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Home My WebLink About820420_INSPECTIONS_20171231A' Facility Number C7Division of Water Resources O Division of Soil and Water Conservation O Other Agency 'type of Visit: ompliance Inspection Operation Review O Structure Evaluation O Technical Assistance Reason for Visit: outine O Complaint O Follow-up 0 Referral O Emergence Q Other Q Denied Access Date of Visit: Arrival Time:. ( —�p/� Departure Time: ; a a County: i__ Region: /�`�, Farm Name: / i 4 J <, Owner Email: Owner Name: Z►-, A �6, ZLZ� Phone: Mailing Address: Physical Address: Facilih Contact jj�.y, �o...; r�:77c !Title: Phone: Onsite Representative: CSS^ Integrator: Certified Operator: Rack -up Operator: Location of Farm: Swine Latitude: Certification Number: Certification Number: Longitude: Design Current Design Current Capacity Pop. Wet Poultry Capacity Pop. Layer Non -La er Wean to Finish Wean to Feeder Fecder to Finish / N Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Boars Other . Other Dry Poultry Lavers Non-Laycrs Pullets Turkeys Turkey Poults Other Design Current Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? Dischar�„e originated at: [] Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State'? (lf ycs. 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 DW R) 3. 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? Design Current Cattle Capacity Pop. Dairy Cow Dairy Calf Dairy Heifer Dry Cow Non -Dairy Beef Stocker Beef Feeder Beef Brood Cow ❑ Yes Z No 0 NA ❑ NE E] Yes No ❑NA ❑NE ❑ Yes [] No ❑ NA [] NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes A�No ❑NA ❑NE ❑ Yes KNo ❑ NA ❑ NE Page I of 3 2/4/2015 Continued Facili Number - ' Date of Inspection: •- S� i Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E2f—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): 07 Observed Freeboard (in): ��- 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ENo [] 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 2No ❑ 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 [;allo ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? [:]Yes 2 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 E[ No ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s):Y- 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3 No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes O No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? 18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes EjNo ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �o ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [7�-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 JEJNo 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J�J_No ❑NA ❑NE [] Weather Code [:]Sludge Survey ❑ NA ❑ NE ❑ NA ❑ NE Page 2 of 3 2/4/2014 Continued Facili Number: - Date of Inspection: 4 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes � No the appropriate box(es) below. ❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels ❑ Non-compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26- Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [54 -No 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes fj No Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP? 33- Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? 34. Does the facility require a follow-up visit by the same agency? ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes allo ❑ NA ❑ NE ❑Yes �0 ❑ NA ❑ NE ❑ Yes n No ❑ NA ❑ NE ❑ Yes ®No ❑ NA ONE ❑ Yes [�No ❑ Yes allo ❑ Yes ®—No ❑ NA [:IN E ❑ NA ❑ NE ❑ NA ❑ NE Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. Use drawings of facRi hto .beter explain stuations use additional pales as necessary).- - Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 Phone: 9`9 31 , Date: 2/4/2015 rype of visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance Reason for Visit: outine 0 Complaint O Follow-up O Referral O Emergency O Other O Denied Access llatc of visit: !-- I� Arrival Time: Departure Time: lj"r Cvunt}:�,A� Region: Farm Name: E-��,: r� 1�W{� Owner Email: �"— Owner Name:ajW Al4L I" If L 1 it Phone: Mailing Address: Physical Address: Facility Contact: ,/,. �l„rC'�j Title: Phone: Onsite Representative: J rF - Integrator-,1r-��(f�� Certified Operator: j'.+•�.L� Certification Number: Bach -up Operator: Location of Farm: Latitude: Certification Number: Longitude: .'4'ISomme � � `Po ,Cattle _ Desi tl Current Desi Current__ Design Current- Laity Pop N eta oultCapact p b Gupacityi Prop h f = Wean to Finish Layer Dairy Cow Wean to Feeder Non Laver '' Dairy Calf Feeder to Finish L' '*' 7 '"- Dairy Heifer Farrow to Weans 'Design Current Dry Cow Farrow to Feeder D�, 'Poult . y�Ca achy_.. 'Po Non -Dairy Farrow to Finish Lavers Beef Stocker Gilts Non -Layers Beef Feeder _ oar, Turk s � Beef brood Cow 1 71 Other. Turke` Poults FI 10ther I I Other ,,,,,.,...,",�. M,: nna.ri..:s.-.. -'..:��,..r�...s: .1 ,�.-,;�-�=�•.x... .,vw.�-.:.:,�....__,:-:mss ._.-_-�-,.,,,�w'n,....,,,,. r,_,e-- _.=s _� 4 . , Discharges and Stream Impacts I . is any dischaTL1e observed from any pan of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. 'Alas the conveyance man-made? b. Did the discharge reach waters of the Stater (If yes, notify DWR) c- What is the estimated volume that reached waters of the State (gallons)" d- Does the discharge bypass the.vaste management system? (If yes. notifl D1k"R) 2. Is there evidence of a past discharge from any parl of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge'? ❑ Yes � No ❑ NA ❑ NI; ❑ Yes ❑ No ❑ NA ❑ NE [:]Yes ❑ No [] NA ❑ NE ❑ Yes ❑ No ❑ Yes allo ❑ Yes RNo ❑ N ❑ NE 0 N E] NE E] NA ❑NE Page 1 of 3 21412015 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 [RNo D 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? ❑ Ycs allo [D NA ❑ NE (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed through a E] Yrs ❑..No ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR 7. Do any of the structures need maintenance or improvement? ❑ Yes N 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 31 No ❑ NA ❑ NE maintenance or improvement'? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes S -No ❑ NA ❑ NE maintenance or improvement? 11. is there evidence of incorrect land application? If yes, check the appropriate box below. 0 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 Drib ❑ Application Outside of Approved Area 12. Crop Type(s):-- 13. Soil Type(s): Z, 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE 16, Did the facility flail to secure and/or operate per the irrigation design or wettable ❑ Yes [�j No ❑ NA [] NE acres determination? 17. Does the facility lack adequate acreage for land application'? 18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes 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 tail to have all components of the CAWMP readily available? If yes. check ❑ Yes Z 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 f, No ❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Sail Analysis ❑ Waste Transfers ❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [2 No 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes V1 No ❑ N A ❑ NE ❑ Weather Code ❑ Sludge Survey ❑NA ❑NE ❑ NA ❑ NE Pulte 2 of 3 21412015 Continued Facili` Number: Date of Inspection. 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes r7l No ❑ NA ❑ NE t 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ 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 [a No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [XNo ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 34. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface 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 Eg-No ❑ NA 0 NE ❑ Yes a No ❑ NA ❑ NE ❑ Yes [allo ❑ NA ❑ NE ❑ Yes 2g No ❑ Yes rM No [:)Yes ® No E] NA ❑NE E] NA ❑N ❑NA ❑N Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. l Use drawings of facility to better exolain situations (use additional Dases as necessarv). I Reviewer/Inspector Name: Reviewer/Inspector Signatut Page 3 of 3 NJ ll� 1:�) Phone: �/� ` X173—D/•5 Date: Z /e. 21412015 j0&— —/—, -7� —fib � � Fach� y Number -' K�r Type of Visit: (�Y-Coroutine nee Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance Reason for Visit: O Complaint O Follow-up O Referral O Emerp-eucv Q Other a Denied Access Date of Visit: Arrival Time: 1? Departure Time: r� cf� County: Farm Name: 2, -amu i f"C Q rYt _ Owner Email: Owner Name: g f-7L4af nor; rr Lc�Th Phone: Mailing Address: Physical Address: Region: E2 D Facility Contact: ,,Zr,;e_ i jo %-rL'1,07X_ Title: Bwn �` Phone: Onsite Representative: Integrator: AZT iCsZA�t Certified Operator: _ �..-• L_ Certification Number: 99 Z.3,_2 Back-up Operator: Location of Farm: Certification Number: Latitude: Longitude: , ,�gDesign Current Design Current Design Current Sw ne Ca aci Po P tY p• Wet Poul � Ga aci P. h' Po P• Cat#le Ca act Po P tY P• _ �� -_ Wean to Finish I ILayer Dairy Cow Wean to Feeder- Non -La er Dai Calf Feeder to Finish 1 Dai Heifer Farrow to Wean Design Current Dry Cow Farrow to Feeder Dr. Poul Ca aci P,u Non -Dat Farrow to Finish Layers Beef Stocker Gilts Non -Layers Beef Feeder ^ Boars Pullets Beef Brood Cow Turkeys Others Turke 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 -trade? 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) z. 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 fZLNo ❑ NA ❑ NE ❑ Yes [::]No ❑ NA ON E ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes [:]No ❑ Yes C, No ❑ Yes allo ❑ NA ❑ NE []NA ❑NE ❑ NA ❑ NE Page I of 3 2/412014 Continued Facili Number. - Date of Inspection: 't Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R 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): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed through a []Yes ® No ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR 7. Do any of the structures need maintenance or improvement? 0 Yes Id�l No ❑ NA ❑ NE S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes DK 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 Eg No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [a No ❑ NA ❑ NE maintenance or improvement? 11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 21 -No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12_ Crop Type(s): fs[ 13. Soil Type(s): 1 zq Z7 _ 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? 18. Is there a lack of properly operating waste application equipment? ❑ Yes g No ❑ NA ❑ NE ❑ Yes fZ No ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? []Yes O No DNA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check D Yes [3 No ❑ NA ❑ NE the appropriate box. ❑WUP ❑Checklists p Design ❑ Maps [:]Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes ta No ❑ Waste Application ❑ Weekly Freeboard [❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [:]Rainfall D Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE ❑ Weather Code ❑ Sludge Survey ❑ NA ❑ NE ❑ NA ❑ NE Page 2 of 3 2/4/2014 Continued Facili Number: - Date of Inspection: / -- ' 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes V�No ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes JSNo ❑ 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 KNo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 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 FNo [:]NA [:]NE ❑ Yes fn -No ❑ NA ❑ NE [:]Yes ELNo ❑ NA ❑ NE ❑ Yes t!�No ❑ NA ❑ NE [::]Yes KC No [:]Yes ®..No [-]Yes f�po ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. Use drawings of facility to better explain situations (use additional pages as necessary). Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 lb3 Phone: 9rJJ3� Date: 2/4/2014 11 r 11 —. : J-- hype of visit: t7e:ompuance tnspecnon v vperanon tcevtew V structure r,vatuanon V iecnntcat Assurance Reason for Visit: �utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: /G-/ Arrival Time: ' 0 `� I Departure Time: 110 : ;? County: -�3 „jr Farm Name: 0, j zi rG/ 4;7� Owner Email: Owner Name: r - f-11 :t'-' fOjTz Phone: Mailing Address: Physical Address: Facility Contact:,�^¢�., ��.� f "�1 '"G� Title: Phone: Onsite Representative: Integrator: ?Yid& Certified Operator: Certification Number: Rack -up Operator: Location of Farm: Certification Number: Latitude: Longitude: Region:/ 6 a;cl C p , g� ent ❑ No Design Current Design Cnrreat F Swine Cap ty wet Poultry Capacity Pap. Cattle Capacity Pap. _ ❑ NE Wean to Finish La cr Dairy Cow Wean to Feeder Non -La er Dairy Calf Dairy Heifer Feeder to Finish Farrow to Wean Design Current Dry Cow Farrow to Feeder D Pool Ca aci Plo . Non -Dairy Farrow to Finish La ers Beef Stocker Gilts Non -La ers Beef Feeder Boars Pullets Beef Brood Cow Turke s Uthe I ITurkeyPoults Other Other F'+..Y�wawcu__�!'�: .:.0 uK:iMf .iai#':.r:.aY:.Pn:i. .iae5 =::.— -..,"• Lr—.ii6V'aV.eFSi�t'.-.=•�•a.�•••JhMli-..- . Discharges and Stream Impacts 1. is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWR) c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (if yes, notify DWR) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? ❑ Yes E&No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes EaNo ❑ NA ❑ NE [:]Yes 54 -No ❑ NA ❑ NE Page 7 of 3 2/4/2014 Continued Facility Number: jDate of Inspection: &-j Waste Collection & Treatment t 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZI No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0 NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway? - Designed Freeboard (in): Observed Freeboard (in): 5. Arc there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1Z No ❑ NA ❑ NE (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes ®No ❑ NA ❑ NE waste management or closure plan? ❑ Yes &LNo ❑ NA ❑ NE If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR 7. Do any of the structures need maintenance or improvement? ❑ Yes [UNo E] NA [:]NE S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ®.No ❑ NA ❑ NE (trot applicable to roofed pits, dry stacks, and/or wet stacks) ❑ NA ❑ NE the appropriate box. 9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes ® No ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ 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):"!`��vrr-�'�x'�� ... 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes C,No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes n No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [S No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes ZNo ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes &LNo ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [0 No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check. ❑ Yes No ❑ NA ❑ NE the appropriate box. ❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes [&No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall Inspections ❑ Sludge Survey 77. Did the facility fail to install and maintain a rain gauge? ❑ Yes gLNo ❑ NA ❑ NE 23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes §�g_J+io ❑ NA ❑ NE Page 2 of 3 2/4/2014 Continued Facility Number: - M Date of Ins ection: / b —/ 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No s 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-comptiant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 25. Did the facility fail to provide documentation of an actively certified operator in charge? 