820619_INSPECTIONS_20171231

NORTH CAROLINA
Qepartment of Environmental Quality
Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:~~ 7#1/J Arrival Time: I B:JO Departure Time: I 1. · j'o !county: ~N Region:
Farm Name: Pe.Ate 511+ f-~ Owner Email: tJ I) ft:--
Owner Name: lfi-.Caet PlffM51tl1-= Phone:
Mailing Address:
Physical Address:
Facility Contact: eu?az[ f~ Title: Phone: CfJO, Jf75", f503.9 Ce/f
Onsite Representative: __ ....:~=.;...;..· _..;;;6 ______________ _ Integrator: PP+ic17t1,e
Certified Operator: UJJ ~ "$. 'PtfMil}~ Certification Number: 2,2,/)" 2-
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? 0 Yes ~No DNA ONE
Discharge originated at: 0 Structure 0 Application Field 0 Other:
a. Was the conveyance man-made? 0 Yes ~No DNA ONE
b. Did the discharge reach waters of the State? (If yes, notify DWR) 0 Yes ~No DNA 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) 0 Yes OJ No DNA 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 ofl
DYes
DYes
~No DNA ONE
No DNA ONE
214/2015 Continued
JFacility Number: fJZ. -lt'J1 I Date of Inspection: /3 w; Wtt?
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): /9
Observed Freeboard (in): '? {p
5. Are there any immediate threats to the integrity of any ofthe structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which arc not properly addressed and/or managed through a
waste management or closure plan?
DYes
0 Ye s
Struct ure 5
It] No 0 N A 0 NE
~No DNA ONE
Structure 6
0 Yes ~ No 0 NA D NE
D Yes ~ N o 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 DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required hy 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?
DYes
DYes
DYes
DYes
~No DNA ONE
No DNA ONE
~No DNA O N E
~No DNA O N E
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~ No D NA D NE
D Excessive Ponding D Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn, etc.)
D PAN D PAN> 10% or 10 \bs. D Total Phosphorus D Failure to Incorporate Manure/Sludg e into Bare Soil
D Outside of Acceptable Crop Window D Evidence of Wind Drift D Application Outside o f A p proved Area
12. CropType(s): ~tv.J.~Glrr /sotaell?f) f}&e.uVJYt OtA:{lC~t:r"Y
13. Soil Type(s): /}J-l; 'j Jt/?., 13
14. Do the receiving crops dih'e( 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?
Page2of3
0 Yes
0 Ye s
0 Ye s
~N o
00 N o
~No
DNA D N E
DNA 0 N E
DNA ONE
0 Ye s riJ N o 0 NA 0 N E
D Ye s C$J N o D NA 0 N E
DYes ~N o
DYes N o
DNA D N E
DNA D N E
Oother:
0 Yes !l1 N o
214/2015 Continued
.)Facility Number: ez -p/9 !nate of Inspection:/_$ Df?~ Jo;ij'
'. 24. Did the facility fail to calibrate waste application equipment as required by the permit? D Yes ~No
~ 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
0 Yes ~No
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 documentation of an actively certified operator in charge? DYes
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? DYes
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes
and report mortality rates that were higher than nonnal?
29. 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.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the 0 Yes
pennit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. DYes
0 Application Field D Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance ofthe permit or CAWMP? DYes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes
tlJ No
[fJ No
liJ No
t1J No
CsJ No
~No
~No
IAJ No
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
34. Does the facility require a follow-up visit by the same agency? 0 Yes tfJ No D NA 0 NE
Comments (refel" to questioo'#):'Expfuiri any. YES an5w'ers a~~dlorap~;;~~di!io~,al ,f'¥o~e~,d~~~ns 9r ~DY, ot!J.~,f ~~~n~ " ;1,, ,, 1,,,
Use drawi.ilgil.offac:ility to:IJetter explain 'situatio:Us 7(1ise addition'al pages1 as necessary). . . ... ' ' ·' '""' .. •"·.. ' . ol '" '~' '"". I
-s~~ff >v.ll./1?1 -t/,J}ItJ o= ?,-z, f.;, s,9
--C~tvlB((!YfltJ.I\J 4Jr3 Jn; e., l s-~ ifyf/1
2AJc. z.w~~welrAA.t6 1 ~ "3w-.t.Jw /Cfr-vt..e.
~~ [-.kl-.V~-1-1 ~A/I ~M
L...-1-"7.-r 1,..; ~M f'L 1 A#bb t7 ,v 9'/3 v/) e e!, '2-1
.-w;t-Jiti ;r;tJ~1s1s ;o/z..j]A)Jf} ,;-=.. CJ;?'r
Reviewer/Inspector Name: l:J::/J/'r' WH t) e-
1 ~~---. r;;-I ~ -Reviewer/Inspector Signature: (VV l/V/ v~
Page3 of3
Jl
Phone: '/10 · ·7-35 iJJ0.9
Date: /3 J)eG -u> iB
214/2015
Reason for Visit: ~tine 0 0 Other 0 Denied Access
Date of Visit: I fi'-dz-1) Arrival Time: I q! 0 () Departure Time: I I D / 0 D I County:~~ Region: ~ U
Farm Name: ff4 {soft r ~ f' YYL ::r:: n c_ • Owner Email:
Owner Name: C /~r r e_,,--.fd/ Phone:
Mailing Address:
Physical Address:
Title: CJ W f1 z-/ Phone:
Onsite Representative: Integrator:
Certified Operator: Lo j.? , ? ?>==a('; iJJZ Certification Number: e?? D (p b
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 ? DYes ~DNA ONE
Discharge originated at : D Structure 0 Application Field 0 Other :
a . Was the conveyance man-made? DYes 0No DNA ON E
b. Did the discharge reach waters of the State? (If yes, notify DWR) 0 Yes 0No DNA ONE
c. What is the e stimated volume that reached waters of the State (gallons)?
d . Does the discharge bypass the waste management system? (If yes, notify DWR) 0 Yes 0No DNA ONE
2 . Is the re evide nce of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or po tential adverse impacts to the waters
of the State other than from a discharge?
Page I of3
DYes
DYes
GJ.-N6' 0 NA ONE
~DNA ON E
11411015 Continued
I Facility Number: n-t;rr I Date of Inspection: k/,-.?f=
.• Waste Collection & Treatment
4. I s 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 Structure3 Structure4
Identifier:
Spillway?:
Designed Freeboard (in): !c:r
Observed Freeboard (in): r?-:7
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?
I 71 .
DYes~
0 Yes 0 No
DNA ONE
DNA ONE
Structure 5 Structure 6
DYes ~DNA ONE
0 Yes [9-N<( 0 NA 0 NE
If any of questions 4-6 were answered yes, and tbe situation poses an immediate public health or environmental threat, notify DWR
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
I 0 . Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
0 Yes 0-No 0 NA 0 NE
0 Yes {2tNo DNA 0 NE
0 Yes 0_No 0 NA 0 NE
0 Yes Q(_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. D Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window D Evidence of Wind Drift 0 Application Outside of Ap~roved Area I ;J
12 . Crop Type(s): Co~'n !dJ-£-7L4 ,/a~rnvb l&u .odrz-/1 /~ ~M<Jlti=~
13 . Soil Type(s): ztt{ /wa:J>
>
I 4 . 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 theCA WMP readily available? If yes, check
the appropriate box.
DYes ~0
0 Yes ~0
0 Yes &No
0 Yes ~No
0 Yes ~No
0 Yes J6l No
DYes j;J_No
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
D NA ONE
DNA ONE
0WUP O checklists 0 Design 0 Maps 0 Lease Agreements 00ther: _________ _
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 D Waste Analysis 0 Soil Analysis 0 Waste Trans fers 0 Weather Code
0 Rainfall 0 Stocking 0 Crop Yield 0 I 20 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 B;a No 0 NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes ~o 0 NA 0 NE
Page1of3 11411015 Continued
• I Facility Number: o--z; /9-I Date of Inspection:
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 (2J-No 0 NA 0 NE
DYes ~No 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 documentation of an actively certified operator in charge?
27 . Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28 . Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal ?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, c heck the appropriate box below .
D Application Field 0 Lagoon/Storage Pond D 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 representat ive?
34. Does the facility require a follow-up visit by the same agency?
0 Yes 12J.No DNA ONE
DYes 0No D NA ONE
DYes ~No DNA ONE
DYes (2J:..No DNA ONE
DYes [}g. No DNA O NE
0 Yes ~No DNA ONE
0 Yes [2j...No DNA O NE
0 Yes j)a_No DNA ONE
0 Yes gNo DNA ONE
Comments (refer to question#): Explain any YES answers and/or any additional recoin.mendations or any other comments.
Use · drawings of facility to better explain situations (use additio~l pages as necessary).
Reviewer/Inspector N arne:
Reviewer/Inspector Signature:
Page3of3
Phone: 9--/o-..S O.J~t? IS/
Date: ~2.£-:;?t:J 1/
11412015
Compliance Inspection Operation Review Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I(, · ~~--I{, I Arrh·al Time: I I b ~ UO "d Departure Time: I I Count)·: S4ifJ"n Region: F /( 0
Farm Name: Peg r ..5~ I{ . fc..r ft'l ) Ioc Owner Email:
Owner Name: .....::::.t?-..Jfuh~t.!..r +..!.__.LP..Iie...,a~r~...ol:!lai5..Jli..Ll ________ _ Phone:
Mailing Address: _tf_'f_'1 __ _..l~·· '""'--'l!1~P...t.ll1.,jSL-----LR..:....<.<::J=-----C_I.;..:..~·'1~h..;.:"'..:....._-=-.)-=j:...cJ~2'--"-f _____________ _
Ph ysical Address: t£0( Har/ar l.f J J.f
Facility Contact: --...:E:...._t....l b~( r_+!....---'P'---e=•=.:.r_,~;_;tl...:..;ll;.__ __ Title: Phone:
Onsite Representative: t:=-:-_l_,bct:..:_.ror~f~........:..P __ e!::::l4a.r..r...,J""'a~/~(---------~.·$ O(J.
Integrator: Pre.Jfqge.
Certified Operator: _.~±-~-::tf:::::[~, eet:.ri-:t:...__.lf:.._t'e....tt.o:.L(2.$~u~/.!.( ________ _ Certification Number: ;;l J. 0 G,;?..
Back-up Operator:
Location of Farm: Latitude:
Di sc harges and Stream Impacts
I . Is any di scharge observed fro m any part of the operati on?
Discharge originated at: 0 Structure 0 Application Field
a. Was the conveyance man-made?
0 Other:
b. Did the discharge reach \Vaters of the State? (If yes , notify DWR)
c. What is the I!Stimated vo lume that reached waters of the State (gallons)?
Certification Number:
Longitude:
DYes ~o
0 Yes 0No
0 Yes 0No
d . Docs th e di sc harge bypass the wast<: management system'! (If yes. notify DWR) 0 Yes 0 No
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 impa cts to the waters
of th e State other than from a discharge'?
Page I of3
0 Yes ~No
0 Yes [d"'No
DNA O N E
DNA ONE
DNA ONE
D NA ONE
DNA ONE
DNA ONE
214/2 015 Continued
{Facilit;o Number: 8 ) -(, I 'I I Date of Inspection: 1 o -) & ·I q
Waste Collection & Treatment
4 . Is sto rage capacity (structural plus stonn storage plus heavy rainfa ll ) less than adequate?
a. [f yes, is waste level in to the structural freeboard?
Stru cture 1 Structu re 2 S tru cture 3 Structu re 4
Identifi e r : I
Spillway?: no
Designed Freeboard (in): J q {I
Observed Freeboard (i n): 31)
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, seve re erosion , seepage, etc.)
