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HomeMy WebLinkAbout310574_INSPECTIONS_20171231NOHTH CAHULINA Department of Environmental Quai Type of Visit: WCompliance Inspection V Operation Review (,,,) Structure Evaluation V Technical Assistance Reason for Visit: atoutine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access Date of Visit: ( Arrival Time: Departure Time: County: i-t---t'- Farm Name: ^ Owner Email: Owner Name: pC 1 k-11 Phone: Mailing Address: Physical Address: Facility Contact: Title: __ Phone: Region: Uj 02b Onsite Representative: " W },-v pJ Integrator: Certified Operator: l_LL'u e Certification Number: ( (4 0 2 Back-up Operator: Location of Farm: Latitude: Certification Number: Longitude: Design C*urrent Swine Capacity Pop. Wet Poultry Design C►a., Design Current Capacity Pop. Cattle Capacity Pop. Wean to Finish La er DairyCow Wean to Feeder Non -La er DairyCalf ceder to Finish 1 Dairy Heifer Farrow to Wean Design Current Dry Cow Farrow to Feeder Drv_ P■ou[tr. Ca acit P■o , Non -Dairy Farrow to Finish Layers Beef Stocker Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow Other Other Turkeys Turkey Poults Other Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWR) c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWR) 2. is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? ❑ Yes IX No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes No ❑ Yes No ❑ NA ❑ NE ❑NA ❑NE ❑ NA ❑ NE Page I of 3 21412015 Continued Facili Number: jDate of Inspection: R 1� Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 19 No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: I Spillway?: Designed Freeboard (in): Observed Freeboard (in): 2 3 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ 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 V No ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR 7. Do any of the structures need maintenance or improvement? ❑ Yes Ex No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE maintenance or improvement? T Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ 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? ❑ Yes No ❑ NA ❑Yes No DNA ❑ Yes No ❑ NA ❑ Yes ❑ Yes Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes the appropriate box. ❑ NE ❑ NE ❑ NE WNo ❑NA ❑NE No ❑ NA ❑ NE No ❑NA ❑NE No ❑ NA ❑ NE ❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 21. Does reoos# keeping need improvement? If yes, check the appropriate box below. Yes ❑ Na *Waste cation ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [� N o ❑ NA ❑ NE ❑ Weather Code ❑ Sludge Survey ❑NA ❑NE ❑NA ❑NE Page 2 of 3 21412015 Continued Ficili Number: Date of Inspection: I2 j 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE the appropriate box(es) below. ❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels ❑ Non -compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes KNo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No M NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [ No ❑ NA ❑ NE and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [ No ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes 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 ❑ NA ❑ NE 33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ YesgNo No ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE Coiihmeii (refe'$to'queshon 4) Explain any'=YES ai swers and/o>r`any addihowtal reeommendations or any other cajr"nents. ' ., ty P .. a� �s l Use�zirawiags of facih to Bette' ibex 'laitusituatious=(6se additional: pages as necessary-}.; �k 42,1 os +0 sahkrit oiac S S cIn Kc�Yd� 1nl�s � j2 r 7. a WASH d x � ra.� s Y�tRc� Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 Phone: —7 Date: 6 214120 S Type of Visit: Q Cance Inspection U Operation Review U Structure Evaluation U Technical Assistance I Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: Arrival Time: Departure Time: 2 County: Region: Farm Name: Owner Email: Owner Name: Phone: Mailing Address: Physical Address: Facility Contact: !! Title: Onsite Representative: 5� G- 4, I Certified Operator: Back-up Operator: Location of Farm: Phone: Integrator: Certification Number: ��►� L Certification Number: Latitude: Longitude: Swine Wean to Finish Design Current Capacity Pop. Design Current Wet Poultry Capacity Pop. Layer Design C+urrent C*attle Capacity Pop. Dairy Cow Wean to Feeder I jNon-Layer I Dairy Calf eeder to Finish Dairy Heifer Farrow to Wean Farrow to Feeder Design Current D P■out C1 aci P■o Layers Dry Cow Non -Dairy Farrow to Finish Beef Stocker Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow Qther Other 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 DWR) c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWR) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? ❑ Yes No ❑ NA ❑ NE [:]Yes [:]No ❑ NA ❑ NE ❑ Yes [:]No [DNA ❑ NE ❑ Yes q No ❑ NA ❑ NE Yes : - No ❑ NA ❑ NE ❑ Yes 9-5-0—❑ NA ❑ NE Page 1 of 3 21412015 Continued Facility Number: - 7 V 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 ' ❑ NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [i]''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 6No ❑ 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 [D..i►lo ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [a -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-Wo- ❑ 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 [�Ko ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2�No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes Ef No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? 18. Is there a lack of properly operating waste application equipment? ❑ Yes [7� o ❑ Yes ][ No ❑ NA ❑ NE ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes VNo �❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE the appropriate box. ❑ WUP ❑ Checklists ❑ Design [) Maps ❑ Lease Agreements ❑ Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes D ❑ 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 21412015 Continued Facility Number: - Date of Inspection: /6 24, DiJ the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EF�❑ NA ❑ NE ./ 7 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE the appropriate box(es) below. ❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels ❑ Non -compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑1 A ❑ 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 [ No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE ❑ Yes ENo ❑ NA ❑ NE [—]Yes No ❑ NA ❑ NE ❑ Yes E:fNo ❑ NA ❑ NE ❑ Yes .EfrNo ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE Reviewer/Inspector Signature: Page 3 of 3 Date: I 2141245 Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Beason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit:/ (Arrival Time:'-f� Departure Time: (4 zp County: Region: Farm Name: Owner Name: Mailing Address: Physical Address: Owner Email: Phone: Facility Contact: Title: Onsite Representative: L-e S It e �•— Integrator: Certified Operator: Back-up Operator: Location of Farm: Latitude: Phone: Certification Number: p Certification Number: Longitude: Design Current Swine Capacity Pop. Finish FLa Design Current Wet Poultry Capacity Pop. er Cattle Dai Cow Design Current Capacity Pop. Feeder o Finish o Wean Non -Layer DairyCalf Dai Heifer D Cow Design Current !Farrowo Feeder FinishLa D , P,oultr, C•_a acit P,o , ers Non-Daio Beef Stocker Non -La ers Beef Feeder Pullets Beef Brood Cow111111 urkes 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? ❑ Yes No ❑ NA ❑ NE ❑Yes ❑No ❑NA ❑NE b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? [:]Yes No ❑ NA ❑ NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ffNo ❑ NA ❑ NE of the State other than from a discharge? Page 1 of 3 21412015 Continued h'acili Number: '3t Date of Inspection- j P Z 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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): C Observed Freeboard (in): 3_ 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No[_] ❑ 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 ETNo ❑ 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 Ko ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ No ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes hTo ❑ NA ❑ NE m m enncor 12. Crop Type(s): 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes L],Ko ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes [3 No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes [;J-?-o ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE the appropriate box. ❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [a 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 21412015 Continued Facili Number: 21- Date of Inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [-- No ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE the appropriate box(es) below. ❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels ❑ Non -compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No []NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E No ❑ NA ❑ NE and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ff 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 permit? (i.e., discharge, freeboard problems, over -application) ❑ Yes No ❑ NA ❑ NE 3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 34. Does the facility require a follow-up visit by the same agency? ❑ Yes ff'No ❑ NA ❑ NE ❑No ❑NA ❑NE No ❑ NA ❑ NE �No❑ NA ❑ NE (Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I Use drawings of facility. to better explain situations (use. additional pages as necessary.):: V 54e_ Gc n,�a SIC Reviewer/Inspector Name: V_-a _ r `' KVt I Phone: Reviewer/Inspector Signature: ��--- Date: n �� Page 3 of 3 21412015 Type of Visit: � Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance Reason for Visit: Routine O Complaint O Follow-up O Referral Q Emergency Q Other 0" 'Denied Access Date of Visit: y Arrival Time: 1 Departure Time: County: Region: Farm Name: 1 T T&b-- A Al K ► XW- Owner Email: Owner Name: 1 �5LjC Q • U�►� i Phone: Mailing Address: C9) —1 "1 ) c- 55 OWyIFe , • C_ C�S3V5 Physical Address: Facility Contact: Title: Phone: Onsite Representative: Integrator: LDS (�. off S Certified Operator: C.y � ��t� 17TF� Certification Number: Back-up Operator: Certification Number: Location of Farm: Latitude: Longitude: ) & L�OQ Design Current Swine Capacity Pop. Wean to Finish Wet Poultry La er Design Capacity Current Pop. Design Cattle Capacity Dairy Cow C*urrent Pop. Wean to Feeder Non -La er Dairy Calf Feeder to Finish Farrow to Wean I) . P"Tu-I Layers Design Ca aci. Current P,o , Dairy Heifer Dry Cow Non-Dan Beef Stocker Farrow to Feeder Farrow to Finish Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow Q€he OtherI I Turke s urkey Poults 10ther Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify 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 x No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE [:]Yes [:]No ❑ Yes Ig No ❑ Yes& o ❑ NA ❑ NE ❑ NA ❑ NE ❑NA ❑NE Page I of 3 21412014 Continued Facility Number: - 5 -1 t-1 Date of Inspection: y 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? 0 Yes No ❑ NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: (,ArX3DN Spillway?: Designed Freeboard (in): �q• S Observed Freeboard (in): - 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA X, ❑ 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 DWR 7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE maintenance or improvement? A Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area +bl� 12. Crop Type(s) �[�► L-E1�I Y b� E�-'7 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? 