0 Yes 5fl No 27. Did the facility fail to secure a phosphorus loss assessments (PLAN') certification? ❑ Yes L4 No Other issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Application Field 0 Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMF? 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? ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes [A No ❑ NA ❑ NE [:]Yes ® No ❑ NA ❑ NE ❑ Yes til No ❑ NA ❑ NE ❑ Yes ® No ❑ NA ❑ NE [:]Yes [ No Yes [ No ❑ Yes Wo ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments. Use drawings of facility to better explain situations (use additional pages as necessary). Reviewer/]nspeetor Name: Reviewer/inspector Signature: Page 3 of 3 Phone: bate: 2/4/2014 I t3—j�:C -o446 Type of Visit: EMompliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access Date of Visit: I T'v—= Arrival Time: Departure Timer County: Region: Farm Name t7x' iia t r� a err �-•.� Owner Email: Owner Name: _ xna- 4jo -v Tag /"C Phone: Mailing Address: Physical Address: Facility Contact: �tjW� rr` Title: BGrJi7�r! Phone: Onsite Representative: w rte_ Integrator: Certified Operator: �/`du-} mss-- �x11�G. -� Certification dumber: 1,793, Back-up Operator: Certification Number: Location of Farm: Latitude: Longitude: !� DesiaciPop. IEQ CP Desig&Cu rrent ❑ Yes Swine CrityPopntWll pgt apa i y Catt fig -No ❑ NA ❑ NE Wean to Finish La er I Dairy Cow Wean to Feeder fl jNo!LLayer Dairy Calf 'AFeeder to Finish ;`"• Dairy Heifer Farrow to Wean Dry Cow Farrow to Feeder Non -Dairy Farrow to Finish x Layers Beef Stocker Gilts I Non -Layers Beef Feeder Boars P. Pullets Beef Brood Cow ..» ''A� , a Turke s Qiher•.=- Turkey Poults Othcr _ Othcr wx Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State'? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWQ) 2. is there evidence of a past discharge from any pan of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? ❑ Yes (,�.No ❑ NA ❑ NE ❑ Yes ❑ No [_]NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes P�No ❑ NA ❑ NE ❑ Yes fig -No ❑ NA ❑ NE Page 1 of 3 2/4/2011 Continued Facility Number: - Date of Inspection. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes S No ❑ NA Waste Collection & Treatment 15. Does the receiving crop and/or land application site need improvement? ❑ Yes C, No 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2FVo ❑ 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 17. Identifier: ❑ Yes 53 No ❑ NA ❑ NE Spillway?: Is there a lack of properly operating waste application equipment? ❑ Yes _E2,No ❑ NA Designed Freeboard (in):_ Re uired Records & Documents Observed Freeboard (in): 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [] Yes 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P�[ No ❑ NA ❑ NE (i.e., large trees, severe erosion, seepage, etc.) 21No ❑ NA ❑ NE 6. Are there structures on-site which are not properly addressed and/or managed through a [:]Yes 2 -No ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes �&No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [E�No ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes [Z -No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [514 -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 l 0 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop /Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s):z�/`171!'�Q�f�?/�EL��'� 13. Soil Type(s): W&9 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 ❑ Yes ® No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes 53 No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes _E2,No ❑ NA ❑ NE Re uired 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 21No ❑ 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. §9 Yes ❑ No ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis .Soil Analysis ,Waste Transfers ❑ Rainfall ❑ Stocking []Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JK No 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KNo ❑ NA ❑ NE ❑ Weather Code ❑ Sludge Survey ❑ NA ❑ NE ❑ NA ❑ NE Page 2 of 3 2/4/2011 Continued Facility Number: - Date of Ins ection: / 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No the appropriate box(es) below. ❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels ❑ Non-compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail to provide documentation of an actively certified operator in charge? 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? 34. Does the facility require a follow-up visit by the same agency? ❑NA E] NE ❑NA ❑NE ❑ Yes U§ No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE ❑ Yes g No ❑ NA ❑ NE [:]Yes RNo ❑ NA ❑ NE ❑ Yes 91 No ❑ NA ❑ NE ❑ Yes Ea No ❑ NA ❑ NE ❑ Yes S No ❑ NA ❑ NE ❑ Yes 5C No ❑ NA N ❑E Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. Use drawings of facility to better explain situations (use additional pages as necessary). om t- 7/7,, W�7-0 iA �¢ u� Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 Phone: 1 Date: �- 2/4/2011 Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 "Technical Assistance Reason for Visit: 42Y6' utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: f Arrival Time: 7 Departure Time: ,3`� County: 5�,,�4�r Region: Farm Name:_ FGz-i rz�4FG;Owner Email: "�— Owner Name: -C),ra'J" ra � r`G LOk Phone: Mailing Address: Physical Address: Facility Contact: rz�, Title: rl s/ Phone: Onsite Representative: Integrator: /2 ✓_f Certified Operator: SG'"'i' Certification Number: l 7X-_3 Back-up Operator: Location of Farm: Latitude: Certification Number: Longitude: �Iitas Design 'Current F krt7R W1Mt i. nY .♦^ j ,�;�;. �' Design Currenent " Design Carrent Swine Capac ty Pop. Wet,Puultry Capacity Pop Cattle Capacity Pop. can to Finish Layer Dairy Cow Wean to Feeder Non -La er Dairy Calf Feeder to Finish Dairy Heifcr Farrow to Wean Design Current Dry Cow Farrow to Feeder D . a Poul Ca achy Pb-. Non -Dairy Farrow to Finish Layers Beef Stocker Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow Turkeys - 101 Other Y . Turkey Poults Other I 10ther Discharges and Stream Impacts 1, is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? ❑Yes ®No ❑NA ❑NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE 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 [allo ❑ NA ❑ NE ❑NA E] NE ❑ NA ❑ NE Page 1 of 3 2/4/2011 Continued Facility Number: - Date of Ins ection: 42p — [&No ❑ NA ❑ NE Waste Collection & Treatment ❑ Yes ® No ❑ NA ❑ NE 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No [] NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes [] No [] NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 ❑ NE Identifier: Spillway?: ❑Other: Designed Freeboard (in): ❑ Yes �jNo ❑ NA ❑ NE Observed Freeboard (in):_ ❑ Waste Transfers ❑ Weather Code ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections 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.) 