6. Are th ere structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
0 Yes BiJo 0 NA 0 NE
0 Yes D No 0 NA 0 NE
Structure 5 Structure 6
0 Yes [jd'No 0 NA 0 NE ·(
0 Yes [Z(No DNA 0 NE
If any of qucstio ~s 4-6 were answered yes, and the situation poses an immediate public health or cn\'ironmental threat, notify DWR
7. Do any oftbe structures ne ed maintenance or imp rovement?
8. Do any of the structu res lack adequate markers as requi red by the perm it ?
(not app licable to .~oofed pits, dry stacks, a nd/o r wet stacks)
9. Does any part of the waste management system oth er than the waste structures requ ire
mainten ance o r improvement?
Waste Application
I 0. Arc there any req uired buffers, setbacks. or compli ance a lternatives that need
maintenance or improvement?
0 Yes 12f"'No
0 Yes G3"No
0 Yes [J;?'No
0 Yes [id'No
DNA ONE
DNA O NE
DNA O NE
DNA D NE
11. Is th ere evidence of incorrect lan d application ? If yes , c heck the appropriate box below. 0 Yes ~ 0 NA 0 NE
D Excess ive 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 In corporate Manu re/S lud ge into Bare Soi l
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drill 0 Application Outside of Approved Area
12 .Crop Type(s): Lorn. lvh~ct~, IJ.eua. aermviu I Se-al! 6-ct,.,·, Uv<rs~.,J y y •
13. Soil Type(s): A v} W GL B
14 . Do the rece iving crops differ from th ose de sih>na ted in th eCA WMP?
15. Do es the rece iv in g crop an d/or la nd applica t ion site need improvemen t'!
16. Did the faci lity fai l to secure an d /o r operate per the irri gation design or we tta bl e
acres determina tion?
l 7. Do es the fa ci I ity lack adequate acreage for land app li cation ?
18. [s there a lack of properly operating waste appl icat ion equipment?
Requi red Records & Documents
19 . Did the facility fail to ha ve the Certi fi cate of Coverage & Permit readi ly avail ab le?
20. Does the faci lity fai l to have all components of the CAWMP readi ly ava il able? If yes , c heck
the app ro priate box.
D Yes 12J'No D N A
0 Yes ~0 D NA
0 Yes ~0 DNA
0 Yes ~0 DNA
0 Yes ~0 D NA
0 Yes [2t1Jo D NA
0 Yes ~0 D NA
O NE
O NE
ONE
ONE
ONE
ONE
ONE
Owt:i'P' 0 f'll eckli9ht 0 Des ign 0 ~ 0 Lease A~,>Teeme nts O Other: __ ---,;--------
2 1. Docs record kee ping need improvement'! lf yes. check the appropria te box be low. 0 Yes ~o 0 NA D NE
D~ O weck:l)Freebcrcrr'd D ·~is 0~ o~ 0Wsathert6dC
0 R11i~ 0~ 6-0fl Yi eld 0 r.w M INut e lnspectiurrs 0 Mouth!) aRe L"Rain f;~ll IA:;peetiens-0 ~
22. Did the faci li ty fail to ins tall and maintain a ra in ga uge'? 0 Yes [l2t"No 0 NA D NE
23 . If selected, did the faci lit y fai l to install and mai ntai n rainbrcakers on irriga ti on equipment ? 0 Yes 0 No 0 NA D NE
Page 2of3 21412 01 5 Continued
f.FltcilitfNumber: /;? -4 I q I Date of Inspection: J(r //,·/If
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes ~No 0 NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
0 OF~·~~
0 P~ n
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification'?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern'?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notifY the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field 0 Lagoon/Storage Pond 0 Other:
32 . Were any additional problems noted which cause non-compliance of the permit o r CA 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 GJ..No 0 NA 0 NE
0 Yes ifNo
0 Yes 0 No
~s 0No
0 Yes Ga"No
0 Yes u;?'No
D Yes ~o
DNA O NE
D NA~
DNA ONE
DNA O NE
0 NA O NE
DNA O NE
0 Yes [3'No 0 NA 0 NE
D Yes ~o DNA ONE
0 Yes ~o 0 NA 0 NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use draw!!tgs of facility to bett~r explain situ~tions (use additional pages as necessary).
Reviewer/Inspector Name :
R e vie wer/Inspector Sign ature :
Page 3 of3
Ph one : J {J-/ t -I(,
Date : lv -::Jb -It
114/2015
ompliance Inspection Operation Review 0 Structure Evaluation
Reason for Visit: 01toutine 0 Complaint 0 FoUow-up 0 Referral 0 Emergency
Date of Visit: I <f"-17-16'1 Arrival Time:l <f:o 0
Farm Name: ? -e't:tr-sa. {(
Departure Time: I t 0 \ ~ u I County: .:feptslr-Region:~ 0
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: -----------------------------------------
Facility Contact: £ I b ~d: ?>-4lCSa // Title: Bwn~r
Oosite Representative: • .5~e;~:cG;:::•~e........==~::: ______________ _
Certified Operator: __.b~o,..L-J;'---'.5'---'"B::::...._ _ ___."D~:....}-..__.:er::::...:....!"5...ao.a__:....;.s.,/f.,_ _____ _
Back-up Operator:
Location of Farm: Latitude:
Dischars:es and Stream Impacts
I . Is any discharge observed from any part of the operation?
Di scharge originated at: D Structure D Application Field 0 Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notifY DWR)
c. What is the estimated vo lume that reached waters of the State (gallons)?
Phone:
Integrator: 7rr.3~~ v
Certification Number: t?-2: C) 1.:. ;2.....
Certification Number:
Longitude:
0 Yes ~No DNA ONE
DYes 0 No DNA ONE
DYes D No DNA ONE
d. Does the discharge bypass the waste management system? (If yes, notifY DWR)
2.1s there evidence of a past discharge from any part ofthe operation?
DYes
DYes
0No DNA ONE
[&No DNA ONE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a di scharge?
Page 1 of3
DYes li?l No DNA ONE
21412014 Continued
I Facility Number: loate oflnspection: ?--I z-15
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 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): t:t
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?
0 Yes J3 No 0 NA 0 NE
DYes 0No DNA ONE
StructureS Structure 6
D Yes 8-,No DNA ONE
0 Yes 12JNo 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
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
0 Yes 13,No 0 NA 0 NE
0 Yes (E_No 0 NA D NE
0 Yes j&No 0 NA 0 NE
0 Yes IX_No 0 NA 0 NE
II . Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes !Li.No 0 NA 0 NE
0 Excessive Ponding D Hydrauli c 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
/..5ft?~'¥'~n.f I Z-r-r-muk /ouc"Y:'~) 12. Crop Type(s):
A:u. /uJa13 13. Soil Type(s):
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 irri gation 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.
Dwup Ochecklists 0 Design D Maps 0 Lease Agre ements
21. Does record keeping need improvement? If yes, check the appropriate box below.
D Yes ~No DNA O NE
D Yes ~No DNA O NE
0 Yes !Bl No DNA ONE
D Yes ~No DNA ONE
D Yes ~No D NA ONE
D Yes [29 No DNA ONE
D Yes (3No DNA ONE
0 0ther:
D Yes ~No DNA ONE
0 Waste Application 0 Weekly Freeboard D Was te Analysis D Soil Analysis D Waste Transfers 0 Weather Code
0 Rainfall 0 Stocking 0 Crop Yield 01 20 Minute Inspections 0Monthly and 1" Rainfall Inspections O sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes ~No DNA D N E
23. I f selected, did th e facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes ~No DNA O NE
Page 1 of3 11412014 Continued
• !Facility Number: a:2:-lor ?I !nate oflnspection: 9:-J 7-1 S1
• 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 IE No
DYes ~No
DNA ONE
DNA ONE
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 offrrst survey indicating non-compliance :
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29 . At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
DYes ~No DNA ONE
0 Yes [&1 No 0 NA 0 NE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No 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 D Other: ------------------------
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Reviewer/Ins pector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
DYes f&lNo DNA ONE
DYes !&No DNA ONE
DYes ~No DNA ONE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings offacility to better explain situations (use additional pages as net:essary).
Reviewer/Inspector Name :
Reviewer/Inspector Signature:
Page 3 of3
Phone: <} I 0-c.{ 3 ::r --33oo
Date: 9--( 7-.?-0 1.)
21412014
\
ompliance Inspection Operation Review 0 Structure Evaluation
Reason for Visit: @'j(outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Denied Access
Date of Visit: l/2:-#-/f I Arrival Time :I f?'! 3 0
Farm Name: TY4r5~ pg,.m. ;;r:;;, c. •
Owner Name: £ /h.,.,cf: "fr't~r.S~
Departure Time: I 2 ~ .J'D I County:..>_/1"~ Region: rFD
Owner Email:
Phone:
Mailing Address:
Physical Address: -----------------------------------------
Title: !}q.N1 't'Y
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
l. Is any discharge observed from any part of the operation?
Di sc harge originated at: 0 Structure 0 Application Field
a. Was the conveyance man-made?
0 Other:
b. Did the d ischarge reach waters of t he State? (If yes, noti fy DWR)
c. What is the estimated vo lume that reac hed waters of the State (gallons}?
Pbone:
Integrator: Prr.;/:~
Certification Number: ;l,;Lof&>;:J-
Certification Number:
Longitude:
D Yes ~o D NA
DYes DNo D NA
DYes 0No D NA
ONE
O NE
O NE
d . Does the discharge bypass the waste management system? (If yes, noti fy DWR ) D Yes 0No D NA O NE
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
D Yes
DYes
li&No D NA O NE
' 13-No D NA O NE
21412 014 Continued
I Facility Number : n--1/tr I Date of Inspection : J?-/1-,ilo till
Waste Collection & Treatment
4 . Is storage capacity (structural plus storm storage plus heavy r ainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure4
Id entifier:
Spillway?:
Designed Freeboard (in): ,~
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the s tructures observed?
(i.e., large trees , severe erosion, seepage, etc.)
6. Are there s tructures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
0 Yes ~N o 0 NA 0 NE
0 Yes D No D NA D NE
Structure 5 Struc ture 6
0 Yes ~ No D NA D NE
D 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 DWR
7 . Do any of the structures need maintenance or improvement?
8. Do any of the struc tures lack adequate markers as required by the p ermit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does an y 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?
0 Yes ~ No DNA D NE
D Yes Eia No D NA D NE
DYes (l?J No DNA ONE
DYes ~No D NA ONE
11. Is there evidence of incorrect land application? If yes, ch eck the appropri ate box below. D Yes ~ No 0 NA D NE
D E xcessive Ponding 0 Hydraulic Overload D Frozen Ground D He avy Meta ls (Cu, Zn, etc.)
D PAN D PAN > 10% or 10 lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window D Evidence of Wind Dri ft 0 Application Outside of Approved Are a
12 . CropType(s): Cor~ /whJ"if/.?eyk~( /~wntf-[7;-r;::f; fJSrmr4a._/9.v ~!>..,...,../
13 . Soil Type(s): 4= tJ /UJa ~
14 . Do the receiving crops differ from those des ignated in the CA WMP?
15 . Does the receiving crop and/or land applicati on site need improvement ?
16. Did the facility fail to sec ure and/or o perate per the irriga tion design or we ttable
acres determination?
