Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
820557_INSPECTIONS_20171231
NORTH CAROLINA Department of Environmental 4ual Date of Visit: -- 7— Arrival Time: / D . OZ� Departure Time: a `. �0 County• Region;IL)t� Farm Name: STtL C�, �at•�is-c.g Owner Email: Owner Name: _ �dS-]-7 r� {a1 Phone: Mailing Address: Physical Address: Facility Contact: �-kt InD6Title: .S t�`cJ`�c� i7'I a�--- Phone: Onsite Representative: 124CO. ` _ Integrator: Certified Operator: Certification Number: Back-up Operator: Location of Farm: Latitude: Certification Number: Longitude: 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? E3 -Yes ❑ No ❑ NA ❑ NE ❑ Yes [-No ❑ NA ❑ NE E]es Design Gnrrent ❑ NA Design Gnrrent Design Current Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pap. Wean to Finish Layer DairyCow Wean to Feeder I INon-Layer I Dairy Calf Feeder to Finish Dairy Heifer Farrow to Wean Design Current D Cow Farrow to Feeder D . P,ouf Ga aci P.o , Non -Dairy Farrow to Finish La ers I Beef Stocker Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow Turke s Other Turke Poults Other Other Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify 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? E3 -Yes ❑ No ❑ NA ❑ NE ❑ Yes [-No ❑ NA ❑ NE E]es [:]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? es ❑ No ❑ NA ❑ NE [:]Yes [q No ❑ NA ❑ NE ❑ Yes NA ❑ NE Page l of 3 2/4/2015 Continued IF*ility Number: Date of Inspection: Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes B -I o ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE Structure 1 Structures Structure 3 Structure 4 Structure 5 Structure 6 n22 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? es ❑ 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 E3 90 ❑ 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? 'es ❑ 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 0 --No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LfNo ❑ NA 0-1NE maintenance or improvement? 1 t. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ❑ No ❑ NA ❑ Excessive Ponding p Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA [� E 15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA 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 [7 NE ❑ Yes ❑ No ❑ NA [DaNlr Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA E3 -14E 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA [D -NP - 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 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 [ E ❑ Weather Code ❑ Sludge Survey ❑ NA ❑-NE ❑ NA D -NE Page 2 of 3 2/412015 Continued Faciii Number: - Date of Ins ection: -,0- 7 ❑ Yes 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA 4Ef`NE 25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ❑ No ❑ NA [D -RE 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 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? List structure(s) and date of first survey indicating non-compliance: ❑To 26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA Q-lq-E 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA EJNE Other Issues ❑ NA 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA []'1GE and report mortality rates that were higher than normal? ❑No 29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA E3<E If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes E No ❑ NA ❑ NE permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA [2 -NE ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑To ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes C] No ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? Ery, es ❑No ❑ NA ❑ NE Comments (refer to gdesf 6n #) Eaplatn.any.YES answers and/or any additional recommendations or any other comments: Use drawings of}tacilitygto-better explain; situations use additional pages as necessary). v, M, m r -Tr m r -r uJ y- Frog k Ft F ,ir- w� I (- � s L Reviewer/Inspector Name: Reviewer/Inspector Signatui Page 3 of 3 Phone: Date: 2/4/2015 N k Type of Visit: Q Compliance Inspection O Operation Review trStructure Evaluation Q Technical Assistance Reason for Visit: Q Routine O Complaint O Follow-up Q Referral O Emergency Cher Q Denied Access Date of Visit: .-/ Arrival Time: : � Departure Time: << b County: Region: Farm Name: err-;J�r/r,•`S Owner Email: Owner Name: _ a��T�f�iGf�' Phone: Mailing Address: Physical Address: Facility Contact: F/-O..A e` Alb&": _ Title; Phone: Onsite Representative: �-- Certified Operator: Back-up Operator: Location of Farm: Latitude: Integrator: .i'-rzac✓/a r-zokA". `-S�� Certification Number: Certification Number* Longitude: _Discharges and Stream Impacts I . Is any discharge observed from any part of the operation? [f Yes ❑ No ❑ NA ❑ NE Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? ❑ Yes E No ❑ NA ❑ NE b. Did the discharge reach waters of the State? (if yes, notify DWR) [ Yes [:]No ❑ NA ❑ NE c. What is the'estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWR) Yes ❑ No ❑ NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? [-]Yes D— o ❑ NA ❑ NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes 'o ❑ NA ❑ NE of the State other than from a discharge? Page I of 3 21412015 Condnved [Facility Number: _ Date of Inspection: Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: 6'0 s" _0 Spillway?: Designed Freeboard (in): � Observed Freeboard (in): �- 5. Are there any immediate threats to the integrity of any of the structures observed? Q Yes ❑ No ❑ NA ❑ NE (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes Blqo ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR 7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? [:]Yes [_J <o ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require [:]Yes ENo ❑ NA ❑ NE maintenance or improvement? Waste Anulication 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA NE maintenance or improvement? 11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [—]Yes ❑ No D. NA ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN [1 PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift p 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 �E 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA []"WE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA 18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA [3-N'E-- Retwired Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [] Yes ❑ No ❑ NA U "E 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA [DNf— 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 E] -'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 ❑ No ❑ NAl�E 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No ❑ NA [EJ NE Page 2 of 3 21412015 Continued 4 lFacility Number: jDate of Inspection: 24. Did the facility fail to calibrate waste application equipment as -required by the permit? ❑ Yes ❑ No ❑ NA L'J rl4 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA 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 EINE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes D No ❑ NA �E and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA [314Ei 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 0 Yes No ❑ NA permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ o ❑ NA ❑ NE 33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes [ o ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? 2]'V -es ❑ No ❑ NA ❑ NE Comments (refer to question #,) Explain;any, YES•answers and/or anyadditional recommendations or any other comments. Use draw..ings of facility to better egplainsituabons (use,ad`ditional pages as necessary):,.. w _ 4C7 waw r Je��5��D' Reviewer/inspector Name: Reviewer/Inspector Signatui Page 3 of 3 Phone:[a�—DlS` Date: 2/4/2015 IF Type of Visit: WC01ppliance Inspection O Operation Review i6Structure Evaluation 0 Technical Assistance Reason for Visite outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 12 artier 0 Denied Access Date of Vlsi . / Arrival Time: [�Departure Time: County: Region: 044Z 0 Farm Name: 1'i .S / Owner Email: Owner Name: _ QNB leAl ty,_Q. i eC le?o j Phone: Mailing Address: Physical Address: Facility Contact:I�ir-; r jf jpiD�� Title: $�rt/r`���" Phone: Onsite Representative: Integrator: Certified Operator: _e' Back-up Operator: Certification Number: Certification Number: Location of Farm: Latitude: Longitude: Discharges and Stream Impacts ❑ [—] I . Is any discharge observed from any part of the operation? Yes o NANE Discharge originated at: Structure ❑ Application Field ❑ Other: 45 a. Was the conveyance man-made? Yes No ❑ NA 0 NE b. Did the discharge reach waters of the State? (If yes, notify DWR) 13"Yeeps ❑ No ❑ NA ❑ NE c. What is the estimated volume that reached waters of the State (gallons)? (arft-7ha,� ��; lea GHQ, d. Does the discharge bypass the waste management system? (if yes, notify DWR) av'ees 0 No ❑ NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [3<o ❑ NA ❑ NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E No ❑ NA ❑ NE of the State other than from a discharge? Page I of 3 214120I5 Continued Facili Number: - Date of Ins ection: / N Waste Collection & Treatment 4. Is Yes No NA NE storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? k, ❑ E] ❑ ❑ 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: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA Spillway?: ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code Designed Freeboard (in): 7 [] Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No Observed Freeboard (in): �Z-Ojlrj i�dr [NNE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 5. Are there any immediate threats to the integrity of any of the structures observed? 