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5g -No ❑ NA 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? g,Yes ❑ No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E,No ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require Yes ❑ No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes ® No ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [D -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 D Application Outside of Approved Area 12. Crop Type(s): 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes [&No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes ® No ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE the appropriate box. ❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �jNo ❑ 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 SC No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5g -No ❑ NA D. NE Page 2 of 3 2/4/2011 Continued Facility Number: jDate of Inspection: 62 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [RNo 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E�J_No the appropriate box(es) below. ❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels ❑ Non-compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [Z No 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Pq No Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. p Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? 34. Does the facility require a follow-up visit by the same agency? ❑ NA ❑ NE ❑ NA ❑ NE ❑NA ❑NE ❑ NA ❑ NE ❑ Yes Eq No ❑ NA ❑ NE ❑ Yes Q No ❑ NA ❑ NE ❑ Yes J2[ No ❑ NA ❑ NE ❑ Yes [No ❑ NA ❑ NE ❑ Yes �, No ❑ NA ❑ NE ❑ Yes ® No ❑ NA ❑ NE ❑ Yes MNo ❑ NA ❑ NE Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. Use drawings of facility to better explain situations (use additional pages. as necessary). 1_pd 1�5 /_ � t` +- L Y-,, k� e - �- Ta�'-W lcr__4V5�( Reviewer/Inspector Name: Reviewer/inspector Signature: Page 3 of 3 /-/-j) [.l SYi Phone: Date: 2/4/2017 Type of Visit: 0 Compliance Inspection Z5 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 denied Access Date of Visit: " rArrival Time: 127 ,Do I DepartureTime: County: Region: Farm Name:,,,,L,2255kA, r0; r� _ G�� Owner Email: Owner Name;ra.,�p..� �di��/� Phone: Mailing Address: Physical Address: Facility Contact:nvv �� %�" c� Title: Phone: Onsite Representative: Integrator: Certified Operator: !S"�.,-� Certification Number: 7 Back-up Operator: Location of Farm: Latitude: Certification Number: Longitude: ' Destgn °Current Design Current CurrenCa pple act h Po P Wet Poult . Ca act . o r3 P P` Cattle Po .P t3' P Wean to Finish La er Dairy Cow Wean to FeederNon-I<avers Dai Calf Feeder to Finish (? M � `` ^ ` "' Dai Heifer Farrow to Wean Design Current•_ Dry Cow Farrow to Feeder D . i'0 It ' tiCa' achy fPa t Non -Dairy Farrow to Finish Layers Beef Stocker Gilts Non -Layers 113eef Feeder Boars J Pullets Beef Brood Cow V - _ Turkeys = t7ther Turkey Poults 01 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 allo ❑ NA ❑ NE ❑ Yes D No ❑ NA ❑ 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 E] NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Pq,No ❑ NA ❑ NE of the State other than from a discharge? Page I of 3 2/4/2011 Continued Facili Number: - jDate of inspection: ❑ Yes &No ❑ NA ❑ NE Waste Collection & Treatment ❑ Yes [2 No ❑ NA ❑ NE 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [LNo ❑ NA ❑ NE acres determination? 21. Does record keeping need improvement? If yes, check the appropriate box below. [9 Yes EfNu ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes E] No ❑ NA ❑ NE Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 ❑ NA Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): �'-;Z! 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P" No ❑ NA ❑ NE (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes LS 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 [DNA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes K No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 11LqNo ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EqNo ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): 13. Soil Type(s): G� 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 treed improvement? ❑ Yes [2 No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes rNA No ❑ NA ❑ NE acres determination? 21. Does record keeping need improvement? If yes, check the appropriate box below. [9 Yes EfNu ❑ 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 Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE the appropriate box. ❑WUP ❑Checklists E] Design ❑ Maps ❑ Lease Agreements ❑Other. 21. Does record keeping need improvement? If yes, check the appropriate box below. [9 Yes EfNu ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard .Waste Analysis 'Soil Analysis ❑ Waste Transfers [] Weather Code ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [R No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes § No ❑ NA ❑ NE Page 2 of 3 2/4/2011 Continued Facility Number: - Mate of Inspection: 24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes KLNo ❑ NA ❑ NE i 25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes El No ❑ NA ❑ NE the appropriate box(es) below_ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels ❑ Non-compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes J� No ❑ NA ❑ NE and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes E4 No ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes MNo ❑ 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 fgNo ❑ NA ❑ NE ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes allo ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative`? ❑ Yes MNo ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes 4 No ❑ NA ❑ NE Comments (refer to question #t): Explain any YES answers and/or any additional recommendations or any other comments. Use drawings of,fafacility to better explain situations (use additional pages as necessary).. jrrd a y�jfr~ � 5 �--�*' f- ate_! n y po r Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 Phone: g/p/33�3 Date: 2/4/2011 Type of Visit (3LCo—mpliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance Reason for Visit outine Q Complaint Q Follow up O Referral Q Emergency O Other ❑ Denied Access Date of Visit: 14 Arrival Time: Departure Time: 3 County: Region: Farm Name: t3- -„ d6i, ✓ :% Owner Email: Owner Name: i r- Phone: Mailing Address: Physical Address: Facility Contact: ` �! Title: to t! `_ Phone No: ! Onsite Representative: a!7ix.�._.F L �4 i7� Integrator: Certified Operator: �� `�.� Operator Certification Number: Back-up Operator: Location of Farm: Back-up Certification Number: Latitude: ❑ F -T ❑ Longitude: ❑ o [�' ❑ Design Current Design Current Design Current ❑ NE Swine Capacity Population Wet Poultry Capacity° Papulation Cattle Capacity Population ❑ NE ❑ Wean to Finish ❑ La cr I ❑ Daia Cow ❑ Wean to Feeder ILI Non -Layer I ❑ DaiEy Calf ❑ No ®-feeder to Finish Q Uvo QNo Daia Heifer ❑ Farrow to Wean Dry Poaltry ❑ Dry Cow ❑ Farrow to Feeder El Layers ❑Non-�.a Non -Layers ❑ Pullets ❑ Turkeys ❑ Non -Dairy ❑ Beef Stocker ❑ Beef Feeder ❑ Beef Brood Co ❑ Farrow to Finish El Gilts ❑ Soars 111 1111 U- ..1,111, t Other ❑ Turkey Poults ❑ Other plumber of Structures: ❑ Other Discharges & Stream Impacts I. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (if yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse: impacts to the Waters of the State other than from a discharge? ❑ Yes E�No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes QNo ❑ NA ❑ NE ❑ Yes Uio ❑ NA ❑ NE 12/28/04 Continued Facility Number: — Date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,� No ❑ NA El 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 Identi fier: Spillway?: Designed Freeboard (in): J Observed Freeboard (in): .