820622_INSPECTIONS_20171231

NORTH CAROLINA
Deparbnent of Environmental Quality
Reason for Vi s it:
Compance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
~outine 0 Complaint 0 Follow-up 0 Referra l 0 Emergency 0 Other 0 Denied Access
Date of Visit: llJ.. M;;</6' Arrival Time :I 'JA!a.~N Departure Time: II t .vo JJMI County:
I
Region:R0
Farm Name: Kf -r FIJ{ v~ J Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
f · r:-_....~t0~c_··...:..'f_ll..:;....__r_~_L-V _____ Title:
\ (
Onsite Repres entative:
Certified Operator: t/
Back-up Operat or:
Location of Farm: Latitude:
Discharges and Stream Impacts
I . Is any d ischarge o b served from any part ofth e o perat ion?
Disc harge o ri g inated at: 0 Structure D Application F ield 0 Other:
a. W as the conveyance man-made?
b. Did the disch a rge reach waters of the S tate? (If yes, noti fY DWR)
c. What is th e esti mated volume that reached wate rs of the State (gall o ns )?
Phone:
Integrator: tfl f)-.S
Certification N umber: / f Lf <-( J
C ertification Number:
Longitude:
D Yes ~NA ONE
D Yes D No ~ O NE
D Yes 0No ~ ONE
d . Does the di scharge bypass th e waste man agement system? (If yes, notifY DWR ) D Yes D N o ~ O NE
2. Is there ev idence of a p as t d ischarge from any part o f th e operati o n ?
3. Were there any ob se rv able ad verse im pacts or po tenti a l adver se impac ts to the waters
of the State other than from a di sc ha rge?
Page 1 of3
D Ye s
D Ye s
GJ'No DNA O NE
eJNo DNA O NE
11412 015 Continued
IFaciUty Number: !Date oflnspection: /2, J1t~ {, t? •
Waste Collection & 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?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
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. Arc there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes ~DNA ONE
DYes Q No ~ ONE
Structure 5 Structure 6
0 Yes [g--MO DNA 0 NE
0 Yes G--Mb 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 requi red by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste s tructures require
maint enance or improvement?
Waste Application
I 0. Are there a ny required butTers, setbacks, or compliance alternatives that need
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
D Yes ~ DNA O NE
DYes ~ DNA ONE
D Yes ~ DNA ONE
0 Yes [31'lo DNA ONE
DYes ~DNA ONE
0 Exces s 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 Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptab le Crop Window 0 Evidenc e of Wind Drill 0 Application Outside of Approved Area
12 . Crop Type(s): Ctul3
13. Soi l Type(s):
14 . Do the receiving crops differ from those designated in theCA WMP?
15 . Doc s the receiving crop and/or land application sit e need improvement?
I 6. Did the facility tail to secure an d/or operate per the irri ga tion design or wettable
acres determination?
I 7. Docs the facility lack adequate acreage for land application?
18. Is there a la ck of properly operatin g waste app lication equipment?
Required Records & Documents
19 . Did the facility tail to have the Certificate ofCoverage & Permit readi ly available?
20. Doc s the fac ility fail to ha ve all components of theCA WMP readily availa ble? If yes, check
the appropriat e box .
0 Yes ~ DNA
0 Yes LtfJO DNA
0 Yes ~DNA
0 Yes ~DNA
0 Yes D~D NA
0 Yes [3<o DNA
0 Yes ~ D NA
ONE
ONE
O NE
ONE
ONE
O NE
O NE
O wuP O checkli sts 0 Design 0 Maps 0 Lease Agreements 00thcr: -----------------------
2 1. Doe s record keeping need improv ement'! Ifyes. check the appropriate box below. 0 Yes ~ 0 NA 0 NE
0 Was te Applicat ion 0 Weekl y Freeboard 0 Wa ste Analysis 0 Soil Analysis 0 Wa ste Transfers 0 Weather Code
0 Rainfall 0 Stockin g 0 Crop Yield 0 120 Minut e In spec ti ons 0 Monthly and I" Rain fa ll Insp ect ion~O Sludge Survey
22 . Did the facility fail to install an d maintain a rain gauge? 0 Ye s 0 ~ 0 NA 0 NE
23. If selected. did th e facility fai l to install and maintain rambreakers on irrigation equipment? 0 Ye s c::'f No 0 NA 0 NE
Page 2 of3 214120 15 Continued
I Facility Number: I Date of lnsp_ection: I J. fJt•'C.-f If' I
24. Did the facility fail to calibrate waste application equipment as required by the permit? •
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
DYes E}rilO 0 NA 0 NE
DYes ~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 of frrst 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 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 fai l to notify the Regional Office of emergency situations as required by the