0 Yes ❑ No ❑ NA ❑ NE (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed through a []'Yes ❑ No ❑ NA ❑ NE waste management or closure plan? 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? Ef Yes ❑ No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 2<o ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes O<o ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ETNFE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA [ ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN [] PAN > 10% or 1 D 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 _ (0 V.t45�lr 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o D NA OINE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA !_ l E 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [] No ❑ NA E] -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 [],11TE ❑ Yes ❑ No ❑ NA [a-Nt Required Records & Documents N 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No [:INA [D 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA 0 -'KE 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 ja E ❑ 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 ❑ No ❑ NA [NNE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA [D -VE Page 2 of 3 2/4/2015 Continued Facility Number: _ :;F–f-7 I 113ate of Inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA Ef rfVE the appropriate box(es) below. ❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels ❑ Non-compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail provide documentation of an actively certified operator in charge? 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: ❑ Yes [] No ❑ NA [a -NE ❑ Yes ❑ No ❑ NA D -NE ❑ Yes ❑ No ❑ NA [EJI�E 0 Yes ❑ No ❑ NA [�NE [—]Yes [T No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA [E '�E 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [r]"No ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? [:]Yes [�T—No ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes [] No ❑ NA ❑ NE Comments (refer to question#) Explacn guy., ES answers and/or any additional recommendations or any other commeats:' Uie drawings offacili _ to better,e larnvsitnations use additional a esus necessa- " A o,,1—UJ 1�uO-RST� WcP6 -�LkPK-,C w;f k `C � -t`�--c �.-c� ��,-�— • /� s! -� w�= r D`�`-S'�••ai /`v i .C� a �-��' .S 1 � l.�- ` ' 4 �d' �t/yt�� i�1 DlX'� >�✓'D•�-� �"GC �7!'I �� � r 4- ��� roj its u ate-a,f.5 Reviewer/Inspector Name: Reviewer/Inspector Signatut Page 3 of 3 Phone: Date: 21412015 ' ivision of Water Resources Facility Number ®- d Division of Snit and Water Conservation Q Other Agency Type of Visit:Com��pliance Inspection Operation Review O Structure Evaluation O Technical Assistance Reason for Visit: 0.1 routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access Date of Visit -Arrival Time: %r � Departure Time: Q County: Region: Farm Name: �0-Jt4Idl�'1?r, Owner Email: Owner Name;- d y p ,� c�'[l��t - j 7' i Gk I c�-+I J Phone.. Mailing Address: Physical Address: Facility Contact; 7—r-� c k far- c( Title: W AT Onsite Representative: Certified Operator: c (i'r (J e- Back-up Operator: Location of Farm: Phone: J_ / Integrator: (ad // ) �""� Certification Number: Certification Number: Latitude: Longitude: Design Curren Swine Capacity Pop. W an to Finish ❑ No ❑ NA ❑ NE ❑ Yes E o Wet Poultry Myer Nan -Layer er Design Capacity Current Pop. Design Current Cattle Capacity Pop. Da' Cow Da' Calf ❑NA can to Feeder a —Cl- Feeder to Finish 1=armw to Wean Farrow to Feeder Farrow to Finish D . P.ottl Layers Design Ca aci Current P,o - Da" Heifer D Cow Non -Da Beef Stocker Beef f=eeder Gilts Non -Layers Boars Pullets I 113eef Brood Cow Other Other Turke s T -ke Poults Other Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? Elly -'es, E:] No ❑ NA ❑ NE ❑ Yes C]�No ❑ NA ❑ NE b. Did the discharge reach waters of the State? (If yes, notify DWR) fYes ❑ No ❑ NA ❑ NE C. What is the estimated volume that reached waters of the State (gallons)? _ d. Does the discharge bypass the waste management system? (if yes, notify DWR) 2. is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes E o [] NA ❑ NE ❑Yes E]—No ❑NA ❑NE Page I of 3 21412015 Continued Facility Number: jDate of Inspection: / Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ 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 ❑ 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 ffNo ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR 7. Do any of the structures need maintenance or improvement? [] Yes ❑ No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Dlo ❑ 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 1 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): 17t.t4jcx_ 13. Soil Type(s): Ag 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0-F o ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes Ef rN"'o ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Ej<o ❑ 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 �o ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E] -Ko ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [ o ❑ NA ❑ NE the appropriate box. ❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements El Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes @'Po ❑ 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 [r3`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 2/4/2015 Continued acili Number; - Date of Inspection: /0 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes PNo ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes ;a No ❑ NA ❑ NE the appropriate box(es) below. ❑ Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels ❑ Non-compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail provide documentation of an actively certified operator in charge? 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately, 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below_ ❑ Application Field ❑ Lagoon/Storage Pond . ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? 34. Does the facility require a follow-up visit by the same agency? g ase additior M,16asses as Reviewer/Inspector Name: Reviewer/Inspector Signatur Page 3 of 3 ❑ Yes 0 No ❑ NA ❑ NE ❑ Yes ED No ❑ NA ❑ NE ❑ Yes M No ❑ NA [] NE ❑ Yes R4 -No ❑ NA ❑ NE [:3 Yes �g No 0 NA ❑ NE ❑ Yes [" No ❑ NA C] NE ❑ Yes No [:]Yes ® No O Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE 7 /r, mza� i.(/f � Phone. Date: _4 %S`z �p 21412015 I t i ypc u, run: %&-x_omppuance inspection %„� Uperar1on KevIew v alrucLure rvaivanon %..J►ecnnicai wssis�aoce Reason for Visit: fi9l outine O Complaint Q Follow-up 0 Referral 0 Emergency Q Other O Denied Access Date of Visit: Arrival Time: Q, S7 I Departure Time: ' J County: Region: Farm Name: ��` �.�. �/,r' Owner Email: Owner Name: dv/l X ��ar /.r..'J Pbone: Mailing Address: Physical Address: Facility Contact: xfld"Title: Phone: Onsite Representative: Certified Operator:. Back-up Operator: Location of Farm: Latitude: Integrator: Certification Number: Certification Number: Longitude: Discharges and Stream Imoaets 1. is any discharge observed from any part of the operation? Design LArrent KNo Design Current Design Current Swine Capacity Pflp. Wet Ponttry Capacity e... Pop? Cattle Capacity Pap. ❑ No ❑ NA ❑ NE b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No Wean to Finish ❑ NE I I Layer er Dai Cow Wean to Feeder 3 Non - Layer ❑ No ¢' Dai Calf Feeder to Finish_ ❑ Yes No ❑ NA '� _ Dai Heifer Farrow to Wean L!U.No ❑ NA Design Current Dry Cow Farrow to Feeder D Poul C �acii KT, Pv Non -Dairy Farrow to Finish La ers Beef Stocker Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow Turke s Other ; Turkey Poults Other Other Discharges and Stream Imoaets 1. is any discharge observed from any part of the operation? ❑ Yes KNo ❑ NA ❑ NE Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE c. What is the estimated volume that reached waters of the State (gallons)? d_ Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes L!U.No ❑ NA ❑ NE of the State other than from a discharge? Page 1 of 3 2/4/2015 Continued Facili Number: - Date of Inspection: f Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CEI No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): L 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes gNo DNA ❑ 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 E&No ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR 7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE S. 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 Byes [—]No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ®,No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus 0 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): �. f ptrC.•-�r�� 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAW MP? ❑ 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 JR No ❑ NA ❑ NE ❑ Yes 4 No ❑ NA ❑ NE Required Record's & 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 RNo ❑ NA ❑ NE the appropriate box. ❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 2 I. 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 'W No 23. If selected, did the facility fail to install and maintain rainbreakers on irritation equipment? ❑ Yes _[g'No ❑ NA ❑ NE ❑ Weather Code ❑ Sludge Survey [] NA ❑ NE ❑ NA ❑ NE Page 2 of 3 2/412015 Continued [Facitity Number: -I Date of Inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CA -No ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [2�3Vo ❑ 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: 25. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes I -No [] NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes MNo ❑ NA ONE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes C8,No ❑ NA ❑ NE and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the [] Yes ER No ❑ NA ❑ NE permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes Q No ❑ NA ❑ NE ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes L&No ❑ NA ❑ NE 33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes RNo ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? R.Yes J&No ❑ NA ❑ NE Recessary).' 0100 C/ f�[fr� �pR l�� 7e— f� /%lClJ Lv� L5 �l� u�'"i T %�e- eP � 74:s L�79 DoT fc—lX Oy / 7—, G1v/-- ly Icrvrr- Artotk '�eu"na 6,1,1 T_4�� 1� Reviewer/Inspector Name: Reviewer/inspector Signatui Page 3 of 3 Phone. Date: 2/412015 St S'ff-6-- Z /5'- 16 I ype or visit. t:zt:ompliance inspection U operation Review V Structure Evaluation V 7 echntcal Assistance Reason for Visit: 4EDZo—utine O Complaint O Follow -tip O Referral O Emergency O Other O Denied Access Date of Visit: �r� Arrival Time: ' () 701 Departure Time: County:Region: 'OF Farm Name:�����,, F��r►-��f � Owner Name: r -O% ; yc bn - / i G -k 1411.1j_ Mailing Address: Physical Address: Owner Email: Phone: Facility Contact: e5elrest' 1,4190e rn- Title: �8=e,. Phone: Onsite Representative: ! integrator: Certified Operator:C_ e1 y _ Certification Number: Back-up Operator: Location of Farm: Latitude: Certification Number: Longitude: Discharees and Stream Imuacts I . Is any discharge observed from any part of the operation? ❑ Yes �o El NA El NE Discharge originated at: ❑ Structure ❑ Application f=ield ❑ Other: a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (if yes, notify DWR) [—]Yes ❑ No ❑ NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? ❑ Yes _5jNo ❑ NA ❑ NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE of the State other than from a discharge? Page 1 of 3 214/1015 Continued Design Curretit�. Design Current Design Current Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pap. Wean to Finish ILayer airy Cow Wean to Feeder_T,&79 I INon-LMer I a' Calf Feeder to Finish airy Heifer Farrow to Wean, Dry Cow Farrow to Feeder Farrow to Finish Gilts q ...D . 1'uu! Layers Non -Layers Ca a ' P,o Non -Dairy Beef Stocker Beef Feeder Boars Pullets Beef Brood Cow Turke s Other s; Turkey Poults Other Other Discharees and Stream Imuacts I . Is any discharge observed from any part of the operation? ❑ Yes �o El NA El NE Discharge originated at: ❑ Structure ❑ Application f=ield ❑ Other: a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (if yes, notify DWR) [—]Yes ❑ No ❑ NA ❑ NE 2. Is there evidence of a past discharge from any part of the operation? ❑ Yes _5jNo ❑ NA ❑ NE 3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE of the State other than from a discharge? Page 1 of 3 214/1015 Continued ;.Facili Number: I Date of Ins ection: e:7011 - Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ONE Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes 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? M -Yes ❑ No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes R5�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 in -No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 5a No ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes IZ-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).ryylu� /�'l�✓jr}—� 13. Soil Type(s): /fte 14. Do the receiving crops differ from those designated in the CAW MP? ❑ Yes ff] 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? Required Records & Documents ❑ Yes ®,No ❑ NA ❑ NE ❑ Yes LQ [DNA ❑ NE 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? D Yes gLNo ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IRNo ❑ NA ❑ NE the appropriate box. ❑ W UP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [. No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code ❑ Rainfall ❑ Stocking ❑ Crop Yield [:]120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? [:]Yes P3.No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5�_No ❑ NA ❑ NE Page 2 of 3 2/412015 Continued ` Facili Number: Date of Ins ection: �ab/6 24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes allo ❑ NA ❑ NE �. 25. Is the facility out of compliance with permit conditions related to sludge? Ifyes, check ❑ Yes [B No ❑ NA ❑ NE the appropriate box(es) below. ❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels ❑ Non-compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Q No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M. No ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes J3 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 B 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 0 No ❑ NA ❑ NE permit? (i.e., discharge, f veboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes Jallo ❑ NA ❑ NE ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other. 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [2�No ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? 0 Yes .0 No ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes .Z. No ❑ NA ❑ NE Reviewer/Inspector Name:t V - CS Phone: &Z::1 Reviewer/Inspector Signature: Date: l _7-0,1,/, Page 3 of 3 2/4/2015 (Type of Visit: aCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance Reason for Visit: &,rooutine O Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access Date of Visit: �/, Arrival Time: �� Departure Time: V ; D O 1 County: , S SS Region: Farm Name: Owner Email: Owner Name: _�f/,�Xp•�— S /,� Phone: Mailing Address: Physical Address: Facility Contact: l�r�Yr /i��p �� Title: Onsite Representative: Certified Operator: '*Nf�z Back-up Operator: Location of Farm: r� �. Phone: Integrator: a�-ezriz"j Certification Number: Certification Number: Latitude: Longitude: Dischar es and Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWR) c. What is the estimated volume that reached waters of the State (gallons)? [:]Yes ® No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA Wet Poultry Des'tgo Capacity Current Pop. Design Current Cattle CapWity Pop. Design Current Swine Capacity Pop. Wean to Finish Layer D Cow Wean to Feeder 4 i Non -La er Dairy Calf Feeder to Finish Design Current D Heifer D Cow Farrow to Wean Farrow to Feeder WROU-lt1 aci P.oaci P.o Non -Dairy Farrow to Finish Layers Beef Stocker Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow HTurkeys 7Lthe LfL Turke Poults Other Dischar es and Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWR) c. What is the estimated volume that reached waters of the State (gallons)? [:]Yes ® No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes [:]No ❑ NA ❑ NE d. Does the discharge bypass the waste management system? (If yes, notify DWR) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? [:)Yes ❑No ❑ Yes No [:]Yes No ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE Page I of 3 2/4/2014 Continued [Facility Number: - Date of Inspection: Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CoNo ❑ 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: ❑ Yes 0 No ❑ NA ❑ NE Spillway?: ❑ Yes E4 No ❑ NA ❑ NE Designed Freeboard (in): Observed Freeboard (in):� ❑ Yes O No ❑ NA ❑ NE 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ 5 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 0 No ❑ NA ❑ NE waste management or closure plan? ❑ Yes ® No ❑ NA ❑ NE If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR 7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) ❑ NE Page 2 of 3 9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ®, No ❑ NA ❑ NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®, No ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes B No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes ® No ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? ❑ Yes 0 No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes E4 No ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes O No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No [] NA ❑ NE the appropriate box. ❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [a No ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes [allo ❑ NA ❑ NE Page 2 of 3 2/4/2014 Continued to Facility Number: jDate of inspection: � --/ x,24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®.No ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA ❑ NE the appropriate box(es) below. ❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels ❑ Non-compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 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 and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: ❑ Yes ® No ❑ NA ❑ NE ❑ Yes 0 No ❑ NA ❑ NE ❑ Yes ® No ❑ NA ❑ NE ❑ Yes Eg No ❑ NA ❑ NE 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ® No ❑ NA ❑ NE 33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ® No ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? ❑ Yes Ca No ❑ NA ❑ NE Comments (refer to'question #)::Explain any YES answers<andMr- any additions! recommendations or. any%other#.commeuts.�, Use drawings oifa.cilety tobefter explain situations (use additional:pages as necessary). 