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HomeMy WebLinkAbout820615_INSPECTIONS_20171231NORTH CAROLINA Qepartment of Environmental Quality o pliance Inspection Operation Review Reason for Visit: ®'Routine 0 Complaint 0 FoUow-u 0 Referral 0 Emergency Region: f«O Date of Visit: I?-..~ llff.(/8 Arrival Time:! f/t! "ltllf I Departure Time:J j/i ca A I County: r.Jv.f-11,( Farm Name: ;g-e<.J b'1 -ryn t,J( _ Owner Email: Owner Name: ~) ,l( i. ~"1. t gtlV'-'6-"'Vf cr.-cJ..c:.[/ Phone: Mailing Address: Physical Address: Facility Contact: Title: Phone: Integrator: ·f V'-f!.Sf..~K 7 Certification Number: / f/J-3 ~~---------------- Onsite Representative: 1 { Certified Operator: _ZC:_· ...;..6'1..<=--· .!::..l)~-L-...!f;.;....;...._;:;..._{L....f'(-"{....:::.....:£.=-.{,/___:;._{ ______ __ Back-up Operator: Certification Number: Location of Farm: Latitude: Longitude: Discharges and Stream Impacts 1 . Is any discharge observed from any part of the operation? DYes Wo DNA ONE Discharge originated at: 0 Structure 0 Application Field 0 Other: a. Was the conveyance man-made? DYes 0No .0}NA ONE ' b . Did the discharge reach waters of the State? (Ifyes, notifY DWR) DYes 0No [J-'NA ONE 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) DYes~ LJNA ONE 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? Page I of3 DYes o DYes r . No DNA ONE DNA ONE 21412015 Continued I Facility Num"ber: I Date of Inspection: J;a ; fl( /81 Waste Collection & Treatment 4 . Is storage ca pacity (structural plus storm storage plus heavy rainfall) less than adequate? a . If yes, is waste level into the structural freeboard? Structure I Structure 2 Structure 3 Structure 4 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): 3 I ----- 5. Are there any immediate threats to the integrity of any of the structures observed? (i.e., large trees , severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed through a waste management or closure plan? D Yes ~NA ONE DYes 0No ~ONE Structure 5 Structure 6 DYes ~o DNA O NE 0 Yes {]?No 0 NA D 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 s tructures need maintenance or improvement? 8. Do an y of the structures lac k adequate markers as required by the permit? (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste s tructures require maintenance or improvement? Waste Application DYes DYes DYes DYes [9'No DNA O NE r::(No DNA ONE ~0 DNA ONE I (]!No DNA ONE I 0. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. DYes ~ 0 NA 0 NE 0 Excessive Ponding D Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn, etc.) 0 PAN 0 PAN > 10% or 10 lbs. D Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil D Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area 12. Crop Type(s): i3 ~ .. Atl{AJ-L S' ~-() 13. Soil Type(s): /1J'1 /3/ w vt.P--1. 1'{aru '(V/ 14. Do the receiving crops differ from those designated in the CA WMP? 15. Does the receiving crop and/or land application site need improvement? 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acres determination? 17 . Does the facility lack adequate acreage for land application? 18 . Is there a lack of properly operating waste application equipment? Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? 20. Does the facility fail to have all components of the CAWM P readily available? If yes, check the appropriate box. 0WUP Ochecklists 0 Design 0 Maps 0 Lease Agreements DYes []}No DNA DYes [JJ1'lo DNA DYes ~0 DNA DYes (d'No DNA DYes ~0 DNA 0 Yes ~0 DNA DYes cttNo D NA Domer: ONE ONE ONE ONE O NE ONE ONE 2 1. Does record keeping need improvement? If yes, check the appropriate box below. DYes []'No DNA ONE 0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers D Weathe r Code 0 Rainfall DStocking 0 C rop Yield D 120 Minute Ins p ections D Monthly and I" Rainfall Inspections 0 Sludge Survey 22. Did the facility fail to install a nd maintain a rain gauge? 0 Yes [!fNo 0 NA 0 NE 23. lfselected, did th e facility fai l to install and maintain rainbreakers on irrigation equipment? D Yes ~o 0 NA 0 NE Page 2of3 114/2015 Continued IF~cility l'I,_Jdber: g' a.= ,z; I 5 ] I Date of Inspection: Q-o 1Jfv-~ 24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes [d.-No 0 NA 0 NE 25. Is the facility out of compliance with pennit conditions related to sludge? If yes, check 0 Yes Q.-NO 0 NA 0 NE the appropriate box(es) below. 0 Failure to complete annual sludge survey D Failure to develop a POA for sludge levels 0 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) 3 I . Do subsurface tile drains exi st at the facility? If yes, check the appropriate box below. D Application Field 0 Lagoon/Storage Pond 0 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? - 0 Yes ~0 DNA ONE 0 Yes ~ DNA O NE 0 Yes [AlJilo DNA ONE 0 Yes [f}No DNA ONE 0 Yes ~ DNA ONE DYes ~ DNA ONE DYes G""No DNA ONE DYes (6'No DNA ONE DYes ~0 DNA ONE II-3rv -17 lr .~ 5o -1 7 F-7. 2 Reviewer/Inspector Name: Reviewer/Inspector Signature: Page3 of3 Phone:'f( olf3 3-J .33 i Date: &:-'i.J Jf\."l.·l l g 1/411015 ompliance Inspection Operation Review 0 Structure Evaluation Reason for Visit: ~outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Denied Access Date of Visit: lltt ~ M I Arrh·al Time: I f}D~ p Departure Time: IJ;Pt? P I County: S f1-V4 Region~ Farm Name: ~ a..So"\ T'(l{.fA£/ Owner Email : Owner Name: .....~etd::....L:t ({.:....:\~~;_~~"---=..::B...;..~_"'....::{p_'bL....:.....::;_-...&..(_,i....:.;..t:....:.~~·f __ _ Phone: Mailing Address: Physical Address: Facility Contact: ....l~~=rl"....:+....:("""'s;.___~_a.._g...:.{;J_cvlt __ Title: Phone: Integrator: p ( t'5 s~ Certification Number: ....~{~8-...~(..:Z.:;;.J"------ Onsite Representative: [( Certified Operator: _.:f.....Jo~Q.:~o..,f~CM....J.....__./.:.~·----'-j;-J'/:....;~;.......:---------- / Back-up Operator: Certification Number: Location of Farm: Latitude: Longitude: Discharges and Stream Impacts I . Is any discharge observed from any part of the operation? D Yes ~D NA O NE· Discharge originated at: 0 Structure 0 Application Field 0 Other: D Yes 0 No 0'NA O NE 0 Yes 0No 6 NA ONE 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 th at reac hed waters of the State (gallons)? d. Does the discharge bypass the waste management system ? (If yes, notify DWR) 0 Ye s 0No GNA ONE 2. Is there evidence of a past discharge from any part of th e operation? 3. Were there any observable adverse impacts or potential adverse impacts to the waters of the State other tha n from a discharge? Page 1 of3 0 Ye s 0 Ye s [2f'No DNA ONE @ No DNA ONE 21412015 Continued I , !Facility Number: ~ -fO/.S .J if_ I Date of Inspection: /~ 44"' r r I • Wastt-Collection & Treatment 4 . Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes , is waste level into the structural freeboard ? Structure I Structure 2 Structure 3 Structure 4 Identifier: Spillway?: Designed Freeboard (in): Ob served Freeboard (in): P-1 5. Are there any immediate threats to the integrity of any of the structures observed? (i.e., large trees, severe erosion, seepage, etc.) 6 . Are there structures on-site which are not properly addressed and/or managed through a waste management or closure plan? DYes ~o 0 Yes 0 No DNA ONE ~A ONE Structure 5 Structure 6 DYes [d')No 0 NA 0 NE DYes [!(No 0 NA 0 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? 8. Do any of the structures lack adequate markers as required by the permit? (not applicable to roofed pits , dry stacks, and/or wet stacks) 9 . Does any part of the waste management system other than the waste structures require ma intenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or improvement? 0 Yes CEJ"o 0 Yes {3'No 0 NA ONE DNA ONE 0 Yes (LfNo 0 NA 0 NE DYes DNA ONE 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~0 ~0 D NA 0 NE 0 Excessive Ponding D Hydraulic O verload D Frozen Ground D Heavy Metals (Cu, Zn, etc.) 0 PAN 0 PAN > 10% or 10 lbs. D Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil 0 Outside of Acceptable Crop Window D Evidence of Wind Drift D Application Outside of Approved Area 12 . Crop Type(s): 13. Soil Type(s): 14 . Do the receiving crops differ from those designated in theCA WMP? I 5. Does the receiving crop and/or land application site need improvement? 16 . Did the facility fail to secure and/or operate per the irrigation des ign or wettable acres determination? 0 Yes 0 Yes DYes DYes DYes DYes DYes 00ther: 0 Yes u;;}No DNA ~0 DNA ~0 DNA [3'No DNA ~0 DNA [3'No DNA Cf'No DNA f.21' No ONE ONE ONE ONE ONE ONE ONE Page 2 of3 21411015 Continued \ .. !Date oflnspection: /C ~;y..(f11 !Facility Number: 4 24. Did the facility fail to calibrate waste application equipment as required by the permit? 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the appropriate box(es) below. DYes [Z).;.ro DNA 0 NE DYes~ DNA ONE D Failure to complete annual sludge survey D 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 provide documentation ofan 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? lfyes, check the appropriate box below. D Application field D Lagoon/Storage Pond D Other: 32. Were any additional problems noted which cause non-compliance ofthe permit orCA WMP? 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? GJ~u-~f '~ {D-f)..__o-r 5 si c._tzr e_ se{ ~ .... t J--?--7 -r 6 -6-3.f- DYes [3'No DNA ONE DYes ~0 DNA ONE 0 Yes ~0 DNA ONE 0 Yes @No DNA ONE DYes [21'No DNA ONE 0 Yes [LfNo DNA ONE D Yes []"No 0 NA 0 NE DYes U(No DNA ONE DNA ONE Reviewer/Inspector Name: -B l1 ( ~ Reviewer/Inspector Signature : __ i~'-'e(,.~UJ~-~~_.Q=~~_,_--------------­ Page 3 of3 Phone170 Jt33-~fS f Date : 1/t>-qbJ -a 3J ~ 21412015 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit: <:irlioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: Ill moPj {'{,Arrival Time:l/ ~00 PI Departure Time:!/ i 'i b A County: ~A-:'11.. Region:~ Farm Name: w~ 5'~ ~~>~t.At( Owner Email: Owner Nameo ltJ, U /'"-""-t ~ 77tii1JJ Phone: Mailing Address: PhysicaiAddr~s: -------------------------------------------------------------------------------------- Facility Contact: C~ts Ba ~'c.{( Title:--------Phone: Onsite Repr~entative: ___ ....,:l~:..l.:...._ ________________ _ Integrator: PV'-c..5 M- Certified Operator: "7J' ((.~h.. L 71~ Certification Number: { f' /2..,) Back-up Operator: Certification Number: Location of Farm: Latitude: Longitude: Discharg~ and Stream Impacts I. Is any discharge observed from any part of the operation? DYes ~DNA ONE Discharge originated at: 0 Structure 0 Application Field 0 Other: a. Was the conveyance man-made? DYes 0No crNA ONE b. Did the discharge reach waters of the State? (If yes, notify DWQ) DYes 0No ~ ONE c. What is the estimated volume that reac hed waters of the State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes 0No [31t\ ONE 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? Page 1 of3 DYes DYes ~ DNA ONE ~ DNA ONE 21412011 Continued I l -1 r::IF=-ac-:-i:-:-lity:N--:-. =-u-m:-be_r_: --4f'!Jrl~r--_---,GI+I::fr.,l I Date of Inspection: 'j VUAi:/6 Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes, is waste level into the structural freeboard? Structure I Structure 2 Structure 3 Structure 4 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not proper ly addressed and/or managed through a waste management or closure plan? DYes ~NA ONE DYes 0 No ~ ONE Structure 5 Structure 6 DYes ~o DNA QNE 0 Yes [9-tfo DNA 0 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? 