permit ? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
D Application Field D Lagoon/Storage Pond D Other:
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
0 Yes
~DNA ONE
~DNA ONE
~ D NA ONE
~0 DNA ONE
~ D NA ONE
14'No DNA ONE
~ DNA ONE
EJNo DNA ONE
~ DNA ONE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any otber comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Review er/Inspector Name:
Reviewer/Inspector Signature:
Page 3 o/3
Phone: q( c~ Lf 31=33 3 Y
Date: l a ~1-t "'-L{ l ~
214!2 015
Date of Visit: t3 (f\7rAf]7 Arrival Time:l r: N7oo-1----, -FarmName: -·f<o~ )~W NtJ..I'-t~
Departure Time:l/~bO '·P I County: ,Ya~~-tf~-~ Regio.J42-D
Owner Email:
Owner Name: k'e~A Tc-(.,V Phone:
M a iling Address:
Physical Address:
Facility Contact: ----~..fr.L~~i~-~~~e<::..:<.,.:>::...._ _____ Title: Phone:
Onsite Representative: ' I Integrator: 0"'\ /3 ... S
Certified Operator: t( Certification Number: .....LJ/8:"'----=({.....;t(!....7....:..... ____ _
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
I . Is any di scharge observed trom any part of the operation? D Yes ~o D NA O NE
D isc harge originate d at : 0 Stmc ture 0 Application Fi eld 0 Other:
a. Was the conveyance man-made ? 0 Yes 0No llJNA ONE
b. Did the discharge reach waters of the State? (If yes , noti fY DWR) 0 Yes 0No Q-NA ONE
c. What is th e estimated vo lume th at reached waters of the State (ga llon s)?
·d. Doe s the di sc ha rge byp ass the wa ste management system? (If yes. notifY DWR) 0 Yes 0 No 0'NA ONE
2. Is there evidence of a past discharge from any part of the operation?
3. W ere there any ob serva ble adverse imp acts or potential adverse impacts to the waters
of the State other than from a discharge'?
Page I of3
0 Yes
0 Yes
cz(No DNA O NE
!Z(No DNA ONE
21411015 Continued
I FacilitY Numb~r: I oat~ of lnspection:3 tV\«.,___(" 7
W,:1st~ Coll~ction & Tr~atment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste le ve l into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
ldenti fier:
Spillway?:
De signed Freeboard (in):
Observed Freeboard (in):
5. Are there any imm ediate threats to the inte grity of any of the structures observe d?
(i.e., large trees, sev ere ero sion, seepage, etc.)
6 . Are there structures on-site whic h are not properly addressed and /or managed through a
waste management or closu re plan?
DYes ~DNA O NE
DYes 0 No ~O NE
Structure 5 Structure 6
0 Yes [!fNo DNA 0 NE
DYes ~o D NA O NE
If any of questions 4-6 wer~ answered yes, and tbe situation poses an immediate public health or environmental threat, notify DWR
7. Do a ny of the structures need maintenance or improvement?
8. Do any of the stru ctures lack adequate markers as required by the permit?
(not app li cable to roofed pits, dry stacks, and/or wet stacks)
9. Does a ny part of the waste management system other than the waste structures requ ire
maintenance or improvement?
Waste Application
I 0. Are there any required butTer s, setbacks, or compliance alternatives th a t need
mai ntenance or improvement?
0 Yes ~o D NA 0 NE
0 Yes [3-1iJ6 DNA 0 NE
0 Yes [!{No D NA 0 NE
DYes ~o D NA ONE
I LIs there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~o D NA 0 NE
0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground D Heavy Metal s (Cu, Zn, etc .)
0 PAN 0 PAN > 10% or 10 lbs. 0 Tota l Phosphorus 0 Fa ilu re to Incorpora te Manure/Sludge int o Bare Soil
0 Outside of Acceptable C rop Window 0 Evidence of Wind Drift D Application Outs ide of Approved Area
12 .cropTyp<(>l If,. Jir,M.J.t S" G,o ~ CW [1,
13.SoHType(>)o Nw{Aii w~~a""
14 . Do the receiving crops differ from those design ated in the WMP?
15. Do es the receiv in g crop and /or land a pp lication s ite need improvement?
16. Die! the facility tail to secure and /or operate per the irrigation de s i~'Tl or wettable
acres determination?
Page 2 of3
0 Yes
0 Yes
0 Yes
0 Yes
0 Yes
0 Yes
0 Yes
00ther:
0 Yes
!2i'No
IZ(No
i)No
(ZfNo
iz(No
~0
(Z{No
0 No
D NA O NE
D NA O NE
D NA O NE
DNA ONE
D NA O NE
DNA O NE
DNA D NE
21412015 Continued
!FacilitY Number: !Date of Inspection: ::g fQa cA {11
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25 .ls the facility out of compliance with permi t conditions re lated to sludge? If yes, check
the appropriate box(es) below.