Pagelof3
DYes
DYes
DYes
DYes
D Yes
~No DNA ONE
~No DNA O N E
~No DNA ONE
~No DNA ONE
~No DNA ONE
D NA ONE
D NA O NE
214/2014 Continued
. !Facility Number: 82:-(,!9 I nate of Inspection: 12-11= J J(
24 . Did the fac ility 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 Ye s jE.No 0 NA 0 NE
DYes {gNo 0 NA 0 NE
D Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
D Non-compliant sludge levels in any lagoon
List structure(s) and date of frrst survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28 . Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29 . At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
3l. Do subsurface tile drains exist at the facility ? If yes, check the appropriate box below.
0 Application Field 0 Lagoon/Storage Pond 0 Other:
DYes ~No
0 Yes ~No
0 Yes !g) No
0 Yes ~No
DYes ~No
0 Yes [2g..No
DNA ONE
DNA O NE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
------------------------
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 (ZJ No
0 Yes ~No
0 Yes ~No
D NA ONE
DNA ONE
DNA ONE
Comments (refer to question tf): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page3of3
Phone: CZzo-t{:r::J~-g-;J iJD
D ate: J :;:J...--/j-... _?-0/~
214/2014
Date of Visit: (2-&-lql Arrival Time: I /I ~ 00 I Departure Time: I I;? ; 00 I County: 13l.a)~,..._. Region: f?E-"'0
Farm Name:_ ..... rQ...._....J.m~w;"-jiJ/.__/~¢ .......... z1"-'-U_.v"""r_"'-_ _._6_.t:U""'"""m..:.....::..._~_r __ Owner Email:
Thtrnt (!U, < li'k-FoJ 1117:"..1&-fv---
Owner Name: Phone:
Mailing Address:
Physical Address: -------------------------------------------
Facility Contact:
Onsite Representative:
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 0 Application Field 0 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)?
Phone:
Integrator: ~Mw­
Certification Number: /4,. Z.&
Certification Number:
Longitude:
0 Yes ~No DNA ONE
0 Ye s 0No DNA ONE
DYes 0No DNA ONE
d . Does the discharge bypass the waste management syste m? (If yes , notify DWQ) QYes 0No DNA ONE
2. Is there evidence of a past disc harge 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
0 Yes
DYes
~No DNA ONE
(2?No DNA ONE
214/10 II Continued
I Facility Number: ~ -fa .5'<?+ lnate oflnspection:£..;:?l -1¥
Waste Collection & Treatment
~.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): 19 I
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?
0 Yes (2i_No 0 NA 0 NE
DYes 0No DNA ONE
Structure 5 Structure 6
0 Yes IBJ No 0 NA 0 NE
0 Yes [E_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 structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Docs any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required butTers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes [ENo DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
0 Yes R,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 D Heavy Metals (Cu, Zn, etc.)
0 PAN D PAN> 10% or 10 lbs. 0 Total Phosphorus D 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): l),dm&k / ().w;--~crJ/S"J:~ / whmr/=/ .... 1R!)'~
13. Soil Type(s): Jj'ull:/ L-~ / Fo4:
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 operatin g 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 .
0WUP Ochecklists 0 Design D Maps D Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
DYes
DYes
DYes
DYes
0 Yes
DYes
DYes
00ther:
DYes
IEJ No DNA
jgNo DNA
~No DNA
5No DNA
[B. No DNA
~No DNA
I2J No DNA
[;3 No DNA
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
D Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Anal ysis 0 Waste Transfers D Weather Code
D Rainfall 0 Stocking 0 Crop Yield D 120 Minute Inspections 0 Monthly and I" Rainfall inspections D Sludge Survey
22. Did th e facility fail to install and maintain a rain gauge? DYes ~No 0 NA 0 NE
23. I f selected, did the facility fail to install and m aintain rainbreakers o n irri gation eq uipme nt? 0 Yes ~No D NA 0 NE
Page 2 of3 21412011 Continued
IFecility Number: f?;2= -k i2: !Date of Inspection: 4B -;z.~,z -.ROt#
24. Did the facility fail to calibrate waste application equipment as required by the permit? D Yes ['SSf No D NA 0 NE
I
•25. Is the facility out of compliance with permit conditions related to sludge? Ifyes, check
the appropriate box(es) below.
0 Yes I)SlNo DNA 0 NE
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 to provide documentation of an actively certified operator in charge? DYes
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? DYes
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes
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? DYes
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the 0 Yes
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
0 Application Field D 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
~No DNA
(g. No DNA
.Ji(l No DNA
l5a No DNA
0,No DNA
12) No DNA
jE.No DNA
~No DNA
[&_No DNA
Comments (refe r to ques tion #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility t o better explain situations (use additional pages as necessary).
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Revie wer/In spector Name:
Revie we r/I nspec tor Sig nature :
Page3 of 3
Phone: 9Jo--,tJ3J-337YD
Date : /-;:::?-fp-£D/If
214/20/J
Operation Review 0 Structure Evaluation
Reason for Visit: ~Routine 0 Complaint 0 FoUow-up 0 Referral 0 Emergency 0 Denied Access
Date of Visit: jqJ L3h3 I Arrival Time:I&UOitf/ Departure Time:IIOiOOI\'1 I County: ~Sfb
Farm Name: Pwsal f £tnb., ~ , Owner Email:
Owner Name: E \ Wtt PeQ/JQ f I Phone:
Mailing Address:
Physical Address: H-&vlbf. R.L.
Facility Contact: b I ba-t PWJa II
Onsite Representative: E I D8:t Pe¥safJ
Title: <!JJI'Ofc Phone:
Integrator: PrfJ~:e.
Region: fRO
Certified Operator: .....;lo::lo!Ui .... s--LP.looe.~~~~M~a:!S...LI.:....J ------------Certification Number: ~D>#AlloC:..IlO~b~aA------
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? DYes t}(J No
Discharge originated at : D Structure 0 Application Field D Other:
a. Was th e conveyance man-made? 0 Yes DNo
b. Did the di scharge reach waters of the State? (lfyes, notify DWQ) 0 Yes DNo
c . What is the estimated volume that reached waters of the State (gallons)?
d . Doe s the discharge bypass the waste management system? (If yes, notify DWQ) 0 Yes 0No
2. Is there evidence of a past discharge from any part of the operat ion?
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
0 Yes ~No
DYes fiJ No
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
11412011 Continued
[Facili; Number: I Date of lnspection:qi~1J )3
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
Identifier:
Spillway?:
Designed F reeboard (in): --l\_q'---
Observed Freeboard (in): ~a~~..L---
Structure 2 Structure 3 Structure 4
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
DYes 0No DNA ONE
Structure 5 Structure 6
D Yes GtJ No D NA 0 NE
DYes ~No DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threa4 notify DWQ
7. Do any of th e structures need maintenance or improvement?
8. Do any of th e 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?
0 Yes ~No DNA 0 NE
DYes ~No DNA ONE
DYes t)6No 0 NA 0 NE
DYes ~No DNA ONE
11. Is there evidence of incorrect land application? If yes, check the appropri ate box be low. 0 Yes C,9-N o 0 NA 0 NE
D Excess ive Ponding D Hydraulic Overload D Frozen Ground 0 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 0 Application Outside of Approved Area
13.Sot1Type(s): _{L__ __ d _ 12 . cmp Type(s) ~~ ~ Cilrlfgf 98'!!1..1«. Gra1i/ Sma1(9roiYJ
14 . Do the receiving crops differ from those designated in theCA WMP? 0 Yes {8 No 0 NA 0 NE
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 Jack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fai l to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA WMP readi ly avai lable? If yes , check
the appropriate box.
0WUP D c heckli sts D Des ign 0 Maps D Lease Agreements
DYes ~No QNA ONE
DYes ~No DNA ONE
DYes 18J"No DNA ONE
DYes T>fNo DNA ONE
MYes 0No DNA ONE
DYes ~No DNA ONE
00ther:
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Ye s ~ No 0 NA 0 NE
D Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Anal ysis 0 Waste Transfers 0 Weather Code
D Rainfall 0 Stocking D Crop Yield D 120 Minute Inspections 0 Monthly and 1" Rainfall In spections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes ~No D NA 0 NE
23. If selected, did the faci lity fail to in sta ll and maintain rainbreakers on irri gation equipment? 0 Yes 0 No !E"NA 0 NE
Page 2 of3 11412011 Continued
(Facili!r Number: '6d.. -fJ.l9 I Date of Ins~ection: g J IJ lt3
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes IXJ No DNA
25 . Is the facility out of compliance with permit conditions related to sludge? If yes, check DYes IS(No DNA
the appropriate box(es) below .
0 Failure to complete annual sludge survey 0Failure to develop a POA for sludge levels
0 Non-compli ant sludge levels in any lagoon
Li st structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? DYes QJNo DNA
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes !E'No DNA
Otber Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document 0 Yes (»No DNA
and report mort a lity rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? D Yes mNo DNA
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 (X No DNA
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 ~No DNA
D Application Field D Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes "[:gNo DNA
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes 18No DNA
34. Does the facility require a follow-up visit by the same agency? DYes fSil'No DNA
Comments (re(er to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary). ·
'Nell ntoh'\-a~~ ~hJ , iOodl~l»\lOvff.
~~e~ f""'fdOIW\ l~ bmre ~ttl~~
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Reviewer/Inspector Nam e: vo l.h, Schntifr Phone: Cfl(}--'f~-33of>
Reviewer/In spector Signature : Date: sqi-1.; c}QJj
Page 3 of3 21412011
.. · · · Elbe--t'
Facility No.1d-/o/9 Farm Name _B!...Jo~o..l!!.'OI~Jd~L>-L-J ____ Date q}f3//]
Permit COC _/__ OIC ../ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
FB Dr~s
I I I I I I I I I I
Lagoon Name, S for spillway 1 2 3
Design Freeboard I Last Recorded (in)
Observed freeboard ;;}a;-
Sludge Survey Date ~lu.\f3
Sludge Depth (ft) ~·~
Liquid Trt. Zone (ft) '1•\
Ratio Sludge to Treatment Volume if> 0.45
Date out of CQI11Piiance/ POA?
r"'~t' r rt"''-t.!, I
Calibration Date 1J~JJ8fl. 2 3 4 5
Ring Size (in) l,.tJC
Design Flow (gr:>_m) Jfb)-
Actual Flow lbt
Design Diam . (ft) .dlf
Actual Diam. JtO
I ·l# PJI "'l'lo
SoiiTestDate qJnl\3 t};s\~~~-~k.Crop~/id / :......t-.1.._
pH Fields (Q, l fxxJ.. ~ Wettable Acres __., ~ll1'1:"-
4 5 6
6 7
Transfer Sheets
RAIN GAUGE
7
8
Lime Needed Cf WUP J
Lime Applied Weekly Freeboa.....:rd.._/-r--
Cu-1 ~ Zn-1 .._.,., 1 1 in Inspections .::;;;--
Needs S (S-1<25) ~!~~&!t~-t-120 min Insp.
Dead box or incinerator --.---
Mortality Records J
Check Lists
Nv IVt'ftl ~-7() ---Storm Water
Needs P 0 -Weather Codes
Waste Date <i) llJ l \1 hill If? ltJl1113 ~bk~
-60 Day ,
+ 60 Day
N (lb/1 000 Gal) 1,, '" J.08 JrN ,, 0J.
pH ~.o J. i' J,h 1}. I
Puii/Fiel.lf Soil Crop Acres PAN Window Max Rate MaxAmt
~-So-l I> o:r -.n
·~j~---
13~
Verify PHONE NUM~l::,~d affiliations"-3-t-~'f ~ _f-s-AtJ ~">~~
Date last WUP FRO fi'IIO~ FRO or Farm Records l:'-c~-l )'v~ JC&$/fl:>l< )'4{)" Se(t
Date last WUP at farm r 1 '3 Lagoon# ~ 0 n. A &ct--H'fW.