� 5. Are there any immediate threats to the integrity of any of the structures observed'? El �No ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) Reviewer/Inspector name j - T — _ _ Phone: 6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes jo No ❑ NA ❑ NE through a waste management or closure plan? ❑ NA ❑ NE If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes jFlNo ❑ NA ❑ NE & Do any of the stuctures lack adequate markers as required by the permit? ❑ yes fNo ❑ NA ❑ NE (Not applicable to roofed pits. dry stacks and/or wet stacks) ❑ Yes a No 9. Does any part of the waste management system other than the waste structures require ❑ Yes C&,No ❑ NA ❑ NE maintenance or improvement? ❑ Yes ANo Waste Aoalication ❑ NE 18. 10. Are there any required buffers. setbacks, or compliance alternatives that need ❑Yes Io ❑ NA ❑ NE maintenance/improvement? ❑ NE 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) 13. Sail typc(s1 kle _ Reviewer/Inspector name j - T — _ _ Phone: 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RNo ❑ NA ❑ NE 15. Does the receivingt7 crop and/or land application site need improvement? ❑ Yes ANo [--]NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes a No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes ANo ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes "' ❑ NA ❑ NE Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments. Use drawings of facility to better explain situations. (use additional pages as necessary): t� Reviewer/Inspector name j - T — _ _ Phone: Reviewer/Inspector Signature: Date: ,z 12/28/04 Continued Facility Number: — Date of Inspection (] '4 Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [(No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CA W M P readily available? If yes, check ❑ Yes JqNo ❑ NA ❑ NE the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &.No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes U No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes NNo ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 9 No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes JkNo ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes RNo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes §;allo ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 25�io ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes b?.No ❑ NA ❑ NE and report the mortality rates that were higher than normal? 30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [R:No ❑ NA ❑ NE- EIf Ifyes, contact a regional Air Quality representative immediately 31 _ Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes 2.No ❑ NA ❑ NE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes 0No ❑ NA ❑ NE 33_ Does facility require a follow-up visit by same agency? ❑ Yes Wo ❑ NA ❑ NE Additional Comments and/or Drawings: 12/28/04 0 ion of WaterQuality LPF.rCi1!tVj1N,_uj=Mnb_erc7 0 Division of Soil and WaC ter onservation c� Q Other Agency Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit &14'routine 0 Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access Date of Visit: Arrival Time:.%� __ Departure Time: ar i County: Region:^ 411/ Farm Name: it tl Y' __ Owner Email: Owner Name: I CELL, �1 t id//'1'IS _/t G . Phone: ;Nailing Address: Physical Address: ,, 11 Facility Contact: V5 U 61 N !aU1 i r Title: ZQv Phone NWX322� _ Ozirai Onsite Representative: Integrator: 4z _ Certified Operator: Operator Certification Number: Back-up Operator: Back-up Certification Number: Location of Farm: Latitude: ❑ o =I = 11 Longitude: = o = 4 = Cd Design Current Design rrent "WetPoultry Design Current Swine Capacity Population Capacity Population Cattle Capacity Population ❑ We to Finish ❑ La er ❑ Dai Cow ❑ Dai Calf Wean to Feeder ❑Non -La er FFeeder to Finish ❑ NA ❑ Dai Heifer ® Farrow to Wean / Dry Poultry ❑ D Cow ❑ Farrow' to Feeder ❑ Layers ❑ Non -Dairy ❑ Farrow to Finish RNo ❑ Beef Stocker Gilts ❑ Non -Layers ElBeef Feeder B POoars El El Beef Brood Co ❑ Turke s Turkeys Other. ❑ Other ❑ Turkey Poults ❑ Other Number of Structures: Discharges & Stream Impacts 1. is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (if yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [.No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes [.NO ❑ NA ❑ NE ❑ Yes RNo ❑ NA ❑ NE 12/28/04 Continued Facility Number: — Date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [6No ❑ NA ❑ NE a. if yes, is waste level into the structural freeboard? [:]Yes ❑ No [INA ❑NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O No ❑ NA ❑ NE (ie/ large trees. severe erosion, seepage, etc.) 6. Arc there structures on-site which are not properly addressed and/or managed ❑ Yes [jd 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 [K 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 ESNo ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need 0 Yes RNo ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If ycs. check the appropriate box below. ❑ Yes 0 N ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10%or 1(1 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Cr//op Window ❑ Evidence of Wind Drift ❑ Application Outside of/Area 12_ Crop type(s)J�r/iN,�fc� 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [@ No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes 4 No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 19 No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes ® No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment'? ❑ Yes No ❑ NA ❑ NE Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments. Use drawings of facility to better explain situations. (use additional pages as necessary): �'�r: Fo��►. Wim':{ -1 f� Fa,-rrio,,lIt illQih,ai G/tle CEi� • CJ I / � ! /1 i✓��!/Y� Gid 1-e l CYI{ Revie,Aer/inspectorName ( 7 —� l Phone: Q Reviewer/inspector Signature: � Date: 12128104 Continued Facility Number: XV -L Date of Inspection ' Reuuired Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C&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 El Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O'No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes KNo ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®No ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 14 No ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes W No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes INo ❑ NA ❑ NE Other Issues 2$. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0No ❑ 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 IN 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 'S No ❑ NA ❑ NE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ®..No ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes RNo ❑ NA ❑ NE Additional Comments and/or Drawings: 12/28/04 s Type of Visit (Si -Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance Reason for Visit ®'Foutine Q Complaint 0 Follow up O Referral 0 Emergency Q Other ❑ Denied Access Date of Visit: - � Arrival Time: :310 Departure Time: I , 3 County: Region: Farm Name:G=f /.�-J Owner Email: Owner Name: „/ Y��—�!!��!o / ^- Phone: _ Mailing Address: Phvsical Address: Facility Contact: �n� �Qrl' Title: Phone No: Onsite Representative: Integrator: ,P/rte Certified Operator: Operator Certification Number: Back-up Operator: Sack -up Certification Number: Location of Farm: Latitude: 0' [--]' = « Longitude: [� o =' [� " Design l urrent SwineYu@apacty Pupulation ,, - Design Current �et,Poultry Capacity Population Design Current Cattle Capacity Population ❑ Wean to Finish ❑ Laver ❑Dai Cow ❑Wean to Feeder x ❑Non-1_aver I i Calf Feeder to Finish 1 119 0 0 - "' ❑ Dai Heifer ❑ Farrow to Wean -...Q l'aultry ❑ Dry Cow ❑ Farrow to Feeder. "`n`v�"`"" Non -Dairy ❑ Farrow to Finish ❑ Layers ❑ Beef Stocker ❑ Gilts ❑ Non -Lavers Beef Feeder ❑ Boars ❑ Pullets 10 ❑ Beer Brood Cowl- owTurke Other Turkeys s ❑ Turkey Poults ❑ NE ❑ Other ❑ Other Number of SVuctu - s: ❑ NA ❑ NE 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State Discharges & Stream impacts 1. Is any discharge observed from any part of the operation? ❑ Yes O No ❑ NA ❑ NE Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made'? ❑ Yes ❑ No ❑ NA ❑ NE b. Did the discharge reach waters of the State? (If yes, notify DWQ) [] Yes ❑ No ❑ NA EINE 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 allo ❑ NA ❑ NE 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes IS No ❑ NA ❑ NE other than from a discharge? 