ NE ❑ Yes g/No' �❑ NA ❑ NE ❑ Yes ❑ NA ❑ NE 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [—]Yes [j-% ❑ 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 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 No ❑ NA ❑ NE Page 2 of 3 21412011 Continued Facf i Number: jDate of Inspection: b ss, - ,24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [e No ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2<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 0 To ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 10 ❑ NA ❑ NE and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface file drains exist at the facility? if yes, check the appropriate box below ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: ❑ Yes [3No ❑ Yes ] No ❑ Yes [lf"No ❑ NA ❑ NE ❑ NA ❑ NE ❑.NA ❑ NE 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ffoNo ❑ NA ❑ NE 33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ga No ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes E<o ❑ NA ❑ NE ` - Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other`commentsr Use drawings of facility to better explain situations (use additional pages as necessary). 7bV"' — tk_(,0 --D 0100A� 0.4 Reviewer/inspector Name: Reviewer/inspector Signature: Page 3 of 3 Phone: T b -L W3 3 �q Date: b� 21412011 e ( M's q_ '�_z --13 Type of Visit: of Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance Reason for Visit: routine Q Complaint O Follow-up 0 Referral Q Emergency O Other O Denied Access Date of Visit: Arrival Time: Departure Time: County Regionl Farm Name: �e x_S r/ Owner Email: Owner Name: ��.o'l��.. Phone: Mailing Address: Physical Address: FacilityContact: tie: Onsite Representative: < < Certified Operator - Back -up Operator: Location of Farm: Latitude: Phone: Integrator: Certification Number: 177 1 Certification Number: Longitude: Design Current Deaign!�Mrrent Design Current Swine Capac ty' Pop. Wet Poultry CapPop. Cattle Capacity Pop. Finish IEWtean La er Non -La er Da' Cow D Calf Feeder o Finish Dairy Heifer o Wean Design . Current Cow to Feeder 1) , P,oul . La ers Ca aci 'Po . Non -Dairy Beef Stocker to Finish Non -La ers Beef Feeder Pullets Beef Brood Cow Turke s 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 [f"ITo— ❑ NA ❑ NE [:]Yes [::]No [:]Yes []No ❑'�iA ❑ NE L^I 1"" ❑ NE ❑ Yes [:)No [`3�A ❑ NE ❑ Yes [�o' ❑ NA ❑ NE ❑ Yes �No ❑ NA ❑ NE Page I of 3 21412011 Continued Facili umber: - Date of Ins ection: 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 Identifier: ETI o ❑ NA ❑ NE ONo ❑NA ❑NE Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Spillway?: Designed Freeboard (in): 9 Observed Freeboard (in):- 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 29'Ro ❑ 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 []moo ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 65.315— ❑ 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 [�'1 0 ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I4-K" ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes []5,N5"�❑ 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 Drift ❑ Ap lication Outside of Approved Area rWiind 12. Crop Type(s): (� V e� 13. Soil Type(s): 14. Do the receiving crops differ lorn those designated in the CAWMP? ❑ Yes 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 ❑ Yes a" "' ❑ 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 M-10 ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ER_1/❑ 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 [ rf o ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code ❑ Rainfall ❑Stocking [:]Crop Yield [D120 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 `Co ❑ NA [:] NE Page 2 of 3 21412011 Continued acili Number: Date of Ins ection 24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes � ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes Q,N� ❑ 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 [!fRo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3-?46 ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Q'loo ❑ 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 ETNo ❑ 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 [3-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 [R11go ❑ NA ❑ NE ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [&Ko ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [R-No ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes 0 No ❑ NA ❑ NE Comments (refer to question;#):::Explain. any YES answers and/or,any.additional recommendations or anyi.otherxofiiments .g^ Use drawings of facility to better explain situations (use additional pages as necessary). -. C7- (o_l-� Z0_*A 0 � ?, �_ P 3C Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 Phoni w Date S d > 21412011 a/aI )tom (Type of Visit: aCompliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance I Reason for Visit: outine 0 Complaint Q Follow-up 0 Referral O Emergencv O Other O Denied Access Date of Visit: ya Arrival Time: Departure Time: County: County: �'gr+n on Region: rRh Farm Name: � p rPAM Owner Email: Owner Name: p2A 4ka, k Ar„ [, Phone: Mailing Address: Physical Address: Facility Contact: Title: Onsite Representative: c IA(h Z. - Certified Operator: IRgQSn fa"O 4A (�3 CV I'An to Sack -up Operator: Location of Farm: Phone: Integrator: _ P(� P_ s E Certification Number: "1 Q .