DYes ~o
DYes ~o
DNA ONE
DNA ONE
0 Failure to c omplete annual sludge survey 0Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide doc umentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus lo ss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates tha t were higher than normal?
29. At the time of the inspection did the facili ty pose an odor or air quality concern?
lfyes, contact a regional Air Quality representative immediately.
30. Did the facil ity fail to notify the Regional Office of emergency situations as required by the
permit? (i.e ., d ischarge, 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 whi ch 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
DYes
DYes
DYes
D Yes
DYes
DYes
~0 DNA ONE
~0 DNA ONE
[f(No DNA O NE
~0 DNA O NE
[1No DNA ONE
[Z('No DNA ONE
rz(No DNA ONE
(Z(No DNA ONE
[l(No D NA ONE
Comments (refer to question #)i Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings offacility to better explain situations (use additional pages as necessary).
CO(,I~ br.ct'io<t -(-S' -17
SI..Jye.-SV~fe1 J ~y((
Reviewer/Inspector Name:
Reviewer/Inspector Sihrnature :
Page 3 of3
c~l/
Phone l{33 :~
Date : ?~cfi_
21411015
0 Denied Access
Date of Visit: I ?){)&;l~Arrival Time:l1 "O. 4' I Departure Time: I <(f 1ta> "4! County: S' ,£b }Ill( Region:
Farm Name: __ ~fl~rJ:,__....~T..__..&,_II::lL...;wvt..~S._ _____ _
kci±h ~w
Owner Email:
Owner Name: Phone:
Mailing Address :
Physical Address: -------------------------------------------
Facility Contact: ...... f{~.-€:::....:....•{h~=--:G~av!!l~C..._ ____ Title: _______ _ Phone:
Onsite Representative: ·( ( ·Integrator:
Certified Operator: t( Certification Number: / go 4 'f 7
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
Discharge ori ginated at: D Structure D Appli cation Fiel d D Other:
a. Was the conveyance man-made? DYes 0No ~A
b. Did th e discharge reach waters of the State ? (If yes , notify DWR) DYes 0No ~A
c. What is th e estimated vo lum e that reached waters of the State (gallon s )?
d. Does th e di sc harge bypass the waste management system? (lfyes, notify DWR) D Yes 0No [1'NA
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 th an from a di sc harge?
DYes
D Yes
EfNo DNA
[2f"No DNA
O NE
ONE
O NE
ONE
ONE
ONE
Page I of3 114/2014 Continued
I Facility Number: I nate of Inspection:
• Waste 'Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6 . Are there structures on-site whi c h are not properly addressed and/or managed through a
waste management or closure plan ?
D Yes ~ D NA ONE
D Yes DNo ~ONE
Structure 5 Structure 6
DYes~ DNA ONE
DYes ~ D NA ONE
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? D Yes ~o 0 NA 0 NE
8. Do a ny of the structures Jack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alte rnati ves that need
maintenance or improveme nt?
DYes ~o DNA ONE
0 Yes C}No D NA 0 NE
DYes ~No DNA ONE
II. Is there evidence of incorrect la nd application? If yes, check the appropriate box below. 0 Yes ~o DNA 0 NE
0 Excessive Ponding D Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN D PAN > 10% or 10 lbs. 0 Total Phosphorus D Fai lure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Appli cation Outside of Approved Area
12. Crop Type(s): cw5
13. Soil Type(s):
14 . Do the receiving crops differ from those des ignated in th eCA WMP?
15. Does the receiving crop and/or land app li cat ion site need improve ment?
I 6. Did the facility fail to secu re and/or operate per the irrigation design or wettable
acres determination?
17 . Does the facility lack adequate acreage for land appli cation?
18 . Is there a la ck of prope rl y operatin g waste application equipment?
Required Records & Documents
19 . Did the faci lity fail to have the Ce rti ficate of Coverage & Perm it readily ava ilable?
20. Does th e facili ty fa il to have all componen ts of the CA WMP readily avai lable? If yes, check
the appropria te box.