App. Hardware Top Dike "fi,Q... «+8S-or• t/ "V I
Stop PumpQ"ttb 'i . ~ ~~tN-;t)~&'O
Start Pump~ -/
'·' ldt ==-rq 11 Au PA~ 'QB Y¢'J Conversion-Cu-I 3000== 108 lbtac:; Z n-1 3000= 213 lb/ac 1 CG I p ..... ftJ -)lv c-~ II\~ rK Llt\tc..J'-~m~)\J~ '370 K;)op f...t\s VxL \\tt~ift 3~dy
\0 ;10 ·"'1 q(l3(\) :t~~"• ~Ot) SvNttt'-3/~j
Operation Review 0 Structure Evaluation
Reason for Visit: Gd'Routine 0 Complaint 0 FoiJow-u 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I '1~~\ \d. I Arrival Time:IOG.t"\S"o/1 Departure Time:lld.!Q.?P/'f'l I County: ~A'f\'\{?SCN
I
Farm Name: __ 'Y..:...t..;;.;~'"'"~"'""""' .......... \._.\_t-=--~-'-R..--'-fT\.__,_"::l.--'-C'\-<:.. ______ _ Owner Email:
Owner Name: ~' "ot4l-, P~<>-~'\ Phone:
Mailing Address:
Region:
Physical Address: -----------------------------------------
Facility Contact: E\bt:~, ~(.~~~~\' Title: 0 Wf\.t,R.
Onsite Representative: ---",3e"""'-'o..acn::..:....;..:t..=----------------
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at : 0 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)?
Phone:
Integrator: ~R€S-4~sf
Certification Number: daO{g C;t ~--=-=-----------
Certification Number:
Longitude:
DYes Q(No D NA ONE
DYes 0 No DNA ONE
DYes 0No D NA ONE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes 0No DNA 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 di sc harge?
Page I of3
DYes
DYes g:· DNA ONE
No DNA ONE
21412011 Continued
jFaciUty Number: !Date of Inspection: Cf { IS[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 Structure2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): \9 -...:....;,.---
Observed Freeboard (in): ~IJ...
5. Arc 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 0NA ONE
DYes DNo DNA ONE
Structure 5 Structure 6
D Yes ~o DNA ONE
DYes f0'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 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?
0 Yes
DYes
DYes
0 Yes
~0 D NA ONE
5fNo DNA ONE
g:No DNA ONE
~0 DNA ONE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes [2{No 0 NA 0 NE
0 Excessive Ponding Q Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn, etc .)
0 PAN 0 PAN > 10% ~r 10 lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
) 0 Outs ide of Acceptable Crop· Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s):
\ 1\
13. Soil T y pe(s): "'-.l\R'\u~\\~1 (\\o~
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?
I 7. 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.
DWUP Ochecklists 0 Des ign D Maps 0 Lease Agreements
D Yes Q'No DNA
DYes ES(No DNA
DYes ~No DNA
D Yes ~0 DNA
DYes f2(N o DNA
D Yes ~0 DNA
0 Yes ~0 DNA
O other:
O NE
ONE
ONE
ONE
ONE
ONE
ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. D Yes ~SiNo DNA ONE
D Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis D Waste Transfers D Weather Code
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections D Monthly and 1" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes GZI No 0 NA 0 NE
23. If selected, did the fa c ility fai l to in stall and maintain rainbreakers on irri gati on equipment? 0 Y es 5{No 0 NA 0 NE
Page 2 of3 214/2011 Continued
. ......
!Facility Number: IDate oflnspection: C\ (t ~\ t'1..
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 (£{No
DYes ~No
DNA ONE
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 documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus Joss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 2 4 hours and/or document
and report mortality rates that were higher than normal ?
29. At the time of the ins pection 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 ., di scharge, freeboard problems, over-appli cation)
3 1. Do subsu rfac e tile drains exist at the facility? If yes, check th e appropriate box below .
DYes (M'No 0 NA D NE
0 Ye s &No 0 NA D NE
DYes ~No DNA ONE
0 Yes (g'No 0 NA D NE
DYes ~o DNA ONE
0 Yes [g'No 0 NA 0 NE
0 Application Field D Lagoon/Storage Pond 0 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
DYes
DYes
DNA ONE
DNA ONE
DNA ONE
Comments,(refer to question#): Explain any YES ~nswers and/or any additional recommendations. or any other comments. . . . ·• Use drawhigs of facility to better explain situations (use additional pages as necessary). * tf\~ :1b Wt.\\ 'i.t\)1"·
~ \\ E..t(){\.~ w t.\.' K tR\ * ~~~() ~~R.~ :tRU~P--\i:O~ ~~9V"~' C.."f'\~~::l t=> -;).o\ }._,
Reviewer/Inspector Name:
Revi ewer/Inspector Signature :
Page3 of3
Phone: '\ \()·~-LL~\
Date: C\\ \ $\\ ~
114/2011
ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: <a1{0utioe 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I rz=--/~II I Arrival Time: I 'f ! Q D I Departure Time: I J 0 '.. v C) I County~o--
Farm Name: ~a..!/ rarrY\-L/1 ~. Owner Email:
Region: ri<o
/
OwnerName: tffl,..cf= J?a.r~d.l Phone:
Mailing Address :
Physical Address: -------------------------------------------
Facility Contact:
Onsite Representative:
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: 0 Structure 0 Application F ield
a. Was the conveyance man-made?
0 Other:
b . Did th e discharge reach waters of th e State? (If yes , notify DWQ)
c. What is the estimated volume th at reached waters of the Stat e (gallons)?
Phone:
Integrator: 7;18~~:.........._· ~.c..L.J:::::,;;,._a...jil:=--------
Certification Number: 4E-;:z.. o G.,?---
Certification Number:
Longitude:
DYes ~No DNA ONE
DYes QNo DNA ONE
DYes QNo D NA ONE
d. Does the di scharge bypass the waste management system? (If yes, notify DWQ) DYes 0No DNA ONE
2. I s there evidence of a past discharge from any part ofthe operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of th e State other than from a di scharge?
Page I of3
DYes ~No
DYes ~No
DNA ONE
DNA ONE
21412011 Continued
[Facility Number: I Date of Inspection: 8:'= l.tf('-l= oA 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
Identifier:
Spillway?:
Designed Freeboard (in): L<j
Observed Freeboard (in):
5. Arc 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','
0 Yes blJ No DNA D NE
DYes 0No DNA ONE
Structure 5 Structure 6
0 Yes 18 No DNA D NE
0 Yes (5iNo DNA 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. no 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?
0 Yes ~ No D NA D NE
0 Yes ~ No D NA D NE
DYes ~No DNA ONE
DYes ~No DNA 0 NE
ILls there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~No DNA D NE
D Excessive Ponding D Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn , etc.)
0 PAN D PAN> 10% or 10 lbs. D Total Phosphorus 0 Failure to In corporat e Manure /Sludge into Bare Soil
D Outside of Acceptable Crop Window D Evidence of Wind Drift D Applic ation Outside of Approved Area
12. Crop Type(s): Cbcl'\-/zvlcJ /5~L
13. Soil Type(s): Au {No IJ
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? J f yes, check
the appropriate box.
DYes ~No DNA
DYes ~No DNA
DYes ~N o DNA
DYes 681 N o DNA
DYes ~No DNA
DYes ~No DNA
DYes 0No DNA
ONE
ONE
ONE
ONE
ONE
ONE
ONE
QWUP Dchecklists D Design D Maps D Lease Agreements DOther: _________ _
21. Does record keeping need improvement? If yes, check the appropriate box below. DYes pzl No DNA 0 NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analys is 0 Wa ste Tran sfers 0 Weather Code
D Rainfall 0 Stocking D Crop Yield D 120 Minute Inspections 0 Monthly and I " Ra infall Inspection s D Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes 6a No 0 NA D NE
23. If selected, did the facility fail to install and maintain rain breakers on irrigation equipment?
Pagel of3
DYes ~No 0 NA D NE
2/412011 Continued
.
IFacili~ Number: 8;?--fat. 9 I Date of lnsl!ection: g-c-; Er-.?liJ;t.l
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes ~No DNA
25 . Is the facility out of compliance with permit conditions related to sludge? If yes, check DYes ~No DNA
the appropriate box(es) below.
0 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
D Non-compliant sludge 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? DYes IE No DNA
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? DYes ~No DNA
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document 0 Yes (&No DNA
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? DYes ~No DNA
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 ~No DNA
permit? (i.e., discharge, freeboard problems, over-application)
31. Do s ubsurface tile dnlins exist at the facility? If yes, check the appropriate box below. DYes gj No D NA
0 Application Field 0 Lagoon/Storage Pond D Other:
32. Were an y additional problems noted which cause non-compliance ofthe permit or CAWMP? DYes [:Sa No DNA
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? 0 Yes ~No DNA
34. Does the facility require a follow-up visit by the same agency? 0 Yes ~No DNA
CommentS (refer to question#): Explain any YES answers and/or !lny ·additiorial recommendati9ns or any o,ther comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Reviewer/Inspector Name :
Reviewer/Inspector Signature :
Page3of3
Phone: :»'p--;0"3-.) :Jc c.
Date: .;f<:/r e?c?/ /
21411011
\
Type of Visit ~pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason tor Visit ~ine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ~/0 I Arrh·al Time : I / {) ~ v 0 I Departure Time: I / I ! l:> () l County: ~~1=:-=: Region: FK D
Farm Name: fr4rsq_.L/ ,6c~ .J::'/Ic . Owner Email:-------------
Owner Name: f3: fb<PcT UL?c<vz.tl Phone:
Mailing Address:
Physical Address:-----------------------------------------
Facility Contact: E-1./,cr ?r.e:::ef'/ Title: db< .c .J n ,.. ,.,-Phone No:---------
Onsite Representative: _ ... s:....~;;__...::=o.-===-------------Integrator: f?t'&.!? ~
Certified Operator: ___ 1.--'o:::::.....;;'""..;>=-----___.?4_~;:::;;.....oP=-<-C_5 ... a ... /:a.o:;;..'.i_=----Operator Certification Number: t£:2 Qfo b
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D" Longitude: D OD'D"
Dischan:es & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: D Structure D App lication 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 impacts to the Waters of the State
other than from a discharge?
Page I of 3
D Yes !)g.No DNA ONE
D Yes 0 No DNA ONE
DYes 0 No DNA O NE
DYes 0No DNA ONE
DYes ~0 DNA ON E
DYes ~&No DNA ON E
12118104 Continued
I Facility Number: re ~ I ~I Date of Inspection f Zf-2-f'd
Waste Collection & Treatment
4. ls 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 ~No DNA ONE
DYes 0No DNA ONE
Structure 5 Structure 6
Identifier:------------------------------------------
Spillway?:
Designed Freeboard (in): __ _.I.___?L.-__ -----------------------------------
Observed Freeboard (in): --2..___,.7'----------------------------------------
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 li{1 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 buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
0 Yes .I&I.No 0 NA 0 NE
DYes !&No DNA ONE
0 Yes PlNo 0 NA 0 NE
DYes ~No DNA ONE
11. Is there evidence of incorrect application? If yes, c heck the appropriate box below. DYes G3-N'o 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 0 Application Outside of Area
12. Crop type(s) __ C""'----U.'bc-~.n.....__+-6"""./M"""~:....c:~':..a/-"'--___,c...B...c....~t:.~~k:.E..C~~<------------------
13. Soil type(s) A-u. / N l.) Jt
~ '
14. Do the receiving crops differ from those designated in the CA WMP? DYes j2gNo DNA ONE
15. Does the receiving crop and/or land application site need improvement? DYes !&No DNA ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? DYes jgJ No 0 NA 0 NE
17. Does the facility lack adequate acreage for land application? DYes ~No DNA ONE
18. Is there a lack of properly operating waste application equipment? DYes ~0 DNA ONE
Comments (refer to question #): Explain any YES answers and/or an); recommendations or any other comments:
Use dra·wings of facility to better explain situations. (use additional pages as necessary):
.... -
-..