'x' Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 Phone: Date: /0 —/ — --5- 214Y2014 S2/4/2014 of Visit: CJrCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance �n for Visit: tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: Arrival Time: ,t t7 Departure Time: / : 5 County: p Region: Farm Name: 57--e ; e�k I es ut A 4u�t,o Owner Email: Owner Name: 44arp jd kts..`, 57- ie—k1 a- Phone: Mailing Address: Physical Address: Facility Contact: � � /2?DOI` -r Title: Onsite Representative: Certified Operator: /�`.0 �t� VI—/ y Phone: Integrator: 6rxrlla-71 F'2/OIL 31'W1-' Certification Number: Back-up Operator: Certification Number: Location of Farm: Latitude: Longitude: DiscbaEges and Stream Impacts 1. is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? _ d. Does the discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? [:]Yes M.No ❑ NA ❑ NE ❑ Yes [] No ❑ NA ❑ NE ❑ Yes T illiffL-�Ml)esiffnlKCburrentstgn ❑ NE ❑ Yes ® No Current Design arreatillill Swine Capacity Pop. Wet Poultry Carty Pop. Cattle'"` Capacity Pop. Wean to Finish La er Dairy Cow Wean to Feeder 35-0 Non -La er I Dairy Calf Feeder to Finishy T Dairy Heifer Farrow to Wean ,Design Current Dry Cow Farrow to Feeder D", I;oul Ca aci P,o Non -Dairy Farrow to Finish La ers Beef Stocker Gilts on -Layer Beef Feeder Boars Pullets Beef Brood Cow Turkeys Qther Turkey Poults Other Other DiscbaEges and Stream Impacts 1. is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? _ d. Does the discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? [:]Yes M.No ❑ NA ❑ NE ❑ Yes [] No ❑ NA ❑ NE ❑ Yes [:]No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes [2 No ❑ NA ❑ NE ❑ Yes ® No ❑ NA ❑ NE Page I of 3 2/412011 Continued Facili Number; - S Date of Inspection: .JIB Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes a. If yes, is waste level into the structural freeboard? ❑ Yes Structure 4 Structure 2 Structure 3 Structure 4 Structure 5 Identifier: Spillway?: 0 Designed Freeboard (in): Observed Freeboard (in): 11� 91- 5. Are there any immediate threats to the integrity of any of the structures observed? (i.e., large trees, severe erosion, seepage, etc.) ®No ❑NA ❑NE ❑ No ❑ NA [ NE Structure 6 ❑ Yes n No [:]NA ❑ NE 6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes Q No ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situatlon poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes 5ff No ❑ NA ❑ NE 8_ Do any of the structures lack adequate markers as required by the permit? ❑ Yes C 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 M No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA [—]NE maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes rNo ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 lbs. [] Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window 0 Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): ZW.'07'W1-Z 04 -'3Y -j 13. Soil Type(s): fj- tA 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 RNo ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 99 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 B No ❑ NA ❑ NE ❑ Yes allo ❑ NA ❑ NE Required Records & Documents 19, Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes S No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE the 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 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" 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 [3 -No ❑ NA ❑ NE ❑ Weather Code ❑ Sludge Survey 0 NA ❑ NE ❑ NA ❑ NE Page 2 of 3 2/4/2011 Continued Facili Number: - Date of Inspection: / 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EA No 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo 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: 2G. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 2,No 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ® No Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31, Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? 34. Does the facility require a follow-up visit by the same agency? ❑ NA ❑ NE ❑ NA ❑ NE F] NA F] NE ❑ NA [] NE ❑ Yes E0 No ❑ NA [] NE ❑ Yes [&No ❑ NA ❑ NE ❑ Yes ® No ❑ NA ❑ NE ❑ Yes ®No ❑ NA ❑ N E ❑ Yes CK No ❑ Yes L Na ❑ Yes ® No ❑ NA ❑ NE ❑NA ❑NE ❑ NA ❑ NE Comments (refer.to question #): Explain any YES answers and/or any additional recommendations'.or:any.other. comments. ; Use drawings of facility'to better explain situations (use additional pages as necessary).: Reviewer/Inspector Name Reviewer/Inspector Signature: Page 3 of 3 Phone: 'n—y33— 33 o Date: 2/4/2011 (Type of Visit: Otompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergencv 0 Other 0 Denied Access Date of Visit: J Arrival Time: t D Departure Time: ', Coun 4� Farm NameIr k �ara+r�5 Owner Email: Owner Name: Ra r��� XF3�'z- �-� �,�(� Phone: Mailing Address: Physical Address: FacilityContact: z --r/ Title: Onsite Representative: Certified Operator: J�i G f4 Urr Back-up Operator: Location of Farm: Latitude: Phone: Region: Integrator: A& a -a Certification Number: Al e1 r Certification Number: Longitude: Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? ❑ Yes Callo ❑ NA ❑ NE ❑ Yes ❑ No Design CurrentDesgnTCu rentDesign Current ❑ No Swine Capacity Pop. Wet Poultry. city iPop "' Capa _• ,... Cattle Capacity Pop. Wean to Finish Wean to Feeder Layer Non -La er D ' Cow Da' Calf Feeder to Finish Dai Heifer Farrow to Wean Design Current Cow Farrow to Feeder Farrow to Finish Gilts Boars D , $oultry .=:Ca La ers Non -Layers Pullets act Po :LL Non -Da' Beef Stocker Beef Feeder Beef Brood Cow 3urke s Other Turke Poults Other LEja Other Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? ❑ Yes Callo ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No [—]Yes [,No ❑ Yes Z No ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE Page I of 3 1/4/2011 Continued G-Acili Number: Date of Ins ection: I3 Waste Collection & Treatment 0. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE a. if yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in):� 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes allo ❑ NA ❑ NE (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures onsite which are not properly addressed and/or managed through a ❑ Yes & No ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes [S No ❑ NA ❑ NE 9. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [Q 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 2g 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): mJ4L 13. Soil Type(s): A U- 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 allo ❑ NA ❑ NE acres determination? 17. Does the facility lack adequate acreage for land application? 18. Is there a lack of properly operating waste application equipment? ❑ Yes ELNo ❑ NA ❑ NE [:]Yes allo ❑ NA ❑ NE Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JKLNo ❑ NA ❑ NE the appropriate box. ❑WUP E] Checklists [3 Design [:]Maps [] Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [K No ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers EDRainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes C&No 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes NtNo Page 2 of 3 ❑ NA ❑ NE 0 Weather Code ❑ Sludge Survey ❑ NA ❑ NE ❑ NA ❑ NE 2/4/2011 Continued Gacili Number: - Date of Inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? Q Yes 0 No ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA ❑ NE the appropriate box(es) below. 0 Failure to complete annual sludge survey E]Failure to develop a POA for sludge levels D 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? 0 Yes 0 No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA D NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: ❑ Yes [g No ❑ NA ❑ NE ❑ Yes Eg No ❑ NA ONE Yes No ❑ NA ❑ NE ❑ Yes ®No DNA ❑ NE 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes No 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No 34. Does the facility require a follow-up visit by the same agency? [—]Yes No DNA ❑NE ❑ NA ❑ NE ❑ NA ❑ NE Coirnments (refer to question #1): Explain any YES answers and/or any additional recommendations•or`any other comments: � use drawings of facility to better explain situations (use additional vaEes as necessary). Reviewer/Inspector Name: Phone Reviewer/Inspector Signature: Date: Page 3of3 iia y33- 33D -D 21412011 1 14 Type of Visit: j2rcomp ' nee Inspection O Operation eview O RStructure Evaluation O Technical Assistance Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access Date of Visit:7 rrival Time: o ; _vp Departure Time: ; J p CountyL_5_!! � Region: t2!:__D_ Farm Name: Owner Email: Owner Name:Gc r��� �X� ���� r ;�� Phone: Mailing Address: Physical Address: Facility Contact: ��ryyr /i7aD-- Title: Phone: Onsite Representative: Certified Operator: y� Back-up Operator: Location of Farm: Latitude: Integrator: Certification NumberA'g-b Certification Number: Longitude: Swine Wean to Finish Destgn lop rent Capacity _ `: Pop: Wet Poultry La er Design Capacity Current '' Pop. Design Current Cattle Capacity Pop. Dairy Cow Wean to Feeder r Dairy Calf Feeder to Finish -" Dairy Heifer Farrow to Wean Desigoti Current Dry Cow Farrow to Feeder ll, P■pu_l Ca achy Non -Dairy Farrow to Finish Layers Beef Stocker Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow Turke s - Othe ITurkey Poults Other Other Discharees and Stream -Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State'? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge`? [—]Yes C&No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE [:]Yes ❑ No ❑ NA [] NE ❑ Yes []No ❑ Yes PM No Ulk [:]Yes ® No ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE Page 1 of 3 2/4/2011 Continued ]Facility Number: - Date of Ins ection: 1-2 Waste Collection & Treatment j 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes VLNo ❑ 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): 3 5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes M -No ❑ NA ❑ NE (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes allo [:INA 0 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 [D -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 allo [] NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > l0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window❑ Evidence of Wind Drift ❑ Application Outside of Approved Area 12. Crop Type(s): a� 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2�No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes g No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E, 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 1, No [] NA ❑ NE Required Records _& Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes (a No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EK[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 allo ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall inspections 22. Did the facility fail to install and maintain a rain gauge? [—]Yes Z_No 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE ❑ Weather Code p Sludge Survey ❑ NA ❑ NE 0 NA ❑ NE Page 2 of 3 2/4/2011 Continued Facili Number: jDate of Inspection: 2– – — 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No C] NA ❑ NE i 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 2 No ❑ NA ❑ NE the appropriate box(es) below. ❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels ❑ Non-compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [&No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo ❑ 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 the 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 D;�'No ❑ NA ❑ NE ❑ Yes QC No ❑ NA ❑ NE ❑ Yes CQ_No ❑ NA ❑ NE ❑ Yes K No ❑ NA ❑ NE ❑ Yes L' No ❑ Yes UNo [:]Yes IM No ❑ NA ❑ NE ❑NA E] 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): TTI Reviewer/Inspector 177 � rr�� � r" aj D Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 Phone: �L3p o Date: /42:- &/a 2/4/2011 a ,t type or visit: ;emompliance Inspection V Operation Keview V Structure Evaluation V Technical Assistance I Reason for Visit: tine O Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access Date of Visit: 1-30-1 Arrival Time: Departure Time: I U �!� County• st-- Region: Farm Name: ; G& Lar m Owner Name: u 1~01 j k 1 Mailing Address: Physical Address: Owner Email: Phone: Facility Contact: A&01 -r— Title: Phone: OF Onsite Representative: Certified Operator: /� U j� ✓ Pr y Back-up Operator: Location of Farm: Latitude: Integrator: ��wf�.✓%�a.�yn-$ALJ Certification Number: Certification Number: Longitude: Design C►urrent Design CurrentDesegn Swine - Capacity Pop. Pu Wet oltry Capacity Pop. Cattle f C parity lient Wean to Finish La er Dairy Cow Wean to Feeder ::KDNon-La er Dai Calf Dairy Heifer Feeder to Finish s. - Farrow to Wean Dry Poultry Design .Current Ca a _ p - D Cow Non -Dairy Farrow to Feeder Farrow to Finish Layers Beef Stocker Gilts Non -Layers Beef Feeder Boars Pullets Beef Brood Cow ;.. _ Turkeys - Other Turke Poults Other Other Discharges and Stream Imoacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? _ d. Does the discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? ❑ Yes [&No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA [] NE ❑ Yes ❑ No ❑ Yes No ❑ Yes No ❑ NA ❑ NE ❑ NA ❑ NE ❑ NA ❑ NE Page l of 3 2/412011 Continued " Facility Number. -5— Date of Inspection: a j�7t i Waste Collection & Treatment ` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes to No ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): 3 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ne ❑ NA ❑ NE (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ® Yes 0 No ❑ NA ❑ NE 8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require Yes ❑ No ❑ NA ❑ NE maintenance or improvement? _Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE maintenance or improvement? 11, Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® 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):� ,r 13. Soil Type(s): et 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ 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 Z 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 [2 No ❑ NA ❑ NE Re aired 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 n No ❑ NA ❑ NE the appropriate box. ❑ WUP F] Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0'No ❑ Waste Application ❑ Weekly Freeboard E] Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ,l No 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ANo [] NA ❑ NE ❑ Weather Code ❑ Sludge Survey ❑ NA ❑ NE ❑ NA ❑ NE Page 2 of 3 21412011 Continued Facili Number: JK7 - Date of Inspection: /�_ 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CE No ❑ NA ❑ NE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ayes [No ❑ NA ❑ NE the appropriate box(es) below. ❑ Failure to complete annual sludge survey Failure to develop a POA for sludge levels [allon-compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance:' i/yr!!.y y—'02"G 26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [S No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [Z No ❑ NA ❑ NE Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [D No ❑ NA ❑ NE and report mortality rates that were higher than normal? 29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ® No ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately. 30. Did the facility fail to notify the Regional Office of emergency situations as required by the [:]Yes ELNo ❑ NA ❑ NE permit? (i.e., discharge, freeboard problems, over -application) 31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ELNo ❑ NA ❑ NE ❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes M No ❑ NA ❑ NE 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? [-]Yes [g No ❑ NA ❑ NE 34. Does the facility require a follow-up visit by the same agency? 0 -yes g 4o ❑ NA ❑ NE FU ents (refer to question #)• Explain any YES.. answers and/or... any additional recommendations or any,other comments awtixgs of facility to better exllain situations: {use additional pages as necessary). ' a_ iyL rv5-i a— U F i N5r�� D Faon•, v� ST �,+.,,3- ,� • c� d --e -1-e i �y Y/ off 71e 1'-elhas v��� �tJ�m% T%t ,S r�-o� T dj r-4 t5 ! r,,.,,,, ,, 14) Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of 3 Phone: Date: Z2--%e.r l/ 2/412011 vision of Water Quality Facility Number 0 Division of Soil and Water Conservation M��J 0 Other Agency Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visitr outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: Arrival Time: : Q Departure Time: County: Region: F - Farm Name: /`" G an I rYr .< Owner Email: p Owner Name:�� _S i /" i r, 1� Phone: /l0' Mailing Address: Physical Address: Facility Contact: �Csr_1` 1;1%P' -e— Title: >e -I e', Phone No: Onsite Representative: Cmr_C_r f— Moo /'V_- - Integrator: �^��a✓ � at �''�'s'tA�T Certified Operator:5 %i r' Operator Certification Number: v2y Back-up Operator: Location of Farm: Swine Back-up Certification Number: Latitude: =0 =' = Longitude: =0=j 0 Design Current Design Current Capacity Population Wet Poultry Capacity Population ❑ Wean to Finish ❑ Layer ® Wean to Feeder I J435 -0100D I JEI Non -La er ❑ Feeder to Finish ❑ Farrow to Wean ❑ Farrow to Feeder ❑ Farrow to Finish ❑ Gilts ❑ Boars Other ❑ Other Dry Poultry ❑ Layers ❑ Non -Lavers ❑ Pullets ❑ Turkeys ❑ Turkey Poults ❑ Other Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWQ) Design Current Cattle Capacity Population ❑ Dairy Cow ❑ Dairy Calf ❑ Dairy Neifei ❑ Dry Cow ❑ Non -Dairy ❑ Beef Stocke€ ❑ Beef Feeder ❑ Beef Brood Co c. What is the estimated volume that reached waters of the State (gallons)? Number of Structures: d. Does discharge bypass the waste management system? (if yes, notify DWQ) 2, is there evidence of a past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 10 No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes ANo ❑ NA ❑ NE ❑ Yes XNo ❑ NA ❑ NE 12128104 Continued Facility Number: — Date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [XNo ❑ NA EINE 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: t• rn..r t J`'�ed. Spillway?: Designed Freeboard (in): 19 19 - Observed Freeboard (in): 1 (r 3(.- (b5. 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 9 No ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 9LNo [INA ❑ NE through a waste management or closure plan? Ir 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? OYes [:]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 [2,No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA EINE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E4No ❑ 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)clyi� 13. Soil type(s) k . 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? EZ Yes ❑ No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes 5allo ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes E,No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes 9410 ❑ NA ❑ NE _!5�. ����1d�S �7�erc G{ e.