� Certification Number: Latitude: Longitude: `- DesignCurrent Design Current Design C►►urrent Swine Capacity.. Pop. Wet..Poultry Capactty Pap. Cattle Capacity Pap. La er Dairy Cow Wean to Finish Wean to Feeder Non -La er aia Calf Feeder to Finish l 0ja600Daia Heifer Farrow to Wean Design Current Ra Cow Farrow to Feeder D . foul ILayers Ca aci P.o . I Non-D m Beef Stocker Farrow to Finish Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow Turkeys - Uther Turkey Poults Other L.Other Discharges and Stream Impacts 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 [20Ho ❑ NA ❑ NE ❑ Yes [:]No [—]Yes ❑ No ❑ NA [] NE [] NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes E�No ❑ NA ❑ NE ❑ Yes [�No [DNA ❑ NE Page I of 3 21412011 Continued Facility Number: $ a - a Date of Inspection: Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ODI�o ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: -1�2 Spillway?: Designed Freeboard (in): 10A Observed Freeboard (in): 4 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [11**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 024o ❑ 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 MNo ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [g'-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 [/7No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes t[ rNo [DNA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [TNo ❑ 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 Approved Area 12. Crop Type(s): E iZ MW100 AEI "saz a f% 1J A 13. Soil Type(s): OR NOW4 J 14. Do the receiving crops differ from those designated in the CAWMP? [—]Yes ff No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q`No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [TNo ❑ 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 �o ❑ NA ❑ NE ❑ Yes [DoINo ❑ NA ❑ NE Re uired Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ✓[ o ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [DNo ❑ NA ❑ NE the appropriate box. ❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes [;'No ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Rainfall [] Stocking[] Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections 22. Did the facility fail to install and maintain a rain gauge? [:]Yes [vrNo 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ErNo ❑NA ❑NE [] Weather Code ❑ Sludge Survey ❑ NA ❑ NE ❑ NA ❑ NE Page 2 of 3 21412011 Continued Facifi n Number: So - t. Date of Inspection: 9 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 5/"No ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes E 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 Q o ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes &Wo ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes [2'No ❑ NA ❑ NE and report mortality rates that were higher than normal? 24. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes []g o [] 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 BNo ❑ 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 Gallo ❑ NA ❑ NE ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E2'No ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [allo ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes [g No ❑ NA 0 NE Reviewer/Inspector Signature: Date: a lei ti rd Page 3 of 3 21412011 Rl'eason ype of Visit: W Compliance Inspection U Operation Review U structure Evaluation U1'ectinical Assistance for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: ('111121 � u--' Arrival Time: Departure Time: ounty n Region: E LfZQ Farm Name: 'VA 9_tn Owner Email: Owner Name: Phone: Mailing Address: 3 Cj Physical Address: Facility Contact: Onsite Representative: Title: Phone: Integrator: PRos �w Certified Operator: (� gR4t �� R,Ic 1L 1An O Back-up Operator: t"1 LoL Location of Farm: Latitude: Certification Number: 7 %'J Certification Number: Longitude: M1 s- - - Design Current <, Design Current InDesign Current Swine Capacity Pop. - +Wet Poultry' C�apty . Pop. Cattle Capacity Pop. Wean to Finish ILayer Dairy Cow ai Calf Wean to Feeder Non -La er I Feeder to Finish N p Dairy Heifer Farrow to Wean Design. Current Dry Cow Farrow to Feeder „D . P,oulC ci P,o Non -Da Farrow to Finish Layers Beef Stocker Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow Turkeys Turkey Poults Other Other Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? [:]Yes [)o No ❑ NA ❑ NE Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? ❑ Yes ❑ No gj NA ❑ NE b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No G&NA ❑ NE c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [] No �h 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 9 No ❑ NA ❑ NE of the State other than from a discharge? Page 1 of 3 21412011 Continued Facility Number: - Date of Inspection: j Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No a. If yes, is waste level into the structural freeboard? ❑ Yes (2 No Structure 1 Structure 2 Structure 3 Identifier: Ak 1_ Spillway?: Designed Freeboard (in): 1 �_ Observed Freeboard (in): ❑ NA ONE ❑NA ❑NE Structure 4 Structure 5 Structure 6 5. Are there any immediate threats to the integrity of any of the structures observed? (i.e., large trees, severe erosion, seepage, etc.) ❑ Yes (D No ❑ NA ❑ NE 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 0 NE 8. Do any of the structures lack adequate markers as required by the permit? [:)Yes ® No ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require [:]Yes No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C� No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN 7 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): Q�4_0. r.\ t) K3 P., C=' RAZZ_� �g1 t C5 , G , (1�i-�[, n I �7 13. Soil Type(s): p,lp iyG 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes] No [DNA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? 18. Is there a lack of properly operating waste application equipment? Retluired Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check the appropriate box. ❑ WUP ❑Cheeklists [:]Design ❑ Maps ❑ Lease Agreements ❑ Yes [4 No ❑ Yes g] No ❑ Yes No [a Yes No ❑ Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes tA No ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections 22. Did the facility fail to install and maintain a rain gauge? 