Reviewer/Inspector Name I ~~~6-~/p--. I Phone: 9-/tJ-t..f f3-3..:mo
Reviewer/] nspector Signature: ~,--LL.. Date: 2::; /D ~/D
Page 2 of3 12128104 Co ntinued
I Facility Number: g;;;2.~J2t"
R e quired Records & Documents
Date of Inspection I ]?'-z--/d
19. Did the faci li ty fail to have Certificate of Coverage & Permit readily avail able?
20. Doe s th e faci li ty fa il to have all components of th e CAWMP readily availa ble? If yes, check
the appropriate box. D WUP D Check li sts 0 De sig n D Maps D Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
0 Yes [21.No D NA D N E
D Yes 1:3No DNA O NE
D Yes ~No DNA O NE
0 Waste Application 0 Weekly Free board 0 Waste Ana lysis 0 Soil Analysis 0 Waste Transfe rs 0 Annual Certification
0 Rainfall 0 Stocking 0 Crop Yie ld 0 120 Minute Inspections 0 Monthly and 1" Rain In spections D Weather Code
22. Did the facility fa il to in stall and mainta in a rain gauge? D Yes SNo D NA O NE
23. If se lected , did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes Jia. No D NA O NE
24. Did the faci lity fai l to calibrate waste appli cation equipment as required by the permit? D Yes J2a No D NA O NE
25. Did the fa cility fa il to condu ct a sludge survey as required by the permit? DYes ~No D NA O NE
26. Did the facili ty fa il to have an actively certified operator in charge? D Yes jia No D NA O NE
27. Did the fac ility fail to secure a phosphorus lo ss assessment (P LAT) certification? DYes p:4. No D NA ONE
Other Iss ues
28 . Were any additiona l problems noted which cause non-compliance of the permit orCA WMP? D Yes ~No D NA ONE
29. Did the faci li ty fail to properly dispose of dead animals within 24 hours and/or document D Yes ~No DNA ONE
and report the morta lity rates that were higher than normal?
30. A t the ti me of the inspection did the facility pose an odor or air quali ty concern? D Yes ~No DNA ONE
If yes, contact a regional Air Quality representative immediately
3 l. Did th e faci li ty fai l to notify the re g io nal office of emergency situat ions as requi red by D Yes ~No D NA ONE
General Permit? (ie/ discharge. freeboard problems, over application)
32. Did Re viewer/In spector fa il to discuss review/in spec ti on with an on-site representative? DYes ~No D NA O NE
33. Does fa c ilit y require a follow-up v isit by sa me agency? D Yes [S No D NA O NE
Additional (:omments and/or Drawings: -.. ...
~
;
~ ....
Page3 of3 12118104
\
Type of Visit ()-C'ompliance Inspection 0 Operation Review . 0 Structure Evaluation 0 Technical Assistance
Reason for Visit erRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Region: FJ!:.T) Date of Visit: f 9:'-tl'"'ifil Arrh·al Time: f /0 0 f Departure Time: k£ !3D f County~
Farm Name: £ fib ef' r 'Pear ...5a.l1. n_,-,........__ Owner Email: ------------
Owner Name: e liect Frar~ Phone:
Mailing Address: ------------------------------------------
Physical Address:------------------------------------____ _
Facility Contact: £ 1/a-/t-Pecv.$c!.!2.Q_ Title:---------PhoneNo: _________ _
Onsite Representative: -~$~!::.a.-.-'L-=:::.....-==-------------Integrator:----------------
Certified Operator: h.o i..S 15 Operator Certification Number: --------
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? 0 Yes liiNo 0 NA D NE
Discharge originated at: 0 Structure 0 Application Field 0 Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
DYes 0No DNA ONE
DYes 0No DNA ONE
DYes 0No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
12/28104 Continued
I Facility Number: g',;J-: k/1 Date of Inspection I $"-17~
Wnstc CoJJection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Stntcture I Stntctun: 2 Structure 3 Structure 4
DYes QJNo DNA ONE
DYes 0No DNA ONE
S1ru{;turc 5 Slructun: 6
Identifier:------------------------------------
Spillway?:
Designed Freeboard (in): __ ___;./___::9 __ ------------------------------
Observed Freeboard tin): __ _..¢<:..-J/~---------------------------------
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 addressed and/or managed
through a waste management or closure plan?
DYes ~No DNA ONE
If aoy 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 pennit?
(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/imp·rovement?
DYes [KNo DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes IXNo 0 NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload D 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 0 Application Outside of Area
12. Croptype(s) )'~or.,&'/ .ev/~/Cbcn
13. Soil type(s) 4 u / N 0 ·7\-
14. Do the receiving crops differ from those designated in the CA WMP? DYes C8..No DNA ONE
15. Does the receiving crop and/or land application site need improvement? DYes 12{No DNA ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination'! 0 Yes QiNo DNA ONE
17. Does the facility lack adequate acreage for land application? DYes ~No DNA ONE
18. Is there a lack of properly operating waste application equipment? DYes NNo DNA ONE
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):
....
f-
f-....
Reviewer/Inspector Name <)77::-._./y -C. ~~ Phone: 9-/ D -~&. :rJ-3 3o~
Reviewer/Inspector Signature: .4' _J~~ Date: 9~ -r>-~~'7 c:;;.7":;ro.
12118104 Continued
' I Facility Number: B1'-lP/91 Oate of Inspection lj'-/7...--Bt:l
H.cquired Records & Ducumenh
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components ofthe CAWMP readily available? lfyes, check
the appropirate box. 0 WuP D Checklists D Design D Maps 0 Other
DYes ~No DNA ONE
DYes gNo DNA ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. D Yes [&No D NA D NE
0 Waste Application 0 Weekly Freeboard D Waste Analysis D Soil Analysis D Waste Transfers D Annual Certification
0 Rainfall D Stocking 0 Crop Yield D 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? DYes K]No DNA· ONE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes ~No DNA ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes [ktNo DNA ONE
25. Did the facility fail to conduct a sludge survey as required by the permit? DYes i:]No DNA ONE
26. Did the facility fail to have an actively certified operator in charge? DYes I&JNo DNA ONE
27. Did the facility fail to secure a phosphorus loss assessment (PLAn certification? DYes pg,No DNA ONE
Other Issues
28. Were any additional problems noted which cause non-compliance ofthe permit orCA WMP? DYes !BfNo DNA ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes !il'No DNA ONE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? DYes (ENo 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 ONE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes igNo DNA ONE
33. Does facility require a follow-up visit by same agency? DYes ~No DNA ONE
Additional Comments and/or Drawings:
• ,..._
r-...
12128104
0 Operation Review 0 Structure Evaluation ompliance Inspection
Reason for Visit ~ne 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
Date of Visit: I ~A rri val Tim e: I l .' 'P j) Region:E;eo
Farm Name: &/bvf: f'ee/3atJ
I Departure Time: I/O! v 'V I C ounty: .., S~
;:::izr ~ Owne r Email: --------------
Owner Name: --~-~:.......loO:;~ ...... f-~;__----.r~c.5&1f Phone:
M a iling Address:
Physical Address:-----------------------------------------
Facility Contact: gjk,..r ? t:"Z'I" .sa.l!! Title: _______ _ Pbone No: ________ _
Onsite Representative: _..,..f.::..~=.::..!:==--------------Integrator: l',cz=1'1ii)-e
Certified Operator: ___.Lc::;;./2~/:..-~ :$.£_ _ ___,.$......,;:::_ ...... f>._c-.<_.-ao::...r.oo:;j::;...;...a-L(__...;;;.. ___ _ Operator Certification Number: _,~::;.....-o~O~~:..-;z_"'----
Back-up Operator: --------------------Back-up Certification N umber:
Location of Farm: L atitude: D OD 'D " Longitude:
Discha rges & Stream Impacts
I . Is any discharge observed from any part of the operatio n? 0 Ye s _lg.No DNA D NE
Di scharge o r iginated at: D Structure 0 Appl ication Field D Other
a. Was the conveyance man-made?
b. Did the d ischarge reac h waters of the State? (If yes, not i fy DWQ )
c. What is the estimated vo lume that reached wa ters of the State (ga ll ons)?
d. Does discharge bypass the waste manag ement system? (If yes . notify DWQ)
2. Is there evidence of a past discharge fro m any part of the ope ration?
3. Were there a ny adverse impacts or potential adverse impacts to the Wate rs of th e State
other th an from a discharge?
Pag e 1 of 3
D Yes D No D NA O NE
D Yes D No D NA O NE
D Yes D No D NA O NE
D Yes !gl No D NA O NE
D Yes lla-No DNA ONE
12128104 Continued
t I Facility Number: t) Jp/ f'l Date oflnspection I ~-;to ::P Y
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 Structure 2 Structure 3 Structure 4
DYes ~ DNA ONE
DYes 0No DNA ONE
Structure 5 Structure 6
Identifier:----------------------------------------
Spillway?:
Desi&'lled Freeboard (in): __ ___._/---'-{/ __ ----------------------------------
Observed Freeboard (in): __ ...,_,z~-L";....._ _________________________ ------
5. Are there any immediate threats to the integrity of any of the structures observed ? DYes
(ie/ large trees, severe erosion, seepage, etc.)
~0 D NA ONE
6. Are there structures on-site which are not properly addressed and/or managed DYes
through a waste management or closure plan?
j8JNo 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. D oes 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?
13.-.Yes 0 No 0 NA D NE
DYes ~No DNA ONE
DYes l&fNo DNA ONE
DYes CijNo DNA ONE
II. Is there evidence of incorrect application? lf yes, check the appropriate box below. 0 Yes ~No 0 NA 0 NE
D Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu , Zn, etc.)
0 PAN D PAN> 10% or 10 lbs 0 Total Phosphorus D Failure to Incorporate Manure/S ludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Area
12 . Croptype(s) ---=Cl;...:O~r"'-n&.....+-</Jv.ll::..!::.c..:.~~~=d;..~~r.....c;..JT~~~~~~:z..~-----------------­
l3. Soi l type(s) 1/:u /No A-
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 desi g n or wettable acre determination?D Yes
17 . Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
t • ... ..= . . .. . . . .
DYes
D Yes
[X No
~N o
Ill No
!Ja No
Q!:1 No
<;;omments (refer ~o qut;~tion #): . .Explain~ any YES answer-S and/or any recC)mmendations or any op.er·comments •
. Use drawings ~~facility. to better expiaiit situations. '(use additional pages 8S necessary): · ·· ·
DNA
DNA
DNA
DNA
DNA
ONE
ONE
ONE
ONE
ONE
...
I-
1--...