�� ` /slt�/`C_ GvO,4 Reviewer/inspector Name Phone: 3c>,o Reviewer/Inspector Signature: Date: Page 2 of 3 12128/04 Continued (a_s'� to t Facility Number: — Date of Inspection 1 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 WMP readily available? If yes, check ❑ Yes JANo ❑ NA ❑ NE the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes gNo ❑ 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 Z.NO ❑ NA ❑ NE 23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [9 No ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ®No ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes gNo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ® No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document [❑ Yes ® No ❑ NA ❑ NE and report the mortality rates that were higher than normal? 30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ® 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 E4 No ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? jo Yes QWo ❑ NA ❑ NE Additional Comments and/or Drawiings: .a " ` /S B41G/'cS__r0/ Aj I- r11 T 6 7-- I -C .4 W'41c 33, -DW R i n �11o�u� W r 1 pr.— it�1r d-- ®es�lSrrG✓. !J Page 3 of " 3 12/28104 /4-zz-zoo4 iWHO of Water Quafiity iFaciIity Numbevision of Soil and Water Conservation Other Agency V. Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance lReasonforVisit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access Date of Visit: VZ -.21-09 Arrival Time: ; 20 ,.. Departure Time: /,'s County:54�+ SIS a�/ Region: Farm Name: S'f rFt�C/a.Jc7� �ar.� S Owner Email: Owner Name:✓��� S�rl c�C�Qn/� Phone: Mailing Address: Physical Address: Facility Contact: GPC. e Y /;(0 6 Title: j z2e- C Phone No: >�•.� Onsite Representative:%cam 1oT�i!�.� Integrator: t�9�✓ G a� S� Certified Operator: -S ri cbl o, d 1 114,-,, D. Operator Certification Number: 2 J� 1V 3 Back-up Operator: Location of Farm: Back-up Certification Number: Latitude: =0 = 0= d Longitude: 0°= i 0« 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 Io ❑ NA [:INE ❑ Yes ElNo ETNA El NE Design Current Swine Capacity Population Design C•urrenE Fret Poultry Capacity topnfation Design Curren# Cattle Capacity Population ❑ NE ❑ Wean to Finish ❑ Layer LINA ❑ Dai Cow ❑ Yes ❑ No ❑ Wean to Feeder -Layer [:INA ❑ Dai Calf [:]Yes 12-<o Feeder to Finish Q p ❑ Farrow to Wean Dry Poaltry ❑ Dai Heifer ❑ D Cow ❑ Non ❑ Farrow to Feeder ❑ La ens -Dairy ❑ Beef Stocker ❑ Farrow to Finish ❑ Gilts ❑Non -La ers ❑ Pullets ❑ Turkeys ❑ Turkey Poults ❑ Other ION El Beef Feeder ❑ Beef Brood Cowi Number of Structures: ❑ Boars Other ❑ Other Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (If yes, notify DWQ) 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Io ❑ NA [:INE ❑ Yes ElNo ETNA El NE El Yes El No [3 A ❑ NE LINA ❑ NE ❑ Yes ❑ No ❑ Yes ❑' 1qo [:INA ❑ NE [:]Yes 12-<o ❑ NA ❑ NE 12/28/04 Continued i iz—Z/—O Facility Number: 2— Date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes rNo ❑ NA ❑ NE a. If yes, is Waste level into the strutural freeboard? ❑ Yes E No ❑ NA ❑ NE Structure 1 Structure Structure 3 Structure 4 Structure 5 Structure 6 Identifier; 2ll�uk� Spillway?: Designed Freeboard (in): Observed Freeboard (in): �$ g 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ! No ❑ NA EINE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE through a waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes EfNo [:INA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E rNo ❑ NA ❑ NE (Not applicable to roofed pits, dry stacks and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes No [INA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Z No ❑ NA ❑ NE maintenance/improvement? H. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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) Sit Cr l�.�r d! C 0 s •� 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? 15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ Yes 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes 17. Does the facility lack adequate acreage for land application? ❑ Yes 18. Is there a lack of properly operating waste application equipment? ❑ Yes ['JNo ❑ NA ❑ NE EI'No ❑ NA ❑ NE No ❑ NA ❑ NE No ❑ NA ❑ NE No ❑ NA ❑ NE Reviewer/Inspector Name I 1C5 Phone: W, 51.3,3, O ReviewerAuspector Signature: Date: lZ-Z/-Zpo 12/28/04 Continued 1,Z -S557 /z Facility Number: —I Date of Inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Yes ,3i o❑ NA ❑ NE El Yes Etff❑ NA ❑ NE ❑ Yes I<o ❑ NA ❑ NE ❑ 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 ITNo ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 24. Did the facility fail to calibrate waste application equipment as required by the permit? 25. Did the facility fail to conduct a sludge survey as required by the permit? 26. Did the facility fail to have an actively certified operator in charge? 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document and report the mortality rates that were higher than normal? 30. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately 31. Did the facility fail to notify the regional office of emergency situations as required by General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? 33. Does facility require a follow-up visit by same agency? Comments and/or El Yes Nom❑ NA El NA El NE ❑ Yes ,_�❑� L El NA El NE Yes C3l-� ��<o No ❑ NA ❑ NE ❑ Yes E5 No ❑ NA ❑ NE ❑ Yes No ❑ NA ❑ NE ❑ Yes Nom❑ NA ❑ NE ❑ Yes NA ❑ NE ❑ Yes ffivo ❑ NA ❑ NE ❑ Yes P Ngo El NA El NE El Yes 2C El NA ❑ NE ❑ Yes B<O❑ NA ❑ NE 12128104 +J S UrDivision of Water Quality Facility Number (j o Division of Soil and Water Conservation Q Other Agency - Type of Visit Compliance Inspection O Operation Review O Structure Evaluation () Technical Assistance Reason for Visit outine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: /x- 'O $ Arrival Time: //i 3Q Departure Time: /�: d County: . 0 -Pso../ Region: Farm Name: 5� r �. k f a� c ,v Owner Email: Owner Name: DfcL Phone: Mailing Address: Physical Address: l' Facility Contact: Certified GreUZ �� v Title: 7_c -,r -Z- 9;Eu Phone No: Onsite Representative: �r��''� Wioo lr�. Integrator— ntegrator �- Certified Operator: Operator Certification Number: Back-up Operator: Location of Farm: Swine Back-up Certification Number: Latitude: E o =I=" Longitude: = 0 = = �s Design Current Design Current Capacity Population Wet Poultry Capacity Population ❑ Wean to Finish ❑ Layer ❑ Wean to Feeder I ID-Non-Layei LN Feeder to Finish .S4 ❑ Farrow to Wean ❑ Farrow to Feeder ❑ Farrow to Finish ❑ Gilts ❑ Boars Other ❑ Other Dry Poultry ❑ La ers ❑ Non -Layers ❑ Pullets ❑ Turkeys ❑ Turkey Poults ❑ Other Disebarizes & Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a, Was the conveyance man-made? Design Current Cattle Capacity Pdpulation - ❑ Dairy Cow ❑ Dairy Calf ❑ Dairy Heifei ❑ Dry Cow ❑ Non -Dairy ❑ Beef Stocker ❑ Beef Feeder ❑ Beef Brood Co =y Number of Structures: b. Did the discharge reach waters of the State? (if yes, notify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Does discharge bypass the waste management system? (if yes, notify DWQ) 1 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 ENA ❑ NE ❑ Yes ❑ No D'1A ❑ NE El< ❑ NE ❑ Yes ❑ No ❑ Yes fo ❑ NA ❑ NE ❑ Yes 2 o ❑ NA ❑ NE 12/28/04 Continued s • Facility Number: 2` ,f",s Date of Inspection Waste Collection & Treatment , 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [3L7 Yes NNoo El NA ❑ NE a_ 1f yes, is waste level into the structural freeboard? ❑ Yes [ fNo ❑ NA ❑ NE Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: 1.4%LG 2— Spillway?: /�o A10 Designed Freeboard (in): Observed Freeboard (in): 3 $ $ 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 El Yes v 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 ❑ NA ❑ NE S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [31 o ❑ NA ❑ NE (Not applicable to roofed pits, dry stacks and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes Mo ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ Nl- maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0'5o ❑ 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) .G va. s C. r. �I4t rai .a O . 13. Soil type(s) AB 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L7 Na ❑ NA ❑ NE 15_ Does the receiving crop and/or land application site need improvement? ❑ Yes ❑,Flo ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes 2.1 o ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ NA ElNE l8_ is there a lack of properly operating waste application equipment? ❑ Yes ,ETNo L3 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): %e . <<t {a[? vt� i. -t i r �Llee ex-SIa �. c� y[ I�Llrt�szJ +�J� p1c,W ; �,j / rre.4✓ -4 4—y,<— � Reviewer/Inspector Name !,�� r / Phone: q/O. Jj r3. 