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E4 No ❑ Yes [A No ❑ NA ❑ NE ❑ NA ❑ NE ❑NA ❑NE ❑ NA ❑ NE ❑NA ❑NE ❑ Weather Code ❑ Sludge Survey ❑ NA ❑ NE ❑ NA ❑ NE Page 2 of 3 21412011 Continued Facili Number: Date of Inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No 25. Is the facility out of compliance with permit conditions related to sludge? if yes, check [] Yes [A 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 provide documentation of an actively certified operator in charge? ❑ Yes 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 file 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 q No ❑ NA ❑ NE ❑ Yes � No ❑ NA ❑ NE ❑ Yes [4 No ❑ NA ❑ NE ❑ Yes M No ❑ NA ❑ NE ❑ Yes [ No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments. Use drawings of facility to better explain situations (use additional pages as necessary). f ������� e�►��.�i���so� w�� b� c�a,lr qy la � 3���1 �P�dcaR W +iS �n EX CEt llyn`[ +� P �CjE CRop PT Reviewer/inspector Name: aZ S Reviewer/Inspector Signature: Page 3 of 3 Leq_-l54 Phone: ' lI D -'(3 3 -33 Date: It h 6 a d I! 2/4a0l ] k d i Type of Visit G-.lCbm�pliance Inspection U Operation Review () Structure Evaluation U Technical Assistance Reason for Visit 0- outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: Arrival Time: ,f �} Departure Time: it7 f9 County: r~' Region: Farm Name: ,—s;r;a)d 57z-,'G%C/aud j!5 __ __ Owner Email: Owner Name: R �o sT/;�k LG-12� - - -- Phone: Mailing Address: Physical Address: Facility Contact: X,4—14-0 r`CA Title: Phone No: Onsite Representative: u/r�r1>� Integrator: Certified Operator: �► ST�� G� r""�"' Operator Certification Number: �,Zf Back-up Operator: Back-up Certification Number: Location of Farm: Latitude: = o = i = Longitude: = o = I = u Design Current Design Swine Capacity Population Wet PouW,;,c.apacity ❑ Wean to Finish ❑ Layer C►urrent Design Current Population Cattle Capacity Population EE] ❑Dai Cow ❑ Wean to Feeder ❑Non -Layer ❑ Dai Calf Feeder to Finish / D ] 7 ❑ Farrow to Wean Dry Poultry ❑ Farrow to Feeder ❑ to Finish ❑ Layers ❑ Gilts ❑Non -Layers ❑ Boars ❑Pullets ❑ Turkeys Other ❑ Turkey Poults ❑ Dairy Heifer ❑ Dry Cow ❑ Non -Dairy ElFarrow Beef Stocker ❑ Beef Feeder ❑ Beef Brood Co Number of Structures: ❑ Other ❑ 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) 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 �&No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes RNo ❑ NA ❑ NE ❑ Yes [�No ❑ NA ❑ NE Page I of 3 12128104 Continued i Facility Number: Date of Inspection /— Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE Structure l 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 [jle- ❑ NA ❑ NE (ie/ 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 ®No ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ®-No [DNA ❑ 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 5kNo ❑ NA ❑ NE maintenance/improvement? I I . 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 l0 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. Croptype(s) 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [X:No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes CgNo ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes C. No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes 19 No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes O-No ❑ NA ❑ NE Comments refer to ` uestiori# . Explain any YES 'atiswe's and/or as recommendations ar an other camme�; "* ;Use drawings of facility to better explain situations. (use'addit,onal pages a`s necessary), Reviewer/Inspector Name 41;-' Phone:0„ Reviewer/inspector Signature: Date: Page 2 of 3 12/28/04 Continued Facility Number: Date of Inspection Required Records & Documents 19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 12�No ❑ NA ❑ NE the appropriate box. ❑ W-UP ❑ Checklists ❑ Design ❑ Maps ❑ Other 21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes MkNo ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes allo ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M No ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [4 No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes L9No ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ,Q No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes CffNo ❑ 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 [ 1 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 E.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 FjNo ❑ 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 C&No ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes Wo ❑ NA ❑ NE Addittonai Comments and/or Drawings Page 3 of 3 12128104 Type of Visit (,.Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit (,.Compliance 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: %%D% Arrival Time: Departure Time: County: Z " Region: P. Farm Name: �77 ���(+- % L iG k I ea .1 .� Fcc�w OIwner Email: Owner Name: rt R iat r% isn_r__r— Phone: Mailing Address: Physical Address: Facility Contact: !� r `r ncL 0 Ste; G Title: Onsite Representative: Certified Operator: Back-up Operator: Phone No: Integrator: Operator Certification Number: Back-up Certification Number: Location of Farm: Latitude: ❑ e ❑ . ❑ 6r Longitude: ❑ ° ❑ i 0 Design Current Design Current Design Current Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population ❑ Dairy Cow ❑ Dairy Calf ❑ Dairy Heifer ❑ Wean to Finish 10 Layer ❑ Wean to Feeder 10 Non -Layer 1 Feeder to Finish / 0 /7 ❑ Farrow to Wean Dry Poultry El Layers ❑ Dry Cow DNon-Dairy ❑ Farrow to Feeder El Farrow to Finish El Beef Stocker ❑ Gilts ❑Nan -La Non -Layers ❑ Beef Feeder ❑ Boars ❑ Pullets ❑ Beef Brood Cold El Turke s Other ❑ Other ❑ Turkey Poults 10 Other Number of Structures: Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? ❑ Yes EUNo ❑ NA ❑ NL Discharge originated at_ ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system'? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes gNo ❑NA ❑ NE other than from a discharge? 12128104 Continued Facility; Number: — Date of Inspection / 7— 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? Stnrcture I Structure 2 Structure 3 Structure 4 Identifier: 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 RNo ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE Structure 5 Structure 6 ❑ Yes 9 No ❑ NA ❑ NE ❑ Yes (9No ❑ 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 [K o ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? El 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 KNo ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U�No ❑ NA ❑ NE maintenance/imp'rovement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L&No ❑ 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) Bvrr r r 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RNo ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes RNo ❑ 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 [4 No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes E�a No ❑ NA ❑ NE Comments (refer to question ell): 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): w Reviewer/Inspector Name p,v Phone: 9/0— L433� 33 r7 o Reviewer/Inspector Signature: Date: -- t 7 r o / 12128104 Continued i ' Facility Number: — Date of Inspection Required Records &Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [KNo ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [4 No ❑ NA ❑ NE the appropirate box. ❑ WUP ❑ Checklists ❑ Desig n ❑Maps ❑Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 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 ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JKNo ❑ NA, ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes & No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes S& No ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 9No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ®.No ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes (9 No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes [9No ❑ NA ❑ NE and report the mortality rates that were higher than normal? 30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ® No ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately 31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes [,No ❑ NA ❑ NE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ® No ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes P No ❑ NA ❑ NE Comments and/or Drawings: l2l18104 Type of Visit C) Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance Reason for Visit Q-1toutine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access Date of Visit: Arrival Time: / Departure Time: County: Region: Farm Name: w �alA - < 7_1 C-k 1,t.J ra 0_K'L— Owner Email: Owner Name: ie_ fC' A-n Phone: Mailing Address: Physical Address: Facility Contact: R�f� I ha I c�7i i�la�dTitle: Onsite Representative: �``--�— Certified Operator: ✓��� Back-up Operator: Phone No: Integrator: Operator Certification Number: Back-up Certification Number: Location of Farm: Latitude: = o = 1 = " Longitude: = ° = 1 = u ign Current Destg'n Current .:lil Design Current e ..MrDes� apacity Population Wet Poultry Capyacity Popetl> won Cattle Capacity Population ean to Finish ❑ La er ❑ DairyCow ean to Feeder ❑Non -La er ❑ Dai Calf eder to Finish [E] Dry Poultry ==r *�" ❑Dai Heifer ❑ D Cow rrow to Wean rrow to Feeder ❑ Layers ❑ Non -Dairy ❑ Beef Stocker rrow to Finish lts Non -La ersPulletsBeef ❑ Turkeys Feeder Beef rood Co _. m; oars ❑ Turke Pouets, Number:of Structures: ❑ Other ❑ Other Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? ❑ Yes J.No ❑ NA ❑ NE Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE b. Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE 2. is there evidence of a past discharge from any part of the operation? ❑ Yes CS No ❑ NA ❑ NE 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes &I No ❑ NA ❑ NE other than from a discharge? Page I of 3 12128104 Continued Facility Number: —A* Date of Inspectiond� Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes MNo ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): / 9' Observed Freeboard (in): 30 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes RNo ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 9No ❑ 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? 59Yes o ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E4No ❑ NA ❑ NE (Not applicable to roofed pits, dry statics and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes 2-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? U. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:1 Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 12. Crop type(s) �x'i v�cJ'�r�el 1k e r d—r/~ ru.4sQ �I �+- 13. Soil type(s) u%a� ' ND 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes C&Vo ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ 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 IT 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 jj No ❑ NA ❑ NE CornmF1(r r to gnestlon #) EaplainanyYES answeis;aridlorany� recommendations or any otleer comments. 'y It re ro sit k Use drawurgss�,o_f factltty to better exptatn�stt-'nateons (use addtttonaltpages as necessary,): ALI Reviewer/inspector Name �— �� :i'z; Phone: a 3300 Reviewer/Inspector Signature: Date:J� rage t of 3 fwaoivv %_ununuea Facility Number: Date of Inspection • Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes SNo ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M 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 ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [54 No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes BNo ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Z No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 54No ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 2[No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes BNo ❑ NA Cl NE Outer issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ER No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes J9 No ❑ NA ❑ NE and report the mortality rates that were higher than normal? 