Reviewer/Inspector Name I. · :-ff'~; · ~~~ .. J Phone: 9-JD '-'fJ:Y-J.3' o 0
Reviewer/Inspector Signature: ~ -~~ Date: &:, -,?Zo <i?'O or-'
Page 1 of 3 12118104 Conttnued
I Facility Number: ~-l:,ftl Date of Inspection I d?i?D ·"Y
Required Records & Documents
19 . Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the fa c il ity fail to have all components of theCA WMP readily available? If yes, check
the a ppropirate box . 0 WUP 0 Checklists 0 Design 0 Maps 0 Other
21. Does record keeping need improvement? If yes, c heck the appropriate box below.
0 Yes []:No D NA O NE
DYes ~No DNA ONE
(}a Yes DNA ONE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Annual Certification
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthl y and l " Rain In spections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? DYes ~No DNA ONE
23 . If selected , did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes ~No D NA ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes ~No DNA O NE
25. Did the facility fa il to conduct a sludge survey as required by the permit? DYes [Sl'No D NA O NE
26. Did the facility fail to have an actively certified operator in char ge? DYes ~No DNA O NE
27. Did the facility fail to sec ure a phosphorus lo ss assessment (PLAT) certification? DYes ~No DNA O NE
Otber~
28. Were any additional problems noted which cause non-compliance of the permit or CAW M P? DYes ~No DNA O NE
29. Did the facility fail to properly dispose of dead animal s within 24 hours and/or document DYes 00No DNA ONE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? DYes IE No DNA ONE
lfyes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of e m er gency situations as required by D Yes ~No DNA O NE
Genera l Permit? (ie/ discharge, freeboard problems. over application)
32. Did Reviewer/Inspector fail to discuss review/i nspection with an on-site representative? DYes !)a No DNA O NE
33. Does faci li ty require a follow-up visit by same agen cy? D Yes ~N o DNA ONE
Additional Comments and/or Drawings: ~ . -'
"""' (!!) ~),J-d/_;,jt>rma/---17\-~"K?--
EOtm_..?
-.....
Page3 of 3 12128/04
'
~·ision of Water Quality 5/f-G· .._.-
IFacility Number 18:J H&!YIJ 0 Division of Soil and Water C onservation ?'-?....V?
0 Other Agency
Type of Visit G-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ~ine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date ofVisit: I ~}-o2'1 Arrival Time: I/ v .. otp Departure Time: WJo I County:-¥,........
Farm Name: .liJ.ArL .&~r~ 6r ~ o~·ner Email: -------------
Region: ff'lJ
Owner Name: pL/:,r:-;r f'e&r.>4 Phone:
Mailing Address: -------------------------------------------
Physical Address:------------------------------------____ _
Facility Contact: Title: ------------PhoneNo: ________ _
Onsite Representative: _5"-'~::..::.=--"-'"---------------Integrator: ft?"~
Certified Operator: ---=:~'--'-Qo<:...:...;_>"""--------~E---c«-...a""'-'-r:-=::!..::..~ocz::..>o....____ Operator Certification Number: PZ.Ofoc
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
ID Wean to Finish I I 10 Layer
D Wean to Feeder
0 Da iry Cow
0 Dairy Calf
gFeeder to Finish Wos-q 5b 0 Dairy Heifc 1 r
D Farrow to Wean
0 Farrow to Feeder
D Farrow to Finish
D Gilts
D Boars
0 Dry Cow '
0Non-D airy
0 BeefStockcr
0 Bee f F ecdcr
0 Beef Brood C ow
Dry Poultry
D Layers
D Non-Layers
0 Pullets
0 Turkeys
Other 0 Turkey Poults
D Other Number of Structures: [TI ID Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? D Yes ~N o D NA O NE
Discharge originated at: D Structure D Application Field D Other
a. Wa s the conveyance man-made? D Yes 0 No DNA O NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) D Yes 0 No D NA O NE
c. What is the estimated volume that reached waters of the State (ga ll ons)?
d. Does discharge bypass the waste management system? (If yes . notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of th e State
other than from a discharge?
D Yes 0 No
D Yes r&No
DYes ~No
12128104
D N A O N E
D NA O NE
D NA O NE
Continued
I Facility Number:Q-bJCf I Date oflnspection l(-3-u /1
Waste Collection & Treatment
4 . Is storage capacity (structu ra l plus storm storage plu s heavy rain fall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
D Yes IZJ.No D NA ONE
D Yes 0 No D NA ONE
Structure 5 Structure 6
Identifier:-----------------------------------------
Spillway?:
Designed Freeboard (in): -~/ ...... 9..-. ___ -----------------------------------
Observed Freeboard (in): _ .......... 5'-2=-::r::::::=---------------------------------
5. Arc there any immediate threats to the inte~:,'Tity of any of the structures observed?
(ic/ large trees, severe erosion, seepage, etc.)
DYes 18No D NA ONE
6. Are there s tru ctures on-site which are not properly addressed and/or managed 0 Yes J:gNo 0 NA 0 NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes , and the situation poses an immediate public health or en,·iroomental threat, notify DWQ
7. Do any of th e structures need maintenance or improveme nt ?
8. Do any of the stuctures lack adequate markers as re quired 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?
l2l Yes 0 No DNA 0 NE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes i:ENo DNA ONE
II. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes ~No DNA 0 NE
0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground 0 Heavy Meta ls (Cu, Zn, etc .)
0 PAN D PAN > 10% or lO lbs 0 Total Phosphorus D Failure to Incorporate Manure/S ludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Out side of Area
12. Crop type(s) '$ 2ey~:, ,/LaO'l /wh-e--;:/:-
13 . Soil type(s) ku / N oA:
14 . Do the receiving crops diller from those designated in theCA WMP? DYes ~No DNA
15. Does the receiving crop and/or land application site ne e d improvement? DYes 1:8 No DNA
16. Did the facility fail to secure and/or operate per the irrigation desi!,>n or wettable acre determination?D Yes jgNo DNA
O NE
ONE
ONE
17. Does the facility lack adequate acreage for land application?
I R. Is there a lack of properly operating waste application e quipment?
DYes ~o D NA ONE
DYes jgNo D NA ONE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings offacility to better n:plain situations. (use additional pages as necessary): ·
Reviewer/Inspector Name
Reviewer IT nspector Signature: Date:
12128104 Continued
'-
I Facility Number: g;L -t./?"1 Date of Inspection 1..3 -3-0'7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readi ly available?
20. Does the facility fail to have all components o f theCA WMP readi ly available? If yes, check
th e appropirate box. D WUP 0 Checklists 0 Design 0 Maps D Other
DYes ~No D NA ONE
D Yes i?JNo 0 NA 0 NE
21. Docs record keeping need improvement? lf yes, c h eck the appropriate box below. 0 Yes gJ No D NA D NE
D Waste App lication 0 Weekly Fre eboard D Waste Ana ly sis D Soil Anal ysis 0 Waste Transfers D Annua l Certification
0 Rainfall D Stocking D Crop Yield D 120 Minute Inspections D Monthly and 1" Rain In spections D Weather Code
22 . Did the facility fai l to install and maintain a rain ga ug e? DYes eg_No DNA ONE
23. If selected, did the facility fail to install and maintain rain breakers on irrigation equipment'! DYes ~No D NA ONE
24. Did the facility fai l to calibrate waste application equipment as req ui red by the permit? DYes ~No DNA O NE
25. Did the facility fail to conduct a slud ge survey as required by the permit? D Yes g},No D NA ONE
26. Did the faci li ty fail to ha ve an actively certifi ed operator in chargt:? DYes !&No D NA O NE
27. Did the facility fai l to secure a pho sphorus loss assessment (PLAT) ce rti fica tion? D Yes ®No D NA O NE
Other I ss u es
28. Were any additiona l problems noted which cause non-compliance of th e permit or CAWMP? DYes ~No D NA O NE
29. Did the taci lity fai l to properly dispose of dead animals within 24 hours and/or document DYes JaNo DNA ONE
and report th e morta lity rates that were higher than normal?
30. At the time of the inspection did the facili ty pose an odor or air qua lity 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 D Yes ~No D NA ONE
General Permit? (ie/ discharge, freeboard problem s, over appli cation)
32 . Did Reviewer/Inspector fail to discuss rev iew/in specti o n with an on-site rep resentative? D Yes ~No D NA O NE
33. Does facilit y require a fo llow-up visit by same agency ? D Yes ~0 D NA O NE
Additional Comments and/or Drawings: .. -
r--...
12128104
1
Type of Visit @-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ~utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 other D Denied Access
Date of Visit: I ~SJ-i!' '=-I Arri\•al Time: I// f 0 0 I Departure Time: I / p?;O D I County: _5~ Region: FJ?CJ
Farm Name: p.L bc~"T Pc==a Cs"rf DeW"--Owner Email:--------------
Owner Name: EL.br'C r .[ P~prsa t( Phone:
Mailing Address: 99 z .5; rn M12 -u 1'\.,/L
Physical Address:-----------------------------------------
Facility Contact: n ..J~,. T f? car.5alf Title: ---------PhoneNo: ________ _
Onsite Representative: _.....:,,/;;....::;A-v---.=.::;.... _____________ _ Integrator: _ _____,6""---Y';,..,_;:;r_..:::s::;_;~_:;;-r?-...L::....;;;. ________ _
7 7
Certified Operator: --==l-___...o"--'-'i-==..s'--_2>""""""--...~P--::~;;Ja~·;!..r_S".u«~l/~-----Operator Certification Number: ~ 0 t::, &
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD 'D " Longitude: D OD'D"
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? D Yes 12i,No DNA D NE
Discharge originated at : D Structure 0 Application Field 0 O ther
a. Was the conveyance man-made? DYes ~No D NA ONE
b. Did the discharge reac h waters of the State? (If yes, notify DWQ) DYes 12l-No D NA ONE
c . What is the estimated vo lum e that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes , notify DWQ) DYes [Kl_No DNA ONE
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?
Page I of3
DYes !&,No
DYes il9No
12128104
·~
DNA ONE
DNA ONE
Continued
..
I Facility Number: s:J;+t, fll Date oflnspection I -s=-3 ;-c 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 the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
DYes IXNo DNA O NE
D Yes IXNo D NA ONE
Structure 5 Structure 6
Identifier:-----------------------------------------
Spillway?:
Designed Freeboard (in): __ -__;/_9-..__ __ ---------------------------------
Observed Freeboard (in): __ ....;;3;;,..._,2'----------------------------------------
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
DYes ~No D NA ONE
6. Are there structures on-site which are not properly addressed and/or managed DYes ~No DNA ONE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and tbe situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ~Yes d 0 NA 0 NE
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
9. Does an y part of the waste management system other than the waste structures require
maintenance or improvement?
DYes ®No DNA ONE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
D Yes J8lNo DNA ONE
II. Is there evidence of incorrect application? lfyes, check the appropriate box below. DYes ®'_No 0 NA 0 NE
D Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
D PAN D PAN > 10% or 10 lbs D Total Phosphorus 0 Fai lure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window D Evide nce of W ind Drift 0 Application Outside of Area
12. Crop type(s) _5=-;~~~"2Z1-..;:!:!l-..J::.12~C.:....· L/..:;;C.;.-'::o~r~~t'---'-6...::W.~J.£..z-:e:./:..__ __________________ _
13. Soi l type(s) A: 1.1 / tJo;f
I
14. Do the receiving crops differ from those designated in theCA WMP?
15 . Does the receiving crop and /or land application site ne ed improvement?