333 0 Reviewer/Inspector Signature: Date: /2—/S-7-009 j AlzaIV'i Lf "2#j4NCi� Facility Number: g Z — Date of Inspection Required Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0'5'o ❑ NA ❑ NE the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L'1No ❑ NA ❑ NE ❑ Yes ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification If yes, contact a regional Air Quality representative immediately ❑ 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? ❑ YesTo❑ NA ❑ NE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑<o/ ❑ 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 pen -nit? ❑ Yes ,LT L'i'lVo ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes Ngo ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? [3E yes Ergo'- No ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes aNo ❑ 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 B 1Vo ❑ NA ❑ NE If yes, contact a regional Air Quality representative immediately 31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ,— 3 tvo El 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 LSNo ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes [2-1 �o❑ NA ❑ NE Comments and/or Drawings: 12/28/44 ,$,j,1S 12 -/9 -zoo 7 vision of Water Quality Facility Number �z .5�� 0 Division of Soil and Water Conservation O Other Agency 11 Type of Visit G�-Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit 01qGutine Q Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: LArrival Time: /O; Departure Time: �'O �.. County: Farm Name: _ .s t ��-JQ�/ /r�cy`r�f Owner Email: OwnerName: a. S�[r"' Phnne- Mailing Address: Region: Physical Address: Facility Contact: Title: Phone No: Onsite Representative: bre G o- /uaDrt Integrator: Certified Operator: ¢#T4 -U. Operator Certification Number: _ z/���3 Back-up Operator: Location of Farm: Swine Back-up Certification Number: Latitude: [=] 0 [--]' F-1 "Longitude: = ° a t � K Design Current Design Current Capacity Population Wet Poultry Capacity Population ❑ Wean to Finish I I ❑ Layer ❑ Wean to Feeder I ❑ Non -Layer ® Feeder to Finish I q,7510 1 14a 6D ❑ Farrow to Wean ❑ Farrow to Feeder ❑ Farrow to Finish ❑ Gilts ❑ Boars Other ❑ Other Dry Poultry Layers Non -Layers Pullets -Turkeys Turkey Poults Other Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? b. Did the discharge reach waters of the State? (If yes, notify DWQ) Design Current Cattle Capacity :_ Population ❑ Dairy Cow ❑ Dairy Calf ❑ Dairy Heifei ❑ Dry Cow ❑ Non -Dairy ❑ Beef Stocker ❑ Beef Feeder ❑ Beef Brood Co c. What is the estimated volume that reached waters of the State (gallons)? Number of Structures: 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? M ❑ Yes [ 1 No ❑ NA ❑ NB ❑ Yes 0 No ❑ NA ❑ NE ❑ Yes [i No ❑ NA ❑ NE ❑ Yes [3 No ❑ NA ❑ NE ❑ Yes [2 No ❑ NA ❑ NE ❑ Yes EW No ❑ NA ❑ NE 11/28/04 Continued 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P 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 Drill ❑ Application Outside of Area 12. Croph'pe(s) RjCrW�ha: ASA(1g,V �0,5. / 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? ❑ Yes [H No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes 0 No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes rJ No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes [2 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): Facility Number: TZ — 7 Date of Inspection Reviewer/inspector Signature: A Date: /Z -17— Z oQ -7 Waste Collection & Treatment 4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ NA ❑ NE a. If yes, is waste level into the structural freeboard? ❑ Yes ER 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 �] Na NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [9 No ❑ NA ❑ NE through a waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE (Not applicable to roofed pits, dry stacks and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [1 No ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P 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 Drill ❑ Application Outside of Area 12. Croph'pe(s) RjCrW�ha: ASA(1g,V �0,5. / 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? ❑ Yes [H No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes 0 No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? ❑ Yes rJ No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes [2 No ❑ NA ❑ NE Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. Use drawings of facility to better explain situations. (use additional pages as necessary): Reviewer/Inspector Name /e/`x A'C vt�_ Phone- Reviewer/inspector Signature: A Date: /Z -17— Z oQ -7 12/28/04 Continued Facility Number: gz -SS`7 Date of Inspection Re wired Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CA W M P readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE the appropirate box. ❑ WUP ❑Checklists ❑Design El Maps El Other ,—y 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes !X No ❑ NA ❑ NE ❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification ❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code 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 [ANo ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �2 No ❑ NA ❑ NE 25_ Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ® No ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes [P 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 [;9 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 [X No ❑ NA ❑ NE General Permit? (iel discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes No ❑ NA ❑ NE 33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE Additional Comments and/or Drawings: 12128104 Type of Visit ® Compliance inspection O Operation Review 0 Structure Evaluation O Technical Assistance Reason for Visit 0 Routine O Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access Date of Visit: /O 2 Arrival Time: /z; ft0 Departure Time: 1.'Q County:. S'cWn�_ Region: Farm Name: St l^1 C K I+ct.,1 d Fa VAA 5 Owner Email: Owner Name: Hogm Ici _,_„_ S41 -i &. jca'jd Phone: Mailing Address: Physical Address: Facility Contact: rex-V- ,B&OKt_ Title eel-- Sne G. Phone No: Onsite Representative: G ►-C.e_t- MLT,*P- _ Integrator: �a+'�ewc Q IruVl/ nn rt., Certified Operator: Q!L lei Operator Certification Number: Back-up Operator: Back-up Certification Number: Location of Farm: Latitude: =0 ❑ 1 =11 Longitude: =0=6 °=6 = it 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? Page 1 of 3 ..4:_& - .. _.. . - _4 ❑ Yes ® No ❑ NA ❑ NE ❑ Yes [ f No ❑ NA Design Current ❑ Yes Design Cuerent Design Cnrrent Swine Capacity Population Wet Paul!ry Capacity Population Cattle Capacity Population ❑ Wean to Finish ❑ Layer ❑NA ❑ Dai Cow Wean to Feeder 141300 ❑ Nan -La er ❑ Yes ❑ Dai Calf ❑ Feeder to Finish ❑ NE ❑ Yes ❑ Dai Heifer ❑ NA ❑ Farrow to Wean Dry Poultry ❑ Dry Cow ❑ Farrow to Feeder ❑ Non -Dairy ❑ Farrow to Finish ❑ 1_a ers ❑Beef Stacker ❑ Gilts ❑ Non -Layers ❑ Beef Feeder ❑ Boars t ❑ Pulles ❑ Beef Brood Cowl Other ❑ Turkeys El Turkey Poults El other ❑ 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? Page 1 of 3 ..4:_& - .. _.. . - _4 ❑ Yes ® No ❑ NA ❑ NE ❑ Yes [ f No ❑ NA ❑ NE ❑ Yes [P No ❑ NA ❑ NE ❑NA [I NE [_1 Yes VNo ❑ Yes 0 No ❑ NA ❑ NE ❑ Yes WNo ❑ NA ❑ NE 12128104 Continued 1 Date of Inspection Z O Facility Number: $L— ' Waste Collection & Treatment 4. Is ❑ 0 ❑ storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes N ❑ NA NE a. If yes, is waste level into the structural freeboard? ❑ Yes (No ❑ NA ❑ NE Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier: 4r'D�5` I ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? Spillway?: (9No ❑ NA ❑ NE Designed Freeboard (in): anw— Observed Freeboard (in): ,,. 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [$No ❑ NA ❑ NE through a waste management or closure plan? If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? ❑ Yes [?No ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ 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 UNo ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes V No ❑ NA EINE maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E?No ❑ NA ❑ NE ❑ Excessive Ponding [I Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > Io% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil ❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 12. Crop type(s) /5 e p -w ii d,2L- PaL, S~o // &V4'7 ►f i n . S 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Lr' Et, No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes [� No ❑ NA ❑ NE 17. Does the facility lack adequate acreage for land application? El Yes lot No ❑ NA ❑ NE 18. Is there a lack of properly operating waste application equipment? ❑ Yes (9No ❑ NA ❑ NE Reviewer/Inspector Name Phone: (9'0 f33 — 3360 Reviewer/Inspector Signature: K Date: Page 2 of 3 72128104 Continued Facility Number: �Z. —S Date of InspectionP75 zLoc61 a REquired Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? 1:1 Yes ip No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No ❑ NA ❑ NE the appropriate box. ❑ wup ❑ Checklists ❑ Design ❑ Maps ❑ Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (A 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 VNo ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes UfNo ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes UfNo ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes T No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes PyNo ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [yNo ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes [F No ❑ NA ❑ NES and report the mortality rates that were higher than normal? 30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ( No ❑ NA ❑ N1? 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 Genera! Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes 1� No ❑ NA ❑ NE Page 3 of 3 12/28/04 01 Type of Visit (0 Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access Date of Visit: Arrival Time: /. U Departure Time: :00 County: ., Region: rR0 Farm Name: 15+., I4kac lArs'ev h Owner Email: Owner Name: 14. t4 W �1 V , c to 1. ___ Phone: Mailing Address: 02 f ay i , e� r.•aQae �1 pQ r�i'•`n oh Al C AU & Z � Physical Address: ,o Facility Contact: Q Title: ,p Phone No: Onsite Representative:,�� Sf .c (acsai Integrator: Lti.