0 Yes No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes V� No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No 0 NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes] No ❑ NA ❑ NE the appropriate box. !� QWUP ❑Checklists QDesign Q Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE 0 Waste Application Q Weekly Freeboard ❑ Waste Analysis Q Soil Analysis ❑ Vte Transfers ❑ Weather Code ❑ Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Q Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE Page 2 of 3 21412014 Continued Facili Ni mber: - S -4 Li I Date of inspection: � 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes gNo ❑ 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? 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: ❑ Yes VNo o ❑ NA ❑ NE ❑ Yes ❑ NA ❑ NE ❑ Yes No ❑ Yes No ❑ Yes No ❑ Yes V No ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes R No ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE 34, Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any"other continents. Use drawings of facility to better explain situations (use additional pages as necessary). S LupC, St.�R, u�� ` p�c �0► y �� 7S H NCH -_wG4. N�(z cAu,/�v4 OEL 60 01 4: 0-(( �qb * ?pA(W_ Q074 CPO �l NAur OL>�.M��i SP SED � 0A1 u�CIASt BS�- P�"'UPFJ``!Tz Qu i F l X _o G l u Yv-t1� L/ 7X� 6- Ad-r� D� F ic�rc'G' /N rho Pia T Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 Phone: R1o_1ib 1*0 Date: q rX'/L/ 21412014 Type of Visit: Reason for Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Technical Assistance 0 Other 0 Denied Access Date of Visit: L Lrrival Time: ; eparture Time: ounty: Region: L_j/16 T Farm Name: ) S d 11 r_ - 3 Z cj�l _ Owner Email: Owner Name: Phone: Mailing Address: Physical Address: Facility Contact: Title: Onsite Representative: Certified Operator: Back-up Operator: Location of Farm: Latitude: Phone: Integrator: m 1 Certification Number: Certification Number: , Longitude: Design Current Swine Capacity Pop. Wean to Finish Design Current Wet Poultry Capacity Pop. Layer Design Cattle Capacity Dairy Cow Dairy Calf Dairy Heifer Current Pop. Wean to Feeder I INon-Layer I Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Design D , P,oult , Ca aci P.o ILayers Dry Cow Non -Da' Beef Stocker Beef Feeder Beef Brood Cow Gilts Non -La ers Boars Pullets Other Other Turke s Turke Puults Other Dischar es 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 4 No ❑ NA ❑ NE ❑ Yes 6 No ❑ NA ❑ NE ❑ Yes ETNo ❑ NA ❑ NE ❑ Yes n No ❑ Yes ZfNo [—]Yes �No ❑NA ONE ❑ NA ❑ NE ❑ NA ❑ NE Page 1 of 3 21412011 Continued 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 8N. ❑ 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? (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or closure plan? ❑ Yes Po ❑ NA ❑ NE ❑ Yes ONo ❑ 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 P No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ro ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) TT 9. Does any part of the waste management system other than the waste structures require ❑ Yes )2No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ETNo ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P]Igo ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 ibs. ❑ Total Phosphorus ❑ Failure to Incorporate ManurelStudge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): 13. Soil Type(s): 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 PrNo ❑ NA ❑ NE ❑ Yes ZfNo ❑ NA ❑ NE ❑ Yes ,,,n No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE ❑ Yes )ETNo ❑ NA ❑ NE ❑ Yes ,,0 No ❑ NA ❑ NE ❑ Yes P No ❑ NA ❑ NE ❑WUP [—]Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4' No 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,rN o ❑ NA ❑ NE ❑ Weather Code ❑ Sludge Survey ❑ NA ❑ NE ❑ NA ❑ NE Page 2 of 3 21412011 Continued Facili Number: - Date of Inspection: e 24. Did the facility fail to calibrate waste application equipment as required by the pen -nix ❑ Yes ;No ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ETNo ❑ 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/ffNo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ,�No ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document 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. 34. 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 P�rNo ❑ NA ❑ NE ❑ Yes [�J`Ro ❑ NA ❑ NE ❑ Yes M No ❑ NA ❑ NE ❑ Yes ETNo ❑ NA ❑ NE 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ffNo ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ETNo ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes �o ❑ NA ❑ NE Comments (refer.to question ff): Explain any YES answers and/or any additional recommendations or any other comments: '. . Use drawings of facility to better explain situations (use additional pages as necessary). Reviewer/Inspector Name: Phone: Reviewer/Inspector Signature: Page 3 of 3 Date: 1/4/207I (Type of Visit: Q Compliance Inspection V Ope on Review taStructure Evaluation (-_)Technical Assistance I Reason for Visit: Q Routine O Complaint Follow-up Q Referral O Emergency O Other O Denied Access Date of Visit: 6 Arrival Time: I—,L ='� Departure Time: ZY County: Region: Farm Name: Owner Name: Mailing Address: Physical Address: Facility Contact: Owner Email: Phone: Title: Phone: Onsite Representative: Integrator: Certified Operator: Back-up Operator: Location of Farm: Latitude: Certification Number: Certification Number: Longitude: Design Swine Capacity Wean to Finish Current Design Current Pap. Wet Poultry Capacity Pop. Layer Design Current Cat#le Capacity Pop. DairyCow Wean to Feeder Non -Layer Dairy Calf Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Design Current i) . P,oultr� Ca aci P.o , La ers Dairy Heifer Dry Cow Non -Dairy lBeef Stocker Gilts Non -Layers Beef Feeder Boars Pullets 113eef Brood Cow Other Other Turke s Turkey Poults Other Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? ❑ Yes [;io ❑ NA ❑ NE Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [:]No ❑ NA ❑ NE c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? ❑ Yes E(t;�i ❑ NA ❑ NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes rj1No ❑ NA ❑ NE of the State other than from a discharge? Page I of 3 21412015 Continued Facility Number: - Date of inspection: 10x / 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? Structure 1 Structure 2 Structure 3 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): ❑ Yes ❑ No ❑ 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.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or closure plan? ❑ Yes 6No ❑ NA ❑ NE ❑ Yes E] No ❑ NA ❑ NE If any of questions 4fi were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR 7. Do any of the structures need maintenance or improvement? [:]Yes [—]No ❑ NA 2NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA EfNE (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 dNE maintenance or improvement? Waste ARiflication / 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE maintenance or improvement? 11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA ❑ 15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA E 16. Did the facility fail to secure and/or operate per the irrigation design or wettable Yes ❑ No ❑ NA [/NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA E?jE 18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA ❑�NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA DE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA fNE 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 E 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes ❑ No ❑ NA ffNE Page 2 of 3 21412015 Continued Facifi Number: jDate of Inspection: 24' Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes [] No 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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? 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? 34. Does the facility require a follow-up visit by the same agency? Reviewer/Inspector Signatut Page 3 of 3 1 ❑ NA NE ❑ NA [�E ❑ Yes ❑ No ❑ NA 4NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA eo'RE Yes �NE ❑ ❑ No ❑ NA ❑ Yes No 0 NA ONE ❑ Yes [] No ❑ NA ,'NE ❑ Yes ]�No [] NA Yes I� `" ❑ NA ❑ Yes No ❑ NA ❑ NE ❑ NE ❑ NE Date: 10A4 l6 21412015 Division of Water Quality Facility Number �j - m Mo. Division Soiland Water Conservation Other Agofency Type of Visit: Wompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit: KRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: F - i Arrival Time: = (, Departure Time: ; v County: if Region: Farm Name: Owner Name: Mailing Address: Physical Address: Facility Contact: Title: Owner Email: Phone: Phone: Onsite Representative: Integrator: Certified Operator: �}- � . �_ �i*1� Certification Number: Back-up Operator: Location of Farm: Latitude: Certification Number: Longitude: Design C►urrent Swine C►apacity Pop. Wean to Finish Design Wet Poultry C*apacity Layer Current Pop. Design Current Cattle Capacity Pop. Dairy Cow Wean to Feeder Non -La er I Dairy Calf Feeder to Finish WO Farrow to Wean Farrow to Feeder Farrow to Finish Design Di, P,oul C_a aci Layers Current P,o Dairy Heifer Dry Cow Non -Dairy Beef Stocker Gilts Boars Other Other Non -Layers Beef Feeder Pullets Beef Brood Cow Turke s Turkey Poults Other Discharees 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 FfNo ❑ NA ❑ NE [:]Yes [:]No [—]Yes ❑ No ❑NA ❑NE ❑NA ❑NE []Yes ❑ No- ❑ NA ❑ NE ❑ Yes 0 No r ❑ NA ❑ NE ❑ Yes ZrNo ❑ NA ❑ NE Page I of 3 21412011 Continued F.citit,y Number: - Date of Inspection: Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: �- Spillway?: Designed Freeboard (in): Observed Freeboard (in):� 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes F1 No ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes K No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [?(No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ 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? ❑ Yes 4 No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes 9No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes PTo ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes Vf No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes VrNo TT ❑ NA ❑ NE Re uired Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE the appropriate box. ❑WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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 [;rNo ❑ NA ❑ NE Page 2 of 3 21412011 Continued _ W. Facility Number: - Date of Inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE the appropriate box(es) below. ❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels ❑ Non -compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes (2rNo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ 'hT Yes �o ❑ NA ❑ NE Other Issues T 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 VfNo [:]Yes 9fNo ❑ Yes ?] No ❑ Yes Pff No ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? [:]Yes VNo ❑ NA ❑ NE Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments. Use drawings of facility to better explain situations (use additional pages as necessary). Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 Phone:���jr?'G` Date:�� 21412011 Type of Visit: Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: Arrival Time: ® Departure Time:-�=--� County: Region: Farm Name: Owner Email: Owner Name: Mailing Address: Physical Address: Phone: Facility Contact: Title: Phone: Onsite Representative: Certified Operator: q—. WH1771ktS Integrator: OG 1 CertificationNumber: Back-up Operator: Certification Number: Location of Farm: Latitude: Longitude: Design Current Design Current Design Current Swine Capacity Pop. Wet Poultr3 Capacity Pop. Cattle Capacity Pop. Wean to Finish Layer DairyCow Wean to Feeder Non -La er Da' Calf Feeder to Finish Da' Heifer Farrow to Wean Farrow to Feeder Design Current Cow Dr, P,oult . C•_a aci P,o Non -Dairy Farrow to Finish Layers Beef Stocker Gilts Non -Layers Beef Feeder Beef Brood Cow Boars Pullets Other Other Turke s Turke Poults 10ther Discharses 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 X No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE [:]Yes [:]No ❑ Yes YesINO No ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE Page I of 3 21412011 Continued Facility Number: jDate of Inspection: 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 t o Structure I Structure 2 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): ❑NA ❑NE ❑NA ❑NE Structure 3 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.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or closure plan? ❑ NA ❑ NE ❑ Yes No ❑ Yes No ❑ NA ❑ NE If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA FINE 8. Do any of the structures lack adequate markers as required by the permit? ❑ YesNo ❑ 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 1No ❑ 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 KNo ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): SG i ' OyLw 13. Soil Type(s): N(jOL-tiL 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes A No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes JK 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. r❑ WUP ❑ Checklists Q Design 0 Maps ❑ Lease Agreements ❑ Yes No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ,' Waste Application Week/ Freeboard Waste Analysis Soil Analysis W to Transfers ❑ pl? ❑ Y ❑ Y ❑ Y ❑ ❑ Rainfall M Stocking Q Crop Yield Q 120 Minute Inspections Q Monthly and I" Rainfall Inspections 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �_9(No 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes A N o ❑NA ❑NE Q Weather Code Q Sludge Survey ❑ NA ❑ NE ❑ NA ❑ NE Page 2 of 3 21412011 Continued Facility Number: - ,-tDate of Inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE 25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE th b 1 e approprrate boxes) a ow. ❑ 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 ❑ No NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes '( No ❑ NA ❑ NE and report mortality rates that were higher than normal? 7� ❑ Yes No ❑ Yes No ❑ Yes No 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? 34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ Yes o ❑ Yes No ❑ NA ❑ NE ❑NA ❑NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. Use drawings of facility to better explain situations (use additional pages as necessary). 5_CA_r_X" VcA ,A. ('Pofio ), I/ 5P!jjQ ),s M-7,04 V � 8 Reviewer/Inspector Name: Reviewer/Inspector Signature: - Page 3 of 3 Phone: "7/6 9j Date: v� 21412011 Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit:� Arrival Time: Departure Time: County: 11r.(. X.1N Region: Farm Name: 1 ITS i — �C I l�f C1 FA (uv, Owner Email: Owner Name:TT iU - - Phone: Mailing Address: d I L ! u C SS E I► C)CQf4 i 0(_/Ufa/AK— cOR 3 b S Physical Address: Facility Contact: Title: Onsite Representative: Loso & LJL__)H 1� J el�, Certified Operator: LE5 (,4 6 V`- d w i--"' 111(r—A�N Back-up Operator: Location of Farm: Phone: Integrator: Certiffiic itrion Number: Certification Number: Latitude: Longitude: Design Current Swine Capacity Pop. Wean to Finish Design Current Wet Poultry Capacity Pop. La er Design Current C►attle Capacity Pop. Dairy Cow Wean to Feeder Non -La er Dairy Calf Feeder to Finish Design Current D . P,oult , C•_a acitV P,o , Layers I Dairy Heifer Dry Cow Non -Dairy 113eef Stocker Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow Other Other Turke s Turkey Poults Other Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? ❑ Yes x 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 the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE 2. is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE of the State other than from a discharge? Page I of 3 21412011 Continued Facility Number: jDate of inspection: J Waste- Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )!� No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: I Spillway?: Designed Freeboard (in): _ g, Observed Freeboard (in):� 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE waste management or closure plan? IX If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes 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 Po ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) , ❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): S( 3-) r CQa-1�i W i4eA"r SA, 13. Soil Type(s): Ww"C 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes P No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El No ❑ NA ❑ NE the appropriate box. ❑ WUP ❑Checklists Q Design 0 Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 04No ❑ NA ❑ NE Q Waste Application 0 Weekly Freeboard [] Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Q Weather Code Q Rainfall Q Stocking ❑ Crop Yield ❑ 120 Minute Inspections Q Monthly and 1" Rainfall Inspections ❑ Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9No ❑ NA ❑ NE Page 2 of 3 21412011 Continued Facility Number: 1 - 5 Date of Ins ection: 1 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ���j�"` No ❑ NA ❑ NE the appropriate box{es) below. 7� ❑ 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 9NO ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No OCNA ❑ 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 �NO ❑ Yes 0 No ❑ Yes ONO [:]Yes g No ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE 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 ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ 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). �fl4r� SUGw���jf�l► 7T 11Cr 'off L{ ;�16 ; > c oVE 1 Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 Phone: 90 7to 0 Date: Ig-4 j 11 21412011 Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: Arrival Time: ©rr Departure Time: County: L-I N Region: Farm Name• — II C�77 C! N C 1— iZM Owner Email: Owner Name: l GSLI G_ V� L^ )" I TTt=—� Phone: (Lc) el 9 66P - uCa3 Mailing Address: 91 " 1 + / y C s s E M6[AN T 0u u Nc DO 3& s Physical Address: Facility Contact: Title: Onsite Representative: LEsc-1 E w1.1 t TTEI�, Certified Operator: LES c-1 Back-up Operator: Location of Farm: Phone No: Integrator: 0�)1Q) Operator Certification Number: Back-up Certification Number: Latitude: = o = f = « Longitude: = ° a d 0 Design Current Design Current Design Current Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population ❑ Wean to Finish ❑ Layer ❑ DairyCow ❑ Wean to Feeder ❑ Non -Layer ❑ DairyCalf Feeder to Finish (9 ❑ DairyHeifer Farrow to Wean ❑ Farrow to Feeder Dry Poultry ❑ D Cow ❑ Non -Dairy ❑ Beef Stocker ❑Beef Feeder El Brood Co ❑ Farrow to Finish ❑ N Layers ❑Non -La ers❑ Pullets PGilts Boars Numher of Structures: ❑ Turke s other ❑ Turkey Poults ❑ 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 ANo ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE 12128104 Continued Facilitt Number: 31 —S4y Date of Inspection okJ !O Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes, is waste level into the structural freeboard? Structure 1 Structure 2 Structure 3 Structure 4 Identifier: L44 oo f Spillway?: Designed Freeboard (in): /Q . •S 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 INo ❑ Yes ❑ No Structure 5 ❑ NA ❑ NE El NA ❑NE Structure 6 ❑ Yes A No ❑ NA ❑ NE ❑ Yes ANo ❑ 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 gNo ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ElNE (Not applicable to roofed pits, dry stacks and/or wet stacks) 19 4. 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 ElNE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes '51No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop W_in�d�owr El Evidence of Wind Drift El Application Outside of Area 12. Croptype(s) 7Q LS.�L-/�1 WPEA 13. Soil type(s) / V 0 "C _A<_ _ 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �§No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes 4 No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ,1�3 No ❑ NA ❑ NE 17. Does the facility tack adequate acreage for land application? ❑ Yes J�No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes pftvo ❑ NA ❑ NE Comments (refer to question #): Explain anv YES:answers and/or any recommendations or any other com�rients� "` t . , Use drawings of facility to better -explain situations. (useadditional pages as necessary}: V.S• AL ONF wl(t,5, Reviewer/Inspector Name M� Phone: ReviewerfInspector Signature: Date: Page 2 of 3 12128104 Continued Facility Number: 3 I — -4 Date of Inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 'El Yes No El NA [I NE the appropriate box. El WUP El Checklists ❑ Design 0 Maps El Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE 0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Ate Transfers ❑ lAual Certification 0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections ED Monthly and 1" Rain Inspections 0 Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes X No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KNo ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes P(No ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No )(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 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 4No ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately 31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes 0 No ❑ NA ❑ NE General Permit? (ie/ discharge, freeboard problems, over application) ���/1111 32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes XNo ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes ENo ❑ NA ❑ NE Additional Comments, and/or Drawings: L %w-r I oN ap l 1 L.141300N IN (=AI9- s6/4PIE - sr -OP ?WMP )5 L-i8, j or, eC-Tr'�- 70 pAU6 Lr4FocvvCc-o5" TO Sroe pkmp rnr pGLEpig (Z -T701v F,09Z yLe�cA- SeA-5c*V -- gEI9A4 (/ /vvw Page 3 of 3 12128104 Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance Reason for Visit O Routine O Complaint XFollow up O Referral O Emergency O Other ❑ Denied Access Date of Visit: ! Arrival Time: ® Departure Time: County: Farm Name: AV 1TTO--K IJ Owner Email: Owner Name: Lznuc �Z• � I T'1"E't�:. Phone: _ Mailing Address: Physical Address: Facility Contact: Title: Phone No: Onsite Representative: Certified Operator: Back-up Operator: Location of Farm: Integrator: Operator Certification Number: Back-up Certification Number: Region: Latitude: 0 0 = r Longitude: = o E_-1 ` = Design Current Design Current Design Current Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population ❑ Wean to Finish ID Layer I 1 ❑ Dairy Cow ❑ Wean to Feeder ID Non -Layer I I ❑ Dairy Calf ❑ Feeder to Finish Dry Poultry ❑ Dairy Heifer ❑ Dry Cow ❑ Farrow to Wean ❑ Farrow to Feeder ElNon-Dairy ❑ Farrow to Finish ❑ Layers Non -Layers El Beef Stocker ❑Beef Feeder ❑ Beef Brood Co ElGilts El Boars ❑ Pullets ❑ Turkeys Other ❑ Turkey Poults ❑ Other 1110 Other I umber of Structures: 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 4No ❑ NA ❑ NE ❑Yes El No El NA ❑NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes t&No ❑ NA ❑ NE ❑ Yes �(No ❑ NA ❑ NE 12128104 Continued Facility Number: 31 —Sy Date of Inspection 1 3 Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? XYes ❑ No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes XNo ❑ NA FINE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: (_PGOCW Spillway?: Designed Freeboard (in): !f Observed Freeboard (in): Ll 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 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 19 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 X ElNA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA �(NE maintenance/improvement? 