8. Do any of the structures lack adequate markers as n:4uired by the permi t? (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 maintenance or improvement? Waste Application I 0. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or improvement? 0 Yes B-M'o DNA 0 NE DYes~ D NA ONE 0 Yes D,No D NA 0 NE DYes~ DNA ONE 11. Is there evidence of incorrect land application? Ifycs, check the appropriate box below. D Yes Q.Wo 0 NA 0 NE 0 Excessive Ponding D Hydraulic Overload D Frozen Ground D Heavy Metals (Cu , Zn, etc.) 0 PAN 0 PAN > 10% or 10 lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil 0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Approved Area 12. Crop Type(s): §(!lr~(/ gG D 13 . Soil Type(s): 14. Do the receiving crops d iffer from those des ignated in theCA WMP? 15. Does the receiv in g c rop and/or land application s ite need improvement? 16 . Did the facility fail to secure and/or operate per the irrigation design or wettable acres determination? 17 . Does the facility lack adequate acreage for land application? 18.ls there a lack of properly operating waste application equipment? Required Records & Documents 19 . Did the facility fail to have the Certificate of Coverage & Permit readily available? DYes DYes DYes DYes DYes DYes 0 Yes CJ-No D NA GI"N~ DNA [d"N o DNA ~No DNA [31'l o DNA CfNo D NA ~0 D NA ONE ONE ONE ONE ONE ONE ONE 20. Does the facility fail to have all components of the CA WMP readily available? If yes, check the appropriate box . OWVP 0Checklists 0 Design 0 Maps D Lease Agreements Oother: _________ _ 21. Does record keeping need improvement? If yes, check the appropriate box below. D Yes ~o 0 NA 0 NE D Waste Application 0 Weekly Freeboard 0 Waste Analysis D Soil Analys is D Waste Trans fers 0 Weather Code 0 Rainfall D Stocking 0 Crop Yield 0 120 Minute Inspections D Monthly and 1" Rainfall Inspections D Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? 0 Yes ll] No 0 NA 0 NE 23 . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes [j' No DNA 0 NE Page 1 of3 11411014 Continued I ; ?1/llit· /(; !Facility Number: I Date of Inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes ~0 DNA ONE DNA ONE 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the appropriate box(es) below. DYes ~0 0 Failure to complete annual sludge survey 0Failure to develop a POA for sludge levels 0 Non-compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: DYes ~0 DNA ONE DYes ~0 DNA ONE 26. Did the facility fail to provide documentation of an actively certified operator in charge? 27 . Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes g1io DNA ONE and report mortality rates that were higher than normal? 29 . At the time of the inspection did the facility pose an odor or air quality concern? 0 Yes ~0 DNA ONE 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 DYes ~0 DNA ONE permit? (i .e ., discharge, freeboard problems, over-application) 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. DYes [B"No DNA ONE D Application Field 0 Lagoon/Storage Pond D Other: ------------------------ 32. Were any additional problems noted which cause non-compliance of the permit orCA WMP? 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? DYes r::;rNo DNA D NE DYes (2('No DNA 0 NE DYes ~No DNA ONE Comments (refer t~fquestion .#):~~~jplaiJu~ny~YES answers andf.or any adc:liti~ft.,!!,~ei.:~mmendations or any,:ijl!j:£_~i~~!'Oielits. Use drawings of facility to better explain sitUations (use additional pages as n'~es~lff.:y). · :~~_::-:f'fSr{:::~ .. Cttl~~l~-(o-~-IS ~~ ,. f 1--'-'2-/ (S b -... 3.5 Reviewer/Inspector Name: Phone: Reviewer/Inspector Signature: Page3 of3 Date: ~4~ l~ --~--~,~-~-------- 11412014 Date of Visit: 1~3 MMJ6f' Arrival Time: I g'rc?6 r Farm Name: f '(cA-.4£{ r/§ 1. t/ Departure Time:l.j~ ~ f I County: 5i1-wL Owner Email: Owner Name: t..J i ({ f ~ -ry~{J Phone: Mailing Address: Physical Address: (6,1 o..--..fc.. • S'" £v:I'W f c..k Facility Contact: f { Title: ---------------------Phone: Region:~ Integrator: P CCS~f Certification Number: {Cf / ~ J Onsite Representative: tl Certified Operator: Back-up Operator: Location of Farm: Latitude: Discharges and Stream Impacts I. Is any discharge observed from any part of the operation? Discharge originated at: D Structure D Application Field a. Was the conveyance man-made? 0 Other: b . Did the discharge reach waters of th e State? (If yes, notify DWQ) c. What is the estimated volume that reach ed waters of the State (gallons)? Certification Number: Longitude: DYes ~NA ONE DYes DNo ~ ONE DYes DNo [J""RA ONE d. Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes DNo ~ONE 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? Poge 1 of3 DYes DYes [3--Ntl DNA ONE ~0 QNA ONE 11412011 Continued • [Fii"cftity Number: I Date oflnspection: ::Z 3 /l6.; ( t;1 • Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes, is waste level into the structural freeboard? Structure I Structure 2 Structure 3 Structure 4 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed through a waste management or closure plan? DYes ~DNA ONE DYes 0 No l3l'f1'r D NE Structure 5 Structure 6 0 Yes EJ-Mt> 0 NA 0 NE DYes (3""NO 0 NA 0 NE If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? 8. Do any of the structures lack adequate markers as required by the permit? (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require maintenance or improvement? Waste Application I 0. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. DYes ~DNA ONE DYes ~DNA ONE DYes ~DNA ONE DYes ~DNA ONE DYes ~ DNA ONE 0 Excessive Ponding 0 Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn, etc.) 0 PAN 0 PAN> 10% or 10 lbs. 0 Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil 0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Approved Area 12. Crop Type(s): ~&~ ~ G<> 13. Soil Type(s): 14. Do the receiving crops differ from those designated in the CA WMP? 15. Does the receiving crop and/or land application site need improvement? 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acres determination? 17. Does the facility lack adequate acreage for land application? 18. Is there a lack of properly operating waste application equipment? Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? 20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check the.appropriate box. OwUP 0Checklists 0 Design D Maps 0 Lease Agreements 21. Does record keeping need improvement? If yes, check the appropriate box below. DYes ~DNA ONE DYes~ DYes [J'No DYes ~ DYes ~ DYes rr( DYes ~ Dother: DYes lti" No DNA ONE DNA ONE DNA ONE DNA ONE DNA ONE DNA ONE DNA ONE 0 Waste Application D Weekly Freeboard D Waste Analysis D Soil Analysis D Waste Transfers 0 Weather Code 0 Rainfall 0 Stocking 0 Crop Yield D 120 Minute Inspections 0 Monthly and I" Rainfall Inspections D Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? D Yes !Z{No 0 NA 0 NE 23.lfselected, did the facility fail to install and maintain rainbrcakers on irrigation equipment? DYes E:('No 0 NA D NE Page2of3 21412011 Continued IFadtity Number: I Date of Inspection: -9\3 · ~I • 24. Did the facility fail to calibrate waste application equipment as required by the permit? 25. Is the facility out of compliance with permit conditions related to s ludge? If yes, check the appropriate box(es) below. DYes~ DNA ONE DYes ~DNA ONE 0 Failure to complete annual sludge survey 0Failure to d evelop a POA for sludge leve ls 0 Non-compliant s ludge levels in any lagoon Li st 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 faci li ty fail to notify the Regional Office of emergency situations as required by the permit? (i.e., discharge, freeboard problems, over-application) DYes D Yes D Yes DYes DYes DYes 31 . Do subsurface tile drain s exist at the facility? If yes , check the appropriate box below. 0 Application Field 0 Lagoon/Storage Pond 0 Other: ------------------------ 32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? DYes 33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? 0 Yes 34. Does the facility require a follow-up visit by the same agency? 0 Yes [9-NO DNA ~DNA ~ DNA ~ DNA [j"No D NA ~DNA [3-No DNA ~ DNA ~ DNA u~ ~ .J-,.,.... co-p-:-1 3 5\~~l( l ~~ '1--l '1 -o-3 u ll r-;, t Reviewer/Inspector Name: Reviewer/Inspector S ignature: Page 3 of3 21412 011 ONE ONE ONE ONE ONE ONE ONE ONE ONE Compliance Inspection CYRoutine 0 Denied Access Date of Visit: I cqL\\ia I Arrival Time:IO~'.W~I Departure Time:llOtOO pr.V'\ I County~AAf!SOO Region: fRO Farm Name:\ 'i,N fNp. \_ 't\~ ~ C.nx.c.kl'. l:PJ\ri\ Owner Email: Owner Name: W:u,~~ -r ~ N,t\'-\L L. ( Phone: Mailing Address: Physical Address: Facility Contact: ~~So\\ t~~O(:\\\ Title: Onsite Representative: ____::§.=-..:::~:!..C!'t:........::----------------- Certified Operator: Back-up Operator: Location of Farm: Latitude: Discharges and Stream Impacts I. Is any discharge observed from any part of the operation? Discharge originated at: D Structure D Application Field a. Was the conveyance man-made? D Other: 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)? Phone: Integrator: S>B~~~ Certification Number: ....~:f;....;Cf:...;t~l::::..::~=------ Certification Number: Longitude: 0 Yes [B'No DNA ONE DYes DNo 152f'NA ONE DYes DNo &f'NA ONE d. Does the discharge bypass the waste management s ystem ? (If yes, notify DWQ) DYes DNo i2(NA ONE 2. Is there evidence of a past discharge from any part of the operation? 3. Were there any observable adverse impac ts or potential adverse impacts to the waters of the State other than from a discharge? Page I ofJ DYes DYes ~0 DNA ONE j0'No DNA ONE 1141201 I Continued .... IFa~ility N~mber: ~~ I Date of Inspection: Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes, is waste level into the structural freeboard? Structure I Structure 2 Structure 3 Structure4 Identifier: ~:1 Spillway?: Designed Freeboard (in): Observed Freeboard (in): 5. Are there any immediate threats to the integrity of any of the structures observed? (i.e., large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed through a waste management or closure plan? DYes ~No DYes ~No DNA ONE DNA ONE Structure 5 Structure 6 DYes g"No DNA ONE D Yes [g'No D NA D NE If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat. notify DWQ 7. Do any ofthe structures need maintenance or improvement? 8. Do any of the structures lack adequate markers as required by the permit? (not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require maintenance or improvement? Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need maintenance or improvement? DYes gNo DNA ONE DYes ~o DNA ONE DYes ~o DNA ONE DYes ~No DNA ONE 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. DYes ~o DNA D NE D Excessive Ponding D Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn, etc.) D PAN D PAN> 10% or 10 lbs. D Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil D Outside of Acceptable Crop Window D Evidence of Wind Drift 0 Application Outside of Approved Area 12. Crop Type(s): c(!J~S.\.(:\L ~~Q..~uo~ 'N\-=t I ~ (rCJ 13. Soil Type(s): \'1\.A\l. v.:tl'\ ) Uffi,i...~~ ' 14. Do the receiving crops differ from those designated in theCA WMP? 15 . Does the receiving crop and/or land application site need improvement? 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acres determination? 