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820714_INSPECTIONS_20171231
NORTH CAROLINA Department of Environmental Qual its (Type of Visit: (:fCompliance Inspection U Operation Review U Structure Evaluation O Technical Assistance Reason for Visit: eutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access Date of Visit: ::, Arrival Time: Departure Time: ,, q County: Region: Farm Name: FctfYv— I Owner Email: Owner Name: oer,-- L � � Phone: e Mailing Address: Physical Address: Facility Contact: �24J01W ;� �,[ Ji /�; p► F.-S Title: /f %c Phone: Onsite Representative: ��7 Integrator: `j,'�-�nI Certified Operator: Certification Number: Back-up Operator: Location of Farm: Latitude: Certification Number: Longitude: ��Design Current Design aCarrent Design Current "Ga„ p� aacrit Pap. Wet Poulfry Capacity Pvp. Cattle Capacity' Pvp. an to Finish La er Dai Cow to Feeder KFder Non -La er Dai Calf to Finish = Dai Heifer arrow to Wean �yf>� A�v Des Careen# D Cow Farrow to FeederD . �PoulCaac" Non -Dairy Farrow to Finish Layers Beef Stocker Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow Turkeys Other TurkeyPoults Other Other Discharizes and Stream Impacts 1. Is any discharge observed from any part of the operation? ❑ Yes ®.No ❑ NA ❑ NE Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? Yes [] No ❑ NA ❑ NE b. Did the discharge reach waters of the State? (If yes, notify DWR) 0 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 [a No ❑ NA ❑ NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters D Yes �o ❑ NA ❑ NE of the State other than from a discharge? Page I of 3 21412015 Continued Facility Number: Date of Inspection: Waste Collection & Treatment I's 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Callo ❑ 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): 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 allo ❑ 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 maintenances or improvement? ❑ Yes allo ❑ NA ❑ NE S. 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, anchor wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes allo ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes L�LNo ❑ 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): ,a-2�_Q. u cr z`r ,rr r✓`�!' � 13_ Soil Type(s): 151�-AJry, �3L 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 0 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 0 No ❑ NA ❑ NE IS. Is there a lack of properly operating waste application equipment? ❑ Yes [0 No ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [A No ❑ NA [] NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [a No ❑ NA ❑ NE the appropriate box. ❑WUP ❑Checklists ❑ Design ❑ Maps ❑ !_.ease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes U�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 E3 No 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑NA ❑NE ❑ Weather Code ❑ Sludge Survey ❑NA ❑NE ❑ NA ❑ NE Page 2 of 3 21412015 Continued Facili Number: - J Date of Inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes 3 No ❑ NA ❑ NE 4r 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes [K 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 [gNo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes g_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. 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 PINo ❑ NA ❑ NE ❑ Yes 23-No ❑ NA ❑ NE ❑ Yes allo ❑ NA ❑ NE ❑ Yes [ No ❑ Yes No ❑ Yes F3� No — ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE Comments (refer #o qu'estton Expla111'RRyliiYES a>lswersand/or`any additioQal reeommenrdattons onany other comments:` «: se dt a J�- [3 wlings ofacility to better explain sttu�ations'(nse aditi©naI pages as necessary) Reviewer/Inspector Name: Phone: �frj Reviewer/Inspector Signature: Date: Page 3 of 3 2141201S type of visit: U Uompliance inspection V operation Keview U structure Evaluation V .1-ecttntcal Assistance Reason for Visit: ta'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: Arrival Time: d Departure Time: County:ililli Farm Name: 1 Owner Email: Owner Name: LC Phone: Mailing Address: Physical Address: q r Facility Contact: �,*%k%lc r- W t �!l't'�l Title: Phone: Onsite Representative: Certified Operator: Back-up Operator: Location of Farm: Latitude: Regionp9 Integrator: Certification Number: x q Certification Number: `��e 0p r Longitude: Design Current Design Current Swine Capacity'' Pop. WetLI'otiltry Capacity Popes Wean to Finish La er Design Current Cattle Capacity Pop. Dairy Cow Wean to Feeder Non -La er Dairy Calf Feeder to Finish - 1600 _151i Desi Cti t I) '.P,oul Ca act l'o _. Layers Non -Layers Pullets Turkeys Turkey Poults Dairy Heifer Farrow to Wean Farrow to Feeder Dry Cow Non -Dairy Farrow to Finish Beef Stocker Gilts Beef Feeder Boars Beef Brood Cow Other Other JEJ 10ther Discharges and Stream Im acts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? ❑ Yes �o ❑ NA 0 NE ❑ Yes ❑ No OINA ❑ NE ❑ Yes [-]No Q'RA ❑ NE d. Does the discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? ❑ Yes ❑ No ❑ Yes &No ❑ Yes ZI No Q NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE LPage I 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 E'N - ❑ 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): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes B-Rbo ❑ 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 [3'�lo ❑ 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 ED' o ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes f 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 [2 No ❑ NA ❑ NE maintenance or improvement? Waste Application N 10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes 2 ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes � "o ❑ 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): a G S G l) c- a 13. Soil Type(s): 1- 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes � No ❑ NA ❑ NE IS. Does the receiving crop and/or land application site need improvement? ❑ Yes ENo ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes dNo ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes [No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑-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 O No ❑ NA ❑ NE the appropriate box. ❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑'No ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 dNo 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes [�No ❑NA ❑NE ❑ Weather Code ❑ Sludge Survey ❑NA ❑NE ❑ NA ❑ NE Page 2 of 3 21412011 Continued Facifi Number: TT - •jt( I I Date of Inspection: T 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [9-9-o ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E3:i.0 ❑ 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 2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes io ❑ 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 [3 o ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes E3 o ❑ NA ❑ NE permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CA WMP? ❑ Yes F No ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [2'Ro ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes dNo ❑ NA [] NE Reviewer/Inspector Signature: Page 3 of 3 ■ uvuc. %,j j V — - Date: -UP-4- 4 21412011 R1-ype of visit: $&-Uom Rance Inspection U Uperatioa Review U Structure Evaluation UTechnical Assistance eason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: Arrival Time: Departure Time: ,54, tf0 County: s� _ Region: iy4 Farm Name.f�- �')a,, Jcnn �,� �s7 t""Owner Email: Owner Name: H td 5 jLy 6-t Phone: Mailing Address: Physical Address: Facility Contact: Title: Onsite Representative: tI Certified Operator: Back-up Operator: kz.�'O.'Ct Location of Farm: Latitude: Phone: Integrator: 6joyt -7 uug / Certification Number: jot 5_l Certification Number:C� �Q�f Longitude: Design Cetrrent Swine Capacity Pop. Wean to Finish Wean to Feeder Wet Poultry La er I INon-Layer_--I Design Capacity Current Pop. Design Current Cattle Capacity Pop. Dairy Cow Daia Calf Dairy Heifer Dry Cow Non -Dairy Feeder to Finish 70 D , tl'oul Ca aci P:o Farrow to Wean Farrow to Feeder Farrow to Finish Layers Beef Stocker Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow - OtherF[Turkey Other Turkeys 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)? ❑ Yes EWo Q NA ❑ NE 0 Yes ❑ No [AIAA ❑ NE [] Yes ❑ No B A ❑ NE d. Does the discharge bypass the waste management system? (If yes, notify DWR) 2. 