11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA XNE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 12. Crop type(s) 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA �j NE 15. Does the receiving crop and/or land application site need improvement? XYes ❑ No ❑ NA ❑ NE 16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ❑ No ❑ NA10 NE 17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA A NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA �( NE Comments (eeferAo questroi ft 'Explain any°YES answers and/or any.recommendationsouany.othevcomments :. � .� �w ., _ ,Use drawmg`s of'facilityto.lietter explain situations. (use -additional pages as necessary)" �i• ['�1Q. wit BIAS A Qp�ON FILC- NEF-bS TC> GEr P1V6MGf_01VC _ -o C3 �u S_r 1(._c__ 1l� �E� A �i �t� SC7 �)a`�5 ylj. �EAN S n 1(_oN THE FtF-Lb S - NIrel-I TC) 6 Ei T1�SC- c�Fr C5Q 1T W�t✓� (3C C) LpTE To AT! T AN�'�fl//►r�' 71 Reviewer/Inspector Name - iJ�"i / /� Phone: !Q q�o` Reviewer/Inspector Signature: Date: ] {�` , 1 " 0 1_ 12128104 Continued Facility Number: 3 j Date of Inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA W NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ONE the appropriate box. ❑ W'Up ❑ Checklists ❑ Design ❑ Maps p El Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA A NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers El 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 ❑ No ❑ NA 0 NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ONE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No ❑ NA NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA kNE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA jX NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ No ❑ NA ONE 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 KNo ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately 31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes 0 No ❑ NA ❑ NE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No [(NA ❑TNE 33. Does facility require a follow-up visit by same agency? xYes ❑ No ❑ NA ❑ NE Additional Comments and/orzDrawinQs::_: l��lcr� 1 phi ►UED aN 7NF F-Aem 1*�S JAI io SEC 1,�11A� Cr�S �C>4)V ©A'- }{ 0V7 aN TO E LA6S WNE2E.7Nf-_BkAuS PZE- - HIm L-DI oaf dr y f71A(�S 740 i C F_ 1 LAN1E� wt�IN ,3C� DA�S. HOGS HAD1N ^- �uaEEIS�`31.�7 5/NEE t-i5 p} i S�EgO��a T NaAU0l/l6' Td C-ACCCf - $EAws n�,✓� R-�ma Rom ELb f I F ij1SCED I N AwlPAty '?"j:�ASE me t"woQmED <2SF PA��C'40-)VGE-s 12128104 I/ Type of Visit I ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: �tt j __� `` � Arrival Time: 1rJOC)o Departure Time: County: ` Region: Farm Name: t J I 'T7 rG — l—IJV C^ P7 1 -A� Owner Email: �SL I L�._�. i..`��I I I -re 9r9- Cos8-4(o 5 we Owner Name: r ! � f /� � Phone: %►� Q ?S/ Mailing Address: of )�� r Y L 5'3 E �1'1 % CJ —1 UE _ , v C o` " 6S Physical Address: Facility Contact: Title: Onsite Representative: L�Su G C,,_) t4,LnC t�,* Certified Operator: LisS L1 ra f?' Back-up Operator: Location of Farm: Phone No: Integrator: Operator Certification Number: _ V-'« Back-up Certification Number: Latitude: [� o 0 f Longitude: [= o =1 Design Current Design Current Design Current Swine C+apacity Population Wet Poultry Capacity Population Cattle Capacity Population ❑ Laver ❑ DairyCow ❑ Non -Layer ❑ DairyCalf ❑ DairyHeifer Dry Poultry ❑ D Cow ❑ Non -Dairy ❑ Layers ❑ Beef Stocker ❑ Non -Layers ❑ Beef Feeder ❑ Pullets ❑ Beef Brood Co ❑ Turkeys Other ❑ Other ❑ TurkeyPoults ❑ Other Number of Structures: ❑ Wean to Finish ❑ Wean to Feeder Feeder to Finish � C� ❑ Farrow to Wean ❑ Farrow to feeder ❑ Farrow to Finish ❑Gilts ❑Boars 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 VNo ❑ NA ❑ NE ❑Yes El No ❑NA ONE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes q] No ❑ NA ❑ NE ❑ Yes I No ❑ NA ❑ NE 121288104 Continued f facility -dumber: 1 --S 4y Date of Inspection I I I W Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. if yes, is waste level into the structural freeboard? Structure 1 Structure 2 Structure 3 Identifier: L 4v:Jt/ ❑ Yes XNo ❑ Yes ❑ No Structure 4 Structure 5 ❑ NA ❑ NE ❑ NA ❑ NE Structure 6 Spillway?: Designed Freeboard (in): Observed Freeboard (in): Is 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) 9 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? X 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 10 No ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE (Not applicable to roofed pits, dry stacks and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ElV No [I NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. [:]Yes ANo ❑ 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 El Application Outside of Area 12. Crop type(s) 'SC-) (2pV_jA/ (�i &4 T L� S 13. Soil type(s) Natf-cy-< 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 o ❑ NA [I NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ YesNo ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes tNo ElNA ElNE 18. Is there a lack of properly operating waste application equipment? ElYeso ❑ NA ❑ NE Commemfs (refer to'quest 'on #) `Eirplain aity YES'answers and/or any recommendations*or any other camments .. Use drawings: of facility.to better, explain situations.- w(use additional pages as necessary) 1 U Gw . 0 5 SOON 95 - t3 N C) NI - o i c Ooc,v,lSOwt r '7U 5 ; pu_� o `' S �Q �C . � 70 � cAu�. SIGNS FrcAf¢IN g Ci5X6 GL�7T�NC (P'j�Cl� !/SITa Cows Reviewer/Ins ector Name'` "` /� ! ��3� P MA'VD 6� /Ve S `'� Phone: O Reviewer/Inspector Signature: Date: I i V0 9 12128104 Continued lFaciUtpNumber: "3 Date of Inspection Re uired Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No El NA [I NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes ,ANo` ❑ NA ❑ NE the appropriate box. ❑ %Up ❑ Checklists ❑ Design [3 Maps ❑Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ✓✓ ❑ NA El NE El Waste Application El Weekly Freeboard 0 Waste Analysis ❑ SoiI Analysis ElY(aste Transfers❑)eme ual Certification 0 Rainfall ❑ Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections El Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 50 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 gNo ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes V No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No X NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes )4No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ❑ NA ❑ NE and report the mortality rates that were higher than normal? 30. At the time of the inspection did the facility pose an odor or air quality concem? ❑ 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 Lo ❑ NA ❑ NE Additional. Comments and/or Dcswin s " g . y CAA NZA-7-10N �S DU � 13c� r� D d C= _1 l2/2&04 Type of Visit qk Compliance Inspection Q Operation Review U Structure Evaluation Q Technical Assistance Reason for Visit Q Routine 0 Complaint `Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access Date of Visit: ( Arrival Time: ® Departure Time: County: t-% / Region: Farm Name: i 7� — �1 a-m Owner Email: Owner Name: C��S a +A�' • ' Phone: f (1 r� Mailing Address: o` r , V L'_ `-' E I' ►ail 7� 7 Ou U r,/ r C d d J(D S Physical Address: Facility Contact: Title: Onsite Representative: Certified Operator: Phone No: Integrator: Operator Certification Number: Back-up Operator: Back-up Certification Number: Location of Farm: Latitude: 0 0 0 d = Longitude: 0 ° = . = ,` Design Current R Des�gr C Trent `� `Y Swine Ca aci P© elation Wet Poi,lt ry ;Ca aci P ulghon P ty R Cattfe ❑ Wean to Finish ❑ Layer ❑Dai Cow ❑ Wean to Feeder .10 Non -La er 1 ❑ Dairy Calf ❑Feeder to Finish '"+,�, p ❑ Dairy Heifer ❑ Farrow to Wean ;._ Poult �l)�ry ry �.� El Dry Cow El Farrow to Feeder � ❑ Non -Dairy ElFarrow to Finish El Layers El Beef Stocker El Gilts ❑ Boars -:-- ❑Non -Layers ❑Pullets ❑ Turkeys ❑ Beef Feeder ❑ Beef Brood . Other - k_ ��; _ ❑Turkey Poults ❑Other ❑ Other Number of ,a•-— ,mod �. Discharses & Stream Impacts 1. is any discharge observed from any part of the operation? ❑ Yes P(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 K No ❑ NA ❑ NE 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes 1 No ❑ NA ❑ NE other than from a discharge? 1 12128104 Continued Facility Number: —S Date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes, is waste level into the structural freeboard? Structure I Structure 2 Structure 3 Structure 4 Identifier: Lg600N Spillway?: Designed Freeboard (in): Observed Freeboard (in): j 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or closure plan? Yes ❑ No ❑ NA ❑ NE ❑ Yes �Io ❑ NA ❑ NE Structure 5 Structure 6 ❑ Yes X No ❑ NA ❑ NE ❑ Yes XNo ❑ 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 avo ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes X 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 Aaalication 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA XNE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA �NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) [:]PAN ❑ PAN > 10% or 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) 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? [Dyes ❑ 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 kNE ❑ No ❑ NA NE ❑ No ❑ NA NE ❑ No ❑ NA NE ❑ No ❑ NA NE Comments'.(r'efer to question #}: Explain any YES answers and/or any--recommendatians�or`any other&comments Use draIvn s of facility -to better'ex lain situations use additional a es as necessa g g P S STl LL IN fr' l EL-5- )NAE Te �C.A i I+C CZ �J� ! T 1 CCU S -- i 4GZ6 I S 14C)7741n) 6 j © ?l,x p 01W . � o&- Rrse GA u_ ME WS S(2)dN th71t-1- oNL NAu E Sap o GTE Reviewer/inspector Name T/ r 5 .7 Phone: qx) 7�p ReviewerlInspector Signature: Date: />rr lob I2128104 Continued Facility Number: Date of Inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA I 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. ElWUp ElChecklists ElDesign El Maps ❑Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA D�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 ❑ No ❑ NA qNE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA qNE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No ❑ NA 81NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA XNE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWIVIP? ❑ Yes bq No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes *o ❑ NA ❑ NE and report the mortality rates that were higher than normal? 30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ 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 XNo ElNA ElNE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ((NA ❑ NE 33. Does facility require a follow-up visit by same agency? Yes ❑ No ❑ NA ❑ NE .. -... -. .: .�;:.. .. ..R.e :"te. ....,._••e.. as._.,: -�.. :.T;.ax a.:"_.:.