17. Does the facility lack adequate acreage for land application? 18. Is there a lack of properly operating waste application equipment? Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? 20. Does the facility fail to have all components of the CA WMP readily available? If yes, check the appropriate box . OwUP 0Checklists D Design D Maps D Lease Agreements 21 . Does record keeping need improvement? If yes, check the appropriate box below. DYes §'No DNA ONE DYes [g'No DNA ONE DYes [S!(No DNA ONE DYes [S?No DNA ONE DYes g1./o DNA ONE DYes ~No DNA ONE DYes ~No DNA ONE Oother: DYes !2r'No DNA ONE 0 Waste Application D Weekly Freeboard D Waste Analysis D Soil Analysis D Waste Transfers 0 Weather Code 0 Rainfall D Stocking D Crop Yield D 120 Minute Inspections D Monthly and l" Rainfall Inspections D Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? DYes 8"No DNA D NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes ~No D NA 0 NE Page 2 of3 21412011 Continued IFa~ility Numher: 24 . Did the facility fail to calibrate waste application equipment as required by the permit ? 25 . Is the facility out of compliance with permit conditions related to sludge? If yes, check the appropriate box(es) below. 0 Yes jg'No 0 NA D NE 0 Yes [g"No 0 NA D NE 0 Failure to complete annual sludge survey D Failure to develop a POA for sludge levels 0 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 as sessments (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. D Yes [g""No DYes [S'No DYes [2fNo DYes ~o DYes ~No DYes ~No 0 NA ONE DNA ONE DNA ONE DNA ONE DNA ONE DNA ONE 0 Application Field D Lagoon/Storage Pond D Other: -------------------- 32 . Were any additional problems noted which cause non-compliance of the permit orCA WMP? 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? 0 Yes ci"No 0 Y cs [}J"No 0 Yes D{No DNA ONE DNA ONE DNA ONE \1~~~:~~~J~~!~r t~:~~~!J.i~~~J~~-pla~n a~y ~s linswcrs ~n.dfor,~(~rJ.~d~itio.-.al recommcnd!lti~ns~:~r a,!lr· ~!_lie Usc~arawmgs ·offaclltty ·to ·b.~.-tcr,explam Situations (use add1honal:pages as necessary). · --_ :: . Reviewer/Inspector Name: Reviewer/Inspector Signature: Page 3 of3 Phone : ~&' .. l,og S \ Date: '-\ \ ~ \'7r ' 214/2011 Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit: @'Routine 0 Complaint 0 FoUow-up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: t7/lt I J 1 I Arrival Time:ft~{)).AR I Departure Time: ItO,' 1?/flq I County: S:tnfStb Region: Fpt} Farm Name:~~~·~±~ Ch!t~ib lilce, }~( Owner Name: ~~ I r nd (I Owner Email: Phone: Mailing Address: Physical Address: .....,.,~-=----------------------------------------·~.5 . 'P':l FadUty Contact: \o.jfrfv., • Jj nJa /L T;tle: M~ Onsite Representative: _\D~Oc~~lhL..:..._}l....J..f.7..Llnd~f!~l ..... f _________ _ Certified Operator: '\ta )(;r 1j nda 1/ Phone: Integrator: p ( fdgj e_ Certification Number: _,}~9~/ d_=3 _____ _ Back-up Operator: Certification Number: Location of Farm: Latitude: Longitude: Discharges and Stream Impacts 1. Is any discharge observed from any part of the operation? DYes ~No DNA ONE Discharge originated at: 0 Structure 0 Application Field 0 Other: a. Was the conveyance man-made? DYes 0No DNA ONE b. Did the discharge reach waters of the State? (If yes, notify DWQ) DYes 0No DNA ONE c. What is the estimated volume that reached waters of th e State (gallons)? d. Does the discharge bypass the waste management system? (If yes, notify DWQ) QYes 0No DNA ONE 2. Is there evidence of a past discharge from any part of the operation? 3. Were th ere any observable adverse impacts or potential adverse impacts to the waters of the State other than from a discharge? Pagel of3 DYes DYes jBNo DNA ONE 18'No DNA ONE 2/4/1011 Continued IFacilitfNumber: 'n ).. !Date of Inspection: i" 7/ld /1 Waste CoUection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes, is waste level into the structural freeboard ? Structure I Structure2 Structure 3 Structure 4 Identifier: Spillway?: Designed Freeboard (in): Observed Freeboard (in): t,.i Q 5. Are there any immediate threats to the integrity of any of the structures observed? (i.e ., large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed through a waste management or closure plan? DYes ~No DNA ONE 0 Yes 0 No 0 NA D NE Structure 5 Structure6 DYes j3No DNA ONE 0 Yes ~No 0 NA 0 NE If any of questions 4-6 were answered yes. and the situation poses an immediate public health or environmental threat. notify DWQ 7. Do any of the structures need maintenance or improvement? 8. Do any of the structures Jack adequate markers as required by the permit? (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 maintenance or improvement? Waste Application IO . Are there any required buffers, setbacks, or compliance alternatives that need maintenance or improvement? ~Yes 0No DNA ONE DYes fi(~No DNA 0 NE 0 Yes 1!0 No 0 NA 0 NE 0 Yes fSj("No 0 NA 0 NE 11. Is there evidence of incorrect land application? If yes , check the appropriate box below. 0 Yes ~No 0 NA 0 NE 0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.) 0 PAN 0 PAN> 10% or 10 lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil 0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Approved Area 12. Crop Type(s): CtJo.Jltr) ~ea, vd/),. tky; Sh'tl/~1in OV~l~r-J_ 13. Soil Type(s): . Hor'f' )s Hac; W1J10?1 I { h~ B 14. Do the receiving crops differ from those designated in theCA WMP? 15. Does the receiving crop and/or land application site need improvement? 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acres determination? 17. Does the facility lack adequate acreage for land application? 18 . Is there a lack of properly operating waste application equipment? Required Records & Documents 19. Did the facility fail to have the Certificate of Coverage & Permit readily available? 20. Does the facility fail to have all components of theCA WMP readily available? If yes, check the appropriate box . OwuP Ochecklists 0 Design 0 Maps 0 Lease Agreements DYes DYes 0 Yes DYes 0 Yes l)fNo ~No lg"No tsa"No liS) No 0 Yes ~No 0 Yes ~No Oother: DNA ONE DNA ONE DNA ONE DNA ONE DNA ONE DNA ONE DNA ONE 21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ~No 0 NA 0 NE 0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Weather Code 0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rainfall Inspections 0 Sludge Survey 22. Did the facility fail to install and maintain a rain gauge? 0 Yes 18J No 0 NA 0 NE 23. Ifselectcd, did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes D No rsa NA D NE PagelofJ 21412011 Continued IFacilit)-NunitJer: ~.}.. I nate of Inspection: 7/11/ f 1 24. Did the facility fail to calibrate waste application equipment as required by the permit? 25 . Is the facility out of compliance with penn it conditions related to sludge? If yes, check the appropriate box(es) below. 0 Yes (8-No D NA 0 NE QYes ~o DNA ONE 0 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels 0 Non-compliant sludge levels in any lagoon List structure(s) and date of first survey indicating non-compliance: 26. Did the facility fail provide doc umentation of an actively certi fied operator in charge? 27. Did the facility fa i l to secure a phosphorus lo ss 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 fa ci lity pose an odor or air quali ty 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) 0 Yes ~0 DNA ONE DYes 0No CiNA ONE DYes I)S1 No DNA ONE DYes !)a" No DNA ONE DYes ~No DNA ONE DYes "5aNo DNA ONE 31 . Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. 0 Application Field 0 Lagoon/Storage Pond 0 Other: ----------------------- 32. Were any additional problems noted which cause non -compliance of the permit orCA WMP? 0 Yes DNA ONE 33 . Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes DNA ONE 34 . Does the facility require a follow-up visit by the same agency? DYes DNA ONE R<viewe<llns pocto< Nam'' ~ ~.~ Re viewer/Inspector Signature: __ \Jo~:....'h....;..L___;:$=(;}J~.:...Oue....L..J eurL----------------------------- Phone : q /trl/23-33/X> /fl6it) Date: Jidv l/, ~ 0 II ffi. J PageJo/3 '411011 Type of Visit ~Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access Region: FRQ Date ofVislt : RJ~IIO I Arriva1Time:I'6;3QAt1 I D epartureTime: lq~l?l\!1 I County: SO~ttfS<i'l Farm Name : 11Jndal/ ~ q_ CJJicke Eat~4 OwnerErnail: ----------- OwnerNa me : ~lltfon 't Tyndq/1 Phone: Mailing Address : -----------------------------------____ _ Phys ical Address:---------------------------------------- Facility Contact: \ra.Jib 1J n. dol/ Title: ---------Phone No: qqo=Lfl-O'f Onsite Rep r esenta tive: _'\t .......... ""'o~' .... £h'-l,-1j..,...n ..... d .... fl ........ l .... l________ Integrator: Prei~ e Certified Oper a tor: "J'm<b -l~)'f''n..u.dol!..a~l.,_J______ Operator Certification Number: ... 1 ..... 9'""/...;::~.,3..._ __ _ Back-up Opera tor: --------------------Back-up Certification Number : Location of Farm: Latitude: D OD 'D " Longitude: Discharges & Stream Impacts 1. Is any discharge observed fro m any part of the operation? D Yes ~o D NA O NE Discharg e ori g in ated at : D Structure D A pplication Fie ld 0 Other a. Was th e con veyan ce man-made? b. D id the d is cha rge reac h waters of th e S ta te? (If yes , notify DW Q) c . Wh at is the estim ated vo lume that reached waters of the State (gall ons)? d . Does d ischarge bypass the waste manage ment system? (If yes , noti fY DWQ) 2 . Is th ere evid ence o f a past disc ha rge fro m any part of the opera ti on? 3 . We re th ere any adverse im pac ts or pote nt ia l adverse impacts to the Waters of the Sta te other than fro m a d ischarge? Page 1 of3 D Yes 0 No D Yes 0 No DYes 0 No DYes l:a'No D Yes ~0 12128104 D NA O NE DNA O N E ] DNA O NE D NA O NE D NA ONE Continued :. jFacill~Number:~;} -€f5" I Date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall ) le ss than adequate? a. If yes, is waste level into the structural freeboard? Structure 1 Structure 2 Structure 3 Structure 4 Identifier: f .J:>.(" Spillway?: DYes ~o DNA ONE DYes 0No DNA ONE Structure 5 Structure 6 De signed Freeboard (in): __.\._Cf..._ ___ ------------------------------- Observed Freeboard (in): _y..::...t-..,.0'----------------------------------------- 5. Are there any immediate threats to the integrity of any of the structures observed? DYes ~0 DNA ONE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properl y addressed and/or managed DYes tij:'No DNA ONE 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? 8. Do any of the stuctures lack adequate markers as required by the permit? (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 maintenance or improvement? Waste Application I 0. Are there any required buffers, setbacks, or compliance alternatives that need maintenance/improvement? DYes !&No DNA ONE DYes ~o DNA ONE DYes ~o DNA ONE DYes 5{No DNA ONE 11. Is there evidence of incorrect application? If ye s, check the appropriate box below. DYes t)I:No 0 NA D NE D Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn, etc.) 0 PAN 0 PAN > 10% or 10 lbs 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil 0 Outside of Ac,eptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Area 12. Crop type(s?1fft m~'o/.sc, 13 . soil type(s) Wa B' BoB· HoC-\s 7 J 14 . Do the receiving crops differ from those designated in the CAWMP? 0 Yes ~No 0 NA 0 NE 15. Does the receiving c rop and/or land application site need improvement? D Yes 18'No 0 NA 0 NE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? 