DYes
DYes
16. Did the facility fail to secure and/or operate per the irri gation design or wettable acre determination: D Yes
17. Does the facility Jack adequate ac reage for land application?
18. Is there a lack of properly operating waste appli cation equipment?
DYes
DYes
IN-No D NA ONE
~No D NA ONE
~No DNA ONE
~No DNA ONE
~No DNA ONE
• .• • J". • .;. :· ~ • ". ', • ; ..... + -·. • •• "" ' ··_ *,,. ~. • • . .. . ~
_Comments (refer· to question #): Explain any YES answers and/or any recommendatioils or a'Dy ·oth~r c.omments:· • • 'c ·:-:f::)
Usectr~~ngsof-facli.ity~!~t:re~lai .. n .sitU~tiogs.(~~e-~dditlonal _pagesa~'oec~~y):. ; ·,; __ :-: ·,~ ••. "·~~-· -~" . -·. ::<'::'
7 (e~1Ji1«-c W'vr~'r~kcf/Jtn"-paAfr~· 8a~r~P"~~
~fW,....-
Reviewer/Inspector Name ... I . ....;··--------~--~· .""4o{;7""'Y;... . .;..v....;-z::...=-'"'"::.'(J.jll'[.:;:.;...-'~u,, ~ ..... "r-.._· .-.-__ "_..__ _ _..• _· ....... ,;.;....,;~-j Phone: ~~/ 6'( /
Reviewer/Inspector Signature: LA ../L.,;C! Date: £-3 1-;;z.l?D '-
11118104 Contlnued
I Facility Number: a -~t<fll Date of In spection I ~f-o.'-1
~ Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Pennit readily available?
20 . Does the facility fail to have all components of theCA WMP readil y available? If yes, check
the appropirate box. D WUP 0 Checklists 0 Design D Maps D Other
D Yes ~No DNA O NE
D Yes ~No DNA ONE
21. Does record keeping need improvement? Ifyes, che ck th e appropriate box below. DYes !Kl No 0 NA D NE
D Waste Application D Weekly Freeboard 0 Waste Analysis 0 Soil Analys is D Waste Transfers D Annual Certification
D Rainfall D Stocking D Crop Yield 0 120 Minute Inspections D Monthl y and I" Rain Inspections D Weather Code
22. Did the facility fail to install and maintain a rain gauge? DYes ~No DNA ONE
23. If selected, did the facility fail to install and maintain rain breakers on irrigation equipment? DYes j:&lN o D NA ONE
24. Did the faci lit y fail to calibrate waste application equipment as required by the permit? DYes (MNo DNA ONE
25. Did the facility fai l to conduct a sludge survey as required by the pennit? DYes JRI.No D NA ONE
26. Did the facility fail to have an actively certified operator in charge? o ·Yes ~N o D NA O NE
27. Did the facility fail to sec ure a phosphorus loss assessment (PLAT) certification? DYes IE No D NA ONE
Other Issues
28. Were any additional problems noted which cause non-compli ance of the pennit orCA WMP? DYes ~No DNA ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or do cumen t DYes ~No DNA ONE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? 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 siruations as required by D Yes ~No DNA ONE
General Permit? (ie/ discharge, freeboard problems, over applica ti on)
32. Did Reviewer/Inspector fail to discuss review/inspec tion with an on-site representative? D Ye s ~No DNA ONE
33. Does facility require a follow-up visit by same agency ? D Yes .it No DNA ONE
~ddiij_oo~ C~m01en.~ ao.d/or D!awings: _ · .. ~·. ~·
~ ......... '. ·~:
~~-. -· ...... ..
1:1
11118104
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 Date or Visit: I Lf-(,. D4 hum:: I /1: 3 0 Facility Number I ~ci H 611
..._ __________________ ..J Jo Not Operational 0 Below Threshold
g-p;rmitted Dtertified D Conditionally Certified C Registered Date Last Operated or Above Threshold: ........................ .
Farm Name: .... f..J.h.~.c.t ...... f.e.~.C..i.~LL. ...... f.e.t: .. '!:l............................................ County: -~-~-!!1./?-.J.~m ................................... ~!!..(?.. ........ .
HPIR4!
Owner Name: ..... £.{~r.r.:.t ..... f:.f/:.~r..J..~!f.._ ............ _.................................................. Phone No: JJ..C?. ..... !f::J!.':L: .... ~.f .. ?..!... ..... _ ............................ .
Mailing Address: ___ q__'1..7.. ......... 5..~::!1 ... ~ .. '? .. ~L .. _./1_!2.tA.rh ................... G.l.~':J.l~ ,_7 _ti._t.:_ ____ ;d_9_3.~.E. .. _________________ ···--····--·-········
(I! II P..
Facility Contact: ............. f..f./;u:..r:.f.. .... .f}:.ff.c,j..~JL ............... Title: ........................................ ·-····-······-···· Phone No: ... ~J.l.L.}.J. .. ~-~f?..39 _______ _
Onsite Representative: ..... f:JP..~r...f:._.f..~q.f:..->..~!L. ......... --····-·········-··-··········-····· Integrator: ... f:.C.{~.ff1-.[1-~---··-E.q_t..~.:L.-----···-·--
Certified Operator: .......... f...P!..!.'j_ ...••.•.... f..~.t: .. ~'1./L................................................... Operator Certification Number: ..... .;;??.-:.!2f:::S:. ............ .
Location of Farm:
[9-Swine 0 Poultry D Cattle D Horse Latitude L....-----'1• L--1 _ _.I• ._I _ _.I" Longitude
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at 0 Lagoon 0 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 gaVmin ?
d. Docs discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste CoUection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? 0 Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............. 1. .................. .
Freeboard (inches): __ '-1....:.....:.3-j __ _
12112103
DYes 9-No
DYes 9-NO
DYes Q.-N"o
DYes g..r¢"o
DYes [!}No
DYes G:).-No
DYes 8-N'o
Structure 6
Continued
.. jFacility Number: 8~ -(, 17 I Date of Inspection I 1.-t -(, -0 r 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!unprovement?
II. Is there evidence of over application? If yes, check the appropriate box below.
0 Excessive Ponding D PAN D Hydraulic Overload D Frozen Ground D Copper and/or Zinc
12. Crop type 'WAeaf, (orn, So'! be"n 5
7 )
13. Do the receiving crops differ with those designated 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 determination?
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.
' TAu~ 1.5 ~ 6 e,,-~ .5_,..-:Jt::J 1-0''! fl,~ s,·J~ o/' f4e-/.-. '} oo..., 'lAc. I
l1r ~~<:-r.se./1 ' s /"!..,.,..,
( ClV~I'.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
12112103
.... ~ fo ~ j,l-f "I"' .s 0 ./ 0'> fo ~ .s I-.e. ~ /. ·s ~
"5"'""'
Date:
DYes 8-No
DYes [!J-NO
DYes gN0
DYes l31fo'
DYes (31\fQ
DYes ~o
DYes~
DYes g.No
DYes 9-NO
DYes (31'fo
DYes ~
DYes [3-N"o
DYes [3-No
DYes DNo
DYes [3-No
DYes @-No
DYes [!}NO
Continued
I FacilitY~umber: S ;z -"1 j I Date of Inspedion I Lt -4-· o ';1 I
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP, checklists, design, maps, etc.)
23. Does record keeping need ~ovement? If yes, check the appropriate box below.
0 Waste Application......----0 Freeboard 0 Waste Analysis/(] Soil Samplin~
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
DYes {31\fo
DYes l3'No
DYes [!}No
DYes G-No
DYes QNo
DYes 8-NO
DYes GI-NO
DYes [3-NO
DYes [3-NO
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ~ONo
31. If selected, did the facility fail to install and maintain rain breakers on irrigation equipment? DYes
32. Did the facility fail to install and maintain a rain gauge? DYes
33. Did the facility fail to conduct an annual sludge survey? DYes
34. Did the facility fail to calibrate waste application equipment? DYes
35. Does record keeping for NPDES required forms need ~ovement? If yes, check the appropriate box belo w . DYes
D Stocking Form 0 Crop Yield Forni'"' 0 Rainfall D Inspection After 1" Rain
D 120 Minute Inspections D Annual Certification Form
[] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
#33 (J I"~.$ /.a j e 4 ~~ d~>1~ -~--~~ A.,nv,._/
!lv ~'-'("f
s lwl~ ~ v6 vf ~4J nof ~e,.,f e. c o ~y.
/
~Js-D:.s,,.,.ss,J ' Nf>DEJ For#75 vs • .,., n~w or r~c...,,~ /(e I!!"'', 'j
12112/03
[B-N"o
G"No
~0
~0
0No
...
f--
f--•
-
Site Requires Immediate Attention: :--:-::---
Facility No. f?Z -~If
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: -"-//-_-.2-_7_, 1995,
Time: ;:t 4 : 3~
Farm Name/Owner: ~ r ~4& '"d=i/ ~, _ .:-z;. , ~
Mailing Address: M._ .3 "8~ I .t..f 2._C. LJ /'V tR..""' ~ .68 32..8"
County: ~~ ~Ao.J 1
,
Integrator: ~~7?"\1$~· Phone: ?to.""" 50-~7?/ ·
On Site Representative: Phone: ~~-~'4-L.' ~I
Physical Address/Location: ~ I~ 1'1 ( tk~J'a •rJe ~ L ew\%1: T~J}-,:: ;4 . ~,fL 2]3/~:;aq; {t3e.-s\''~LRe.v.vcrA4 ~ ~J
Type of Operation: Swine ~ Poultry __ Cattle ----=,.-------------
Design Capacity: d '74o Number of Animals on Site: --=--------------
DEM Certification Number: ACE DEM Certification Number: ACNEW ______ _
Latitude: __ o __ .. Longitude:_ o _._.
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) ~No Actual Freeboard::::t-3 Ft. __ Inches
Was any seepage obseiVed from th~n(s)? Yes or~as any erosion obseiVed? Yes~
Is adequate land available for spray? Ye No Is the cover crop adequate? Yes or No
Crop(s) being utilized: _____ +-~:;....__------------~,......-~o:=-...:::;;_---
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin~ e or No
100 Feet from Wells?~or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream~ or No.. ·
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o@
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or@ If Yes, Please Explain .
Does the facility maintain adequate waste management records (volume~anure, land applied ,
spray irrigated on s . ific acreag with cover rop)? Yes No~/-.... L. -
Additional Comments· > . · ~
A o/.:S'.
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.
_.,
.;.,.,-..~ ~~~ ~"'Q.G~r:' ?~ ~~.'!':?::c.;..~:::ON ?CR NE"H OR ,":'?A..'m~D l"ZE::::n:~':'S
?lease =at-..:_-:::. ~:!:a ec::;:JletaC. !o= ~,::, ~!:::.• D!a'""ris!.c::t o£ ~ .. r:!.=:::.:::la.z:.:a.~ ~aca::~t a~
~~e ~c~esa on ~~a =•ve=s• sica of t~~a !o~.
~;a::~e of f a=::l ( P!. ea.s e :;:: = :.n r:: ) : __.,E......,L ...... f3"'-"E;._'l.;;;_I __ .:...P_E..~Il-11....;._5....;A.....;..;l...::.....;;'-;._ _________________ _
_ :...c.::.=ess: P-.T 3 Bo)C. 19-SC.
Cun Ton n c ,2..8 31.8 ?!:one ~0. : 9 10-S''4: . 'wBI
Cou:-:.-::y: 5.Am,DSon
?a=::1 :oc3.::.:.o:;.: :...at:.:.-:::.:.~e and Lonq:.-::.:.C.e:iS:,.0 t;B' QS! .. ;ze..• :bl.' ~"{=ecui=~C.). .::..lso,
;~ease at:':a.c~ a ~opy of a cou:;.cy =oad ~P ~i~~ !.oca::.:.on .:.cencifiec.