�'x::.:;9hs—"��s3,sh'^.yMaL:�'�f "_ Fr`_': +�":3� - . .1 e_caueb 13� t—rr} �jc,� Av So L� AT GiZ/,9 j 14 109 c� f n GM,`ac rn TO C�5WJ_C- ON L-4G-03/\J $TPT(._S 12/?9104 n7, .Drgsjonaof,Wate Quality O Divtston"of Soil apd Water'Conseryatton:+• �-.. -06 her Agency . Facility Number�� Type of Visit Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance Reason for Visit O Routine O Complaint )0 Follow up O Referral O Emergency O Other ❑ Denied Access Date of Visit: �rr� --�p Arrival Time: Departure Time: County: Region: Farm Name: lW 1f17TC-D — Kj VC Tpy-rn Owner Email: Owner Name: LCS u E V_• ��1 l 7?E �] Phone: Mailing Address: Physical Address: Facility Contact: Title: Phone No: Onsite Representative: Integrator: Certified Operator: Operator Certification Number: Back-up Operator: Back-up Certification Number: Location of Farm: Latitude: = o = A = Longitude: � o � , EJ ��,�Design � Cum ovine Capacity nPopula` ] Wean to Finish ] Wean to Feeder ] Feeder to Finish . ] Farrow to Wean ] Farrow to Feeder ] Farrow to Finish Wet Poultry " ❑ La er ;c ❑ Non La er f ;Ur,� Poultry J Boars ��- Other" ❑ La ers ❑ Non -Layers ❑ Pullets ❑ Turkeys ❑ TurkeyPoults ❑ Other Cow Heifer Non -Dairy Beef Stocker Beef Feeder Beef Brood 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 KNo ElNA ElNE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE I2/28/04 Continued Faciliiy umber: f } t-/ Date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes ❑ No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: U600 J Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Wo ❑ 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 ❑ 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 Auulication 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA NE V maintenance/improvement? 11. is there evidence of incorrect application? If yes, check the appropriate box below. El Yes El No El NA ,�,/ L,�$ NE El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.) ✓ ❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 12. Crop type(s) 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA V 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 YE5 answers and/or any"fecommendahons 6r4anyother comments ._� Use drawings of facilityto better ex la►n situations. use additional as necessar , m Sc-L�= ��b�� N IC N P4�-SAP-iT+i rs mo(Z�N� - AL Q(LOuC HT Po A pPpGZu xxz6 -ra ti 1 S Son/ 'SO -F44RT T+I E C.CLkL)� utter cx�I q-'FILL- � P 1C1C�TNA?t k N�U54 NC T��1SL �Gtac IA(Z I �CT1C�y ttilq Reviewer/inspector Name WAIF E Phone: ej �Q 1Co` Reviewer/Inspector Signature: I Date: 12/ cY/04 conttnuea Facility Number: 3 , -- Date of Inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA [ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA `] NE the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 4NE ❑ 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 ❑ No ❑ NA J4 NE .23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA " 1 NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ZNE '27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NANE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes El No ❑ NA ,y� 1�J NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ No ❑ NA CkNE 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 W 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 OkNo ❑ NA ❑ NE General Permit? (iel discharge, freeboard problems, over application) 32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA V NE 33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA El NE 12128104 4 0 Division of Water Quality :Facility Number �j S� 1 Q'Division of Soil and Water Conservation - - 0.Other Agency . Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: Arrival Time: Departure Time: I� County: C-IN Region: Farm Name: n Owner Email: Owner Name: LE S LI c Phone: _ Mailing Address: Physical Address: Facility Contact: [� Title: Onsite Representative: C �S L 1 En 1� • (A3 H l T i C PN Certified Operator:. L Cr S L I C V` _ (A3 H t7T6•1�, Back-up Operator: Location of Farm: Phone No: Integrator: l_ Operator Certification Number: w Back-up Certification Number: Latitude: = c = d Longitude: = ° = 1 = LI Design . Current Design. Current Design Current 1.­S'vine, . Capacity Population Wet Poultry Capacity Population Cattle Capacity; _Population , Wean to Finish er Wean to Feeder � 1. rEPINon-Layer Feeder to Finish (0 CST & SCE i Farrow to Wean Dry Poultry Farrow to Feeder Farrow to Finish Gilts Other ❑ Other ❑ Layers El 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? ❑ Dairy Cow ❑ Dairy Calf ❑ Dairy Heifer ❑ Dry Cow ❑ Non -Dairy ❑ Beef Stocker ❑ Beef Feeder ❑ Beef Brood Co 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)? Numberof Structures:v., 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? Page I of 3 ❑ Yes �No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes gNo ❑ NA ❑ NE ❑ Yes UqNo ❑ NA ❑ NE 12128104 Continued L Facility Number: — y Date of Inspection MQ Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes, is waste level into the structural freeboard? Structure 1 Structure 2 Structure 3 Structure 4 Identifier: 6 /GO OA -1 Spillway?: Designed Freeboard (in): S 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 XNo ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE Structure 5 Structure 6 ❑ Yes .0 No ❑ NA ❑ NE ❑ Yes VNo ❑ 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 4 No ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes _J�'No ❑ NA ❑ NE (Not applicable to roofed pits, dry stacks and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes/ No ❑ NA ❑ NE maintenance/improvement? 11 11. Is there evidence of incorrect 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 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 12. Crop type(s) 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes i 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 4� No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes o ElNA ElNE 18. Is there a lack of properly operating waste application equipment? ElYeso T ❑ 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): ReviewerlInspector Name X6A Q [ 14 F Phone: Reviewer/Inspector Signature: Oj� Date: q 4 Page 2 of 3 12128104 Continued Facility Number: Date of Inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes I� No ElNA ❑ NE the appropirate box. ElWUp El Checklists El Design ❑Maps El Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes AIo ❑ 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 Cade 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ''o No ❑ NA ❑ NE 23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes fi�'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 ONo ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes KNo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 9No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ElNA ❑ 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 [I NA El NE 33. Does facility require a follow-up visit by same agency? ❑ Yes 4No ❑ NA ❑ NE Page 3 of 3 12128104 Division of Water Quality Fdcility Number S') ( O Division of Soil and Water Conservation Q Other Agency Type of Visit Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit ,Coopliance (;Routine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access Date of Visit: Arrival Time: ® Departure Time: County: V Region: Farm Name: Owner Name: Mailing Address: Physical Address: Facility Contact: Title: Onsite Representative: LESLI. = _ WIMP Certified Operator: Back-up Operator: Location of Farm: Swine Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Boars Other ❑ Other Owner Email: Phone: Phone No: Integrator: Operator Certification Number: Back-up Certification Number: Latitude: [ c =' = Longitude: = o = 6 = Design Current Design Current Capacity Population Wet Poultry Capacity Population ❑ La er ❑ Non -Layer Dry Poultry ❑ Layers ❑ Non -Layers ❑ Pullets ❑ Turkeys ❑ Turkey Poults ❑ Other Discharees & Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? Cattle Design Current I Capacity Population ❑ Daia Cow ❑ Dairy Calf ❑ Dairy Heifei ❑ Dry Cow ❑ Non -Dairy ❑ Beef Stocker ❑ Beef Feeder ❑ Beef Brood Co Number of Structures: 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 No ElNA ❑ NE ElYes 2rNo ❑ NA ❑ NE 12128104 Continued Facility Number: 31 Date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L✓j No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: LACy" tJ Spillway?: Designed Freeboard (in): «�S Observed Freeboard (in): 34 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes El NA El NE (ie/ large trees, severe erosion, seepage, etc.) /No 6. Are there structures on -site which are not properly addressed and/or managed [:]Yes ❑ 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 ENo ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PNo ❑ 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 ENo ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZJ No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 1 o Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area 12. Crop type(s) 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ON' o ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes O�No El NA El NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes , TKI o ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes ff 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. f Use drawings of facility to better explain situations. (use additional pages as necessary): 0(w UACrGOti DESZ60 DoA)E . OX) WASTfo APftTL4T.1GW AP LL(cD ON aSS nNJ J:OCAL S`WD 6F &R-of 0FG, zv6fo. ►Jciir' -(Cp" O"Pao.% ArAe#vDM.E►­rT FroA-- CA.0e A ll Que-smo&A CAij- Dw4 � P �J►TL 1�.2.aP `�Sk LA R� Lo2DS . e,r 'r4 u Reviewerllnspector Name J 14Phone: �'j l p) 7 1G �— 7W Reviewer/Inspector Signature: Date: u 12128104 Continued Facility' Number: Date of Inspection I T/t Required Records & Documents ,—,/ 19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes ,DNo El NA El NE lK 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other ��,, �� 21. Ram ord keeping need improvement? If yes, check the appropriate box below. D'Yes ❑ No El NA ❑ NE e Application ❑ Wee Freeboard El Waste Analysis El Soil Analysis El 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 [TN_ ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E]�No ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2,90 ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ElNA ElNE 26. Did the facility fail to have an actively certified operator in charge? ElYes ,0,No ETNo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No 2NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0'9-o- ElNA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes O 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 To ❑ 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 -.to ❑ NA ElNE 33. Does facility require a follow-up visit by same agency? ElYes ,El, L`"fNo ❑ NA ❑ NE Comments and/or Drawings: 12128104 Division of water Quality Facility Number �� Division of Soil and Water Conservation -. _ - _.. Other Agency Type of Visit (Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance Reason for Visit Q Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access Date of Visit: Arrival Time: ® Departure Time: County: Farm Name: Owner Name: Mailing Address: Physical Address: Facility Contact: Title: Onsite Representative: ids Uz- tl, 01TT60 _ Certified Operator: Back-up Operator: Location of Farm: Owner Email: Phone: Phone No: Integrator: Operator Certification Number: Back-up Certification Number: Region: Latitude: = o ❑ t = Longitude: ❑ o = ' = Design Current. Design Current Design Currents Swine. Capacity Population Wet Poultry Capacity Population Cattle Capacity 'Population,-, Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Boars Other ❑ Other ❑ La er ❑ Dairy Cow ❑ Non -La er ❑ Dairy Calf -` - Dry Poultry ❑ Dairy Heifer E]Dry Cow ❑ Non -Dairy ❑ La era ❑ Beef Stocker ❑ 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? JL! Beef Brood Cow4 1 11 gg k pb7 um of Structures p.I IF 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? Page 1 of 3 ❑ Yes 6No' ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes L2(No ❑ NA ❑ NE ❑ Yes [DN/o ❑ NA ❑ NE 12128104 Continued Facility Number: y — Date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes, is waste level into the structural freeboard? Structure 1 Structure 2 Structure 3 Identifier: G-W/J Spillway?: W, Designed Freeboard (in): a4 Observed Freeboard (in): 1 ❑ Yes /No ❑ NA ❑ NE El Yes ❑No El NA ❑NE Structure 4 Structure 5 Structure 6 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or closure plan? ❑ Yes No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm ntal 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? El Yes LQ 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 2eo ❑ NA ❑ NE maintenance or improvement? Waste Application -- 10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes QTo ❑ NA ❑ NE maintenance/improvement? l l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes io ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 12. Crop type(s)n}� 13. Soil type(s) tj 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes -ETNo ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes E; N ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? El Yes ElNA [INE 18. Is there a lack of properly operating waste application equipment? El;NoYes ❑ 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):. 