•.-!��f' Certified Operator: %7*t+� �Iri t f.P , Operator Certification Number: a,114"3 Back-up Operator: Back-up Certification Number: Location of Farm: Latitude: Q e 0 Longitude: =0=1 = µ Swine Design Current Design Current Capacity Papulation Wet Poultry Capacity Population ❑ can to Finish ❑ Layer O Wean to Feeder �O Dp ❑Non -La et 'i i ❑ Feeder to Finish ❑ Farrow to Wean ❑ Farrow to Feeder ❑ Farrow to Finish ❑ Gilts ❑ Boars Other 1.0.0th-er Dry Poultry i ❑ Layers ❑ Non -Lavers Turkey Poults Other W Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: ❑ Structure ❑ Application Field ❑ Other a. Was the conveyance man-made? Design Current Cattle Capacity, Population ❑ Dairy Cow ❑ Dairy Calf ❑ Dairy Heifej ❑ DpLCow ❑ Non -Dairy ❑ Beef Stocket ❑ Beef Feeder ❑ Beef Brood Co Number of Structures: _k 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) 1 Is there evidence of a past discharge from any part orthe operation? 3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ecr :1 ❑ Yes [DNo ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ Yes ❑ No ❑ NA ❑ NE ❑ NA ❑ NE ❑ Yes ❑ No ❑ Yes [TNo ElNA ❑ NE ElYes 2 No ❑ NA ❑ NE 12/28/04 Continued Comments (refer to [It1eS lOII #): Explaan'any YES:'ansRers and/or=any recommendations orwany other comments. Use drawings of�facihty tosbey t'err a s1taattons:-(use additional pages as necessary):. Reviewer/Inspector Name ' tk: w` Phone: Reviewer/Inspector Signature: Date: —1,5 --Aa o 12/28/04 Continued Facility Number: P.�)_ — Date of inspection=df— Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Dl�o ❑ 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: _ G Spillway?: Designed Freeboard (in): % Observed Freeboard (in): " 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Flo ❑ NA ❑ NE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes []'lqo ❑ 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 [9 No ❑ NA ❑ NE 8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2 N ❑ 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 Q No ❑ NA ❑ NE maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes B No ❑ NA ❑ NE maintenance/improvement? 11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ENo ❑ NA ❑ NE ❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ❑ PAN ❑ PAN > 10% or 10 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) f3e�t r.. �.► . ca.,.a // v� ,`-, 13. Soil type(s)� 14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 5No ❑ NA ❑ NE 15. Does the receiving crop and/or land application site need improvement? ❑ Yes ONo ❑ NA ❑ NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes ['rNo ❑ 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 E]�No ❑ NA ❑ NE Comments (refer to [It1eS lOII #): Explaan'any YES:'ansRers and/or=any recommendations orwany other comments. Use drawings of�facihty tosbey t'err a s1taattons:-(use additional pages as necessary):. Reviewer/Inspector Name ' tk: w` Phone: Reviewer/Inspector Signature: Date: —1,5 --Aa o 12/28/04 Continued R Facility Number: — Date of Inspection Reguir_e_d Records & Documents 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes G -No ❑ NA ❑ NE 20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes B -No ❑ NA ❑ NE the appropirate box. ❑ WUP El Checklists El Design ❑Maps ❑Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE ❑ Waste`Apptication - ❑ ❑psis ❑ Waste Transfers ❑ ❑ Ramfall ❑ stoo ieg ❑ 120 Minute Inspections ❑ tions ❑ the"T-C_oUe_ 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes RNo ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ETNo ❑ NA ❑ NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [D -No ❑ NA ❑ NE 25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes RNo ❑ NA ❑ NE 26. Did the facility fail to have an actively certified operator in charge? ❑ Yes E'No ❑ NA ❑ NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ['No ❑ NA ❑ NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes O No ❑ NA ❑ NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ETNO ❑ 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 UNo ❑ 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 UNo ❑ 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 O'No ❑ NA ❑ NE tiComents and/or,Da rvtwgs a Iy " rte; 4� Addion 1 12/78/04 12/78/04 Type of Visit * Compliance Inspection Q Operation Review O Lagoon Evaluation Reason for Visit • Routine O Complaint O Follow up Q Emergency Notification Q Other 0 Denied Access Facility Number D$e of Visit: 10 O Tune: 3 O Q Not Operational O Below Threshold ® Permitted 13 C�err ified 1 13 Conditionally Certified 0 Registered Date Last Operated or Above Tbreshold: Farm Name: _. a%L:!r:W._A4A1 N OV-16--e-Irl - -- ,--------- --- County: - - -- T I - r— Owner Name: AS Cst 5 Phone No: wading Address: Facility Contact:... �� 5ketG �taTitle: __ Phone No: Onsite Representative: _ !! Q - - LCA_ „--_------• Integrator Certified Operator:-- _ Q� Operator Certification Number:—? -Lf A LL Location of Farm: '.Swine ❑ Poultry 0 Cattle ❑ Horse Latitude • 9 Qu Longitude • ` imes 8 Stream impacts I. Is any discharge observed from any part of the operation? [:]Yes %No Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other a. If discharge is observed, was the conveyance matt -made? ❑ Yes ❑ No b. If discharge is observed, did it reach Water of the State? (If yes, notify, DWQ) ❑ Yes ❑ No c. If discharge is observed, what is the estimated flow in gal/min? d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No 2. Is there evidence of past discharge from any part of the operation? ❑ Yes RNo 3. Were there any adverse impacts or potential adverse mpacts to the Waters of the State other titan fr(m a discharge? ❑ Yes IQ No Waste Collection & Treatment 4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Callo Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 Identifier:scce j Freeboard (inches): 12/12/03 Continued Facility Number: L3 — 5 Date of Inspection 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IR No seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed through a waste management or ❑ Yes BNo closure plan? (If any of questions 4-6 was answered yes, and the situation poses an . immediate public health or environmental threat, notify DWQ) 7. Do any of the structures need maintenance./improvement? ❑ Yes E&No 8. Does any part of the waste manaaQement system other than waste structures require maintenance unprovement? ❑Yes No 9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes RNo elevation markings? Waste Application 10. Are there any buffers that need maintenance./improvement? ❑ Yes 2jNo 11. Is there evidence of over application? if yes, check the appropriate box below. [I Yes MNo ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc 12. Crop type a rm udacAir-ou 13. Do the receiving crops differ with those designated in the Or - ed Animal Waste Management Plan (CAWMP)? ❑ Yes R No 14. a) Does the facility lack adequate acreage for land application? ❑ Yes 9No b) Does the facility need a wettable acre determination? ❑ Yes ® No c) This facility is pended for a wettable acre determination? ❑ Yes (&No 15. Does the receiving crop need improvement? ❑ Yes JgNo 16. Is there a lack of adequate waste application equipment? ❑ Yes J4No Odor Issaes 17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No liquid level of lagoon or storage pond with no agitation? 18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes�No I9_ Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes N(No roads, building structure, and/or public property) 20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional D Yes ®No Air Quality representative immediately. C (reftr to:�#j"YSS _ e A. Reviewer /Inspector Name ' ,U� -' _` 3: .."r . R, x Reviewer3 _... .:. = -R_= Reviewer/Inspector Signature: Date: to 12/12/03 a Continued Facility Number: 82 — Jr Elate of Inspection Required Records & Documents 21 _ Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes U(No 22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? (ie/ WUP, checklists, design, maps, etc.) ❑ Yes XNo 23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �lo (3 Waste Applicati�❑ Freeboardnt❑ Waste Analysie,*'b Soil Sampling L� 24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes KNo 2-5- Did the facility fail to have a actively certified operator in charge? ❑ Yes RNo 26. Fail to notify regional DWQ of emergency situations as required by General Permit? (ie/ discharge, freeboard problems, over application) ❑ Yes KNo 27. Did Reviewer/Inspector fail to discuss reviewfwspection with on-site representative? ❑ Yes E�No 28. Does facility require a follow-up visit by same agency? ❑ Yes C,No 29- Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes, C,No NMES Permitted Facilities 30. Is the facility covered under a NPDES Permit? (If no, skip questions 31,-35) ❑ Yes C[No 31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No 33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No 34_ Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No 35. Does record keeping for NPDF.S required forms need improvement? If yes, check the appropriate boa below. ❑ Yes ❑ No ❑ Stocking Form ❑ Crop Yield Farm ❑ Rainfall [1 Inspection After 1" Rain ❑ 120 Minute inspections ❑ Annual Certification Form © No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. 5Wq,r, . ?:,5,- ar- [4j. �4e w+�.i� •a; -, lllZ6l03 Z• D z-llq /oq Z• 3 2.1 1R 0.87. 9 /lo/uH 1.3 I211VO3