:':f?e of C;:Je=at:ion (s·,..ri:'le, ·lay'!!::-, ca.:.:=--.f, etc.) :~S:::.;W::::.:':.::".:.:E.:::... ________________ _
:=:es.:.r;:: ::apac:.t:y (::t:....--.=e::-of a.'"li--nals) : 29'1-o Fg£p-&n1sn
_::..verar;e s.:.ze of c;:e=a.c:.or:· (::.2 ::ncr:cj, ;:o;:t.::i.a.c.:.cr: avr;.) :.,.2......,9::..4-o=~-----=--------
_;•.re::-a<;e ac::-eage :1.eedeci =or lane appl.:.:::a:ion of. ·,o~a.s::e (ac=es; : __ _,S:::...:o::.._ _____ _
==:=~;===~=======~===~==~===~a=s==~====•============~=;::=====~=a=~==========~ ~ac~~ca~ S~ec~A~~at Ce--:~~~cat~on .
. :..s a t:ec:...-:ical s;:ec.ial.ist desi;-::.ateci ::.y th-e Nor':~ Ca::-ol:.::a So.i!. and Wace:::-
C:mse::-.-ac.:.cr: C;:;=.iss:.;,~ ~u:=-st!ant: to 15..\ ~C).C 6? • OOOS, I ce:=--:::.£y ~~at: ::he r:ew or
~anced ar..i~l ...,a.s::e :nana~e!Ilent: syst:~ as ins::alled for ::he fa_-r:n named above
has a..'"l an~l ·.;aste manar;ement: plan that: meets the desi.,;n. const:=-.:c-:.:.c::,
c;;erat:.ion a.."d :na.i::-:.t:enance s1:ancards a."'ld specif.icat:.ions of the Dh·is.:.on of
:::."'lv:!.=or.rnent:.al Mar..ac;;e.'":l.ent: and che uSDA-Soil Cor:.se::-va::.ion Ser.r:.~e and/or tj,e :-Jo::--::.h
Ce=ol.:.~a Soil and ~acer Conser.rat:ion Commission ~u::-suant ':o :SA NCAC 2H.0217 and
:SA NC~C 5? .0001-.000S. The following ~l~ents and ':hei::-::or=esponcing minL~~u
==.:.~e=:.~-~ave_been_ve=:.fied ~y me or other desigr.at:~ci cac~"lical specialises ar..d
a=e i.::cluceC. in ::::e pla."l as appl.i-::able: ;:rini.mum sepa:::-at.ior..s (~u:::fers); liners or
e~ivalent: for lac;;ocns or wast:e s::orage ponds; waste st:o::-age capacity; acequar::e
~uantit:y a..-:c amou..-:c cf land for waste ut~lizat.ion (or use of third part:y) : ac=ess
or o· ... -r-.ership of ?r=pe:::-waste applic.at:i.on equi;:Jrnent: sc~eC.ule fo= ti.":linr; of
a;;pli~acions; appli·=at:ion =aces; loading :-aces; and t:~e cor::::=ol of t~e disc::ar;-e
of pollut:ants f::-om st:=::::IWacer ~off evencs less severe ::han t:he 25-yea:::-, 24-hour
scor:n.
!'a.ma o~ '!'ac~ca~ Spac!a..!.iat (Please P::::-:..:1-t) : 6. §t.Enn C /..IF/c,.
Af::iliacion: P~e.T~.IIent_:i ~~
.::\cd=ess ()..r;e-"lC'..f): A6:8i,C t:3f} CL1n1bn t'IC. 6,.632..8 Phone No.21o-51jZ-'!£77/
S ir;natu=-e: J:l. J!f..wvc. CJ;..J. t-.. Date: _7."'-/~Z.:.o:S~/....t.2:...5::.._ ___ _ =======~=~•====•=•==~c=•~~a~--~=•as=a•~==~•••aaa:maa:3==~~~~====~==~
CW:ler /Ma.nagar Ag:oe.emant
~ (we) unce:=-st~"lc t~e cpe:::-ation and mai:1te-"lance ;:Jrocedu::-es establi.shed :.~ t~a
approved ani;na.l was-=a zuanagement: plan fa= t~e fa_-.n :1a.meC. c.i::Jove and will i.mplemer..::
~~ese ;_::l::-ocecures. I (·..re) knew. t..'lat any additional expansion to t=:.e ex:.st:.i::c;
cesi:;;n .capacity of t!'1e .,...aste t=eacnent ar.d storage system or con·sc=-..lct:icn of ::ew
:acilities ~ill :::-equi=e a new ~ert:ificacion to ~e subrnit'=ed to the Division cE
-:-:lvi=ol".:nencal Manaqeme-"lC before the ne·"' an.i.mals are s::ockec. I (we) also
unde=st:~~d ~~at :::~e::-e ~s:: be :;.a discha=;e of a"l~~l ~as::e ===m t~is sys~~~ ':~
su::-:::.:;.-:: ~ ~-4at: e:=s o= :._"":e stat:e -s.:. ~!'ler -=~:j!..lgh a ::-..c:L.~-~..ac~ c~;:".·~y:L~ce or t::=-=~ ;::
::--...u:o::f ==om a s::o:=::! e-v·ent: less seve==a :::-:.an ::he 2.3-vea=, :.;-:"'leu= s::o=::1. -::.e
approved plan will ~e ::iled at tbe fa_~ and at the office of t:~e local Soil and
Hate:::-Conserr.ation Dis::::-ict.
~ame o~ Land own-=. (,Please P:::-int): ~6 [t./.Jtf/2 7 .~&&JRL L
Signatu=eyo£ ~/ /((?#4~1' Date: 7~~.;/rs,--·
~a.me o: :!!ana.ge.r, if c.:.=:erent: f==m owner (Please pri.~t) =----------------
s.:.gnac:u=~: Ca.t: e =-------------
new ce::-::ific~c.:.on
~he Divisior:. of
~: A c~ange in ~ar.c cwne:::-ship ::-e~ui=es noti£~=a~ior. or a
(if t:be approved pla~ is c~angeci) ::.o be subcit:::ed to
~"'l7i=or~en~al Management within 60 days of a ti~le ::::-ansfe::-.
DE!-1 USZ C~"L Y: AC.."iZ'.-i'#·------------
State ot North Ccroiir~c
Deccr.ment ct Environm&nt
Heclth end l"lct:.Jrct Resources
Division ct E ..... vircr.~entc! Mcr.cgemenr
Jc:-nes 8 . 1-:cnt. Jr., Gc\;err-.cr
Jcr.c7hcn s. :-:cws-s. Sec:ercry
A. Prestcn :-:ewe:-:: . ...!r .. P . .:: .• Direc7cr
C~:?.'!';:o-:-c;~'!':;;CN ?0?. ~..t OR =::t?~ "TD'E:D W'!Y-:;_r. ?ZEDLC':'~
Il·fS'!'P.GC':'::CNS ?CR C:::::?.-:o::::c.;-:=cN CF -~PPP.CVEiJ .l..N!~1A.L ii;;s-r=: ~-N.~.G-28-IT .?~15 ::"CR
NE"".-i cR :::::G .. ~..:-m::::J .l.N!.."!;,l., WAS':"E M..~"l;;c::::€-IT s·.cs-::=:1s s:c::;;:.•,~rc :=:zcr..c'!'s
?,ZCID:?~r:"S I ~m t1QS;:
I:-1 o rd.e~ to =e C.ee.":teC. ~e~i t: ~~d ::y ::~e Di ·ris icn o E E..-'l.".r:.=;r"--=e~t:al !-!a...""laqeme::.t:
\DE:·!), c::e c;..-ne= of a...•:r ne'"' or eX";Jar..C.ed ·an~al '"'as::a ::tar..ac;e.rner.c: s:rs::e . .''n
c~ns::=uc~e~ a=~e= uar.ca=£ 1, :994 whic~ is ciesi~ee to se~re c;=eac:er t::an or
e~al. co ::;,.e a~; ::~a:. ;>opul.at::icns ~ist:=C. ::elc:-' is re~i:.ree :::: sul::rni:: a sic;r.ee
cer-::..fica::icn for::t ::c DE:! ~e(;:-a t~e :.ew anL-;~als a=e s::-::ckeci on ::::e fa..-:n.
?as::~re operac:ions a=e ~xempc trcm ~~e rs~iremect ::o ::e ·c2:r~~=ie~.
lOO ~ead ot cat~~e
iS 2:.or3ea
250 aw-1-=.e
l,OOO sheep
30,000 !:d._-ds W:.~ a l!.~ici 7ta&t:a system
The ce:rtif~cac:ion ~ust be sic;ned by ~~e owner of the feedloc (and manager if
C.ifferenc from t~e owner) ar.d by any te~~ical specialise desi~ated by ~~e Soil
ar.ci •..tater .:::cnser"racion Commi.ssion pursuant to lSA. NC\C 6F ·.0001-. 0005 . .~
~ec~ical s~ecialisc must: ve~ify by an on-site inspec~ion t~at all applicable
C.esic;n ~~d c~r.sc~~c-:icn scandards and specifications are met as insta!led ar.d
that all applicable operation and ~intenance standards and specificati ons can
be met.
rtlt:-houc;h t!le ac~ual numbe::r of animals at the facility may •rar.t from t:i..rne to t.i.!lle ,
::.~e cies i;-n ca;:acity of t~e . ..,asce handling syste!!l should be used. to decer.nine if
a fa~ is su~jecc to the cercificat:ion requirement. For example, if the waste
sys::cm for a feedlot: is desic;ned to handle 300 hogs but: t!1.e ·a•.rerage populacion
will =e 200 ~cgs. ::~en the waste manaqemen: syste!!l requi=es a cerci!icatio n.
·::'~is csr-::::i.fic3.i:icn is r~ired by regulations gover:1inq a.ni..:na.l o;.;ast:e Cla..."la<;e!ller.t:
S :(SCeJ::S aC.opced cy t:.e 2nvi=or~ent:al Manac;e.rnent: Commission (~C) on Dece!IU:::er 10,
~:92 (Ti~!e 15A N~C 2H .0217).
C~,TT~-CQ~TCN ?0~~
Or: t~e reverse si=e of t!1.is pac;e is the cert:i!icaticn for::1 whic~ mus-= ~e
sul:mit:::.ed t:.:J i:::2-! :::;e=ore new an~ls are stocked on t:!le fa.-.-::1. Assistance in
c~mpletinq t:~e :o~ can be obtained from one of t:~e local ac;=~~~lt:~al aqencies
sue~ as t:~e soil ar.ci ~ater conserrat:ion dist:ricc, c::e crsDA-Soil Conserration
Service. or cbe N.C. Cooperat:i•re Exr:ension Service . The for:n should be sent t:o:-
Depa=-::ne~': cf L'"l.viror-..me.."lC. Hea.lt~ anC. Natural
Division of ~vironment:al Management
Resources
.Water Quali~E Sec:ion. PlannL'"l.q Branc~
P.O. Eox 29535 .
Ra.leic;h , N.C . 27626-0535-.
P~one: 3:~-733-5083
~o~ !D: A~~Ol94
. .-> ~;/~
s::k~;.e w. Tedcer, chief.
Water Quali~E Sec~ion
Data : /k,. ~.:... 1-Tf'>
P.O. 3ox 295.:.5. Rdei~h .. 'Jcrth C::roiinc 2762.6-C£.3.5
An =~~c! Ccc::r.:...::-:it-t Atf.:m<7-ive Ac~cn 20cioyer
Tel9~hone 919-73.3-701.5 i=AX 9 i9-73J-2.496
51..~ raC'tc:ac/ I ~ .:::cs:--:: :::r.s..;mer ;::c::er
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