30. Al the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 54 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 jKNo ❑ 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 [K No ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? 0 Yes �R No ❑ NA ❑ NE Page 3 of 3 12128104 IF c sion of Water Quality Facility Number 2DQ Division of Soil and Water Conservation �_C"::] —7--c� Q Other Agency Type of Visit Compliance 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 [I Denied Access Date of Visit: 1 2�3:T:oj Arrival Time: 109 1Departure Time: 01 00 County) Region: Farm Name: e_9-i n �.�i�C�ia4LFQ a of Owner Email: roe Owner Name: _ t.,i4,& Phone: OF Mailing Address: Physical Address: n Facility Contact: „r`e1-► /LcrLJ !!�TZ;C- 1'( itle: Phone No: Onsite Representative: Integrator: Certified Operator: Ste— Operator Certification Number: Back-up Operator: Back-up Certification Number: Location of Farm: Latitude: E] 0 01 El « Longitude: E--] ° El , 0 " Design Current Design Current Swine Capacity Population Wet Poultry Capacity Population Cattle ❑ Laver ❑ Non -Layer ❑ Wean to Finish ❑ Wean to Feeder Reeder to Finish Id710 ❑ Farrow to Wean ❑ Farrow to Feeder ❑ Farrow to Finish ❑ Gilts ❑ Boars Other ❑ Other Dry Poultry ❑ Lavers ❑ Non -Layers ❑ Pullets ❑ Turkeys ❑ Turkey Poults ❑ Other Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made'? Design Current Capacity Population ❑ Dairy Cow ❑ Dairy Calf ❑ Daia Heifer ❑ Dry Cow ❑ Non-Dai ❑ Beef Stocker ❑ Beef Feeder ❑ Beef Brood Co Number of Structures:j3 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 99 No ❑ NA ❑ NE El Yes El No ❑NA [I NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes 5a No ❑ NA ❑ NE ❑ Yes MNo ❑ NA ❑ NE 12128104 Continued Facility Number: — LvDate of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [XNo ❑ 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): / Q Observed Freeboard (in): 3V 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CS 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 [XNo ❑ 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? `(AYes ❑ No ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes JRNo ❑ 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 �-1'es ❑ NA El NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EZ No ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [WNo ❑ 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) / /-yhUL Zat4d,f�� K/;: J—►.+Gina !( " 13. Soil type(s) W A Z U 42 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ❑ No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA ❑ NE 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 % � B^�- j Phone: aO Reviewer/inspector Signature: Date: �% ;2c>d� `12128104 Continued Facility Number: — Date of Inspection rV Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �4 No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [8 No ❑ NA ❑ NE the appropriate box. ❑ WUP ❑ Checklists ❑Design ❑Maps ❑Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 19 No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes r 91 No ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes No ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes KNo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes I&No ❑ 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 Eff 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 R[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 [ANo ❑ NA ❑ NE General Permit? (ic/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [KNo ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes E&NO ❑ NA ❑ NE Comments and/or Drawings: 12128104 Type of Visit D-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit &1outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: ! Arrival Time: ; 1, !Departure Time: County: Region: .100 Farm Name: ;?& T i n,2LJ Pei -Y+-- Owner Email: Owner Name: `rr �l'1` C-;P-a ,.r/re- �'1 /+' G K L o.24 Phone: Mailing Address: A, SLR . �'�4 u.. r .. lid, _ G j v� 2J� _ '3 Physical Address: Facility Contact: ' "eJ'Title: Onsite Representative: s-•-�� Certified Operator: Phone No: Integrator: ��Y r T s— Operator Certification Number: Back-up Operator: Back-up Certification Number: Location of Farm: Latitude: E=1 o=' El u Longitude: 0 0 I =" Design C►urrent Design Current Design Current Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population ❑ Wean to Finish ❑ La er ❑ DairyCow ❑ Wean to Feeder ❑Non -La er ❑ DairyCalf Feeder to Finish ❑ DairyHeifer ❑ Farrow to Wean Dry Poultry ❑ D Cow ❑ Farrow to Feeder ❑ Non -Dairy ❑ Farrow to Finish ❑ Layers ❑ Beef Stocker Gilts ❑Non -La ers ❑ Beef Feeder LBoars ❑ Pullets ❑ Beef Brood Cowl ❑ Turkeys Other ❑ Turkey Poults Number of Structures: ❑ Other ❑Other Discharges & Stream Impacts i _ Is any discharge observed from any part of the operation? ❑ Yes 4 No ❑ NA ❑ NE Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? ❑ Yes 2.No ❑ NA ❑ NE b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes gNo ❑ NA ❑ NE c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes UR No ❑ NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation`? ❑ Yes ANo ❑ NA ❑ NE 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes [&No ❑ NA ❑ NE other than from a discharge? Page I of 3 12128.104 Continued Facility Number: Date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JZNo ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes Wo ❑ NA ❑ NE 4Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: O Designed Freeboard (in): Observed Freeboard (in): _ 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [9 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 9jNo ❑ 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 S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes EffNo ❑ 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 0No ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes R No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > l0% 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 A 12. Crop type(s) a ✓ 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [4 No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? rV Yes 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 17. Does the facility lack adequate acreage for land application? ❑ Yes 18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA ❑ NE [R No ❑ NA ❑ NE KNo ❑ NA ❑ NE [&No ❑ NA ❑ NE Comments (refer to question #): Explain any YES answers andlar any recommendations or any other comments. Use drawings of facility to better explain situations. (use additional pages as necessary}: I �J "e5� Y" ba� Q IA" -7 -5 webk Boa erri oil ` T Reviewer/inspector Name 1''iYv G - Phone: Reviewer/Inspector Signature: Date: 411 ::�o Page 2 of 3 12128104 Continued Facility Number: — Date of Inspection Reuuired Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE the appropriate box. ❑ WUP El Checklists El Design [I Maps El Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 50 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 ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EgNo ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [RNo ❑ 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 SNo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes UNo ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EgNo ❑ NA ❑ NE 29. Did the facility fail to property dispose of dead animals within 24 hours and/or document ❑ Yes M No ❑ NA ❑ NE and report the mortality rates that were higher than normal? 30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ® No ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately 31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes 21 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 0No ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes §qNo ❑ NA ❑ NE Additional Comrnerits:and/or Drawings:: .1 Page 3 of 3 12128104 ra IType of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation I Reason for Visit O Routine Q Complaint 0 Follow up O Emergency Notification O Other ❑ Denied Access Facility Number G Date of Visit: EYTL E Tune: � : Y �Ien Not Operational O Below Threshold permitted C Certified 13 Conditionally /Certified [3 Registered Date Last Operated or Above Threshold: ......_. ...._.. Farm Name. �e°�.���9��! �t� '�.�{L�. F tea..... _...------- County: Owner Name: ........ ...lf. .�.:.7u[. c� gl .14Phone No: `%/O- _`r�1.:.`�.y............................ viailing Address:.._ .LLS{'_-_-_-• {_� �s7tc.. ��.�. _________-�..... Facility Contact: ........... .. _..._ ...._ .._._.. Title. Phone No: Onsite Representative:.. Certified Operator: ................... .. __..W..._ _ ..... W ....._ Operator Certification Number: Location of Farm: wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' 46 Longitude �• �4 g< Discharees & Stream Impacts 1. Is y distil b, erved �raa}r part of�tion? ❑Yes [ I�Io ischarge on inated at: ❑ Lagoon y)~ield Other a ge is observed, was the do ri ce man-made'? [I Yes [ o b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes G-go c. If discharge is observed, what is the estimated flow in gal/min? -- d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 314o 2. Is there evidence of past discharge from any part of the operation? ❑ Yes B190 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes B No Waste Collection & Treatment 4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier= — _.. _ . _....... _.............. ..... --.._..... _._. . Freeboard (inches): 12112103 Continued s Facility Number: g —, _� [s Date of Inspection v y 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or closure plan? (If any of questions 4-6 was answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ) 7. Do any of the structures need maintenancelimprovement? 8. Does any part of the waste management system other than waste structures require maintenance/improvement? 9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level elevation markings? Waste Application 10. Are there any buffers that need maintenance/improvement? I 1. Is there evidence of over application? If yes, check the appropriate box below. ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc 12" Crop type ❑ Yes [Q-Ko- ❑ Yes U-No ❑ Yes [3-No ❑ Yes [,-3AIo ❑ Yes 13-M ❑ Yes ❑ No ❑ Yes ❑ No 13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No 14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No b) Does the facility need a wettable acre determination? ❑ Yes ❑ No c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No 15. Does the receiving crop need improvement? ❑ Yes ❑ No I6. is there a lack of adequate waste application equipment? ❑ Yes ❑ No Odor Issues 17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No liquid level of lagoon or storage pond with no agitation? 18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No 19_ Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [:]No roads, building structure, and/or public property) 20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No Air Quality representative immediately. - :_ -max - Camnients (refer to ijn ani #} Explaut any YFS amwers and/or any= recamaacnda ous or any<other oommeuts. - Use drawmgsof far�sty to better rxpta�n sEtuaizons. (aseaddittoaal pages as`nesary) ❑Field Copy ❑Final Notes - �'`' ,_�._ :tea . � —,- ..._': ��a�..