1s there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? [:]Yes [:]No ❑ Yes [3 No [:]Yes [EfrNo [J A ❑ NE E]NA ❑NE ❑ NA ❑ NE Page I of 3 21412014 Continued Faciliq Number: = - 71 Date of Inspection: Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? [—]Yes [:]No Ea KA ❑ 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? 0 Yes lo ❑ NA ❑ NE (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envtro mental threat, notify DWR 7. Do any of the structures need maintenance or improvement? Yes o ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [R' o ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes []-No ❑ NA ❑ NE maintenance or improvement? Waste Ann6cation 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2<o ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes (ZKo ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu., Zn, etc.) ❑ PAN ❑ PAN > 101/6 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): -� ems' "4,A 5-ta Z> -!�' 44.r e" 24 Y wC"T 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes gg-No ❑ 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 0 Yes [! No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes [g,<o ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes 011 to ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes E�No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes r�;Ko ❑ 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 [R<o ❑ NA 0 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 eNo ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ENo ❑ NA ❑ NE Page 2 of 3 21412014 Continued F.acili Number: NIX- S Date of Inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? [:)Yes ❑.?do ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [JKo ❑ 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 Lam <o ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C;3'<o ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31- Do subsurface tile drains exist at the facility? If yes, check the appropriate box below ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: ❑ Yes �o ❑ NA ❑ NE ❑ Yes `ems - ❑ NA ❑ NE ❑ Yes [] No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE 32. Were any additional problems noted which cause non-compliance of the permit or CAW T [:]Yes r—;Ko ❑ NA [] NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes (3"No ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes �No ❑ NA ❑ NE Comments (refer:to question ft Explain any YES answers and/or any, additional recommendations-Mr.any_,other commentsji Use drawings of facility -to better explain situations (use additional pages as'necessary). 7 I �[ .G. l �.-C �p Ut!� wl h�� J t�•rt �Grtl� f, (['� JJ 51'7Y S Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 143 --r l( a - I C1 _ 6 ^C>_). J-� ?'--?S Phone: '19 3 `333 Date: 10 6 21412014 Type of Visit: QCompliance Inspection V Operation Review Q Structure Evaluation CU Technical Assistance Reason for Visit: (DRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: Arrival Time: r Departure Time: i� County:/9`m Regions T Farm Name: )txr ij* �I "� Owner Email: Owner Name: ;S _ Sots) FLitilvx Phone: ' Mailing Address: Physical Address: Facility Contact: Q0y1 A t 'L Title: --�L Phone: lOpsite Representative, Integrator: l( Certified Operator: Certification Number: o9-I! 15-3 Back-up Operator: Certification Number: Location of Farm: Latitude: Longitude: Design Swine Capacity Wean to Finish Current Pop. Design Current We# Poultry Capacity Pop. Cattle La er Da' Cow Desigu Capacity Current Pop. Wean to Feeder Non -La er Da' Ca ` Feeder to Finish D Heifer Farrow to Wean b0 �{ Design Current D , P,nul Ca aci P,o La ers D Cow Farrow to Feeder Farrow to Finish Non -Dairy Beef Stocker Gilts Non -Layers Pullets Turke s Turke Poults Other Beef Feeder Boars Beef Brood Cow Other Other Dischar es and Stream Im acts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify 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 [DN'6--0 NA ❑ NE ❑ Yes ❑ No jf NA ❑ NE ❑ Yes ❑ No QNA ❑ NE [:]Yes ❑ No E3 A ❑ NE ❑ Yes 0:1,M ❑ NA ❑ NE [:]Yes �Ko❑ NA ❑ NE t r Page 1 of 3 21412014 Condnued FacilityNumber: - Date of Tns ection: Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No e-NX- ❑ NE Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier; Spillway?: Designed Freeboard (in): Observed Freeboard (in):� 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EJ N ❑ 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 [ ,9,D 0 NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR 7. Do any of the structures need maintenance or improvement? ❑ Yes [Bo ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [3 1`'o ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes L d ro ❑ NA ❑ NE maintenance or improvement? ` Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes L3 5"o ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ErN—o ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > I0°/a or 10 Ibs. ❑ TotaI 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): Aar,u a 14. Do the receiving crops differ m those designated in the CAWMP? ❑ Yes [04ft ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes []-3q0 ❑ NA ❑ NE 16, Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes U go- ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes C]-1do [] NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes [Vivo ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [ZNo ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E�rNo ❑ 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. 0 Yes [3/No ❑ NA ❑ Nl ❑ 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 ff No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [J'No ❑ NA ❑ NE Page 2 of 3 21412014 Continued Facili Number: - f Date of Ins ection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I+ qo 0 NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 structures) and date of first survey indicating non-compliance: 26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes ZKo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes [De o ❑ NA [] NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below. ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP? 33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative? 34. Does the facility require a follow-up visit by the same agency? Cormnents (refer M"estion # ,ExpFs and 5 � Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 ❑ Yes ❑,Ai6" ❑ NA ❑ NE ❑ Yes [g-To ❑ NA [] NE ❑ Yes []l ,Kn ❑ NA ❑ NE ❑ Yes [� o ❑ NA ❑ NE ❑ Yes [3- o ❑ NA ❑ NE ❑ Yes '�No ❑ NA ❑ NE ❑Yes [/]No ❑NA ❑NE additional; recommendation es as necessarvl. - 3� Phone: 4 3 3 Lj Date: n 21412014 iType of Visit: 'Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance J Reason for Visit: 42KRoutine 0 Complaint 0 Foliow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Ij } Date of Visit: `" Arrival Time: rlh? Departure Time: CauntyeRegion: j Farm Name: Owner Email: Owner Name: sow M AA L Phone: Mailing Address: Physical Address: Facility Contact: i AM&je +� t4 a 14'-s Title: Onsite Representative: U Certified Operator: 4 Back-up Operator: Phone: Integrator: r Certification Number: 9 Nsi Certification Number: Location of Farm: Latitude: Longitude: '+- Design Current :, FDesignrCarrent Design Curren# Swine Capacity Pop.: Wet Poultry parity Pop. Cattle+' capacity Pap. �� Wean to Finish airy Cow Wean to Feeder Non -La er Dairy Calf Feeder to Finish Daia Heifer Farrow to Wean I _,urrent Dry Cow Farrow to Feeder D ; PoW CapactvPo P. Non -Dairy_ Farrow to Finish Layers Beef Stocker Gilts Non -La ers Beef Feeder Boars Pullets Beef Brood Cow Turkeys �m Other , z', Turkey Pouets:k"' Othcr 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 �o [DNA ❑ NE ❑ Yes [] No [—]Yes [:]No [] Yes ❑ No [] Yes [3-No ❑ Yes ❑ No []-RA ❑ NE 3-NA ❑ NE [}NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE Page I of 3 2/4/2011 Continued lFa6lity Number: - )Hate of Inspection: . s Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes .Elitu'❑ NA [3 NE a. If yes, is waste level into the structural freeboard? ❑ Yes [] No [5-NA__0 NE Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q_Nd" ❑ 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 6fo ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? [] Yes E. Q ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes F "" ❑ 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 r-- No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes allo ❑ NA ❑ NE maintenance 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 [3Application Outside of Approved Area Type(s): 19_4VWJ4A S 6 V CI 12. Crop 13. Soil Type(s): L& _ U L& 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes r_e1'1qo ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? [] Yes Ef No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes [�:f No ❑ NA ❑ NE acres determination? IT Does the facility lack adequate acreage for land application? ❑ Yes E] No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? [] Yes dNo ❑ NA ❑ NE Reauired 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 E No ❑ NA ❑ NA- -r the appropriate box. f ❑ WUP ❑Checklists ❑ Design 0 Maps ❑ Lease Agreements ❑Other: 2I. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [n No ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers .'E] Weather Code ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspec iiii'1�13 Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? , 0 yes Ej Nc ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes fo ❑ NA ❑ NE Page 2 o. f 3 � V4,120I1 Continued k Facility umber: ILL -1 Date of Inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes k ,"" ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes GO ❑ 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 structurc(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 Eg'N/o ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [T'No _ ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [34''o❑ 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 ❑,W ❑ NA ❑ NE 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 ❑ Yes C 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 �o ❑ NA ❑ NE ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 01Z ❑ NA ❑ NE 33. Did the ReviewerAnspector fail to discuss review/inspection with an on -site representative? ❑ Yes [D No ❑ NA [] NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes En --No ❑ NA ❑ -NE Comments (refer to question #f} `Ealam anv°YES answers and/or3any additional;recommendations or any other comments. Use drawings of facility to Better ezplam situations.(use�addibonaJ.pages aspecessaryj acr �'r-jf (,)-I 7 �- si� --�r3 -- 2.3 Reviewer/Inspector Name: I LAll Phone%- q63-333 c Reviewer/Inspector 6Date: 1) V ' Signature: Page 3 of 3 21412014 I Type of Visit: OCompliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance Reason for Visit: (Routine 0 Complaint Q Follow-up p Referral Q Emergency Q Other p Denied Access Date of Visit: Arrival Time: J : pd f>? Departure Time: U ounty: sftft"rN Region: Farm Name: 1pC{ Owner Email: Owner Name: a1Phone: Mailing Address: Physical Address: Facility Contact: 1 lCl,(1,ltt� `,� �`\ZA rs\S Title: Phone: Onsite Representative: Certified Operator Back-up Operator: Location of Farm: Latitude: Integrator: Certification Number: q 1� 2M2R Certification Number: Longitude: �� -- Design Current Design Curren# Design Current Swine Capacity Pap. Wet Pointry Cap tty Pop. Cattle Capacity Pop. Wean to Finish Layer Dairy Cow Wean to Feeder I jNon-Layer I Dairy Calf Feeder to Finish Dairy Heifer Farrow to Wean ILea[x) Design Current Dry Cow Farrow to Feeder D . P,oult . Ga aci Po Non -Dairy Farrow to Finish La ers Beef Stocker Gilts Non -La ers Beef Feeder Boars Pullets Beef Brood Cow Turkeys 11101 Other Turkey Poults Other Other Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (if yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? [:]Yes (ANo [:]NA ❑ NE [:]Yes [:]No ❑ Yes [:]No d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [:)No U NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �4 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 21417011 Continued Facili Number: jDate of Inspection: 4_p7114 J Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Q No ❑ NA [] NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No g] NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: i b Spillway?: Designed Freeboard (in): Observed Freeboard (in): qn 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes � No 0 NA ❑ NE (i.e., large trees, severe erosion, seepage, etc.) 6_ Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes R] No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? [:]Yes [)g No ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE maintenance or improvement? Waste Apiflication 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE maintenance or improvement? l 1. Is there evidence of incorrect land 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 7 10% or 10 lbs. 0 Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Windo/wr ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): I'.fLi`hV1E] P. 13. Soil Type(s): L n `z' k�\V 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes IM No 0 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 [jQ No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes 0 No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes � No ❑ NA ❑ NE Regulred 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 LN 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 [jD No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes t] No [] NA ❑ NE Page 2 of 3 21412011 Continued Facili Number: a - —I% IDaleof Inspection: Li/ 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 15 ] 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 Ievels 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 M No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes W No ❑ NA ❑ NE Other Issues 28. Did the facility fail to property 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 the drains exist at the facility? If yes, check the appropriate box below. ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: ❑Yes ®No ❑NA ❑NE ❑Yes 17]No ❑NA ❑NE ❑Yes ®No ❑NA ❑NE ❑ Yes ® No ❑ 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 No ❑ NA ❑ NE y menu .' Comments refer to uestron �Ex Iatn any YI✓S ansRers and/or. an adds#tonalrecommendations or any o#her Conti ( q # P (- Use drawings of facility to better�explam�sttuahons iae additlohn1 pages as necessary Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 Phone: 910-309' & Date: 3- 21412011 Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance Reason for Visit: O Routine �mplaint O Follow-up 0 Referral Q Emergency 0 Other Q Denied Access Date of Visit: Arrival Time: o Departure Time: County: Region: Farm Name:/`rI.✓ G Owner Email: Owner Name rYY�� Phone: Mailing Address: Physical Address: Facility Contact: (�G2 jr)4 r-c/L Title: �C' Cln�!`_ - Phone: Onsite Representative: n �} .Z, �/i �o�f per. Integrator: Uj&jo1'/Y"PL 5a1i.7e= J:�&_Afgj Certified Operator: —J5/r—re Certification Number: Back-up Operator: Certification Number: Location of Farm: Latitude: Longitude: Design Eurrent n3xCurrent ' [DO"' Design C►urrent Swiae C p cityWet i'oultey pa �ty�Pop. Cottle Capacity Pop. Wean to Finish La er DairyCow Wean to Feeder Non -La er Da' Calf Feeder to Finish _ Da' Heifer Farrow to Wean =i1)esignCurrent D Cow Farrow to Feeder D . Poult , Ca _aciP,o Non-Dai Farrow to Finish Layers Beef Stocker Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow Other Pilo urke Poults Other 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)? [] Yes EINo ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE d. Does the discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? ❑ Ycs ❑ No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE [:]Yes No ❑ NA ❑ NE Page 1 of 3 21412011 Continued • Facility Number: Date of Ins ection: / Waste Collection & Treatment • 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [5 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): 1 Observed Freeboard (in): ` 5. Are there any immediate threats to the integrity of any of the structures observed? 0 Yes [RrNo ❑ NA ❑ NE (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA JR3 NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ONE 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 ❑ Evidcnce of Wind Drift 24 Application Outside of Approved Area 12. Crop Type(s) 13_ SoiI Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA [] NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA U "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 NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA NE Re uired Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA aNE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes ❑ No 0 NA ® NE the appropriate box. ' ❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No 23. If selected, did'the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA (3 NE ❑ Weather Code ❑ Sludge Survey ❑ NA [g NE ❑ NA ®-NE Page 2 of 3 21412011 Continued Facilq Number: - P l jDate of Inspection: 77-1 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 structures) 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) ❑ NA [&NE ❑ NA aNE ❑ Yes ❑ No ❑ NA [Z NE ❑ Yes ❑ No ❑ NA ® NE [] Yes ❑ No ❑ NA �] NE ❑ Yes ❑ No ❑ NA "0 NE O Yes O No ❑ NA ❑ NE 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No 0 NA ® NE ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ® NE 33. Did the Reviewer/inspector fail to discuss reviewtinspection with an on -site representative? ❑ Yes ® No ❑ NA �fZ-NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA V[NE Comments (refer ta;gaesbon # ExplainanyYES;aiatswers and/or any additional recommeodatian�,orarly„ttther�coinQeents. dawituatrons(geiadcatonal. pages as necessaryinsOse,txa ��� ,/� �Brz•�ai� Gi'ef t�a� !'t- �—d�p'!