0 Yes ~ No 0 N~ 0 NE 17 . Does the facility lack adequate acreage for land application? 18. Is there a lack of properly operating waste application equipment? Reviewerflnspector Name Reviewer/Inspector Signature: Page 1of1 0 Yes .lS'No DNA D NE DYes ~No DNA ONE Continued I FaciJity Number: %d. -<0121 Date of Inspection I 91~ 'til() I 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 CA WMP readily available? If yes, check the appropriate box . 0 WUP 0 Checklists 0 Design 0 Maps 0 Other DYes ~o DNA ONE 0 Yes 1St-No 0 NA 0 NE 21 . Does re cord keeping need improvement? If yes, check the appropriate box below. ~Ye s 0No DNA ONE 0 Waste Application 0 Weekly Freeboard 5ii-\Vaste Analysis D Soil Analysis 0 Waste Transfers 0 Annual Certification 0 Rainfall D Stocking D Crop Yield D 120 Minute Inspections D Monthly and I" Rain Inspections D Weather Code 22. Did the facility fail to install and maintain a rain gauge? DYes ~0 DNA 23. If se lected, did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes 0No ~NA 24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes ~0 DNA 25. Did the facility fail to conduct a sludge survey as required by the permit? DYes IS(No DNA 26. Did the facility fail to have an actively certified operator in charge? DYes ~o DNA 27. Did the facility fail to secure a phosphorus lo ss assessment (PLAT) certification? Other Issues DYes INo v~NA 28. Were a ny 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 v isit by same agency? Ms-tvOte.-J(norrT) DYes 18-No DNA DYes ~No DNA DYes ~No DNA DYes ~0 DNA DYes BNo DNA DYes ~0 DNA l,s+; ll o,e. \orje_ hue. sror 01 'badtsfde_ C!tf JaJoo". R-estvt· 1~00\ hPJ ~ ooci . C.OJPr ::<1.vvos/e ~~h11a\y5rr qof -f1~ tJo" ~ooq-~e_ ;;,o,o. Sane..e.~~~~p:m, d01t \~ t1£Vc~ o" tJoJt.,bfr Yl"-11 )')er_s bvt PAAJ lS not-eve" c{oJe -ftf be, VJed uf 1 Pie~ siJ" off-:tt.lt ~ a+ f!ul of.St'tUCYJ OvfrO)\J:JOOd. Joo~~ fo,"' q_!Joetl re(cr/J. r .• • · o{_ _j r ...-~-'-"a~~ l/\riaHtt!---(&-Sv~~~tswt-sleanc~ Cl.. }Joe 1)01 01 ?'oa"'w .._ofy -J(n~ '' · g flvNlb~ ore tttiT 1tt Cdont>dl'tl\, a rend 'J +of rod vue r Pag e 3 of 3 12118104 ONE ONE ONE ONE ONE ONE ONE ONE ONE ONE ONE ONE .Facility No.~(plr Permit J' COC t-1 ~q_CA/Ct"' Farm Name \~ndal\ ti lt?J Date ____ _ _., OIC_ NPDES {Rain breaker Pop. Design Current Type Lagoon 1 2 Spillway Design freeboard Uo Observed freeboard (in) Sludge Survey Date lUJiRlfH Sludge Depth _(ft) 3J/J Liquid Trt. Zone (ft) 7r!.J Ratio Sludge to Treatment Volume Calibration Date 1 lci 1~1/(J:; 2 3 4 Design Flow lc'D). /{:])' Actual Flow /6if. lbY: Design Width ~1~15: Actual Width 1.-Aiy:[jf({J ldi"F d / Soil Test Date j' /~'( ll 0 Wettable Acres __ _ pH Fields h-5 -7 Lime Needed /uO WUP Weekly Freeboard __tL_ Lime Applied Cu-I '-"""zn-1~ 1 in Inspections ...........- 120 min Insp. , L NeedsP ~ Weather Codes ~ Crop Yield Transfer Sheets nt, Waste Analy_sis Date q 1-;:,J /I() lf;/tl/0 Jlld3!00 -60 Day + 60 Day 4/~ leo I} ~)/09 N Amt {lb/1 000 Gal) } .... _d. ~--3 t . //1\59) pH (fl#~ I Pull/Field Soil Crop Acres .fb-N 1-4-'t'VaiJ .()P--h-d~ (\,l(p _.J .i--. /\.rJT ~· J)o(7 ~--~dJ b--{~ ~0.~ /\-'de .~ JnO Verify PHONE NUMBERS and affiliations Date last WUP FRO Date last WUP at farm FRO or Farm Records Lagoon# Top Dike Stop Pump Start Pump Conversion-Cu-I 3000== 1081b/ac; Zn-1 3000= 213 lb/ac ....._ PLAT Annual Cert) I I I I 3 4 5 6 7 5 6 7 8 ~UGE \../ ~or incinerator ~ Mortality Records ~ '"'~ ~le~ Window Max Rate Max Amt :rio O<G f-0 App. Hardware Type of Visit ~Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit ~Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit : f6/~ Of I Arrival Time: jl/~J0-4111 Departure Time: 110; 3oAfil County: SI/Wf.lfh Region:F/20 Farm Nam., Jy1 ~11 4 S' 0, Owner Email: Owner Name: ~~lr-T;nda/j Phone: ----------- Mailing Address: -----------------------------------____ _ Physical Address:---------------------------------------- Facility Contact: VbJl?J IjndaU Title: .:...Hu:®~IJjq.:...ft~-----Phone No:------- Onsite Representative: VoJ t>l ry rda (I Integrator: .p, erfcy e._ Certified Operator: "'\t? 1Xb __,Ti~T._.n .... d......:;Ja ..... / .. J_____ Operator Certification Number: fA . .....:.:..~.14....~...-....:.l....~9....~.:/J........,3:::;...__ Back-up Operator: --------------------Back-up Certification Number: Location of Farm: Latitude: D OD'D" Longitude: Discharges & Stream Impacts I. Is any discharge observed from any part of the operation? DYes &No DNA ONE Discharge originated at: 0 Structure D Application Field D 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 rrom 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? DYes 0No DYes 0No DYes 0No DYes NNo DYes ~0 11/18104 DNA ONE DNA ONE ] DNA O NE DNA ONE DNA ONE Continued .... · §Cffity Number~s). -{Gft) Date oflnspection lB I ~i/12 ~ Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes, is waste level into the structural freeboard ? Structure 1 Structure 2 Structure 3 Structure4 DYes ~No DNA ONE DYes 0No DNA ONE Structure 5 Structure 6 Identifi er:----------------------------------------- Spillway?: Designed Freeboard (in): _ __.1 ..... ~+-------------------------------------- Observed Freeboard (in): __ 3.....L.OQ~----------------------------------- 5. Are there any immediate threats to the integrity of any of the s tructures observed? (ic/ large trees, severe erosion, seepage, etc .) DYes .QNo DNA O NE 6. Are there structures on-site which are not properly addressed and/or managed DYes through a waste management or closure plan? 2-No DNA O NE If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? 8 . Do any of the st uctures lac k adequate markers as required by the permit? (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 maintenance or improvement? Waste Application I 0. Are there any required buffers, setbacks, or compliance a lternatives that need maintenance/improvement? EYes 0No DNA ONE DYes lia-No DNA O NE DYes 5;!-No DNA O NE DYes R'No DNA ONE ll. Is there evidence of incorrect application? If yes , check the appropriate box below . 0 Yes ~o DNA 0 NE 0 Excessive Ponding D Hydraulic Overload D Frozen Ground D Heavy M etal s (Cu, Zn, etc.) 0 PAN D PAN> 10% or 10 lbs 0 Total Phosphorus D Failure to Incorporate Manure/S ludge into Bare Soil D Outside of Acceptable Crop Window D Evidence of Wind Drift D Application Outside of Area 12 . Crop type(s) Cob/la I f>e,..c.da f!o/ J s G or 13. soil type(s) BoB s ' HaC \s '. 'rvaB iS J J 14. Do the receiving crops differ from those designated in the CA WMP? 15 . Does the receiving crop and/or land application site need improvement? DYes DYes 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination?O Yes 17. Does the facility lack adequate acreage for land application? 18 . Is there a lack of properly operating waste application equipment? DYes DYes l8No ~0 ~0 '18No ~0 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): Re,iewer/lnspec:tor Name Reviewer/Inspector Signature: DNA DNA DNA DNA D NA ONE ONE O NE O N E ONE Date of lnspedion ~~~~~lor I 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 theCA WMP readily available? If yes, check the appropriate box . D WUP D Checklists D Design D Maps D Other ·--. ·-:; DYes 8-No DNA ONE 0 Yes [SI-No 0 NA 0 NE 21. Does record keeping need improvement? If yes , check the appropriate box below. DYes ~o 0 NA 0 NE D Waste Application D Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers D Annual Certification 0 Rainfall D Stocking 0 Crop Yield D 120 Minute Inspections 0 Monthly and 1" Rain Inspections D Weather Code 22. Did the facility fail to install and maintain a rain gauge? DYes l);J:No DNA . 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes D No (S}NA 24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes [S;(No DNA 25. Did th e facility fail to conduct a sludge survey as required by the permit? DYes §-No DNA 26. Did the facility fail to have an actively certified operator in charge? DYes ~0 DNA 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? DYes 0No ~NA Other Issues 28. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes· l2$N'o DNA 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes and report the mortality rates that were higher than normal? ~0 DNA 30. At the time of the inspection did the facility pose an odor or air quality concern? DYes ~No DNA 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 DYes EtNo DNA General Permit? (ie/ discharge, freeboard problems, over application) 0 Yes 'li;a-No 32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DNA 33. Does facility require a follow-up visit by same agency? DYes ~No DNA 7, Pre~e mvfc11 One.la--,e blf'e.rebt<fJ hactt!fo(e off~ -fbt..,.,a(f.l ClbPd-Ct~nf.&t · 4. PleBJe.. C/1 II bra/e! +ht's ye11r. I B"od foolc!J -thr,., ~oa:L recods. 12/28/04 ONE ONE ONE ONE ONE ONE ONE ONE ONE ONE ONE ONE .. ' .... Facility No. ~d-b(): Farm Name -~~y'-'-n~Jc=q._,_J.._/ ~..!....5=fhL..f---Date ____ _ ..._.,/ I Permit ./ COC ____ OIC_ NPDES (Rainbreaker PLAT Annual Cert } Pop. Type Design Current FB Drops I I I b 't\ / ~ ·~ ~ ( f/Al. Lagoon 1 -L 3 4 5 6 7 Spillway Design freeboard Observed freeboard (in 20 ;:;;L'"') ~3 Sludge Survey Date 1 n J;:,~lrn Sludge Depth ft) & % Liquid Trt. Zone (ft) (;)f) \Of.IY Calibration Date l-(rl)-I(J/ 2 Design Flow lr~<; Actual Flow bl Design Width ~~ Actua I Width ~yO soil Test Date iorr~~ ~~~~ pH F1elds Lime Needed l/07 Lime Applied Cu ~Zn ~ Needs P Pull/Field Soil Crop 1-"1 \llm n 5 go_p, b-tl t1 aQ A II }),/fs ' ~. / ~-<& 1-U 3 4 Crop Yield ~lq Wettable Acres __ _ WUP -.,.../' Weekly Freeboard~ Rainfall > 1" _......- 1 in Inspections __ RYE PAN So m! }-:;)_-,) ~0-lYS ;>'{ 1 )~b~ 3tJO so Verify PHONE NUMBER,.S and affiliations · Date last WUP FRO a IOJ....,-Urtf.J1'. Date last WUP at farm FRO or Farm Records Lagoon# Top Dike 4()tj Stop Pump :)/,~..} Start PumP, 3Cf, 'b +- Aff'pJ.fty \')nLVa1-J~ f~i 5 6 7 8 120 min Inspections V"""" Weather Codes ~ Transfer Sheets ~ RAIN~UGE (Qead ~ or incinerator __ _ ~ll /' Window Max Rate Max Amt ~-lLt-O.G j.l() I Sf£1-Hp.., ,_ ' / App. Hardware I .. .... Type of Visit 0"tompliance Inspection 0 Ope r ati on Review 0 Structure Evaluation 0 Technical Assistance Reason for V isit 0 Routi ne 0 Complai nt 0 Follow up 0 Referral 0 Emergency er0ther 0 Denied Access Date of Visit: l"i-z-o91 Arrival Time:! 't . 0 0 I Departure Time: II I : 0 0 I C ounty: s-ay~ Region: E'i< 0 Farm Name: --ryab/1 r;i:.~l Owner Email : -------------- Owner Name: --u.B~·~' .~'1;'-'o-?,.__.....,T.__ __ ~77...,Y'--A.,.~~ ..... ~~~% ___ _ Mailing Address: V 43 I N U S '-1¢.1 tlw ~ L / i nP ~ / Phone: A) C. Physical Address:---------------------------------------- Facility C ontact: ___,1«'-='-5.1-'0~Yl-'---_ _,_T-.....,· v~_,_Yl..:..).""""'tt;...cf+/--Title: f~;,-,_ l1f,, ~ rr" 7 II Phone No: c; /o-990-'tSt:l!f Onsite Representative: ------------------Integrator:---------------- Certified Operator:--------------------Operator Certification Number: ------- Back-up Operator: --------------------Back-up Certification Number: Location of Farm: Latitude: D OD'D" Longitude: Discharges & Str eam Impacts l. Is any discharge observed from any part of the operation ? D Yes iJ No D NA O N E Discharge originated at: D Structure 0 Application Field D 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, not ify DWQ) 2. Is there evide nce of a past discharge fro m any part of the operation? 