12/28/04 Continued Facility Number: — Date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Jallo ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes V,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 E4 No ❑ NA ❑ NI, 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 WNo ❑ NA ❑ NE R. Do anv of the stuctures lack adequate markers as required by the permit? ❑ Yes IN 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 Da No ❑ NA ❑ NE maintenance or improvement? Waste Annlication 10. Are there any required buffers. setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA EINE maintenance/improvement? 11. is there evidence of incorrect application? If yes. check the appropriate box below. ❑ Yes JZ 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) 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [RNo ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes L# No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes L.qNo ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes 13 -No ❑ NA ❑ NE Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. Use drawings of facility to better explain situations. (use additional pages as necessary): -rte l rxQV--r-x VIP --7'0 lypol- a �- Reviewer/inspector Name Phone: Wr C-0 Reviewer/Inspector Signature: Date:p�wc�� 12128104 Continued Facility Number: — Date of Inspection Re uired Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0aNo ❑ 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 p ❑ Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ESYes ❑ No ❑ NA ❑ NE Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �SNo ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑~No ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [9No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes Wo ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes B,No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes KNo ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 5irNo ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes 5,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 ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately JRNo 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 reviewfinspection with an on-site representative? ❑ Yes [ZNo ❑ NA ❑ NE 33_ Does facility require a follow-up visit by same agency'? ❑ Yes 18 No ❑ NA ❑ NE Additional Comments andlor Drawings: 12128104 Other ❑Denied Access Date of Visit: Arrival Time: Departure Time: i County: Region: ZEE� Farm Name: 'Z Q fr �^' /�� Owner Email: Owner Name: /�Gys�A 0��_ /� . i r` If 10 Phone: 5-2 ?= a 10 Mailing Address: Physical Address: Facility Contact: d' /G itle: Phone No: Onsite Representative: _ I-517_� Integrator: Certified Operator, c Scab–e— Operator Certification Number: % 7� --7– Back-up Operator: Back-up Certification Number: Location of Farm: Latitude: [=]' [—] ' =]" Longitude: = ° [� j =" A. Design Current Designf Current Design Current S�wtnea Capacity Population Wet`Poultry P c tv��PopulationC_attle Capacity Population El Wean to Finish ❑ La er ❑ Dai!y Cow Wean to Feeder ❑ Non -La er ❑ Dai Calf ❑ Feeder to Finish a rt_,_ ❑ Dai Heifer El Farrow to Wean D - Pault I ry :. El Dry Cow El Farrow to Feeder El Non -Dai El Farrow to Finish ❑ Lavers El Beef Stocker El Gilts ❑ Non -Layers ❑ Beef Feeder El El pullets ❑ Beef Brood Cow _. ElTurkeys Other Y,. El Turkey Poults ti ❑ Other ❑Other T .* Number�of Structures: . .. .... d Boars Discharges &Stream Impacts 1. Is any discharge observed from any part of the operation? ❑Yes [&No ❑ NA ❑ NE Discharge originated at: El Structure El Application Field El Other a. Was the conveyance man-made? ❑ Yes ❑ No [] NA ❑ NE b. Did the discharge reach wafers of the State? ([f yes, notify DWQ) ❑Yes ❑ Na ❑ NA ❑ NE c. What is the estimated volume that reached waters of the State {gallons}? d. Does discharge bypass the waste management system? ([f yes, notify DWQ) ❑yes ❑ No ❑ NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? ❑Yes ®No ❑ NA ❑ NE 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State [I Yes DRLNo ❑ NA ❑ NE other than from a discharge? Page l of 3 12/28/04 Continued Type of Visit fKCompliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance Reason for Visit C7 Routine Q Complaint Q Follow up 0 Referral a Emergency 0 Facility Number: Date of Inspection KNo ❑ NA ❑ NE (Not applicable to roofed pits, dry stacks and/or wet stacks) T Waste Collection & Treatment 9. Does any part of the waste management system other than the waste structures require ❑ Yes MNo ❑ NA ❑ NE maintenance or improvement? 4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PjNo ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Stricture 5 Structure 6 Identifier: ❑ PAN ❑ PAN > 10% or i b lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil Spillway?: 12. Crop type(s) Designed Freeboard (in): 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Observed Freeboard (in): [INA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes ER No ❑ NA ❑ NE 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes RNo ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) 18, is there a lack of properly operating waste application equipment? ❑ Yes ,®.No ❑ NA ❑ NE 6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 19 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 O No [JNA ❑NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes KNo ❑ NA ❑ NE (Not applicable to roofed pits, dry stacks and/or wet stacks) T Reviewer/Inspector Name — �_. �v w �� Phone:1-x/33 �33D 9. Does any part of the waste management system other than the waste structures require ❑ Yes MNo ❑ NA ❑ NE maintenance or improvement? Waste Aoplication 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 I&No [INA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu. Zn, etc.) ❑ PAN ❑ PAN > 10% or i b lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area 12. Crop type(s) 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 4 N [INA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes ER No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?❑ Yes 4 No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes JKNo ❑ NA ❑ NE 18, is there a lack of properly operating waste application equipment? ❑ Yes ,®.No ❑ NA ❑ NE Comments (refer to question#): Explain any YES answers and/or any recommendations or any other comments. Use drawings of facility to better explain situations. (use -additional pages as necessary): i T Reviewer/Inspector Name — �_. �v w �� Phone:1-x/33 �33D Reviewer/Inspector Signature: Date: (Vol Page 2 of 3 /2/28/04 Continued M • Facility Number: — Date of Inspection IV Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [SNo ❑ NA [:]NL 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [9No ❑ NA ❑ NE the appropirate box. ❑ WUP El Checklists El Design El Maps [3 Other 21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes ISNo ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers []Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 19 No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes (A No ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I,No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ,E9,No ❑ NA ❑ NF� 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes Klo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes 19 No ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No ❑ NA ❑ NE 29_ Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes %No ❑ NA ❑ NE and report the mortality rates that were higher than normal? 