-zp/I D� J�•GeJ=�'�� t4cr'� ��—>Ke� Fa/ m ev R s Sf rdi i 7`1vv7`-- 4 7 ! L �uS/ ✓/ !I/� r �t /��/!<i j /tom Reviewer/Inspector Name: Reviewer/Inspector Silmature: Page 3 of 3 �-// 303-rV it _j Phone:_{ Date:—�' 21412011 iF Type of Visit: &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit: 9 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: Arrival Time: q'.3Q Departure Time: County: S. Region: Farm Name: Sflw SQI, NMI Owner Name: J�F✓ �Y tm LLL- Mailing Address: Physical Address: [/ 5` fli/ri-f M_ , C I Owner Email: Phone: Facility Contact: ° Wd I iftS Title: Phone: Onsite Representative: ROnnAo'iam f Integrator: Certified Operator: �B3- ffi?- T Certification Number: 2M 24a` Ogg Back-up Operator: M[ Certification Number: 0T7 Location of Farm: Latitude: Longitude: Pi.Design Current Design Ctirrent Design Current xv� Swine "Capacity Pop. IVet Poultry Capacity Pop. Cattle Capacity Pap. Wean to Finish La er DairyCow Wean to Feeder Non -La er Dai Calf Feeder to Finish Dai Heifer t Farrow to Wean j Farrow to Feeder Q . P,oultry Design Ca ac-ity Cur`reiit to . —Dry Cow Non -Dairy Farrow to Finish Layers Beef Stocker Gilts Boars ' Non -Layers Pullets Turkeys Beef Feeder Beef Brood Cow RhRer i' Turkey Poults Other 10ther Discharges and Stream Impacts 1. is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (if yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? ❑ Yes ® No [] NA ❑ NE ❑ Yes [:]No ❑ NA 0 NE []Yes ❑ No ❑ NA ❑ NE d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [] Yes ❑ No [] NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? [-]Yes No [] NA ❑ NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters [-]Yes No ❑ NA ❑ NE of the State other than from a discharge'? Page I of 3 21412011 Continued lFacility Nutttber: --71q jDate 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 0 No ❑ NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): 3a Observed Freeboard (in): " 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ca 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 C-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? IS 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 [a No ❑ NA ❑ NE maintenance or improvement? Waste Application 10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C'No ❑ NA ❑ NE maintenance or improvement? I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D-No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 100% or 10 Ibs_ ❑ 'Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? 15. Does the receiving crop and/or land application site need improvement? 16, Did the facility fail to secure and/or operate per the irrigation design or wettable acres determination? 17. Does the facility lack adequate acreage for land application? 18. Is there a lack of properly operating waste application equipment? Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? 20, Does the facility fail to have all components of the CAWMP readily available? If yes, check the appropriate box. ❑ Yes ® No Ej NA ❑ NE ❑ Yes [' g No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE ❑ Yes CS No ❑ NA ❑ NE ❑ Yes ® No ❑ NA ❑ NE ® Yes ❑ No ❑ NA ❑ NE C] Yes ® No ❑ NA ❑ NE ❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [a 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 EEI-No 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE ❑ Weather Code ❑ Sludge Survey ❑ NA ❑ NE CR NA ❑ NE Page 2 of 3 21412011 Continued Facili Number: $ a. - 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 (2 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? 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? 1 f 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/lnspector 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 r�4 No ❑ NA ❑ NE ❑ Yes CR No ❑ NA ❑ NE ❑ Yes ® No ❑ NA ❑ NE ❑ Yes ®-No ❑ NA ❑ NE ❑ Yes [�JNo ❑ Yes ® No [—]Yes No ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE Comments (refer to question #) Explain any YES answers- and/or any'additional recommendatronslor any other comments. I Use drawin s offacility. to better.ex lain situations-(useadditiona1. pa es as,necessary}. * ' , l± h: p �. Goak 3ross cote- m -for of )a cam, ,TrvUe sl o fej np�d_ m� j cr wark S Preaje add- o�so ad rnL'l cA San e- 9 Nd walk kyal done 07 4�)a o _ .I�2S �O�sn 0 $ � lnrar�l wPC�"� 9r�se1 YY�fl�1ot �s�blr)he(., of MT ryof k sy 30 r1), )t-I, Scr-e. fi eId-s 1vi-e plot in iobacro b ��P�e_ YvPrP nD`i� irr,9a (-fh�r � Is n,�7"�eae rye? )G, Plea,e ror a CU�r�f permj�,� no�ebeok. Tile Ce��firalte o_(Copra ud d Ivdrfh°re. �r��d 4ile j014 ej � �l1rm has a mova 6k eW5 f� 3 ) 0Cailb4l eaC/? }plus o ftae�, Reviewer/inspector Name Reviewer/Inspector Signature: Page 3 of 3 Phone:33- Date: q a Q 11/ 21412011 ft Feciiity No. Farm Name Permit COC ✓ 5 SOw F Date 11aq j 1 OIC NPDES (Rain breaker PLAT Annual Cert ) FB Drops r - - .. _ . Observed freeboard Sludge Survey Date ----�� Sludge r - . ---_--- Calibration Date 2 j 3 4 5 6 7 8 Design Flow Actual Flow Q oo n C Do Design Width q 4 _44 Gic Actual Width .Y : -N- Soil Test Date 1 1)1WP Wettable Acresy RAIN GAUGE pH Fields WUP Dead box or incinerator Lime Needed Weekly Freeboard Mortality Records Lime Applied 1 in Inspections L,-, Cu-I L.- Zn-I 120 min Insp. Needs P Weather Codes CroD Yield .,/ Transfer Sheets �1211 1 V ' I Mt., Wzl Me= Wh�`LI+- / Verify PHONE NUM6Eff S and affiliations Date last WUP FRO Date Date last WUP at farm App. Hardware FRO or Farm Records Lagoon # Top Dike �Y Stop Pump Start Pump Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Ib/ac &rws 8-I2- 0o/0 Type of Visit GeCo_mpliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance Reason for Vis€t outine O Complaint O Follow up O Referral O Emergency O 0ther ❑ Denied Access Date of Visit: g /O —,�I�, rArrival Time: �:.iSRw Departure Time: �.'/S County: - A=e5_ON Farm Name: t'7 W o L'i . �°`Y"" Owner Email: nwnvr Namr- -S I'l LJ 'j , 'LY#"s L�' � Phone - Mailing Address: Physical Address: Region: �/ZO Facility Contact: %20AIlul'C. LJ��ai� S _ Title: �vA- � T _ _ Phone No: Onsite Representative: Integrator: Af'k!! „ SAZ -JAI Certified Operator: Operator Certification Number: 7 3 Back-up Operator: Back-up Certification Number: Location of Farm: Latitude: = o = 11 Longitude: = o 0 , = " Swine Design Capacity Current Population Wet Poultry Design Current Design Current C►apacity Population Cattle Capacity Population ❑ Wean to Finish ❑ La er ❑ DairyCow ❑ Wean to Feeder ❑ Non -Layer ❑ DairyCalf ❑ Feeder to Finish (Z Farrow to Wean Dry Pou{try ❑ DairyHeifer ❑ D Cow ❑ Non -Dairy ❑ Farrow to Feeder ❑ Farrow to Finish ❑ Layers ❑ Non -Layers ❑ Beef Stocker ❑ Gilts ❑Beef Feeder ❑ Boars Uther ❑ Other ❑ Pullets ❑ Turkeys ❑ TurkeyPoints ❑ Other ❑ Beef Brood Cow t__l Number of Structures: Ell l Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ tither a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No ❑ NA ❑ NE ❑ Yes ❑ No !✓J NA ❑ NE ❑ Yes ❑ No 9<A ❑ NE ❑ Yes ❑ No !J NA ❑ NE Cl Yes lT�No NA ❑ NE ❑ Yes ❑ NA ❑ NE Page 1 of 3 72128104 Continued . . d6 Facility Number: 92--71ql Date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N ❑ 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: /0 Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes MZNo ❑ 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 thr t, 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 dNo ❑ 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 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE maintenance/improvement? II. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 12. Crop type(s)e�-stet n 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? ❑ Yes ❑ 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 El NA El NE [ffNo ❑ NA ❑ NE No ❑ NA ❑ NE VNo ❑ NA ElNE ❑ NA ❑ NE Comments (refer to question #): Explatn�a y YES answers and/or any recommendations or any:other commen#s. Use drawings `of facility to better explain srtiations. (use additional pages as necessary,): ;r 4f33.33D o � Reviewer/Inspector Name c �y � Phone: _ Reviewer/Inspector Signature: Date: 6 /47 — ZU /0 12128104 Continued Facility Number: �jZ —71Y Date of Inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check the appropriate box. ❑ wUP ❑ Checklists ❑ Desig n Q Maps ❑ Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Rainfall ❑ Stocking ❑ Yes IN ❑ NA ❑ NE ❑ Yes ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NI ❑ Waste Transfers ❑ Annual Certification ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE 23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L1N El NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes lJ N ❑ NA El NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes N ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes L'7 N ❑ 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 N ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ NA ❑ NE and report the mortality rates that were higher than normal? 7Np 30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [INA ElNE 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) ZN El ❑ 32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes NA NE 33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE Addlt:0ual�CoenmentsBE[d/prDraR'litaS:Ilh 7 Page 3 of 3 12128104 -,T_.sA5 11-23-zvo9 2 H 7/ 91 Type of Visit &6ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access Date of Visit: I/-20-DQ Arrival Time: �.'D.s ,,,, Departure Time: County: S*4=9s+rl Region: �� Farm Name: , SN A% Sa:..j (3,urkc. Owner Email: Owner Name: , _�; h_w Sc,.i_ F4 rr- L L G Phone: Mailing Address: Physical Address: Facility Contact: �oF;N»- �t1���s Title: _N4rvw i1A��— Phone No: Onsite Representative: U `a... Integrator: - �✓�l �Q .tld Certified Operator: p"i�+� �- W� Li:aY.S Operator Certification Number: 2AV/53 Back-up Operator: rrt a A! Back-up Certification Number: ! 9 1`f5 Location of Farm: Latitude: = = 4 =" Longitude: = o ❑ I = u Design Current Design Current Design C►urren# Swine Capacity Population Wet Poultry Capacity Eopulahon Cattle Capacity Population ❑ Wean to Finish 10 Layer ❑ Dairy Cow DEC- an to Feeder 1 1110 Non -Layer ❑ Dairy Calf ❑ Feeder to Finish 1 ❑ Dairy Heifer ❑farrow to Wean 1 /72 5� Dom, pouf ❑ Dry Cow ❑ Farrow to Feeder ElNon-Dairy El Farrow to Finish ❑ Layers ❑ Beef Stocker Gilts ❑ Non -La ers El Beef Feeder PBoars ❑Pullets ❑ Turke s ❑ Beef Brood Cowl I Other ❑ Other ❑ Turkey Pouets ❑Other Number of Structures: Discharges && Stream Impacts 1. Is any discharge observed from any part of the operation? ❑ Yes lr [No ❑ NA ❑ NE Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? ❑ Yes ❑ No &RA ❑ NE b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No E?qA ❑ 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 [IAA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [ No ❑ NA ❑ NE 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes ❑'%o— ❑ NA ❑ NE other than from a discharge? 12128104 Continued Facility Number: Date of Inspection Waste Collection & Treatment 4_ is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,L�7 NNoo [I NA [I NE a. If yes, is waste level into the structural freeboard? El Yes l o ❑ NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: 4alis I Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �,/ L� 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? [IYes 2hrNo ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? [] Yes ldNo ❑ 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 2 o ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ^._,,/�� I3 No ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes - No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10%or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 12. Crop type(s) `�cr�--...� �a.. �rl.•� 6. 7 y 5,&14 5 •') Ammads x- 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? ❑ Yes [] 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 [3No ❑ NA ❑ NE [3< ❑ NA ❑ NE 3--'No ❑ NA ❑ NE D<0' ❑ NA ❑ NE l__1'No ❑ NA ❑ NE Comments (refer to'yuestion #) "EacplaitE any YES.answers and/or any recommendarions or, any outer comments Use drawings of""facility to better-cx lain situarions. (use additional a es as necessary"�� "+ g 4 P ( p i; . �ctw I+te foit�c.�ed ►6/xI�7.:.g Slawce� !.� l+�i//otY��r S� 5a�p�� - j S,: j strrla �r� a iC dart J, efif/ any 4.61 fw.1't. b;-7/y 59-~4cC. t. i (l Y 7 Reviewer/]nspector Name �, ,!� v % ` {' � �Y�:%: � �,� Phone: it, Reviewer/Inspector Signature: Date: 1 — —ZOD 12128104 Continued Facility Number: Z —712 Date of Inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check the appropriate box. ❑ NVUp ❑ Checklists ❑ Design ❑ 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 I" Rain Inspections ❑ Weather Code ❑ Yes No ❑ NA ❑ NE ❑ Yes ONo ❑ NA ❑ NE 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 [R o ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E"No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes D<o ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes [3- o ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes 2<o ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ffNo ❑ 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 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 ElD Yes � No ❑ NA ❑ NE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewerflnspector fail to discuss review/inspection with an on -site representative? ❑ Yes �,/ L7 No ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes B<o ❑ NA ❑ NE 12128104 . i_, Type of Visit V Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance Reason for Visit 0 Routine 0 Complaint (81 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: f f� Arrival Time: Departure Time: County: Region: Farm Name: .J T7 w S4W FQ/M �. _ Owner Email: Owner Name: Phone: Mailing Address: Physical Address: t�f Facility Contact: RMnfP _ VV i 11I nt S Title: Arlo, rt an I g Phone No: $n 5%47+:7 Onsite Representative: integrator: Certified Operator: Back-up Operator: Operator Certification Number: Back-up Certification Number: Location of Farm: Latitude: = = = Longitude: Q o = ' = " Design Design Current Design Current RuQt Swine Capacity Pulation Wet Po,� gltry @apaeity Population. Cattle Capacity Population ❑ Wean to Finish ❑ La er ❑Dai Cow ❑ Wean to Feeder ❑Non -La er ❑Dai Calf ❑ Feeder to Finish Dry poultry . ❑Dairy Heifer (8Farrow to Wean ❑ Dry Cow ❑ Farrow to Feeder ElNon-Dai ❑ Farrow to Finish El Layers ❑ Beef Stocker Gilts ❑ Non -La ers El❑ Beef Feeder PE01 Boars Pullets ❑ Beef Brood Co ❑Turke s Other ❑ Other. Turke Puults roOther Number of siretcturss: Discharges & Stream Im acts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? b. Did the discharge reach waters of the State'? (If yes, notify DWQ) c_ What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (if yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes R No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes NJ No ❑ NA ❑ NE ❑ Yes 81 No ❑ NA ❑ NE Page I of 3 12128104 Continued Date of Inspection Facility Number: _ Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9 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): .a-,5 Observed Freeboard (in), 4 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P 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 ,J 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 N No ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes 5d 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 §JNE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA fZ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA PNE ❑ 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) CAPSfa I J�ffm ✓day. [QaVLrv) ' S & OS 13. Soil type(s) 4�vA j C '_ Dd8 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA aNE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA JKNE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes ❑ No ❑ NA aNE 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 ❑ No ❑ NA aNE ;ilia, 'uy,t-i%. -,._..`.-r--,$'1.: '.: ,�.-}�i��r`.s,t't�'.'