3. Were there any advers e impacts or potenti a l adverse impacts to the Waters ofthe State other than from a discharge? DYes D No D NA O NE D Y es 0 No D NA O NE D Yes 0No D NA O NE D Yes OJ.No D NA O NE D Yes ~No D NA O N E 1212810-1 Co ntinued ~ .. J Facility Number:~ -/piS J Date of Inspection Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy ra infa ll) less than adequate ? a. If yes, is waste level into the structural free board? Structure 1 Structure 2 Structure 3 Structure 4 DYes ~No DNA ONE DYes ~No DNA ONE Structure 5 Structure 6 Identifier:---------------------------------------- Spillway?: Designed Freeboard (in): _ ___.1~.--~.J ___ ------------------------------ Observed Freeboard (in): _ _..\. ... }.,b'"""""'-------------------------------------- 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ large trees, severe erosion, seepage, etc.) DYes ~No DNA ONE 6. Are there structures on-site which are not properly addres sed and/or managed through a waste management or closure plan? DYes ~No DNA ONE 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? 8. Do any of the stuctures lack adequate markers as required by the permit? (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 maintenance or improvement? Waste Application 10. Are there any required butTers, setbacks, or compliance alternatives that need maintenance/improvement? 0 Yes bZINo DNA D NE DYes ~No DNA ONE DYes l)(~No DNA ONE 0 Yes 0No DNA ~NE II. Is there evidence of incorrect application? If yes , check the appropriate box below. D Yes 0 No D NA 121 NE 0 Exces sive Ponding 0 Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn, etc.) D PAN D PAN > 10% or 10 lbs D Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil D Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outs ide of Area 12. Crop type(s) -----------=----------------------------- 13. Soil type(s) 14. Do the receiving crops differ from those designated in the CA WMP? DYes DNo 15. Does the receiving crop and/or land application site need improvement? DYes 0No 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination?O Yes 0No 17. Docs the facility lack adequate acreage for land application? DYes 0No 18. Is there a lack of properly operating waste application equipment? DYes 0No 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): 12128104 DNA (XI NE DNA ~NE DNA 6?:)NE DNA ~NE DNA ~NE Continued I -.. I Facility Number: a-~ t51 Reguired Records & Documents Date of Inspection I 2-2-0' 19 . Did the facility fail to have Certificate of Coverage & Permit readily available? 20. Does the facility fail to have all components of theCA WMP readi ly available? If yes , check the appropirate box. 0 WUP 0 Checklists 0 Design 0 Maps 0 Other DYes gjNo DNA ~ D Yes g[ No 0 NA r;d{tf 21. Does record keeping need improvement? If yes , check the appropriate box below. DYes 0 No 0 NA ~ NE 0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste T ransfers 0 Annual Certification D Rainfall 0 Stocking D Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rain In spections 0 Weather Code 22. Did the facility fail to install and maintain a rain gauge? DYes 0 No DNA ~NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes 0 No D NA ~NE 24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes D No D NA ~NE 25. Did the facility fail to conduct a sludge survey as required by the permit? DYes D No D NA ~NE 26. Did the facility fail to have an actively certified operator in charge? DYes DNo D NA ~NE 27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? DYes DNo DNA ~NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes DNo DNA ~NE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes 0 No DNA ~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? DYes If yes, contact a regional Air Quality representative immediately 0 No DNA [!NE 31. Did the facility fail to notifY the regional office of emergency situations as required by DYes 0 No DNA laNE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on-s ite representative? DYes ~No DNA ONE 33. Does facility require a follow-up visit by same agency? DYes ~No DNA ONE . -. Furl'/1,,-w.,~ aJv.c.-) T5 C'D""'..$# .5·~~ ~J .5Jt:i'~;/i..2..~.:1ro ·-/.s~·??,_J Cot&~n 17--, CJ/I .. o;;.lv 914. .,_____ -"".,;L tvt!J~ ..£~'1--r-w.-7-4_ ,..~ 1 ..L / C.I!Y?7/Hr-,ncf111Lh7l""J ~ ~h!Jcr--... ~ v;Lf 1d t;r/.,_, c~1~ c;PA't:..c t,_Ut:L_s .5'PnTTr'c ktr,....J cF rl~ of,·fc' a-uo/ TZ; /) -JI~ w~ .5~ /VO c.t»-u--nL;~-~ · _'I _ .J . -;y· c. !.S-5&~ ~ ·U/•''"lt1 l1t; ~ -Fc;I'JI'Vt. Page3 of 3 11128104 Type of Vi s it ~Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit ~ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access Dat e of Visit: L4'tLI.JI::.I..::~...J ArrivaiTime:lq; WJtPtl Depa rture Time: llr.,3oAf'JI County: ~,PJih Region:F Je-0 Farm N a me: ....!~~-~,d~..LIJJ~t.pV.:...;.:1JVJ:..:. ~----l---11 :..;; I-!::J~I'3::;;._ _______ _ Owner Email: ------------- Own erNa me : ~ qfj~ 5yrcL I Phone: Mailing Address: ---------------------------------------- Physica l Address :---------------------------------------- Fa cility conta ct: 'Pavrcl( 9ynl. T itle: _tJ=-.:,.~_n:....loe..L..r______ Phon e No : ______ _ Oosit e Representative: p;r\rjc;t ~y rJ_ Integrator: ...;f1......_......,8""------------- Certified Operator: J().e j) -~~,J.'""-=-------Operator C e rtifica ti on Numbe~: If... A J qg II../ Back-up Operator: 'J":ohn -? _,,,.,.d_..IL..!:=--------Back-up Certifica tion Number: _AtvA J 90(, 7 Location of F arm: D OD'r--1 " Latitude: L..J Longitude: Discharges & Stream Impacts I . Is any d ischarge o bserved fro m any p art o f the operation? Disch arge ori ginated at: D Structu re D Applicat io n Fi e ld 0 O th er a. Was the conveyance man-made? b. Did th e d isc harge reach waters of the State? (If yes, noti fy DWQ) c. What is the estimated volume tha t reached waters of the State (gall ons)? d. Does di sc harge bypass the waste manage men t system? (If yes, noti fy DWQ) 2. Is th e re eviden ce of a pas t di scharge fr om any pa rt of the o pe ration? 3. Were there any adverse impacts or potenti a l adverse impacts to th e Waters of the Sta te oth er th a n fro m a disc harge ? 0 Yes 'lia'No D NA D N E D Yes 0 No D NA O NE D Yes 0 No D NA ONE I DYes 0 No D NA O NE D Yes g No DNA O N E D Ye s !)No DNA ON E 12128104 Con tinued \ .... Date of Inspection Waste Colledion & Treatment 4. Is storage capacity (structural plus storm storage plus heavy minfall) less than adequate? a. If yes, is waste level into the structural freeboard? Structure I Structure 2 Structure 3 Structure 4 D Yes ~o DNA O NE D Yes D No DNA O NE Structure 5 Structure 6 Identifie r:----------------------------------------- Spillway?: Designed Freeboard (in): _.~..J '1 .......... ____ ____.l_'l...._ ___ ....:,.l_'f'----------'-1 <=f....__ __ ---------- Observed Freeboard (in): _::::::3._'3~----~3~lf+-------::~:.....l!!W~-------'Y.u8"~..~--__ ----------- 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ large trees, severe erosion, seepage, etc.) DYes fiaNo DNA O NE 6. Are there structures on-site which are not properly addressed and/or managed through a waste management or closure plan? DYes )J"No 0 NA D NE If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ 7. Do any of the structures need maintenance or improvement? 8 . Do any of the stuctures lack adequate markers as required by the permit? (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 maintenance or improvement? Waste Application 10 . Are there any required buffers, setbacks, or compliance alternatives that need maintenance/improvement? DYes iSJNo DNA O NE DYes l'$(No DNA D NE D Yes ~N o DNA O NE DYes 18'No DNA ONE 11. Is there evidence of incorrect appli cation? If yes, check the appropriate box below. D Yes ~o D NA 0 NE 0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn, etc.} 0 PAN D PAN > 10% or 10 lbs D Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil 0 Outside of Acceptable Crop Window D Evidence of Wind Drift D Application Outside of Area 12. Croptype(s} COh:kl &lh~~ &i/ve '.S6 OJ J 13. Soil type(s) W1 B IS ' GoA 15 7 14. Do the recei ving crop s differ from those designated in theCA WMP? 15 . Does the receiving crop and/or land application site need improvement? D Yes f2No DNA ONE K)Yes 0No DNA ONE 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?O Yes DNA ONE DNA ONE DNA ONE 17 . Does the facility lack adequate acreage for land application'! 18 . Is there a lack of properly operating waste application equipment? DYes DYes Comments (refer to question#): Explain any YES answers and/or any recommendations or any other comments. Use dra\\ings offacility to better explain situations. (use additional pages as necessary): Reviewer/Inspector Name Reviewer/Inspector Signature: Phone:~~-:~-==:......::=~~=C/ Date: ...• I Facility Number~;)._ -<R (J I Is- Date of Inspection lbll'f10f I 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 theCA WMP readily available? If yes, check the appropirate box. 0 WUP 0 Checklists 0 Design 0 Maps D Other DYes ~No DNA ONE DYes ENo DNA ONE 21 . Does record keeping need improvement? If yes, check the appropriate box below . DYes ~No 0 NA 0 NE 0 Waste Application D Weekly Freeboard 0 Waste Analysis D Soil Analysis D Waste Transfers D Annual Certification 0 Rainfall 0 Stocking D Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 Weather Code 22. Did the facility fail to in stall and maintain a rain gauge? 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 penn it? 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 orCA WMP? 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 nonnal? 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? DYes DYes DYes DYes DYes DYes DYes DYes DYes DYes DYes DYes ~No DNA ONE 0No r:ilNA ONE ~No DNA ONE ~No DNA ONE ~No DNA ONE 0No [S(NA ONE fia"No DNA ONE ~0 DNA ONE i2J'No DNA ONE gNo DNA ONE ~0 DNA ONE ~0 DNA ONE l, Tree5 'rvf/e,. DFv~hfJ o..;f 0'\ I f(Jo01 3 15'1 Need_lfme. fYt sfttJ.J -0e/Js, err/{, .~ b..fh, ~ Also l!feJ-to Sfld.f .sf~t!&frcldo-()!) I Aq.IB. Cvrr '/be:::; ::9. frler+o s&ra,ftj' 43~-:t>osaJ ;;)), lttjco, 4 hod.. .slvtf1e. deoneJ od-Nov d008 (stnce-I tlJi-slvr/Jesv~). L~(X)') ~ hal,asl"~ -to ir~ votv/)1-e of ~ t~r~o-~ill not-n-eeJ...clea,Dv-f- ~ se~Q~ ~etts. Go:d_~hl. ~welt ~-e[+'f'ecoJJ .. Vole$,~ o, ~rod~tr c ory~ 0o~ sittlft( vml Ia~ oo-fo reviev ~lJJe cletr~ofreunh-' ~ ;rtfk clekl L Oafe '"'Or ertO,eo~ J,\W a.r 0/ ltf-, o, frodl..fEr Cof Page 3 of 3 12128/04 . . .. ;acility No. ~;)-(? P Permit .../ COC Farm Name -~-~-r'i~d:l....J0-.L....;v:.....::J--"'B'-IY'----Date ____ _ ./ OIC_7_ ( NPDES (Rain breaker Desi n Current I FB Drops I I I Lagoon 1 2 3 Spillway Design freeboard ' ' Observed freeboard (in SludQe Survey Date 1=1\tO!« Sludge Depth (ft) & % I Lig_uid Trt. Zone (ft) \ 15.~ Calibration Date 1Q 14/~ 2 3 4 Design Flow Actual Flow Design Width Actual Width ;nO Soil Test Date yl tJlO£( Crop Yield ..I\Jiy02(( pH Fields Wettable Acres Lime Needed ~ l:a T(/15/ Ac--WUP --- Lime Appli~d , ' 12 L-. Weekly Freeboard .....=::::::_ Cu _v_ zn ~ ~w.> rJ:tl's leN Rainfall > 1" _.,.- Needs P ~~~ 1 .in Inspections __ Pull/Field Soil r ..... .&rop RYE PAN 1-:) Waara"" 'ttA: ·n _-&t'Ji' V ••· ,, "-~~ '1 (.;}{A l(iJ.J{J 1-p ~:>1 l4c.