�T.`�_r_.."�. ».: c�s.„�-.:.-'=-..c,.-.._ut..x.—�'._..>'4.� -� v7-""-'.=� crE".,zY",•-^'a�-i=:.:--5.+�--..----:_�5��=4-_,r;.'-`:.rx:.z.?s.�.F-r....'. s Reviewer/Inspector Name12 �— Reviewer/Inspector Signature: Date: 11 -'7 --D "1 12112103 Continued >"acility Number: 1 �27 L Date of Inspection 7 0 Reouired Records & Documents 21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? 22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? (ie/ WUP, checklists, design, maps, etc.) 23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling 24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? 25. Did the facility fail to have a actively certified operator in charge? 26. Fail to notify regional DWQ of emergency situations as required by General Permit? (ie/ discharge, freeboard problems, over application) 27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? 28. Does facility require a follow-up visit by same agency? 29_ Were any additional problems noted which cause noncompliance of the Certified AWMP? NPDES Permitted Facilities 30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) 31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 32. Did the facility fail to install and maintain a rain gauge? 33_ Did the facility fail to conduct an annual sludge survey? 34. Did the facility fail to calibrate waste application equipment? 35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain ❑ 120 Minute Inspections ❑ Annual Certification Form ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No [3 Yes E]40 ❑ Yes O-No ❑ Yes [•}moo P-Yes ❑ No ❑ Yes O-No ❑ Yes EtNo ❑ Yes p o ❑ Yes Q-No ❑ Yes 9 No 12112103 ��. �" w� ��� O Division of So �d �Waber�Coaservat<on` � _ _ Type of Visit 0 Compliance Inspection O Operation Review O lagoon Evaluation I Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access Facility Number Date of visit: S �1 Tune: Q Not O rational Q Below Thresbold U40'ermitted [ln .ertilied © Conditionally Certified © Registered Date Last Operated or Above Threshold: Farm Name: .. L1E ------- . L �tG� . --_ ._ — -- County: Owner Name:.Rf�:c�b/ld...krl.„.!:Ce Sr lei c�c� . Phone No: Mailing Address:..1%. ,�r... .....(avn.%"! y...„ t'ir4 l.!.p � ...........„. . Facility Contact:.._.�.,� .Gl.-„ y .„ f�Gr Title:..„.... ..___ _........ --�_. Phone No: Onsite Representative: ark „ _ _ „� _ Integrator: Certified Operator:.1` :!?u --__. ?� c�t/ _ _ Operator Certification Number: Location of Farm: wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` " Longitude • 4 6f Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? ❑ Yes allo Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other a. If discharge is observed, was the conveyance man-made'? ❑ Yes El -No b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes t❑No c. If discharge is observed, what is the estimated flow in gallmin? -- d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes [RNo 2. Is there evidence of past discharge from any part of the operation? ❑ Yes g No 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes B No Waste Collection & Treatment 4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Gwo Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure b Identifier: ... - - f ......... ................... ....... ....... .... ............ -_.... ................ Freeboard (inches): 3 12112103 Continued r. Facility Number: 9,R Date of Inspection O 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes j-No seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes E�No closure plan? (If any of questions 4-6 was answered yes, and the situation posses an immediate public health or environmental threat, notify DWQ) 7. Do any of the structures need maintenancelimprovement? ❑ Yes I-10 8. Does any part of the waste management system other than waste structures require maintenancehimprovement? ❑ Yes ❑'IGo 9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level [j Yes allo elevation markings? Waste Aonlication 10. Are there any buffers that need maintenancehmprovement? ❑ Yes ONO 11. is there evidence of over application? If yes, check the appropriate box below. ❑ Yes �o ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc 12. Crop type 13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes M No 14. 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? Odor I ,sues 17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below liquid level of lagoon or storage pond with no agitation? 18. Are there any dead animals not disposed of properly within 24 hours? 19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, roads, building structure, and/or public property) 20. 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. ❑ Yes M.No ❑ Yes QIio ❑ Yes [9}A10 ❑ Yes allo ❑ Yes ONO ❑ Yes ❑ No ❑ Yes O[io ❑ Yes UNo ❑ Yes ❑-Pdfi Reviewer/Inspector Name /14 Z `� ; Reviewer/Inspector Signature: Date: 1-! - G- -o� 12112103 Continued 1 , Facility Number: gz _I,,7 G Date of Inspection Reouired Records & Documents 21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 0,71Q 22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? (ie/ WUF ,checkl, ts,.desigmaps, .) ❑ Yes 23. Does record keeping need improvement? If yes, check the appropriate box below. 