20.) 5l'N11 bt,/o COY ar' ntEl-�) LAG 6oAJ kJ fv 9,6V-ZOJ IV ANO rrAE_(f3on1e40 "V&C OIL REs&r LC-vEL RU(,Z) z5,) leC-C,t ,op oG rLaoGC SSdaVf tVZM R-6LOrlb, SCND cof? AL4d& wz719 0 & aov Q c ,fx(N . Reviewer/Inspector Name Reviewer/Inspector Signature: Page 2 of 3 L�Gu I Phone: A.. Date: 12128104 Facility Number: —124 Date of Inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Y s VNIo ElNA ❑ NE 20. Does the facility fail to have all components of the CA readily available? If yes, check Yes El El NA ❑ NE the appropriate box. ❑ WUP ❑Checklists esign El Maps ❑Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E o ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes WN El NA [I NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes L� o ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? Ld Yes ❑ No ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes �eo ❑ N ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes El No fA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ,.[Xo LJ o ❑ NA ❑ NE and report the mortality rates that were higher than normal? 30. At the time of the inspection did the facility pose an odor or air quality concern? ElYes 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 El"'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 EVo ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes LJ No ❑ NA ❑ NE Additional Comments and/or Drawings: Page 3 of 3 12128104 Type of Visit to Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit )6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: 9!1 �� Arri� al Tim/e�: 2i eparture Time: 2r OC, ounty: Farm Name: ( ,'fF r��Q — i[ ,-"4 �. Owner Email: Owner Name GE�Z [rTTef� Phone: _ Mailing Address: Physical Address: Region: Facility Contact: Title: Phone No: Onsite Representative: Zs.Sz rc 44r- y' SS'a Integrator: &/.t oe /_5;71'�Ll Certified Operator: Back-up Operator: Location of Farm: Swine Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Boars Operator Certification Number: Back-up Certification Number: Latitude: = c = 6 [ Longitude: ❑ o ❑ d Design Current Design Current Capacity Population Wet Poultry Capacity Population ❑ Layer I❑ Non -Layer. Other ❑ Other - -- - - i Dry Poultry ❑ Layers ❑ Non -Layers ❑ Pullets ❑ Turkeys ❑ urkey Poults ❑ Other Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? Design Current Cattle Capacity Population ❑ Dairy Cow ❑ Dairy Calf ❑ Dairy Heifej ❑ Dry Cow ❑ Non -Dairy ❑ Beef Stocker ❑ Beef Feeder ❑ Beef Brood Cow Number of Structures: 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 Z No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes No ❑ NA ❑ NE ❑ YesxNo ❑ NA ❑ NE 12128104 Continued Facility NumberO/ Date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes, is waste level into the structural freeboard? Structure 1 _ Structure 2 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): Structure 3 Structure 4 ❑ Yes ZNo ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE Structure 5 Structure 6 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ElNA ElNE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes '0 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 ANo ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes /JZNo ❑ 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 ONo ❑ NA ❑ NE maintenance or improvement? Waste Application I0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VrNo ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 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) L/.. &21Jt�J 13. Soil type(s) �Ql� 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 ElNA [INE 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? ❑ YesP No El NA El NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes YNo ❑ NA ❑ NE cry=s7 70'_ t4t2Fa=- rW �rj� �i�st/ fir✓ ���`' %��,.D� � �� ��/�JOr/.�. Reviewer/Inspector Name 63t4,: /Q i Phone: Reviewer/Inspector Signature: Date: 12129104 Condnued Lt Facility Number: — Date of Inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P"'o ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes XNo ❑ NA ❑ NE the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No [I NA El 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 XNo [:INA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYes 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 XNo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No eNA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ONo ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes �dNo ❑ 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 ONo ❑ 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 jNo ❑ 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 VNo ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes 2INo ❑ NA ❑ NE (Additional 'Coruments.and/or'. Drawings lU T I212&04 ]Type of Visit 0 Coopliance Inspection Q Operation Review O Lagoon Evaluation Reason for Visit O(Routine O Complaint Q Follow up O Emergency Notification Q Other ❑ Denied Access Date of Visit: Tune: 2 D Facility Number Q Not erational Q Below Threshold Permitted Certified © Con�.ditionally Certified Q Registered Date -Last Operated or Above Threshold - Farm Name: . _ . %f-�Q ...$NI_ _ , County: Ail P I/vj Owner Name: Mailing Address: Phone No: Facility Contact: ____ _ _ . _ _ _. Title: Phone No: Onsite Representative: .. l,S l+l Integrator. Certified Operator: Location of Farm: Operator Certification Number: ❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • U As Longitude • 4 �u �Destgij t ; t > 'Curren r `Garrett — uD - t - Curren _ r Swine =i~Ponitry 'tin Cattle _ spa-Po Wean to Feeder Layer Dairy Feeder to Finish 2,,25 b Non -Layer Non -Dairy Farrow to Wean " t Other Farrow to Feeder El Farrow to Finish To#a� Gilts Boars �� a; " r JL6bFSSLW _ ar Namber olf �_ ,�r,;� _ ..... _.. ,.,_ yam.....';.^" Discharges & Stream tin acts 1. Is any discharge observed from any part of the operation? ❑ yes Imo Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ 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 ❑ No 2. Is there evidence of past discharge from any part of the operation? ❑ Yes 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No Waste Collection & Treatment 4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: -- I -- _ . ---- _ M__.... .. _ _ _ _ _ Freeboard (inches): 24 12112103 Continued Facility Number: 31— 57 Date of inspection W d 5. :Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [/No seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or El Yes ]�No closure plan? (If any of questions 4-6 was answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ) 7. Do any of the structures need maintenance/improvement? ❑ Yes F'Ko 8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes 1.1wo 9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ o elevation markings? Waste Application 10. Are there any buffers that need maintenance/improvement? ❑ Yes LSN/o 11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes M'1VO ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc 12. Crop type C 5W 13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes lmo 14. a) Does the facility lack adequate acreage for land application? ❑ Yes No b) Does the facility need a wettable acre determination? ❑ Yes UNo c) This facility is pended for a wettable acre determination? ❑ Yes GKo 15. Does the receiving crop need improvement? ❑ Yes To 16. Is there a lack of adequate waste application equipment? ❑ Yes Lh"No Odor Issues 17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below ❑ yes E:CNo liquid level of lagoon or storage pond with no agitation? 18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes EI(No 19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �Fo 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 VNo Air Quality representative immediately. ❑ Field Copy ❑ Final Notes 23,) APP L_tr.AT",,,/ otJ ca- rw l C"i' wM +r h SUP196SCO tb 8(c Coo -IV Au n A -ra gjusr_ eAR-APhrz (,A-FEMJ 6-f N;7OG(d, P ru, 6� a fin-, =�' S�-c.Y} Q.�m ,�v 6"-V MW Cn'dN �k,Urstl. N1 qz 1. � Ej_,_A 7T(tV`1�, eAg-0 L.C`CT. a'.►� W-T-t-^tJ6-'i�It TbalaJ fA Reviewer/Inspector Name t, Reviewer/Inspector Signature: Date: 1 ti t' UtUtu1 LAnunaw Facility Number: Date of Inspection # •► 0 Rom. aired 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. Doe ord 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 reviewlmspection with on -site representative? 28. Does facility require a follow-up visit by same agency? 29. Were any additional problems noted which cattle 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 V Rain ❑ 120 Minute Inspections ❑ Annual Certification Form ❑ Yes ❑ Yes �No OYes ❑ No ❑ Yes ❑ Yes lJ I ❑ Yes N ❑ Yes ❑ Yes FNo ❑ Yes Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No 12112103 i Is Type of Visit 'Compliance Inspection 0 Operation Review 0 Lagoon Evaluation Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access Facility Number Date of Visit: Z 1S O Time:IQ I 3 t S 4 Not O erationat 0 Below Threshold [] Permitted Q Certified [3Conditionally Certified 0 Registered Date Last Operated or Above Threshold: Farm Name: Q �' 11 G di Y_� hc, -r4r "`. County: , nw e)1►1 Owner Name: +' e S)'G W � ` -A Phone No: Mailing Address: Faeility Contact: Title: Onsite Representative: &S a 1A Certified Operator: Location of Farm: Phone No: Integrator: e boo npfe hl Operator Certification Number: swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 " Longitude 0 6 IJ K Wean to Feeder Feeder to Finish I / 2- A I 6, / D Farrow to Feeder "LJOthcr Farrow to Finish Boars Subsurface Drains Present jjU Lagoon Area No Liquid Waste Management Svstem Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other a. If discharge is observed, was the conveyance man-made? b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) c. If discharge is observed, what is the estimated flow in galimin? d. Does discharge bypass a lagoon system? (If yes, notify DWQ) 2. Is there evidence of past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? Waste Collection & Treatment 4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Identifier: i Freeboard (inches): 2 05103101 iWW1' ❑ Yes Y(No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No ❑ Yes,"No ❑ Yes �No ❑ Yes ONO Structure 6 Continued M Facility Number: 31 -5 94 Date of Inspection Z l5 D Z 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or closure plan? (if any of questions 4-6 was answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ) 7. Do any of the structures need maintenance/improvement? 