-~E M !Ol7ul r~ ~(}.) htl l506~ )DO ~b ?0 Verify PHONE NJ,U.(IBERS and affiliations Date last WUP<EB9 crlt I Oy Date last WUP at farm @9 or Farm R~o~s ':)_ 0 _I_ Lagoon# · 5U~ Top Dike 10 1· ')0.{) ~S-0 Stop Pump q"), '3 Llvo '-N .D ifl .. o Start Pump ~fj.). u~,() ~0~ ~4 .. 00 ~ I 1<g 5JJ;d .. v;': ').0 ;).0 . ..,,.., ~,v ·. 4 fc.n) , 5 Window 11u-~n. ., Ocf .-Hcv PLAT Annual Cert ) I I 5 6 7 6 7 8 120 min Inspections Weather Codes Transfer Sheets RAIN GAUGE Dead box or incinerator t1 aia\~ -v- Max Rate MaxAmt Od:; I, o (),') ~ / \J ... r r • • Type of Visit ~Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit ~outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access Date of Visit: 191fa\ Q! I Arrival Time: 19PSAf1 I Departure Time: lfB~OiAt'] I County: Sa.,ps"' Region : FR(} Farm Name: T1tt.dal{ 4Sil') Owner Email: ------------ Owner Name: B fJ4t_ ~nb U Phone: Mamng Addm" J{;, N l?.s ~ a.1 :iJ!!l _;;C=.,:I~i'aitn.L.L.K..I~.-______ 0>~8 Physical Address:---------------------------------------- Facility Contact: "\t4J~ TyaJ.qlf Title: CQ.ovlltr' Phone No:-------'---- Onsite Representative: -:f4JP1 Ty nda II Integrator: -~"--'-'re=--i-;;;&;....pe...-..:::;.... ________ _ Certified Operator: )'w&l Tt,nJo U Operator Certification Number: ANA JqJd) I Back-up Operator: Back-up Certification Number: Location of Farm: D O JI'D" Latitude: L__J D OIJ• D" Longitude: L__J Discharges & Stream Impacts I. Is any discharge observed from any part of the operation? Discharge originated at: D Structure D Application Field D 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 impac ts to the Waters of the State other than from a discharge? Page I of 3 . ,, .. : • ,·_ .: . ·• ~-. -... _;.!;;:.. ·-~:-. - -..... DYes 'T)}No 0 NA D NE DYes 0No DNA ONE DYes DNo DNA ONE DYes DNo D NA O NE DYes fiS No DNA ONE DYes ~No DNA ONE 11128/04 Continued ··(Facility Number:~d_ -k{L I Date oflnspection 1~15'" I Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes, is waste level into the structural freeboard? Structure 1 Structure 2 Structure 3 Structure 4 DYes riJNo DNA ONE DYes 0No DNA ONE Structure 5 Structure 6 Identifier: ---+L------------------------------------- Spillway?: l; '( Designedfreeboard(in): _ _,l'-'f~--------------------------------- Observed Freeboard (in): _.::;a.:...;f~;.-___ ------------------------------ 5. Are there any immediate threats to the integrity of any of the structures observed? DYes '1:81 No DNA ONE (ie/ large trees, severe erosion, seepage, etc.) 6 . Are there structures on-site which are not properly addressed and/or managed DYes r.8'No DNA ONE 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? 8. Do any of the stuctures lack adequate markers as required by the permit? (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 maintenance or improvement? Waste Application 10. Are there any required butTers, setbacks, or compliance alternatives that need maintenance/improvement? 15lYes 0No DNA ONE DYes l)lNo DNA ONE DYes ~No DNA ONE DYes ~No DNA ONE 11. Is there; evidence of incorrect application ? If yes , check the appropriate box below. DYes lif"No DNA 0 NE D Excessive Ponding 0 Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn , etc.) 0 PAN D PAN > 10% or 10 lbs 0 Total Phosphorus 0 Failure to Incorporate Manu re/Sludge into Bare Soil 0 Outside of Acceptable Crop Window D Evidence of Wind Drift 0 Application Outside of Area 12. Crop type(•) Coma l ~ .. ~ #a. ·.S"' oS' -----.._ /J 13. Soiltype(s) BoB '5 m. I.5·HZC rr ) 14. Do the receiving crops differ from those designated in the CA WMP ? 15 . Does the receiving crop and/or land application site need improvement? DYes DYes 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?D Yes ~No ~0 ~No 17. Does the facility lac k adequate acreage for land application? 18 . Is there a lack of properly operating waste application equipment? Reviewer/Inspector Name Reviewer/1 nspector Signature: Pagel of 3 DYes 'fit No DYes ~o DNA DNA DNA DNA DNA ONE ONE ONE ONE ONE · · I Facility Number:~ :J. jo(£ I Date of Inspection lq;Ja, ... Oi I Reguired 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. D WUP D Checklists 0 Design 0 Maps D Other 21. Does record keeping need improvement? lfyes, check the appropriate box below. DYes ~No DNA ONE DYes !R-No DNA D NE DYes 15l-No DNA D NE D Waste Application D Weekly Freeboard D Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Annual Certification 0 Rainfall 0 Stocking D Crop Yield D 120 Minute Inspections D Monthly and I" Rain Inspections D Weather Code 22. Did the facility fail to install and maintain a rain gauge? 23. If selected , did the facility fail to install and maintain rainbreakers on irrigation equipment? 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 pennit? 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 orCA WMP? 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 t ime of the inspe ction d id the fa cility po se an odor or air quality c oncern? If yes, contact a reg iona l Air Qual ity repres entative im mediatel y 31 . Did the fac ility fail to notify the reg ion al office o f e merge ncy situations as requ ired by General Permit? (i e/ di scharge , fre eboard probl ems, over application) 32. Did Re vi ewer/In spector fail to di scuss review/inspec ti on wi t h an on-site re pres enta tiv e? 33. Does facilit y require a follow -up visit by same agency? DYes ~No DYes 0No DYes A(~' No DYes ~No DYes ~No DYes 0No DYes ~No DYes ~No DYes ~N o DYes gNo DYes SNo DYe s ,EJ No 7, ~lfl!e.. rvtvf< lNl Ot\€-bao-e.. SffJT On i"rlJe.. bac~t. tara II uP-I '!JOf¥l~ Mo.rt t*- \~tnt! h1.s eKcell~~st-C().Jfl· w-e 1\ rn 1 hl.tl'n-AL -fN ~tt tNvJ. r e r ords. Pa ge3 of 3 12118104 DNA ONE ~NA ONE DNA ONE DNA ONE DNA ONE i)NA ONE DNA ONE DNA ONE DNA ONE DNA ONE DNA ONE DNA ONE -• .,., • · · Facility No .~;)-~!';;-Farm Name \y nJ11J/ q. _\Ll:-J Perm it __ COC __ _ OIC_ NPDES (Rain breaker PLAT Annual Cert ) Pop . Type Design Current I FB Drops I I I Freeboard 1 2 Design SIMS Observed (in) 'J." Sludge Survey Date Perm liquid (ft) "7.'Y ~l)Oitn Sludge Depth {ft) ~..,. Calibration Date 1 Qlrltn Des ign Flow '",.-Actual Flow lb7 Spray Flow Design Width ;)tf" Actual Width . ~ Soil Test Date II !01 -aff'Oi'. pH Fields __ Lime Needed Cu v-Zn :7 NeedsP--~ 2 3 Crop Yield Wettable Acres WUP Rain Gauge 4 / 07 v Weekly Freeboard ..,...- Rainfall >1" / 3 Waste Analysis Date ~~~' -OWf1 hftoc~~ Ot~.-ln.. \ .. athl~' '-Q,., -60 Day ' I + 60 Day N Amt {lb/1 000 Gal) =:)-, pH ~·Dr Pull/Field Soil Crop 1>fl 111vJ11 -=it2 1 se:, --iA/m .P I J ·- 4 5 Pan l"?r-:Joo :;-o 5 6 6 7 1 in Inspections 120 min Inspections Weather Codes Transfer Sheets Window ~A--M y p-/1u1 " / 7 8 ll ·-BBo · ~PM t1Dt O.h/hr il+ 'i" hrTo'ltil /tb'~fC ~~" ~ 31 ~1.:1 -rr~t i kfrt \'J~t~( 1/L ~ D.in:J~-n' MQ -F~ or CJvb ~ twryrtt~ ~~ge D:bli ·€t;JL r ~ ~Ftot\ ~ ~ N~Jf~nC + . 'fil Division of Water Quality :-b \ \(\ S 'Eacility Number (~;l. _HwL~ 11 0 Di\·ision of Soil and Water Conservation . \ 1 c{6 0 Other Agency ""\ ~ Q'1 · Type of Visit ~ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit ~Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access Date of Visit: 11 /~tJIJ11 Arrival Time: I j 3 J I Departure Time: 1{6 30 I County:...~~ ' Region:i=t:D , Farm Name: lbQlf.g II rJ Snn Owner Email: ------------- Owner Name:-----------------------Phone: Mailing Address: ---------------------------------------- Physical Address:~~-------------------------------------- Facility Contact: ~ ~ cf.a // Title: Cc ~owner= Onsite Representative: =x; SOn '§ada f / Certified Operator:J 4.$ID"' :Jtj n Ca 1/ n~::O.;h;p Integrator: __ V::......:II_; ~~::::;:a'-Q-==!!1!1~--------- 0perator Certification Number: __../_~..;......:/:....d=......,J,__ __ Back-up Operator: --------------------Back-up Certification Number: Location of Farm: Latitude: D OD 'D " Longitude: D OD 'D" . . ,. Design Current : Design Current Design Current Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population -~10 Wean to Finis h I I I 10 Layer I ·-·· . I . . .. I_: F-O~D;...;;a~iry-....;;;..C..;;..ow __ +-----~-----1; ::i D Wean to Feeder O Non-L aye1 _ . _ _ . 0 Dairy Ca lf i ~~eeder to Finish I~~ ~ ~<fto =..:...:.::::..:....;:..::.o...;;.:.....---'-......,., _ _....~.,-_,...,=--~ F-O~D;....;a;;.;.iry~J-..;;.;Ie;;.;.ifi;..;;.el_-+---t-----41 ·.' D Farrow to Wean Dry Poultry 0 Dry Cow }~ 0 Farrow to Feeder 0 Non -Dairy ·.. 0 Layers F-O~~;....;;;;..;;;..;..;..,o'---t----+------l i '~ 0 Farrow to Finish =:::-=:;J....;;.:..:::...--+---~~--~ Beef Stockel i ;~: D Gilts F.:O~N...;..o;;..;;n'--""La""'lY'""~e.;;..;rs~t-----+----t : 0 Beef Feeder ';: D Boars 0 Pullets F-0::;.-;:B;..;e;..;;c...;..f ..;;..B..;;.;ro;..;;o;..;;.d.;.....C_o_lw+-----i-----1 -·· ·· -··· ·--··-,.-· 0 Turkeys J 'Oth'~r ' . . ,_ 0 Turkey Poults 4 ~,;;:1.Q=-...;;..O, __ .;.;;th,;.;;er""'----=--'""'· _ ___.I..__ __ L-1 __ ___.!' D Other Number of Structures: CZJ. Discharges & Stream Impacts 1. Is any di scharge observed from any part of the operation? Di sc harge originated at: D Structure 0 Appli cation Field D Other a . Was the conveyance man-made ? b. Did th e discharge reach waters of the State? (If yes , no tify DWQ) c. What is the estimated volume that reached waters of the State (gallons)? d. Docs di scharge 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 potentia l adverse impacts to the Waters of the State other than from a discharge? D Yes ~o D NA ON E DYes 0 No R!/NA O NE DYes 0No .J3 NA O NE I D Yes 0 No~A ONE DYes ~o DNA ONE O YevhNo D NA ONE 11128104 Continued ..... Date of Inspection ~ I Fa~ility Nbmber~ _:) -GJ/S:I Waste Collection & Treatment 4 . Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes , is waste level into the structural freeboard? Structure l Structure 2 Structure 3 Structure 4 0 Yes ';iflNo DNA 0 NE 0Yes ~o DNA ONE Structure 5 Structure 6 Identifier: ______________________________________ _ Spillway?: ~A Designed Freeboard (in): ---r:::::.-1-( 4-~-~L ;----:: 5::-/w~~¥/'----------------------- Observed Freeboard (in): 3 3 ~ ....qt!r ~0 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/large trees, severe erosion, seepage, etc .) 6 . Are there structures on-site which are not properly addressed and/or managed through a waste management or closure plan? 0Yes~o DNA ONE DYes ~No DNA ONE 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? 0 Yes ~No 0 NA 0 NE 8. Do any of the stucturcs lack adequate markers as required by the permit? 0 Yes ~No 0 NA 0 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 maintenance or improvement? 0Yes~o DNA ONE Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need maintenance/improvement? DYes !lVNo DNA 0 NE l L Is there evidence of incorrect application? If yes, check th e appropriate box below. DYes t(No DNA 0 NE 0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn, etc.) 0 PAN D PAN > 10% or lO lbs 0 Total Phos phorus 0 Failure to Incorporate Manure/Sludge into Bare Soil 0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Area 12 . Crop type(s) ~much 13 . Soil type(s) l.Ua_8 14. Do the receiving crops differ fTom those designated in the CA WMP? DYes ~o 15. Does the receiving crop and/or land application site need improvement? DYes ~No 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?D Yes ~0 17. Does the facility lack adequate acreage for land application? DYes $No 18. Is there a lack of properly operating wa ste application equipment? DYes ~0 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 Reviewer/Tnspector Signature: Phone: Date: DNA DNA DNA DNA DNA ONE ONE ONE ONE ONE Date of Inspection ~ Required Records & Documents I 9 . Did the facility fail to have Certificate of Coverage & Permit readily available? 