9-Yes ❑ No ❑ Waste Applicatiorr E[Treeboard ❑ Waste Analysis--[] Soil Sampling-- 24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [ -PQo 25. Did the facility fail to have a actively certified operator in charge? ❑ Yes OWo 26. Fail to notify regional DWQ of emergency situations as required by General Permit? (ie/ discharge, freeboard problems, over application) ❑ Yes MXo 27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? [-Yes ❑ No 28. Does facility require a follow-up visit by same agency? Byes ❑ No 29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes GINo NPDES Permitted Facilities 30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) des ❑ No 31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [s No 32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No 33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No 34. Did the facility fail to calibrate waste application equipment? ❑ Yes Qom_ 35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. 0-Yes ❑ No ❑ Stocking Fort rop Yield Form 04tginfall [:]Inspection After 1" Rain ❑ 120 Minute Inspections❑ Annual Certification Fornr— © No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. 12112103 Farm Name/Owner: Mailing Address:- P Site Requires Immediate Attention:iL FacWty No. � DIVISION OF ENVIRONMENTAL MANAGEMENT ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD DATE: 77h R , 1995 Time: _ y '_ aD _ ., r,., C. 1 i [' i s k County: - Integrator: . . - e _ Phone: On Site Representative: - ����� C_.,1/-%, - Phone: Physical Address/Location: S�,rre.,r} _ _ r t Type of Operation: Swine ✓ Poultry Cattle _ Design Capacity: 24 s' _ - Number of Animals on Site: _ 'ZC� G12ca - 2- 735� -- DEM Certification Number: ACE DEM Certification Number: ACNEW Latitude: Longitude: Circle Yes or No Does the Animal Waste Lagoon ha ufficient freeboard of 1 Foot + 25 year 24 hour storm event (approximately 1 Foot + 7 inches) IeZr No Actual Freeboard: 11 Ft. Inches Was any seepage observed from the lagoon(s)? Yes or& Was any erosion observed? Yes oi&D Is adequate land available for spTa,,? I'e ar No Is the cover crop adequate? Yes or No Crop(s) being utilized:_ _ e' Does the facility meet SCS minimum setback criteria? 200 Feet from Dwel No 100 Feet from Wells? GWor No Is the animal waste stockpiled within I00 Feet of USGS Blue -Line Stream? Yes MAP Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes orao Is animal waste discharged into water of the state by man-made ditch, flushing system, or other similar man-made devices? Yes or &0 If Yes, Please Explain. Does the facility maintain adequate waste management rep s (volumes of manure, land applied, spray irrigated on specific acreage with cover crop)? Yes or No Additional Comments: ,- L f �-1vq z Inspector Name - - C— Signature cc: Facility Assessment Unit Use Attachments if Needed. K 4W WMTS CAROLnWW DKPARTNMT OF ENVIROMIENT, HEALTH b MTURAL RESOMS DIVISION or ENMOMMTAL Fayetteville Regional Office Animal Operation Compliance inspection Form _ ��Vp%l-�pc,�.fp�l-ys.�YG����Wx'n1�f✓�rsTy�wrf�ylfr��,YMN��•..'�f.� .�„". :irra+�/.i{niWRi• v '5.�Kr' ",DATE '��. bo ;' "'�iat7.. <]. :' +rLa.++iJa7 -if�i�la�R SirickICtrd Fnrm5 ReginoJd �GQrre4Sfn aM ,'...,w.,��.......>k�rr3r:�ar�t�oNE:�.�ur+�ss�.. Rt 3 Boi 47q M+. G 11 Ve, I1 C 2_P,3 5 q i o - 5q4 --1 944 All questions answered negatively will be discussed in sufficient detail in the -Comments Section to enable the deemed Permittee to perform the appropriate corrections: SECTION I Animal Overation : Fier io R niSh Horses, cattle, QEin , poultry, or sheep SECTION IT Y I N I COTS 1. Does the number and type of animal tweet or exceed the (.0217) criteria? [Cattle (100 head), horses (75), suine (250), sheep (1,000), and poultry (30,000 birds with liquid waste syst�ua) ] 2. Does this facility meet criteria for Animal Operation RECI§WkATIOW. 3. Are animals confined fed or maintained in this facility for a 12-month period? - 4. Does this facility have a CERTIFIED WASTE WANAGMPM PLAP P 5. Does this facility maintain waste management records (volumes of manure, land applied, spray irrigated on specific acreage with specific cover crop)? 6. Does this facility meet the SCS minimum setback criteria for neighboring houses, wells, etc? rf r Y I M Field Site Mana went 1. is animal waste stockpiled or lagoon construction within 100 ft. of a USGS Map Slue Line Stream? 2. Is animal waste land applied or spray irrigated within 25 ft. of a USGS Map Blue Line Stream? 3. Does this facility have adequate acreage on which to apply the waste? 4. Does the land application'site have a cover crop in accordance'with the CLit IFICATION PLAN? 5. Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other similar man-made devices? 6. Does the animal waste management at this farm adhere to Best Management Practices ($MP) of the approved TiFICATION? 7_ Does animal waste lagoon have sufficient freeboard? How much? (Approximately } a. Is the general condition of this CATO facility, including management and operation, satisfactory? SMCTION IV Comment S s RwGI57RAT:CN FORM FOR ANIMAL F77=7 OPERATION Department of Environment, Health and Natural Resources Division of Environmental Management Water Quality Section if the animal waste management system for your feedlot operation is designed to serge more than a= equal to 100 head of cattie, 75 horses, 250 swine, 1,000 sheep, ar 30,000 birds z at are served by a liquid waste system, then t_._s fWM .rust ie ___'red out and mailed by Ce_emb e= 31, 1993 pursuant _.. MA NCAC 2 =.02=7 (c) in order to be deemed permitted ty DE.`"_. Please print c'_ear' y . arm Name: �ii,'V{/X�r�_ 16 Mail_^g Address: ccu4 z•. Owner (s) Name: Manzcer (s) Name Lessee Name: Farm Location (Be as specific as noss'_ble* road awes, milemost„ etc A T,4,�r� '7'O/ /!.'_!- �. __" &W 4 y -at i rude/Lcngi _.:de if known: Design capacity of animal waste management system (Number and type a confined anima:. (s) ) -71C EV R by ,L - „-- Average animal population on the farm (Number and type of animal (s) raised) r 11 l .-i l / - Year Production Began :./'720 ASCS Tract No.:�J Type of Waste Management System Used: ' �r Acres Available far 0 Owner (s) Signature (s) U