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? ❑ Yes 'ONO ❑ Yes ONO Yes ❑ No ❑ Yes O'No ❑ Yes ONO Waste Application 10. Are there any buffers that need maintenance/improvement? ❑ Yes VNo 11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 0No 12. Crop hype C a rv+114 A. -A 6e_e, Y•s _ 13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ;;rNo 14. a) Does the facility lack adequate acreage for land application? ❑ Yes VNo b) Does the facility need a wettable acre determination? ❑ Yes No c) This facility is pended for a wettable acre determination? ❑ Yes VNo 15. Does the receiving crop need improvement? ❑ Yes'0No 16. Is there a lack of adequate waste application equipment? ❑ Yes ONO Required Records & Documents 17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes,ONO l8. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? (ie/ WUP, checklists, design, maps, etc.) ❑ Yes ❑ No l9. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ZNo 20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes , /ZNo 21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ,["No 22. Fail to notify regional DWQ of emergency situations as required by General Permit? ❑ Yes �No (ie/ discharge, freeboard problems, over application) 23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes j'No 24. Does facility require a follow-up visit by same agency? ❑ Yes ffNo 25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes JZ No 10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. Comments (refe�r�to queshon#} Egplatn anyYES answers=andlvr�any recvmmend.ahons ats;any otlier'c'o'inments y., . , h � Use drawings of facrlityFto better exglam situahons (use addihonaLpages as necessary) � ,; "� ,, ° ❑Field Copv ❑ Final Notes T TI ere are Sowte looks c? ' wAs+r, 4ke hag kac.'-Se . yet^ need Jo _�';)e 4t ese tea ks , J 14, We; able'Acecs �Ctse 6ecen chine as o-' NOvern6e,r ZOO]. N eed 1..,r;11 oLd ; vtSCt_+) 04..3 q n d ►'ri 0 foal t ti� �,cC►v+�v� G�!' c �t� }' �, Reviewer/Inspector Name '' ` j) z-: �k �,S Reviewer/Inspector Signature: Date: 1 O Z 05103101 Continued r Facility Number: -3 1 --5 741 Date of Inspection Printed on: 7/21/2000 Odor Issues 25. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes ❑ No liquid level of lagoon or storage pond with no agitation? 27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONo 28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ff No roads, building structure, and/or public property) 29. Is the Iand application spray system intake not located near the liquid surface of the lagoon? ❑ Yes f'No 30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or or broken fan blade(s), inoperable shutters, etc.) ❑ Yes E'No 31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑'No 32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNo 5100 L ti. Division of Water all Qu ty _.. Divrsiori of Soil and Water Consesrvatroa r Other A enc - - - 0 g y m N Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation Reason for Visit outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access Facility Number Date of Visit: Time: [--= Printed on: 7/21/2000 NNot Operational Q Below Threshold 13 Permitted 4-certified © Conditionally Certified © Registered Date Last Oper d or Above Threshold: Farm Name: ...... .!!.1r4... ...1.' ' ..................I.. .................................. County:... .... .f / 1..................................... OwnerName:........................................................................................................................... Phone No:.................................................. Facility Contact:..................................................................... .... Title: .. ..... Phone No: MailingAddress:..................................................................... ....................... ...._............._................................................................................... .......................... Onsite Representative:.. �,,5�/........... UR,� Integrator....... .............. :.... Certified Operator:....................................................................._.......................................... Operator Certification Number:.......................................... Location 'of Farm: 0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude D A' Curreul Svidne , _Ca a -Po uladC Wean to Feeder ceder to Finish Farrow to Wean s Farrow to Feeder Farrow to Finish Gilts Boars Nttiubetr of Lagoons HbMini Ponds'PSohn Trai PS.. ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area ❑ No Liquid Waste Management System Discharees & Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other a. If discharge is observed, was the conveyance man-made'' b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) c. If discharge is observed, what is the cstirnated flow in gal/min? d. Does discharge bypass a lagoon system? (If yes, notify DWQ) 2. Is there evidence of past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? Waste Collection & Treatment 4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Structure I Structure 2 Structure 3 Structure 4 Structure 5 Identifier: ......... Iiz.(4.......................................................................................................................I............................., Freeboard (inches): 5/00 ❑ Yes 9No ❑ Yes ❑ No ❑ Yes A //❑ No ✓vq_J ❑ Yes ❑ No ❑ Yes 14 No ❑ Yes r 0 ❑ Yes KNo Structure b Continued on back Fa ility Number: Date of Imspection Printed on: 7/21/2000 Odor Issues 26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ,KNo liquid level of lagoon or storage pond with no agitation? 27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes )kNo 28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes IVNo roads, building structure, and/or public property) 29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes )ETN0 30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or or broken fan blade(s), inoperable shutters, etc.) ❑ Yes o 31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �00 32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ,'VNo 5100 FaONty Number: 1— Date of Inspection r/ Printed on: 7/21/2000 1 5. Are there any immediate thre s to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or closure plan? El Yes �No (If any of questions 4-6 was answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ) 7. Do any of the structures need maintenance/improvement? ❑ Yes KNo 8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes (VTNo 9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level elevation markings? ❑ Yes �,, kNo ,r Waste Application 10. Are there any buffers that need maintenance/improvement? ❑ Yes kNo '"�\'�i� 11. Is there evidence of over pplication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes o ' 12. Crop type 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 o c) This facility is pended for a wettable acre determination? ❑ Yes No 15. Does the receiving crop need improvement? ❑ Yes No 16. Is there a lack of adequate waste application equipment? ❑ Yes AFo Reauired Records & Documents 17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes kNo 18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? (ie/ WUP, checklists, design, maps, etc.) ElYes KNO 19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes XNo 20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes J�rNo 21. Did the facility fail to have a actively certified operator in charge? ❑ Yes <N0 22. Fail to notify regional DWQ of emergency situations as required by General Permit? (ie/ discharge, freeboard problems, over application) ❑ Yes 15r-No 23. Did Reviewer/]nspector fail to discuss review/inspection with on -site representative'? ❑ Yes JAio 24. Does facility require a follow-up visit by same agency? ❑ Yes ONO 25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes )�INo : To-yiolatioris:or deficiencies •were hotted• during this:visit. • Y:oil will-k& ive 1i0 furthgr - eorres o deik' ahotiti this visit. . .,ommenfs (refer to" question ft Explain any YES answers and/or any recommendations 6r any other comments .- Jse drawui of facility to better.explain situations. (use additional pages as neeessary)^ ,:. Its.. _ _ � . = _ ., r _.. 00 RA C w Reviewer/Inspector Name Reviewer/Inspector Signature: �' �� n/I I Dri-,�i� Date: L D&s U1Wz5/pp _ .E3 Division of Soil and -Water Conservation �-Operation Review : , - w; rvrsion of Soil and: Water Conservation Compli nee Inspection 0 Division of Water Quality ;Compliance Icpectiori { ` .,• R , „0 Other Agency Qperation Review E - ISERoutine O Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other Facility Number 3 Date of Inspection 'Time of Inspection 0 O 24 hr. {hh:mm} ❑ Permitted afied © Conditionally Certified Q 13 Not Operational Date Last Operated: Registered �" 1 Farm Name: ~ County:._........- t.. I,i_............................ I.................. Owner Name: Facility Contact: ........... :Mailing Address:..-.-. ................. ... .......... ...... ..... ........ .............................................. ....... Phone No:...................._.... ................... .............. ....................................... _ Title: .... .---- -........ ............................ I................. Phone No: Onsite Representative:. 1,,+` Q! .....,,..- Certified Operator; Location of Farm: .....................................................................................................................................:... .......................... Integrator:... ...................... ....................................................... Operator Certification Number: Latitude �� Longitude • �° �= =- Design Current Design Current.. Design Current v... , .. :. ... Swine _ v Canacity Ponulation Poultry_. Canacity Podulation Cattle CanacltV Pooulatron,, ❑ Wean to Feeder Feeder to Finish ' 'a-0 ❑ Farrow to Wean ❑ Farrow to Feeder ❑ Farrow to Finish ❑ Gilts ❑ Boars Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? ❑ Yes KNo Discharge originated at: ElLagoon ElSpray Field ❑ Other a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No c. If discharge is observed, what is the estimated flow in gal/ruin'? d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) 2. Is there evidence of past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? Waste Collection & Treatment 4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Structure I Identifier: Freeboard (inches): _..........a. y ..�............. Structure 2 Structure 3 Structure 4 Structure 5 ❑ Yes ❑ No ❑ Yes PJ No ❑ Yes 9No ❑ Yes IxNo Structure 6 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, seepage, etc.) 3/23/99 ❑ Yes ��No Continued on f back aciliOOumber: — Date (11• Inspection 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or closure plan? (If any of questions 4-6 was answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ) 7. Do any of the structures need maintenance/improvement? S. Does any pan 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? 11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN 12. Crop type 13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? 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? Required Records & Documents 17. Fail to have Certificate of Coverage & General Permit readily available? 18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? (ie/ WUP, checklists, design, maps, etc.) 19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) 20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? 21. Did the facility fail to have a actively certified operator in charge? 