20. Does the facility fail to have all components of theCA WMP readily available? ff yes, check the appropriate box. 0 WUP 0 Checklists 0 Design 0 Maps 0 Other DYes )'No D NA ONE DYes ~No DNA ONE 21. Does record keeping need improvement? ffyes , check the appropriate box below. 0 Yes ~No 0 NA D NE D Waste Application D Weekly Freeboard D Waste Analysis D Soil Analysis 0 Waste Transfers 0 Annual Certification 0 Rainfall 0 Stocking D Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rain Inspections 0 Weather Code 22. Did the facility fail to install and maintain a rain gauge? 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 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 orCA WMP? 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 appli cation) 32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? 33. Does faci lity require a follow-up visit by same agency? DYes ~No DYes ~No DYes tllNo DYes ~No DYes ~No 0 Yes )!lNo DYes ~No DYes ElNo D Yes _..fQNo DYes ~No DYes ,fit No D Yes kJNo DNA ONE DNA ONE DNA ONE D NA O NE D NA ONE D NA O NE DNA ONE DNA ONE DNA ONE DNA ONE DNA ONE DNA ONE ·:r~~:-:·:-.:~··}~: :~ ~~~}~-t~~~~~-··_:t.~ Page 3 of3 -+o.J:.Q LP._S 6()"' I""~/) +D Oc/ 31 11128104 ..... - -• ~ . ~acility No. &J (o / ~ Time In 9 6/ TimeOut__ Date 'l/A/~7 Integrator /?//.£flo~/ 1 ::.~~;rs Operator :::Ca. So-n. ~~k,J J.U Back-up coc_ Wean-Feed We::an Fini~h c ~eed ...... Finish "") Farrow-Wean Circle: . ~eneral1 or Design -current I SliW _(n~lo S~eRep ____________________ __ No. lCJ Jd-.3 No NPDES Design Current Farrow-Feed Farrow Finish Gilts I Boars Others FREEBOARD: Design __ J~...-'1_---=~ {620 ~~ ~ ~ ~::·~;=~ ... , L/ -;.?/ Soil -r:~~t~-=--~--PLAT \. .. / Observed _________ _, Cali brn!ic!"!/GPM ·~ ! l W 7 Waste Transfers ) - Rain Breakef......, -'---- Wettable Acres ' _. Weekly Freeboard ~ Daily Rainfall -------1-in Inspections ____ _ Spray/Freeboard Drop ----------------------- ~~~K__J-, Weather Codes __ _ 120 min Inspections __ _ Waste Analysis: Date Nitrogen (N) Date Nitrogen (N) . t-:f»_uii/Field Soil Cro2_ Pan Window -· I () . -'"' n IL ....... -....... ( . ---n'-:-'t-lA.h)::> '"")(? 1 fn t.U6 _{)._ tT di'S f. Y -~r -UC-j ..,_~ ·~ 25m &)r o 1 <\ ~ _,,~ J y u /l 0 I::\ ~-0_ /)o/!S -.......... (_~-[1-N1 r ~ ! I' lY\ '--- ~· f Type of Visit @-COmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Reason for Visit ~tine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access I Departure Time: IJ;_ ... , $" I County: ' , . Region: z=iirV Date of Visit: I z-;o'M Arrival Timed//: t>O Farm Name: T:jA-?Ia/f r/:...SZP--Owner Email: -------------- Owner Name: 13; I J v TY&:Ja/1 Phone: r ~ Mailing Address: _Ce~'£~~~....~....1_...:::U=.$"--.....,~""~=-,_I _.J.}J _____ -"C.=L:.....r:' r-L' n-..::.-:t'll~~:.....=;.. __ .!,_JI/___;_C....::....___~n..,;L..JV Physical Address:------------------------------------____ _ Facility Contact: (/ii.sen-= Tytzdal/ Title: ------------PhoneNo: ________ _ Onsite Representative: _2~::;~..::~::==--------------Integrator: ?/z-:-s~r: Certified Operator: ---=./c::;....;;~......;..~.-..--------------Operator Certification Number: ) ?lt:?-3 Back-up Operator: --------------------Back-up Certification Number: Location of Farm: Latitude: D OD'D" Longitude: D OD'D" Discharges & Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated at: D Structure D Application Field D Other a. Was the conveyance man-made? b. Did the discharge reac h waters of the State? (If yes, notify DWQ) c. What is the estimated volume that reached waters ofthe 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 advers e impacts to the Waters of the State other than from a di sc harge? Page 1 oj3 DYes i&l.No DNA ONE DYes J&lNo DNA ONE DYes ~No DNA ONE DYes iZJ_No DNA ONE DYes l&l.No DNA ONE DYe s ~0 DNA ONE 12128/04 Continued Date of Inspection 12---Lo-~4 Waste Collection & Treatment '' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes, is waste level into th e structural freeboard? . S tru cture 1 Structure 2 Structure 3 Structure 4 D Yes 1;8.No 0 NA D NE D Yes ~No D NA O NE Structure 5 Structure 6 Identifier:---------------------------------------- Spi llway?: Vz",:S Designed Freeboard (in): __ 1 ..._!::-?4---------------------------------------- Observed Freeboard (in): _d"'" ...... ~..__ ___ ----------------------------------- 5. Aie there any immediate threats to the integrity of any of the structures observed? DYes !&No DNA O NE (ie/ large trees, severe erosion, seepage, etc.) 6. Are there s tructures on-site which are not properly addressed and/or managed DYes j8J No DNA ONE through a waste management or closure plan? If any of question s U were answered yes, and tbe s ituation p oses an immediate public bealtb or environmental tbreat, notify DWQ 7. Do any of the structures need maintenance or improvement? 8. Do any of the stuctures lack adequate markers as require d by the permit? (Not appli cable to roofed pits, d ry stacks and/or wet s tacks) 9. Does any part of the waste management system other than the waste structures require maintenance or improvement? Waste Application D Yes ~No D NA O NE D Yes ~No D NA O NE D Yes fiaNo D NA O NE 10 . Aie there any required buffers, setbacks, or compliance alternatives that need 0 Yes )ZJ No D NA D NE maintenance/improvement? 11 . Is there evidence of incorrect application? If yes, check the appropriate box below. D Yes BJ No 0 NA 0 NE D Excessive Ponding 0 Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn, etc.) D PAN D PAN> 10% or 10 lbs D Total Phosphorus D Fai lure to Incorporate Manure/S l udge into Bare Soil D Outside of Acceptable C ro p Window D Evidence of Wind Drift 0 Application Outside of Area 12. Crop type(s) .lSr:rJn u /4 1/7 ,I t911«...£r-d.tfoy t?cG?;? ;z.. e 13 . Soi l type(s) Wa 13 j :JS o 71 /m4t? 14. Do the receiving crops differ from those designated in the C A WMP? D Yes ~&(N o D NA ONE 15. Does the receiving crop and/or land application site need improvement? D Yes ~No O N~ ONE 16. Did the facility fai l to secure and/or operate per th e irrigation design or wettaSle acre determination ? DYes Jiq No 0 NA 0 NE 17. Does the faci li ty lack adequate acreage for land application? 18. Is th ere a lack of properly operating waste application equipment? Reviewer/lnspectorName I..Wv--r::::..... b~~ Reviewer/Inspector Signature: ~ /// Pagelof3 DYes ~N o DNA O NE DYes llJNo DNA ONE I Phone: 9-/o -lf:J J -:r J J,;L Date: 7 -I t>-d-\>0 \.... 12128104 Continued ·~ .l . .. I Facility Number: 4CJ:-bldr" Date of Inspection I :ZI () -DQ 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 theCA WMP readily available? If yes, check the appropriate box. D WUP D Checklists D Design D Maps D Other 21. Does record keeping need improvement? If yes, check the appropriate box below. DYes ~No DNA ONE DYes 2i-No DNA D NE DYes g]No DNA ONE D Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis D Waste Transfers 0 Annual Certification 0 Rainfall D Stocking D Crop Yield D 120 Minute Inspections 0 Monthly and I" Rain Inspections D Weather Code 22. Did the facility fail to install and maintain a rain gauge? 23. If selected, did the facility fail to install and maintain rain breakers 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 ofthe permit orCA WMP? 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? Page3of3 DYes !J,No DYes 8fNo DYes IZ]No DYes 5?J. No DYes R!No DYes [5{No DYes ~No DYes ~No DYes ~No DYes ~No DYes ~No DYes 18No 12118104 DNA DNA DNA DNA DNA DNA DNA DNA DNA DNA DNA DNA ONE ONE ONE ONE ONE ONE ONE ONE ONE ONE ONE ONE ... 1-- 1--..... Division of Water Q" n,.,,,.,, •.. , ·· -Division of Soil and "'·~•.,.,,;..r•;...,.. . . <Age~c~. ·.·· '·. 0 Operation Review 0 Structure Evaluation 0 Technical Assistance Type of Visit 8 Compliance Inspection Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access DateofVisit: l~/~.:!o/orl Arrival Timed I~ ;.,lo I Departure Ti me: L..l ___ _...l Cou nt y: -~~r-~~,.J Region: J=="RO Farm Name : --1-y-n.c/d.i( : .5~m ~f ,._., 1-<f Owner Email: ------------- Owner Na me: ~ ~~ clo..J ~ _e_; ll.t-htn~ // Phone: _lfiD -S'Y I. -L> .33 ~ Mailing Address: '3 3 ~ CeJ..o..r._L~kc_L~c. _ _,e""""_;_;Vft,~_u(J ;;J ~ .SJ..l- Physical Address: __3'~4>.V £C:.( ( : ,,0 ~ «to ~ 4./ Sb'f_ ____________ _ Facility Contact: --------------Title: -----------Phone No:--------- Onsite Represe ntati\·e: ::::s=a..>~-~=---"'-'1-~-lt,______ Integrator: Pr-~.J..::~~'fr«-=-------- Certified Op erator :--=:)~ ),o--> -'~-""·o!c:.:::;...\,_\'------Operator Certification N umber: __ (_q___:_I_..;J._,.,3.._ __ Back-up Operator: --------------------Back-up Certification Number: Location of Farm: Latitude: D OD 'D " Longitude: D OD 'D " 'f~~~~~ ~H D W ean to finish ¢~ ~· : D Wean to Feeder ,. ~-~ ·.:.~ • fil Feeder to Finish ~: D Farrow to Wean .~ '~ , D Farrow to Feeder ·, D Farrow to Finish ,DGilts 'D Boars --· --··--··-· - Design . Current Capacity Population 5Bi'IJ 5.2_9_~,.. . .. .. ·-···· I· I Discharges & Stream Impacts Wet Poultry I ID La yer Dry Poultry D Layers D Non-Layers D Pu ll ets D T urk eys D Tu rk ey Poults 0 Other I. Is any discharge observed trom any part of the operation? Des ign Capacity Current Population D ischarge orig ina ted at: 0 Struct ure D Appli cation Field 0 Other a. Was the conveyance man-made? b. Did th e disc harge reach waters of the State? (If yes, noti fY DWQ) Cattle · . .· Design Current ... ·· · .. Capacity Population D Oai_ryCow D Dairy Calf I: · D Oai_ryHeife1 ' D OryCow D Non-Dairy i ' D Bee f Stocker t D Beef Feeder D Beef Brood Cow ·-·· --. ·--'-.... Number of Structures: ,'CIJ. D -Yes ~No D NA O NE DYes D No D NA O NE DYes DNo D NA O NE c. What is the estimated volu me th a t reached wate rs of the State (gallons)? d. Does di sc harge bypass th e waste manage men t system? (If yes, not ify OWQ) 2. Is there evidence of a past discharge from any part of the operati on? 3. Were thcre .any adverse impacts or potentia l adv erse impacts to th e Waters ofthe State other th an from a di sc harge? DYes DNo D Yes {J No D Yes l11 No 12128104 D NA O NE DNA O NE D NA O NE Continued Date of Inspection (C, ),23 li'ff Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? a. If yes. is waste level into the structural freeboard? Structure 1 Structure 2 Structure 3 Structure 4 0 Yes riNo DNA ONE DYes 0No DNA ONE Structure 5 Structure 6 Identifier: __ ...;;~;:../L~-· __ --------------------------------- Spillway?: t1 Vo 4-c.-9:J:...__ _________ ---------- Designed Freeboard (in): ----=~:..2e;.o.:l_-•_• __ ---------------------------------- Observed Freeboard (in): -~;3""-"'3._1_' __ ----------------------------------- 5. Are there any immediate threats to the integrity of any of the structures observed? DYes ~No DNA ONE (ie/large trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed DYes {1No DNA ONE 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? 