•. .. ,.. Comments trefer,to question #) Explain any YES.answers and/or anyyrecommendaddns or"any otirer commenu. Use drawings ofM1tacility�to better explain siivahan �(nse adda#ron � pales as ee'��essary,) Reviewer/Inspector Name 3b, U �'( Phone: CPO -33QD () X�.3 Reviewer/inspector Signature: w Date: Page 2 of 3 v 12128104 Continued Facility Number: — Date of Inspection Reuuired 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 appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA t�[NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and F Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA [5kNE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No N NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ONE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA 10 NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes CRNo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA RNE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 9No ❑ NA Cl NE 29. Did the facility fail to property dispose of dead animals within 24 hours and/or document [] Yes 10 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 duality concern? ❑ Yes XNo ❑ 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 W 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 9No ❑ NA ❑ NE 33- Does facility require a follow-up visit by same agency? ❑ Yes D§"No ❑ NA ❑ NE Additeonat;Commeri s andlor Drangs� _.`�. Followup ia check a,joo) c13"-e1-' hl s ummer �v llowM q *Ji' e� �M o� b��r �d ae l e 4�'ti l �-��, 4d ; d m h cr -h 1fQ�� , � �d ►� 6--e +�'f- Q..�r o 04 sFa-,d . L- y,,eelt -+he pvllet Up wcobei i4.n la d� 4,yiewd 1 � o7 b� -�o1;�fa/ lo--rc to - l �z of �! Of 1 a� n h fed- >bt a, ?s bal ri of whea#- rahv m v!CA . 14a-r n &*Sf r bps h oalk h a.�t, oad- l^eJU�-si reitoffi elds (S7be,%jU1--Tf- Wro*4 Page 3 of 3 12128104 0IMS-7Jaa1r,� Jl�_ Type of Visit §kcompiiance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance Reason for Visit R Routine 0 Complaint O'Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access Date of Visit:[jj;)2,0$ Arrival Time: ,3 Departure Time: f7. County: S Region: Farm Name: s 44 w SOW Owner Email: mi�ll`` �� - Owner Name: W SAW, pofm U C- Phone: Mailing Address: kda Hill RL _Sr%1+hCI & a� Physical Address: f- J i Facility Contact: �1� 7y S es,,GII S itle: Phone No Onsite Representative:f 01 Integrator: VI i1 Certified Operator: k k,- affit Operator Certification Number: Back-up Operator: Back-up Certification Number: Location of Farm: Latitude: ❑ e ❑ f 0 11 Longitude: 0 ° 0 6 = 14 Des lles�gn.� Current �F" Design Currentillill Swine Capacity Population Wet Poultry ;Ca pacit�Psopulation Gattic Gap=acgi�ty Population ❑ an to Finish ❑ La er ❑Non -La er ❑Dai Cow ❑Dai Calf ❑ an to Feeder ❑ Feeder to Finish= << = 7 3� D . Poul � �` � .. ❑Dairy Heifer ❑ Dry Cow ® Farrow to Wean ( ❑ Farrow to Feeder ❑ Non -Dairy ❑ Farrow to Finish ❑ Layers ❑ Beef Stocker ❑ Gilts ❑ Non -Layers ❑ Pullets ❑ Beef Feeder ❑Beef 13raod Cow ❑ Boars ❑ Turkeys O#her ❑Turkey Poults El Other .7f'r 98FRUmbermf Structures: ❑ Other Discharees & Stream Impacts I . Is any discharge observed from any part of the operation? ❑ Yes N1 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 ❑ NI 2. Is there evidence of a past discharge from any part of the operation? 0 Yes D3 No ❑ NA ❑ NE 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes C'No ❑ NA ❑ NE other than from a discharge? Page 1 of 3 12128104 Continued Facility Number: a— j Date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ERNo ❑ 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: o Spillway?: Designed Freeboard (in): 3 �l• j Observed Freeboard (in): qTjQ 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Eallo ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes O'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? 5? Yes ❑ No ❑ NA ❑ NE 8. Do any of the stuctures tack adequate markers as required by the permit? ❑ Yes [RNo ❑ 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 DkNo ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J'No ❑ NA ❑ NE maintenance/improvement? 1 I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop ❑ Evidence of Wind Drift ❑ Application Outside of Area /Window 12. Crop type(s) i V'4'A �QA �9 , STg _ ^�l 13. Soil typeAvg V g i $ , RIA 5* ..,. , . 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes S'No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes C'No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes ERNo ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes IgNo ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes C-No ❑ NA ❑ NE Reviewer/Inspector Name I '� Phone: rro y � 0 x Reviewer/Inspector Signature: Date: 7 as Q Facility Number: &L Date of Inspection !�•t? t Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes U No ❑ NA ❑ NE the appropirate box. ❑ WCiP El Checklists ❑Design El Maps ❑Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE ❑ Waste Application []Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes CR'No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes []No U NA ❑ NE 24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes RNo ❑ NA ❑ NE 25_ Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No 5'NA ❑ NE 26, Did the facility fail to have an actively certified operator in charge? ❑ Yes I*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 12 No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes (k 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 I'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 19 No ❑_NA ❑ NE 33. Does facility require a follow-up visit by same agency? 'R Yes C`No ❑ NA ❑ NE Additional Comineut and/ar- sitesvval� Iqlo4s'nedr `fopsaf),seed, a1rfro.•1 ' . wa cow y, Cal; bwaf edC._. a 1�. yv i I{ �Pl - Ca Ir` "&► u >°a-, as. U-MM f ls� sVIV-e LAW /aooq fne►Y_1 6F043j 63, P011 ftLp ©n 1 g3047 c&e.,.6 ordvh i aoog M �ld�t—f� Ply wog �e ��� s��aj��C -Fo�►�t�r, Ier-heh Covey . yve mifMaLled- ` ' vtn 4 goal lFt Ald-C. Page 3 of 3 12128104 A,rs f6rat Facility No, qa -) N Farm Name :S l ✓ -SOW � Date Msilh Hill kk L Permit COC Pop.Type Desi n Current OIC NPDES (Rainbreaker PLAT Annual Cent) Freeboard 10 2 3 4 Desi n S' BIMS Observed in Sludge SurveyDate Perm Li uid ft a Sludge Depth ft _ 5 8 7 Calibration Date 1 2 3 4 5 6 7 8 Design Flow 0 — _ Actual Flow 0 _ Design Width .33 Actual Width airy - 3 Soil Test 3�y1� !' / G Weftable Acres `� ��1� Rainfall >1" ✓ pH Fields i pH Lagoon_ Crop Yield �!orDawr"I 1 in Inspections � Lime Neede-�j Rain Gauge 120 rain Inspections Cu %' - / Weekly Freeboard ✓ Transfer Sheets zn � �v I li n � ro I I bdHbn 09 60 Day Pw*tJiYM IAFe PulYFiela Soil }{ps Wr Clam! W* 5;w C Pan T T 1 Mom' la 33.3, :31F---r 7 rj—a S0-S it— OO- `` 70 L Type of Visit ImCompliance Inspection Q Operation Review D Structure Evaluation O Technical Assistance Reason for Visit Routine Q Complaint O Follow up O Referral 4 Emergency 0 Other ❑ Denied Access Date of Visit: I VG / Q /1 Arrival Time: P, Q Departure Time: County: Region: `A Farm Name: nA Lul Owner Email: Owner Name: Q +r Yr% I LLc, Phone: Mailing Address: Physical Address: � ] Facility Contact: l`C1t\l'Lb.k- 0 .l 1CAmS Titie: 'Pnv'., i,,,,I J PhooeNa:�t® I-), 101, 71 Onsite Representative: 2QNC�V_ W ��� s0.tM_,!�, Integrator: _m( A j Certified Operator: GaxcA _0al V Operator Certification Number: Back-up Operator: Back-up Certification Number. - Location of Farm: Latitude: f—] e 0 ' = " Longitude: = ° ❑ ' = Design Current Swine Capacity Population Design We Poultry Capacity .. Current Population Design Current Cattle111mc-apacirvor opulation ❑ Dairy Cow ❑ Wean to Finish ❑ La er ❑ Wean to Feeder ❑ Non -Laver w ❑ Dairy Calf ❑ Feeder to Finish- - ---''='ei="`: Dry Poultry �' ❑Layers La ers :- ❑ Dai Heifer arrow to Wean I (PUU 1 7 ❑ D Cow ❑ Farrow to Feeder El Non -Dairy ElFarrow to Finish : ❑ Beef Stocker ❑ Non -La em ❑ Gilts ❑ Boars ❑ Beef Feeder ❑ Pullets ❑Beef Broad Co El Turkeys Other ;k,_; ' Number of Structures: M1 TurkeyPoults ❑ Other F13 Other �kn.mft� Discharees & Stream Impacts 1. Is any discharge observed from any part of the operation? ❑ Yes (No ❑ NA ElNE Discharge originated at: ❑ Structure ❑ Application Field ElOther a. Was the conveyance man-made? ❑ Yes ❑ No JU NA ❑ NE b- Did the discharge reach waters of the State? (if yes, notify DWQ) ❑ Yes ❑ No P 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 DNo ❑ NA ❑ NE 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes/lkNo ❑ NA ❑ NE other than from a discharge? Page 1 of 3 12/2S/04 Continued Facility Number: — Date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes, is waste level into the structural freeboard? Structure I Structure 2 Structure 3 Structure 4 Identifier: i ❑ Yes h No ❑ Yes PNo Structure 5 El NA ❑NE ❑ NA ❑ NE Structure 6 Spillway?: Designed Freeboard (in): Observed Freeboard (in): ti 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 �o ❑ NA ❑ NE through a waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health o ental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? Y s 10 ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �3 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 )allo ❑ NA ❑ NE maintenance or improvement? Waste ADnlication 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes *o ❑ NA ❑ NE maintenance/improvement? ,,��}} 11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes 1 No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 1 O 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) �t �'"1 ✓ Q i Y S 13. Soil type(s) E a 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 �Z�14)0 ElNA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ElYes ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes '*o ❑ NA El NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes !l%No ❑ NA ❑ NE � C v .Comments (refer to question #): Explain any YES answers and/or any recommendations or any other commeats% , Y� Use drawings of facility to better explain situations. (use additional pages as necessary):�� `x_ Reviewer/Inspector Name � v A Q Phone: 310 Reviewer/Inspector Signature: Date: UCn Z4�� Page 2 of 3 12128104 Continued Facility Number: = 7 Date of Inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'Aj No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �`No ❑ NA ❑ NE the appropriate box. ❑ WUP El Checklists ❑Design ❑Maps ❑Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code 22. Did the facility fai I to install and maintain a rain gauge? ❑ Yes 1Z No ❑ NA ❑ NE 23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No *A ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes KNo ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? [:]Yes ,ZNo ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? 0 Yes ANo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes [:]No �:LNA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Xo ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document 0 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 *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 �bo ❑ 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 )SNo ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes Olo ❑ NA ❑ NE Additional Cornmedts and/or Drawings: �xnS . AL _Sly T Page 3 of 3 12128104 Facility No. Time In Time Out Date Farm Name !E�'1 -SeW �70Y 1 ; l .� Integrator r S`` Owner W t�Q�Yur� Site Rep Operator .Z_�-�C�Ji V�-1,�� _ No.i a Back-up No. - COC Circle: nera or NPDES Desi n Current Design Current Wean - Feed Farrow — Feed Wean — Finish Farrow — Finish F sh Gilts I Boars. farrow — Wea Others FREEBOARD: Design oludge -un ley Crop Yield -32 .�-' - Observed Z 1-0 Waste Transfers�' V`{ Rain Gauge Rain Breaker- -Soil Test PLAT '� Wettable Acres Weekly Freeboard �� Daily Rainfall 1-in Inspections~/ Spray/Freeboard Drop .-_1 la -/ 'S 1�z _ Weather Codes Waste Analysis: 120 min Inspections Date Nitrogen (N) Date Nitrogen (N) F'uIIlFleld Soil Crop Part Window ry C_'► f fl - r e 'r ja Type of Visit ® Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance Reason for Visit *Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access Date of Visit: g ZS Q(p Arrival Time: Departure Time: County: _5'+!LjgYr%�, Region: L—o Farm Name: 1�— i c Owner Email: OwnerName.- /y!l /'—e- �fl - Phone: Mailing Address: Physical Address: ,/� Facility Contact: r t'rl /`�- f7� Dt _ Title: �/ri✓ Phone No: Onsite Representative: 0AJAJP`t � ��- -- Integrator: dtm,; , S�iY. r. S Certified Operator: Back-up Operator: Operator Certification Number: Back-up Certification Number: Location of Farm: latitude: = e 0 ` = « Longitude: a o 01 = u Design Current _Design Current Design Current Swine Capacity Population Wct Yeultry _'•Cg i3ty Population Cattle Capacity Population .: ❑ Wean to Finish ❑ La er ❑ Dairy Cow ❑ Wean to Feeder ❑Non -La er ❑ Dairy Calf ❑ Feeder to Finish ❑ Dairy Heifer Farrow to Wean O Dry Paaliry ❑ Dry Cow El Farrow to Feeder ''' ``' ElN Layers ❑ Non -Dairy El Beef Stocker ❑ Farrow to Finish ❑on -La Non -Layers ❑ Beef Feeder ❑Gilts ❑ Boars ❑ Pullets ❑ Beef Brood Co ❑ Turke s Other ❑ Turkey Poults ❑ Other ❑Other Number of Structures: El Discharges & Stream Impacts l . Is any discharge observed from any part of the operation? ❑ Yes M No ❑ NA ❑ NE Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? Cl Yes CO No ❑ NA ❑ NE b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes N 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 0 No ❑ NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? ❑ Yes WNo ❑ NA ❑ NE 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes Wo ❑ NA ❑ NE other than from a discharge? Page I of 3 12128104 Continued I, 1 Facility Number: $2 — j Date of Inspection ZS 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 I Structure 2 Structure 3 Structure 4 Identifier: ,D Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or closure plan? ❑ Yes 5(No ❑ Yes ® No Structure 5 ❑ NA ❑ NE El NA El NE Structure 6 ❑ Yes 59 No ❑ NA ❑ NE ❑ Yes {2 No ❑ NA ❑ NE If any of questions 4-6 were answered yes, and the situation poses an immediate public stealth or environmental threat, notify DWQ 7_ Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Qj No ❑ NA ❑ NE (Not applicable to roofed pits, dry stacks and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require [] Yes [� No ❑ NA ❑ NE maintenance or improvement? Waste Application 10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes T No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop //Window ❑ Evidence of Wind Drift ❑ Application Outsiide� of Area 12. Crop type(s) ycrMu Qom_ �6,�., 13. Soil type(s) �r, j A. rrl 14. Do the receiving crops differ from those designated in the CAWMP? [I Yes f No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? 18. Is there a lack of properly operating waste application equipment? ❑ Yes VNo ❑ NA Cl NE ❑ Yes D;INo ❑ NA ❑ NE Comments (refeir to question #): Explain any YEs&savers and/or any recommendations or: any other comments , "i Use drawings of facility to better explain sltuation�!(use additional pages as necessary): : Reviewer/Inspector Name �� �.��� Reviewer/Inspector Signature: Date; zS ZOd Page 2 of 3 12128104 Continued 1 Facility Number: SZ, -771qDate of Inspection S 6 Re uired Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes WNo ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes �No ❑ NA ❑ NE the appropriate box. ❑ WUP El Checklists El Design El Maps El Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 40 No ❑ NA ❑ NE 23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ bNo ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes PipNo ❑ 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 UNo ❑ 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 A 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 �TNo ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately 3I. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes W No ❑ NA ❑ NE General Perm ? (ie/ discharge, freeboard problems, over application) 32. Did Reviewerlinspector 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 D4 No ❑ NA ❑ NE Additional Comments and/or Drawings: Page 3 of 3 12128104 r . (Type of Visit & Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: OS Arrival Time: Departure Time: County: Socni Eon Region: %/10 Farm Name: _ �, cheer He0ae f rn, _ Owner Email: Owner Name: Jr f-lW Saw �itr� f LLC Phone: g/4- StfG- 87L7 Mailing Address: ;2 i980 Lt/, I $ do - ✓1'l •�tl �s S117 1 �4 /�''e'1'j - N_C Physical Address: Facility Contact: �vn G+i �o..,5 Title: Onsite Representative: _ ifdn re AV"mi,. -f Certified Operator: 6e,-"Iw �✓p�/'tn Back-up Operator: Location of Farm: Phone No: Integrator: Ale-7,).,.7 Slo,7jo el T Operator Certification Number: Back-up Certification Number: Latitude: 0 0 0 4= Longitude: = o= i w. Design Current Design . Current: Design Gtirreut Swine Capacity Population Wet Poultry. Capacity Popuiation TCattle Capacity, Population ❑ Wean to Finish ❑ Wean to Feeder ❑ Feeder to Finish [Marrow to Wean p ❑ Farrow to Feeder. ❑ Farrow to Finish ❑ Gilts ❑ Boars - Other ❑ Layer ❑ Non -La et I IY -J Dry Poultry ❑ La ers ❑ Non -Layers ❑ Pullets ❑ Turke s El Turkey Points ❑ Other Dischar,& 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 ❑ Daia lleifei ❑ Da Cow ❑ Non -Dairy ❑ Beef Stocket ❑ Beef Feeder ❑ Beef Brood Cowl-�, Nurnber of Structures. . Y _ 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 ['f No ❑ NA ❑ NE ❑ Yes [?