30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 5LNo ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately 31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes [9 No ❑ NA ❑ NE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes RNo ❑ NA ❑ NE Comments and/or Page 3 of 3 12/28/04 0T Division of Water Quality 5 P—r-dr . Facility Number Q Division of Soil and Water Conservation Q Other Agency Type of Visit,,, m��pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit �TRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: Arrival Time: 1 3.' P-0 1 Departure Time: �•� J County: " v-'"'- Region: � Farm Name: 5 ra--Ado,. larY`GLa/ `t 6ae"*IL Owner Email: Owner Name: eA 6;ri r- e -Z A- Phone: Mailing Address: Physical Address: Facility Contact: 'rQ *'�-� 01 �Gt • r _ ide: Onsite Representative: Certified Operator: Back-up Operator: Operator: Phone No - Integrator: iz- Operator Certification Number: Back-up Certification Number: Location of Farm: Latitude: = o ❑ I 0 l{ Longitude: =0=1 e=1 = Swine Wean to Finish Wean to Feeder Feeder to Finish Farrow to Wean Farrow to Feeder Farrow to Finish Gilts Boars Other ❑ Other Design Current Design Current Capacity Population Wet Poultry Capacity Population ❑ Laver 1I J[j Non -Laver Dry Poultry ❑ Layers ❑ Non -Layers ❑ Pullets ❑ Turkeys ❑ urkey Poults ❑ Other Discharges & Stream lmoacts 1. is any discharge observed from any part of the operation'? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? Design Current Cattle Capacity Population ❑ Dairy Cow ❑ Dairy Calf ❑ Daia Heifer ❑ Dry Cow ❑ Non -Dairy ❑ Beef Stocker ❑ Beef Feeder ❑ Beef Brood Ca Number of Structures: F 7t 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 0 No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes t] No ❑ NA ❑ NE ❑ Yes (R No ❑ NA ❑ NE 12/28/04 Continued Facilih- Number: — Gf Date of Inspection 7 ' 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: Spillway?: Designed Freeboard (in): Observed Freeboard (in): l�( 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 14 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? K.Yes ❑ No ❑ NA ❑ NE 8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9 No ❑ NA ❑ NE (Not applicable to roofed pits, dry stacks and/or wet stacks) 9. Does any pan of the waste management system other than the waste structures require ❑ Yes RNo ❑ NA ❑ NE maintenance or improvement? Waste Application 10_ Are there any required buffers, setbacks. or compliance alternatives that need ❑ Yes �R No ❑ NA ❑ NE maintenance/improvement? 11. 1s there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes J,No ❑ NA ❑ NE ❑ Excessive Ponding ❑ 1-[ydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 12_ Crop type(s)l�C 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes tZ No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement'? ❑ Yes R No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes ® No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes 2.No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes ONo ❑ NA ❑ NE Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments. Use drawings of facility to better explain situations. (use additional pages as necessary): ReviewerAnspector Name Phone: ��I/ :: 153-33 Reviewer/Inspector Signature: Date: fQ- 3 r Q -C> 7 12/28/04 Continued Facility Number: — Date of Inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check E] 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 ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 3,No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑YesNo ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 16kNo ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes 09 No ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes RNo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ENo ❑ NA ❑ NE Outer issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes RNo ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes Z 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 U&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 RNo ❑ 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 1No ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes BN o ❑ NA ❑ NE Comments and/or Drawings: 12/28/04 ViEssioon n of Water Quality11 Number a� of Soil and Water Conservationer Agency" Type of Visitom�ppliance Inspection O Operation Review O Structure Evaluation O Technical Assistance Reason for Visit &I outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access Date of visit: L-L�Arrival 'rime: ) Departure Tiinne: Fh`,,3_M County:.�V Farm Name: 1 _an V ti ea ��' 4p%h. ,�%Tk%HL Owner Email: Owner Name: /3Ystvt Ao✓t- e rQ,✓`0_L07 k Phone: Mailing Address: Phvsical Address: J Facility Contact: :� YAG t" G'O itle. Onsite Representative: SaH Certified Operator: Back-up Operator: Location of Farm: Swine Other ❑ Other le C-.. Phone No: Integrator: Re"- 51 Operator Certification Number: Back-up Certification Number: Latitude: =0 =1 =11, Longitude: = o Design Current Design Current Capacity Population Wet Poultry Capacity Population ❑ La er ❑ Non -La et Dry Poultry ❑ Layers ❑ Non -Lavers ❑ Pullets ❑ Turkeys ❑ Turkev Poults ❑ Other Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? Region:lf� Design Current Cattle Capacity Population ❑ Dai ry Cow El Dairy Calf ❑ Dairy Heifer ❑ Dry Cow ❑ Non -Dairy ❑ Beef Stocker ❑ Beef Feeder ❑ Beef Brood Cow b. Did the discharee reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? Number of Structures: M d. Does discharee bypass the waste management system? (If yes. notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNo ❑ NA ❑ NE EI Yes ❑ NA ❑ NE ❑ Yes rLNNo 1� No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes No ❑ Yes KNo ❑ NA ❑ NE ❑ Yes 9 No ❑ NA ❑ NE 12/28/04 Continued Facility Number.9F_11 T19701 Date of Inspection 14, � 7mb(o Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PR No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes DINo ❑ NA ❑ NE Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): p? 5 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �jNo ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) ❑ NE 15. Does the receiving crop and/or land application site need improvement? 6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes LgNo ❑ NA ❑ NE through a waste management or closure plan? 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[] Yes 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? 4 Yes ❑ No ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No [j NA El NE (Not applicable to roofed pits, dry stacks and/or wet slacks) ❑ Yes O No 9. Does any pan of the waste management system other than the waste structures require ❑ Yes r7 No Yk ElNA E3NE maintenance or improvement? Waste Aonlication 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes Na ❑ NA ❑ NE maintenance/improvement? 