8. Do any of the stuctures lack adequate markers as required by the permit? (Not applicable to roofed pits, dry stacks and/or wet stacks) DYes ~No DNA ONE 0 Yes llJNo DNA ONE 9. Does any part of the waste management system other than the waste structures require maintenance or improvement? DYes Q;!No 0 NA ONE Waste Application 10. Are there any required buffers, setbacks, or compliance alternatives that need maintenance/improvement? D Yes f¥J No D NA 0 NE 11. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes mNo DNA 0 NE D Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn, etc.) 0 PAN 0 PAN> 10% or 10 lbs 0 Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil 0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Area 12. Crop type(s) /Jerrn IA.Ja.c ,1/4"( / 5 C -0 ~ 13. Soil type(s) /4)4 ~ frl<& C 14. Do the receiving crops differ from those designated in theCA WMP? 15. Does the receiving crop and/or land application site need improvement? DYes DYes 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre deterrninationiD Yes 17. Does the facility lack adequate acreage for land application? 18. Is there a lack of properly operating waste application equipment? £1-o.;J "fvu <.-1-i! ;.,oL ~ f .-,~v .C~~. ~t-11 DYes DYes Reviewer/Inspector Name ~;_;_~:..!:::..:;.;~~~~~~;...:;;*~__.;.;:..:.:;2.::::..;::..:i;!:!!:!!!~!:!~~ Phone: Reviewer/Inspector Signature: Date: r,EINo DNA !1iNo DNA rJ1No DNA ~No DNA ~No DNA ONE ONE ONE ONE ONE 12/28104 Continued §my ~:mber: S'.l. -'1Si Date of Inspection I /;/»frrl Required Records & Documents 19. Did the facili ty fail to have Certificate of Coverage & Permit readil y available? 20 . Does the facility fail to have all components of theCA WMP readily available? lfyes, check the appropirate box. 0 WUP 0 Checklists D Design D Maps D Other DYes ~No DNA ONE DYes CBNo DNA ONE 21. Does record keeping need improvement? If yes , c heck the appropriate box below . DYes I:E No D NA D NE 0 Waste Application 0 Weekly Freeboard 0 Waste Anal ysis 0 Soil Analysis 0 Waste Trans fers 0 Annual Certification 0 Rainfall 0 Stocking 0 Crop Yi e ld 0 120 Minute Inspe ctions 0 Monthly and I" Rain Inspectio ns 0 Weather Code 22 . Did the facility fail to install and maintain a rain gauge? DYes [1 No D NA ONE 23 . If selected , did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes 00 No D NA O NE 24. Did the facility fail to calibrate waste application equipment as require d by the permit? DYes 5:1No DNA ONE 25. Did the facility fail to conduct a s ludge survey as required by the permit? DYes Iii No DNA O NE 26. Did the facility fail to have an actively certified operator in charge? DYes KlJNo DNA ONE 27 . Did the facility fail to secure a phosphoru s loss a ssessment (PLAT) certification? D Yes 0No DNA ri)NE Other Issues 28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? DYes ~No DNA ONE 29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes and report the mortali ty rates that were higher than normal? lj]No DNA ONE 30. At the time of the in spection did the facility pose an odor or air quality concern? DYes ~No DNA ONE 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 DYes ~No DNA O NE General Permit? (ie/ discharge, freeboard problems, over application) 32. Did Reviewer/Inspector fail to discuss review/i nspection with a n on-site representative? DYes (}I No D NA ONE 33. Does facility require a follow-up visit by same agency? DYes ~No DNA O NE 11/18104 General Information: Division of Environmental Management Animal Feedlot Operations Site Visitation Record Date: fA/1'/?~ Time: 11;oo FannName: B~B \jnJJ9. \ ··( Owner Name: pil\ j t B.~ l'i r::i:J6: County: . · S.4.siM Phone No:C<=r1o) '56<f -vf7o On Site Representative: lb\lUv\ Lli '~1:0V\ Mailing Address : C,~ 3/ ttJ 5 4;).1 N Integrator: _ ___._£_!"f.;:..;s;_~=-'-i!P""------- Gll"±on 1 NC. ~832-8 ~----------~L=a=tiru==d~e:====='~==~'====~L=o=n~~~·ru=d~e~=====~'====~'====~--------~1 - Operation Description: (based on design characteristics) Type of Swine No. of Animals OSow a Nursery ~eeder _t;/4S: Other Type of Livestock: Type of Poultry No. of Animals Q Layer 0 Non-Layer Number of Animals: Type of Cattle a Dairy OBeef No. of Animals Ntlmber of Lagoons: J. (include in the Drawings and Observations the freeboard of each lagoon) F~cilitv Inspection: Lagoon . . Is lagoon(s) freeboard less than 1 foot+ 25 year 24 hour_ st~rm storage?: _Is seepage observed from the_ lagoon?: Is erosion observed?: -Is any discharge observed? 0 Man-made 0 Not Man-made Cover Crop Does the facility need more acreage for spraying?: Does the cover ~rop need improvement?: ( list tht! crops which need improvement) Crop type: CoG.st-J,, Acreage:. ______________ _ Setback Criteria . . --, ·. Is a dwelling located withiri 200 feet of waste application? Is a well located within 100 feet of waSte application? ·-· .: · .... Is animal waste~tockpiled within 100 f~t of USGS Blue Line S~eam? . - Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream? AOI-January 17,1996 YesO No>(- YesO No~ YesO No~f YesO NoZl ..... ~ YesO No~ YesO No~ ·.Yes· a ··;~<?~.· Yes· o ;: .. No~ .. :.. ~-::.-. YesO . No§J '••• O'W '• ' -· ' -·-·· YesO No~ Maintenance Does lhe facility maintenance need improvemenl? Is there evidence of past discharge from any part of the operation? Does record keeping need improvement? YesO NoKl YesO No !Sa YesO No~ Did the facility fail to have a copy of the Animal Waste Management Plan on site? YesO NoJa Explain any Yes answers:. ____________________________ _ cc: Facility A.rsessment Unit Drawin2s or Observations: --~· _; :.. ... ! ! AOI-J anuary 17,1996 . . Use Attachments if Needed .. · ... . . . :•~:·~···.,.;;,,_:·.~ ._;·:~·r •.t ··~ ·~:~:~ ~~l·! .i ~~;:~"'!f·b:r:.:~:l·~~-~~·l'a\,1.' ~ ":1 "--· .. · .. ::.· Type of Visit e Compliance Inspection 0 Operation Review 0 Lagoon Evaluation Reason for Visit e Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other 0 Denied Access I nate of Visit: IS /).f/l?Y! Time: I I : or- Facility Number I :¥t51 H ~/s-"----------------------...,; IO Not Operational 0 Below Threshold m Permitted Date Last Operated or Above Threshold: Farm Name: 12] Certified C Conditionally Certified [J Registered /:,ada 1/ ; -So..u.> J:;;; ,_ m / County: _ _,.5=-=a=-""":...:!...f"f:.=*~o::..;"-.::.....----___,_f=_R....:..a __ Owner Name: Jo...~:o;..,. ~ f?:,',\11 1'1"'-..Q-.\1 Phone No: ~ ID -r'jL Mailing Address: 3s3 C<-d2a ..... L-al.cs. L..o-..c. NC Facility Contact: ---------------Title: ------------PhoneNo: ----------- Integrator: f .-e: s+s1 <-~a. ..... ..-:> Onsite Representath·e: -;:I c.. do r I '1 ~.oil a.\\ Operator Certification Number: ~ I 9 / a2 3 Certified Operator: "J"" <1. .s o fJ _(.:...'1-i--=-...,~~= .. ;::....:..\\.l..-____ _ Location of Farm: [lt Swine 0 Poultry 0 Cattle D Horse Latitude Discharges .& Stream Impacts 1. Is any discharge observed from any part of the operation? Discharge originated a t: D Lagoon D Spray Field D Other a. If discharge is observed, was the conveyance man-made? b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) c. If discharge is observed. what is the estimated flow in gal/min? d. Does discharge bypass a lagoon system ? (If yes, notify DWQ) 2. Is there evidence of past discharge from any part of the operation? 3. Were there any adverse impac ts or potential adverse impacts to the Waters of the State other than from a di scharge? Waste Collection & Treatment 4. Is storage capaci ty (freeboard plus s torm storage) less than adequate? Identifier: Freeboard (inc hes): 05103101 Srrucrure I I S tructure 2 Structure 3 0 Spillway Structure 4 Strucrure5 DYes DNo DYes DNo DYes DNo NIA DYes DNo DYes DNo DYes DNo DYes DNo Suucture 6 Continued Date of Inspection IS I /J' )O"f I Required Records & Documenlor; 21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? 22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? (ie/ WUP, checklists, design, maps. etc.) 23. Does record keeping need improvement? If yes , check the appropriate box below. D Waste Application 0 Freeboard D Waste Analys is 0 Soil Sampling 24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? 25. Did the facility fail to have a actively certified operator in charge? 26. Fail to notify regional DWQ of emergency situations as required by General Permit? (ie/ discharge, freeboard problems, over application) 27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative? 28 . Does facility require a follow-up visit by same agency? 29. Were any additional problems noted which cause noncompliance of the Certified A WMP? NPDES Permitted Facilities 30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) 31. If selected, did the facility fail to install and maintain rain breakers on irrigation equipment? 32. Did the facility fail to install and maintain a rain gauge? 33. Did the facility fail to conduct an annual sludge survey? 34. Did the facility fail to calibrate waste application equipment? 35. Does record keeping for NPDES required forms need improvement? If yes , check the appropriate box below. D Stocking Form 0 Crop Yield Form D Rainfall 0 Inspection After 1" Rain 0 120 Minute Inspections 0 Annual Certification Form DYes (JNo DYes fi1 No DYes flJNo DYes IiJ No DYes liJNo DYes ~No DYes E}No DYes (!}No DYes [XJNo ~Yes 0No DYes 00No DYes ~No DYes !&)No DYes f:QNo DYes _KiNo 11;1 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. ..... - -.... 12112/03 Date of Inspection I S /1 i J P¥ I 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, seepage, etc.) 6. Are there structures on-site which are not properly addressed and/or managed through a waste management or closure plan? (If any of questions 4-6 was answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ) 7. Do any of the structures need maintenance/improvement? 8. Does any part of the waste management system other than waste structures require maintenance/improvement? 9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level elevation markings? Waste Application 10. Are there any buffers that need maintenance/improvement? 11, ls there evidence of over application? If yes, check the appropriate box below. D Excessive Ponding D PAN D Hydraulic Overload D Frozen Ground 0 Copper and/or Zinc 12. Crop type oa-t J) 13. Do the receiving crops differ with those de ignated in the Certified Animal Waste Management Plan (CA WMP)? 14. a) Does the facility lack adequate acreage for land application? b) Does the facility need a wettable acre determination? c) This facility is pended for a wettable acre detennination? 15. Does the receiving crop need improvement? 16. Is there a lack of adequate waste application equipment? Odor Issues 17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below liquid level of lagoon or storage pond with no agitation? 18. Are there any dead animals not disposed of properly within 24 hours? 19. Is there any evidence of wind drift during land application? (i.e . residue on neighboring vegetation, asphalt, roads, building structure, and/or public property) 20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional Air Quality representative immediately. CoM 'f' c.-"'..\-\ 0"'- f> l!>'f:) ,J . l-\ c. ~-' \\ DYes ~No DYes ~No DYes J(J No DYes I]! No DYes t(J No DYes ~No DYes [ijNo DYes ~No DYes f:lNo DYes [).No DYes BNo [iJ Yes 0No DYes 1;21 No DYes []I No DYes I:ZJ-,No DYes !;!No DYes ~No Reviewer/Inspector Name ~:~~~~;y~~~~~~~tl[~j~~~J~}~j£~,;~i[~~~i~w-,[~~1~~~~~~~FZ~:~' Reviewerllnspector Signature: Date: S//.? / 0 ~ 12112103 Continued