-I�fo. ❑ NA ❑ NE i 12128104 Continued r . � Facility Number: $;Z — 17/y Date of Inspection 3 YJ 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: i Spillway?: Designed Freeboard (in): Observed Freeboard (in): —i,SO r. ❑ Yes ❑ No ❑ 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 ❑ 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 Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE maintenance/improvement? 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 12. Crop type(s) B S^ .' 13. Soil type(s`� ) [)n� 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 ❑ No ❑ NA ❑ NE lb. 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)queshon,#) F.aplatn any�Y�ES answers andlor4khy�recommendations ar any other comments. Use drarvmgs tyMto°hetter�fiezumh,s�tQahons (use ad(;}Rhon�I{pages:as nn r PI�pSG [e.>{+wl {o Wtsr('� O.a Clfd��rd�.gg gpy� 9/riSS OA! �O?o�w 6F�ks TN prfvy+ti/ eras ►e.� 61 Reviewer/Inspector Name = f( �2 €, . •4,� �' '• Phone: 9[ / Reviewer/Inspector Signature: Date: / 12128104 Continued e It Facility Number: 9 Date of Inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 21�o ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 0`Yes ❑ No ❑ NA ❑ NE the appropirate box. ❑ WUP El Checklists Design El Maps El Other 21. Does record keeping need improvement? If yes, check the appropriate box below. [Yes ❑ No ❑ NA ❑ NE -fa— :X A ❑ Waste Application ❑ Weekly Freeboard ❑ ❑ Fb@i! A�ly�sis ❑ ❑ Annual Certification ❑ fk�l ❑ S oe4,ng ❑ Crop Yield ❑ 120 Minute Inspections ❑ ons ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ErNo ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [2 No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA 2"NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes [R'No [] NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA RrNE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ZNo ❑ 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 ❑ No ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately 31. Did the facility fail to notify the regional office ofemergency situations as required by ❑ Yes ❑ No ❑ NA ❑ NE General Permit'? (ie/ discharge, freeboard problems, over application) 31 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 Additional Camments'addlor Drawirigs: FGY.M, Oee�aA 90/00AW"/'019 /Air/ 7/tu, A/O 10tepw ,'a rPV iy, fk /PJayh /7PS •�dr' [I �Ou�nPi np� 3 ' S fP /rrpr A[ S.+rr J vAr •irf-#orr �OPArS� �r$p3� Plere� G eV eI( : Ae 12128104 0.F W R rF� Michael F. Easley, Governor William G. Ross Jr., Secretary North Carolina Department of Environment and Natural Resources Alan W. Klimek, P.E. Director Division of Water Quality August 23, 2005 CERTIFIED MAIL, RETURN RECEIPT REQUESTED L- SHW RECEIPT # 7002 2410 0003 0272 8613 SHW Sow Farm LLC Sow Farm LLC " 2080 Wilson Mill Rd. Smithfield, NC 27577 RE: Sludge Survey Testing Dates Facility # 82-714 Sampson County Dear SHW Sow Farm LLC: The Division of Water Quality (DWQ) received your sludge survey information on July 27, 2005. With your survey results, you requested that a sludge survey for the lagoon at the Johnny Hope Farms not be required until 2009. Because this lagoon started operation in 2004, a sludge survey is not required for 5 years, or 2009. Thank you for your attention to this matter. if you have any questions, please call me at (919) 715-6185. Sincerely, W' Keith Larick Animal Feeding Operations Unit cc: File# 82-714 Fayetteville Regional Office Or N Cars a 'atur; Aquifer Protection Section 1636 Mail Service Center Raleigh, NC 27699-1636 Phone (919) 733-3221 Customer Service Internet: http:llh2o.enr.staic.ne-us 2728 Capital Boulevard Ralcigh, NC 27604 Fax (919) 715-0588 1-877-623-6748 Fax (919)715-6048 An Equal Opportunity/Affirmative Action Employer - 50% Recyded110% Post Consumer Paper Facility Number �'a 1 Date of Visit: `JF%% Tune: - O Not rational O Below Threshold Permitted [3 Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold• _ __. ........ Farm Name: ......Jl���....�'G.... fGr'^"... �l�i^S _.r'~-—�I..iti1� County: �4 D Owner —......fig �'.......z... Phone No: ... . ... Mailing Address:.. ._._ �nc+nc4 1..�� .. ... l��i ►1` �_ /q e- �.. _ .. -TI329 Facility Contact: ..__ �� .......... P G......._............... Title:....... ....... ?�.........._ _ Phone No: 1 Onsite Representative:------M---'..._..�_�.�G ...... Integrator: I�a rw�... �.,^^......._............_.............. Certified Operator:......_. ! ,._ �.. _ Operator Certification Number: Location of Farts: wine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude • 4 « Design Current Design Cinmut,�� Current_ Swipe— Ca -Po ejlaDon ¢ f Ca Cattiel. . a .,.Pqultry _ city ^Po ulatibii . _ Y Wean to Feeder ❑Layer ❑ Dairy - Feeder to Finish ❑ Non -Layer tiv ❑ Non -Dairy =- Farrow to Wean pp /b oa OtherY Farrow to Feeder Farrow to Finish Total DeSig[1 Capacity Dp Gilts = - - T Boars :Total SSLVV r _ Number of Lagoons§ � � � _ T� Discharges & Stream lmpacts 1. Is any discharge observed from any part of the operation? [:]Yes io 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 gal/min? 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 [<ll!ko 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Qlf o Waste Collection & Treatment 4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes L`to Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b Identifier: ......... - ..... I.......... ........ ......... _........ ... ... ...... ....................... Freeboard (inches): orw l ebh 12112103 g ; ►,, {,� Continued Facility Number: Yqt — Date of Inspection 3 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes & o seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ 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 1� No 8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes ffNo 9- Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Eg"No elevation markings? Waste Anulication 10. Are there any buffers that need maintenancelimprovement? ❑ Yes ❑N6 11. is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ago ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc 11 Crop type 1 c", A �+�. (uk; i A _i! ; vl` to 13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [PNo 14. a) Does the facility lack adequate acreage for land application? ❑ Yes 13% b) Does the facility need a wettable acre determination? ❑ Yes [EfNo c) This facility is pended for a wettable acre determination? ❑ Yes [No, 15. Does the receiving crop need improvement? ❑ Yes [YNo 16. Is there a lack of adequate waste application equipment? ❑ Yes ONo Odor Issues 17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes [�(No liquid level of lagoon or storage pond with no agitation? 18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ©No 19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 03'&o 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 S No Air Quality representative immediately. Caxu�nuents (refer to gtusteon ) F.�cplain aay YFS an .weirs arid/ oranyirrec�ommtadatioas or aay their.comments "Yw s Use drawings-o# faciity to better expl sibostsua5. {�etenn8l pages as necessary) , geld CopY ❑ Final Notes E�J �ci'r►� � i �oD; �n cttc �4 I �k..., use! ! � 14- 1&0 t 77, Reviewer/Inspector Name ReviewerAkspector Signature: Date: a l D 12/12/01 Caniinued •I Facility Number: Date of Inspection Required Records & Document,; 21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes YNo 22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? (ie/ WUP, checklists, design, maps, etc.) ❑ Yes [klo 23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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? ❑ Yes 01&o 25. Did the facility fail to have a actively certified operator in charge? ❑ Yes qko 26. Fail to notify regional DWQ of emergency situations as required by General Permit? ❑ Yes (ie/ discharge, freeboard problems, over application) (EIINo 27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [fNo 28. Does facility require a follow-up visit by same agency? ❑ Yes [vrNo 29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [2rNo \'PDES Permitted Facilities 30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes �No 31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No 33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No 34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No 35. Does record keeping for NPDES required forms need improvement? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain ❑-120 Minute Inspections ❑ Annual Certification Form �[V No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. 12112103