22. Fail to notify regional DWQ of emergency situations as required by General Permit? (ie/ discharge, freeboard problems, over application) 23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? 24. Does facility require a follow-up visit by same agency? 25. Were any additional problems noted which cause noncompliance of the Certified AWMP? 0: Rio •yiblaliEgns:or• &hcje.ncies were noted• during tbis'visit: • Y:oik will•r. eeeiye iio further " correspoiidehc' e' abauti this visit. ❑ Yes VNo ❑ Yes VNo ❑ Yes b�No ❑ Yes D�(No ❑ Yes No ❑ Yes No ❑ Yes XNo ❑ Yes Nf No ❑ Yes 9No ❑ Yes No ❑ Yes No ❑ Yes NtNo ❑ Yes N'No, ❑ Yes IRrNo ❑ Yes Wo ❑ Yes [yNo ❑ Yes P(No ❑ Yes j0No ❑ Yes No ❑ Yes 0 'No ar. ❑ Yes _�O -Comments `(refer to-questida #) Eacplarn any -YES answers and/or any recommendations or any, other--'-'cmments Use dr-a. w_i.n o_f facilrtY to'better ,ilain situatibnsi �.u.se.addi-tt o�n._al a s_ as_mecessaryex _ 1 1 1 f �G.�'2 rytre �1[Y>�� ii� i� y'� `7`� ►��� CC'�C.l �_ C � W�3' � Q ` i S - Ale,— � y 3/23199 Facility Number:,-3 Date of Inspection Odor Issues 26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes gNo liquid level of lagoon or storage pond with no agitation? 27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes RNo 28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XfNo roads, building structure, and/or public property) 29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes t`No 30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 19No 31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 9No 32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes �No AdditionalComments and/or. Drawingsc J 3/23/99 Division of Soil and Water Conservation [3 Other Agency 4 z ®Dtviston of Water Quality ri Routine O Complaint O Follow-up of DIVQ inspection O Follow-up of DSWC review O Other Date of Inspection t �� Facility Number Time of Inspection L.[J 24 hr. (hh:mm) 'Registered © Certified 13 Applied for Permit © Permitted 113 Not O eretirsnal Date Last Operated: ,.,,,,,, Farm ]Name �;�;il<i�.'.���.►`g �1;; rr. ....................... ... County:..... pw�>) } c......................................... ....................... `. OwnerName: ....... Le. -La ......... 11 kiiij........................................................................ Phone No:. r' 19i..�i.S. %... L.Z............................................. FacilityContact: - } . Title .....�t.Sift........W�rl,:�a�fJ...................................D.:.As�..................................... Phone No: .61..11.k5k16.41........ Mailing Address: ... .,t'19.3......... N.L,..55skn..................... ....... OnsiteRepresentative: ....... PfS i. .....'!?�i. at ........................................................ Integrator: ....... 1.n�.t. .>............................................. Certified Operator:........ Lnkc.............. 9 .............Gj................................ Operator Certification Number, .... J1j...&.P4.................. Location of Farm. �Y.L....Ihay...y ..-r..... x .... .-.!�R.! �. a�rr...... e.......t1.r�....SR.1.F�,.. F.arm...... a.s........A.,.l...miLt ...(�5.1 ......S&J.111..I...... 4.n .....>a a s.... 4 L...... !..:......................................... ............................................. ....................................................................................... ......................... F, Latitude 0• 04 46 Longitude • 0° 44 General 1. Are there any buffers that need maintenancelimprovement? ❑ Yes 12 No 2. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other a. If discharge is observed, was the conveyance man-made? b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) c. If discharge is observed, what is the estimated flow in gal/min? d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) 3. Is there evidence of past discharge from any part of the operation? 4. Were there any adverse impacts to the waters of the State other than from a discharge? 5. Does any part of the waste management system (other than lagoonstholding ponds) require maintenance/improvement? 6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? 7. Did the facility fail to have a certified operator in responsible charge? 7125I97 ❑ Yes P No ❑ Yes ® No ❑ Yes No - T ❑ Yes No ❑ Yes ® No ❑ Yes No ❑ Yes No ❑ Yes ® No ❑ Yes ER No Continued on back Facility Number: — 5 8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No Structures (L oons,Holdin2 Ponds Flush Pits, etc.I 9. Is storage capacity (freeboard plus storm storage) less than adequate? Yes No Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 0 Identifier: Freeboard(tt1-L., ................................................................................................................................................................................... 10. Is seepage observed from any of the structures? ❑ Yes [9 No 11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ® No 12. Do any of the structures need maintenance/improvement? Q Yes ❑ No (If any of questions 9-12 was answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ) 13. Do any of the structures lack adequate minimum or maximum liquid level markers? Yes ❑ No Waste Application 14- is there physical evidence of over application? ❑ Yes ® No (If in excess of WNW, or runoff entering waters of the State, notify DWQ) 15. Crop type ...........S9, )V 4A!s................. lr_O.r.1.A................. W1.1 .. A ................. ........................... ............... .............. ........................ ..................... .............. .-. 16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? Yes ❑ No 17. Does the facility have a lack of adequate acreage for land application? ❑ Yes 5d No 18. Does the receiving crop need improvement? ❑ Yes N No 19. Is there a lack of available waste application equipment? ❑ Yes ® No 20. Does facility require a fallow -up visit by same agency? ® Yes ❑ No 2t. Did ReviewerAnspector fail to discuss review/inspection with on -site representative? ❑ Yes 10 No 22. Does record keeping need improvement? ®,Yes ❑ No For Certified or Permitted Facilities Only 23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ❑ No 24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No 25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ❑ No 0 No.violations or. deficiencies were noted during this, visit. :You4ill receive''no further ` correspondence about this.visit:-' ; Explain:any YES answers and/or any reromrtiendattonsor any -other comments. �r.+ -re � - - r - - - :a ri -- _ .+ Fes•, F' a,X„� '„'�"as 1 Z. r -0c,18-r, (,_ms o„ ►, l �ntr rOv�ta� dlke Wfr if c S�cv� x �i ��C� u;i e u�.d wsee�{�t Tfcrs �_a:r 6�4ur del& w,,11,. anl, c.+ S�►ou�r� 1t rccPeJt��. �►"(Ak y %. S�. -e cvj� I),-,. t, -ex d c -,?-�cs iocmaoq l�Ck - llN 1 to, k r icar cl.,t2 t,,-1e-e ed 13. i.•Cteppn i�dulit ljU� �lF*V►� t,c.wt� yy,gr��.�, Ifs 5at4�ran S f1WA frl' iA Pit11)t atZ� Ttd �r �Irr+ owuJ hi�n►WL�. ZZ. ?J nvt.6 . a-f Ert(iV t. A�iti;ts#►,:r-fat 14 Yay r, wtu rosvij hAct Reviewerfinspector Name , Reviewer/Inspector Signature: µ - Date: I l h-7 q7 • Site Requires Immediate Attentio Facility No. DIVISION OF ENVIRONMENTAL MANAGEMENT ANIMAL FEEDLOT OPERATION SITE VISITATION RECORD DATE: / , 1995 Time: i33o Farm Name/Owner: Mailing Address: County: LAG/ nl Integrator. On Site Representative: Physical Address/Location: W141 , -4/ng, Phone: J (5 4yN Phone: �/ y G =S_e�q) Type of Operation: Swine ✓ Poultry , Cattle Design Capacity: �IJrJ Number of Animals on Site:�Q DEM Certification Number: ACE DEM Certification Number: ACNEW Latitude. /� ' �" Longitude: -72—' _Q2_LL" Elevation: Feet Circle Yes or No Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event (approximately 1 Foot + 7 inches) Yes q9 Actual Freeboard'x� LFL Inches Was any seepage observed from the lagoon(s)? Yes N� Was any erosion observed? Yes No '% Is adequate land available forj� my? Yes or No Is the cover crop adequate? Yes or No Crop(s) being utilized: C1_D19 ST^t- Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es, r No 100 Feet from Wells?(5 r No Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other similar man-made devices? Yes or No If Yes, Please Explain. Does the facility maintain adequate waste management records (volumes of manure, land applied, spray irrigated on specific acreage with cover crop)? Yes or No Additional C 1pments: el �P�1�77al LeOiCS MtUN- -F. RLTf9R 30 i�)ifVW_ 41 cc: Facility Assessment Unit Use Attachments if Needed. • • Site Requires Ittunediate Attention: ' Facility No31= ;Ez< DIVISION OF ENVIRON-iMENTAL MANAGE:yIE�`"I' ANI`T%/ AL FEEDLOT OPERA;MYE VISITATION RECORD DATE: 1995 Time: Farm Name/Owner: Mailing Address: County: � Inteato,' 0 Phone: On Site Representative: Phone: - Physical Address/Location: J Type of Operadon: Swine Poultry Cattle Design Capacity: i Number of Animals on Site: DEM Certification Number. ACE DEM Ce:dficadon Number: ACNEW Ladnide3i ° �_' /i " Longitude: % 0Y- ' ��—" Elevation: Fee: Circle Yes or No Does the Animal Waste Lagoon have sufficient ueeboard of 1 Foot _ 25 year 24 hour storm event (approximately 1 Foot 7 inches) Yes or No Actual Freeboard: Ft. Inches Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No Is adequate land available for st3rav? Yes or No Is the cover crop -adequate? Yes o No Crop(s) being utilized: Does the facility meet SCS minimum setback, criteria? 200 Feet from Dwe'.IinQs? Yes or No 100 Feet from Weis? Yes or No Is the animal waste stockpiled within 100 Feet of USGS Blue Line Swam? Yes or No Is animal waste land applied or spray irrigated within 25 Feet of a USGS I'Viap Blue Line? Yes or No Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other similar man -trade devices? Yes or No If Yes, Please Explain_ Does the facility maintain adequate waste management records (volumes o; manure, land applied, spray irrigated on specific acreage with cover crop)? Yes or No Additional Comments: � a t ,. c { IC<�'r 17..L 4i1 Vvi.� c, Yl Inspector Name Signature cc: Facility Assessment Unit Use Anachrni nts if Needed. Site Requires Immediate Attention - Facility No. 3 $ DIVISION OF ENVIRONMENTAL MANAGEMENT ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD_ ' DATE: .1995 Time: Farm Name/Owner: P&LIA:t Pu,(aw, Mailing Address: _Q [ "�t LfL 06t 1i��e,t r C rib'S'c� County: r- Integrator: Phone,,. On Site Representative: ke/ . C,�ti „_!_ Phor v i�— a - Physical Address/Location: S A KI I2 v ` e—C � Type of Operation: Swine Poultry Cattle Design Capacity: LqLQ _ % Zv ( � Number of Animals on Site:. two Sv L's t a 6cx> S DEM Certification Number: ACE DEM Certification Number: ACNEW Latitude: Longitude: T) L(3' 3 S " Elevation: Feet Circle Yes or No Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event (approximately 1 Foot + 7 inches) r No Actual Freeboard: Ft. ® Inches Was any seepage observed from the agoon(s)? Yes o& Was any erosion obs�Yes 010 Is adequate land available for spray? or No Is the cover crop ade'q�u. }at Yes or No au S` Crop(s) being utilized: Lo war [_.__.- Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es r No 100 Feet from Wells? es or No Is the animal waste stockpiled within 100 Feet of USES Blue Line Stream? Yes or No Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No Is animal waste discharged into waters of the state by man-made ditch, flushing system, or" other similar man-made devices? Yes orC11 If Yes, Please Explain. Does the facility maintain adequate waste management records (volumes of manure, land applied, spray irrigated on specific acreage with cover crop)? Yes or No Additional Comments: - 1%w` / Inspector Name Signat lb cc: Facility Assessment Unit ., Use Attachments if Needed.