11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNI,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 Drib ❑ Application Outside of Area 12. Crop type(s) �5 T's' tttA t, I',-ro l.., t�-rJ / Ota Y!"Sr•� 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes XNo ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? kYes ❑ No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[] Yes U�No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes N No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes O No ❑ NA ❑ NE Commenti (refer to question #t): Explain any YES answers and/oryany recommendations or any other• comments:. Use`drawings offaciility to better explain situations. (use additional pages - necessary)G` a 0 1 J ReviewerAnspector Name 0-- Phone: Reviewer/Inspector Signature: Date: —12 2�I4 12/28/04 Continued Facility Number: — Date of Inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JR No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 10 No ❑ NA ❑ NE the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps E] Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 19 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 ® No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CR No ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes [;4 No ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes 10 No ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ®No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes 4No ❑ 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 [4 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 CK No ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes ® No ❑ NA ❑ NE Comments and/or Drawings: Page 3 of 3 12128104 .��t�' �`•�'�' '''�. ��i'�^x:,.'c' "�?an`:A��Y,: ra „� ..,_ +as '�.-�'S '� s r' 'Gr � `=.,� ��' ,��.�''a. �'.r -r sd �?;''��-_- "�F'i -� _ -� �a'1 � �� 0 D1t175t0A tli�5illj and Water C IISlt'VfftlOtl �� _ �-."• w.a"�-�,� �- � ' �-� - rt't' Y'�}.;s a'� TM �'.ii•-r �i�-V�LCi,1�et0� �r � �.. _ ��n.,ri aur - , � � � r -'y', _�c�""s___ y Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation Reason for Visit *Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access Date of Vkit: �-/-/-�.�LI v�- Time: t- Y � Facilitr� Number .?a t Not Operational 0 Belot Threshold Permitted 12 Certified El Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: Farm Name: Vr ..`r Count': 5 a� SQN r -2O Owner Name: g r o.«.dl in .. 9'R . r 1 s:t\.. Phone No:: J_^_ y 9 0.3 ceM 410-4'7p -.IJ;S Mailing Address: Po R.1c 'u. 5 v 1 e: w. % t.r 4 .AlC .2 3 S Facility Contact:�� F�ise�ntt. Title: Phone No: Onsite Representative: Integrator: Fcr..+r Certified Operator: R Ar,,uA&. F-; -, G I a �� Operator Certifir/ cation Number: 1783 Z Locarion of Farm: [X swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ` - Longitudes• �K Design Current Swine Canacity Ponulation ❑ Wean to Feeder ® Feeder to Finish I 1 A'{ O ❑ Farrow to ' ean ❑ Farrowto Feeder ❑ Farrow to Finish [] Gill, ❑ Boars Number of Lagoons !I 1LJ Subsurface Drains Present IL Lagoon Area EL Sprzv Field Area Holding Ponds I Solid Traps ❑ No Liquid Waste Management System Discharges S Stream Impacts 1. is any discharge observed from any past of the operation? ❑ yes [91 o Discharge orimnated at: ❑ Lagoon ❑ 5uray Field ❑ Otber a. Ifdiscbarre is observed, was the conveyance man-made? ❑ Yes ❑ No b. if discharge is obsen-ed, did it reach Water of the State? (if yes. notify DWQ) ❑ yes ❑ No c. if discharse is observed.what is the estimated flow in galimin? d_ Does discharge bNpass a lagoon system? (if yes. notify DWQ) ❑ Yes ❑ No 2_ is there evidence of past discharge from any part of the operation? ❑ Yes [M No 3. Were there any adverse impacts or potential adverse impar to the Raters of the State other than from a discbarge? ❑ Yes ❑ No Waste Uleclilon & Treatment 4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 ldenrifit r: i Freeboard (inches): 33 05/03/01 Continued Design Current Design Current Poultr— Capacity Population Cattle Capacity Population ❑ Laver ❑ Dairy ❑ Non•La,er I I ID Non-Dair> ❑ Other Total Design Capacity Total SSLW Number of Lagoons !I 1LJ Subsurface Drains Present IL Lagoon Area EL Sprzv Field Area Holding Ponds I Solid Traps ❑ No Liquid Waste Management System Discharges S Stream Impacts 1. is any discharge observed from any past of the operation? ❑ yes [91 o Discharge orimnated at: ❑ Lagoon ❑ 5uray Field ❑ Otber a. Ifdiscbarre is observed, was the conveyance man-made? ❑ Yes ❑ No b. if discharge is obsen-ed, did it reach Water of the State? (if yes. notify DWQ) ❑ yes ❑ No c. if discharse is observed.what is the estimated flow in galimin? d_ Does discharge bNpass a lagoon system? (if yes. notify DWQ) ❑ Yes ❑ No 2_ is there evidence of past discharge from any part of the operation? ❑ Yes [M No 3. Were there any adverse impacts or potential adverse impar to the Raters of the State other than from a discbarge? ❑ Yes ❑ No Waste Uleclilon & Treatment 4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 ldenrifit r: i Freeboard (inches): 33 05/03/01 Continued f V Facili11 Number: *a —LF3_1 Date of Inspection 5- Are there any immediate threats to the integrity of any of the structures observer]? (iel 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 pian? (If any of questions 4-6 was answered yes, and the situation poses an immediate public health or environmental tbreat, notify DWQ) 7- Do any of the structures need maintenance/improvement? 8. Does any part of the waste management system other than waste structures require maintenance/improvement? 9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level elevation markings? Waste Aoolication ❑ Yes M No ❑ Yes ® No 19 Yes ❑ No ❑ Yes 1,_4 No ❑ Yes EP' No 10. Are there any buffers that need maintenance/improvement? ❑ Yes No 11. Is there evidence of over application? El Excessive Ponding El PAN ❑ Hydraulic Overload ❑ Yes No 12. Crop type rJer/erPot Leo% �Srrfajt or�i�, n -S r, 1-0 13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No 14. a) Does the facility lack adequate acreage for land application? ❑ Yes [A No b) Does the facility need a wettable acre determination? ❑ Yes JA No c) This facility is pended for a wettable acre determination? ❑ Yes No 15. Does the receiving crop need improvement? ❑ Yes] No 16. Is there a lack of adequate waste application equipment? ❑ Yes ® No Required Records & Documents 17. Fail to have Certificate of Coveraee & General Permit or other Permit readily available? ❑Yes12 No Lfu 18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? (ie/ WUP, checklists, design, maps, etc.) ❑ Yes [V No 19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes 4e1 No 20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes V1 No 21. Did the facility fail to have a actively certified operator in charge? ❑ Yes UO No 22. Fait to notifj' regional DWQ of emergency situations as required by General Permit? (ief discharge. freeboard problems, over application) ❑Yes CA No 23. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? ❑ Yes Q9 No 24. Does facility require a follow-up visit by same agency? ❑ Yes �9 No 25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes t No 113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. Comments (refer to question #): Explain any YES answers and/or, any recommendations or any other commients.: Use drawings of faciliiri to better explant situations°(ttse;addidoaatpages as necessary): Field Copy C3 Final Notes +-4L cvvsiiov- �wc�0.� 7- C�,r�♦l.,wt +r0 ...rot1L or. %acloor. to ..�,i 6o� a0 s tChndv Oi +%%c LAJaeJAy S4%_ S +0 -mfC +0 e- 41%a &%k". h dL t S o w. t.a it C' G e �.. �a e -A %it 0- ■t C. I Ot� +%t +0 I � Reviewer/luspector Name ReviewerA nspecto r Signature: Date: v 72�776y_ 05/03/01 C/ z Continued