OwuP O chccklists 0 Des ign 0 Maps 0 Lease Agreements
DYes ~ DNA O NE
DYes ~ D NA O NE
DYes [qNo DNA ONE
DYes ~0 DNA O NE
Q Yes crNo D NA ONE
DYes (!(No DNA ONE
D Yes ~0 D NA ONE
Dother:
2 1. Does record keeping need improvement? If yes, check the appropriat e box below. D Yes .[2f'No 0 NA 0 NE
0 Waste Application 0 Weekl y Freeboard D Waste Analys is 0 Soil Analysis 0 Waste Transfers 0 Weather Code
0 Rainfall 0 Stocki ng 0 Crop Yield 0 I 20 Minute Inspections 0 Monthl y and 1" Rainfall In spections D Slud ge Survey
DYes ~No 0 NA 0 NE
D Yes 0 No 0 N A 0 NE
22. Did the facility fail to install and maintain a rain gauge?
23. If sele cted, did th e fa cil ity fail to insta ll and maintain rainbrcakers on irrigation equipment?
Page 1 of3 114/20 14 Continued
!Facility Number: I Date oflnspection: (Of~Y4(: /b I
~. Dld 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.
D Yes ~o DNA O NE
DYes 4J.Xo DNA D NE
D Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss asse ss ments (PLAT) certification?
Other Issues
28 . Did th e 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 fai l to notify the Regional Office of emergency s ituations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
DYes
DYes
DYes
DYes
D Yes
DYes 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field 0 Lagoon/Storage Pond 0 Other: ------------------------
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes
33. Did the Reviewer/Inspector fail to discuss review/i nspection with an on-site representative? D Yes
34. Does the facility require a follow-up visit by the same agenc y? DYes
~0 DNA
(J-No D NA
[2J'No DNA
(2fNo DNA
~No DNA
j2fNo DNA
12fNo DNA
E:j"No DNA
(:dNo D NA
Comments (refer to question If): 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).
ONE
ONE
O NE
ONE
O NE
ONE
ONE
ONE
ONE
Reviewer/Inspector Name :
Reviewer/Inspector Signature:
Phone: L{ 33'" 3.?J q
Dat e: &zytvda tb
Page 3 of3 21412014
Denied Access
Date of Visit: fr& '(1, I§ Arrival Time: I No oN Region: {J'(.;J
Farm Name: __ +'K~,--±..._T..___---'-~--"~~----------Owner Email:
Owner Name: k-e-•~ ~w Phone:
Mailing Address:
Physical Address: -------------------------------------------
Facility Contact: K -ec-k Tew Title: _ ..... f) ..... w...,;=....:...;fli:....:.E_t{( __ _ Pbone:
Onsite Representative: __,_K_,\...~"t......:.•-~t......::..~.-·--jJ~-e~W~------------·Integrator: __ t11_.f ___________ _
Certified Operator: /l Certification Number:
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 Ye s ~DNA ONE
Discharge originated at: 0 Structure 0 Application Field 0 Other:
a. Was the conveyance man-made? 0 Ye s 0 No ~A ONE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) 0 Ye s 0No ~A ONE
c. What is the estimated volume that reached waters of the State (gallon s)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) 0 Ye s 0No
~0
~A ONE
2. Is there evidence of a past discharge from any part of th e operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of3
DYes
D Yes
D NA ONE
~0 DNA ONE
114/2011 Continued
I Facility "Number: !Date of Inspection: [3 Y'YLU{ fl;
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any inunediate 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 arc not properly addressed and/or managed through a
waste management or closure plan?
DYes ~DNA ONE
DYes 0No ~ ONE
Structure 5 Structure 6
DYes~ DNA ONE
DYes ~o 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
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes ~ DNA ONE
DYes ~o DNA ONE
0 Yes B'"No 0 NA 0 NE
DYes ~ DNA ONE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~ 0 NA D NE
0 Excessive Ponding 0 Hydraulic Overload 0 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
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): t)~
14. Do the receiving crops differ from those designated in the CA WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reguired 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? lfyes, check
the appropriate box.
DYes ~0 DNA ONE
DYes EJNo DNA ONE
DYes ~0 DNA ONE
DYes ~ DNA ONE
DYes ~ DNA ONE
DYes ~0 DNA ONE
DYes ~ DNA ONE
0WUP Ochecklists 0Design 0 Maps 0 Lease Agreements Oother: ----------------------
21. Does record keeping need improvement? If yes , check the appropriate box below. 0 Yes ~ DNA 0 NE
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 0 Monthly and I" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes ~ 0 NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment? 0 Yes ~o 0 NA 0 NE
Page2of3 21412011 Continued
IFacilitiNumb~r: ~b-I lnate oflnspection: tJ'tioy ' l.S
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes ~0 DNA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check DYes E('No DNA
the appropriate box(es) below.
D Failure to complete annual sludge survey 0Failurc to develop a POA for sludge levels
D Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? DYes [VNo DNA
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? DYes G:YNo DNA
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes [21\lo 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 D-No DNA
If yes, contact a regional Air Quality representative immediately.
~0 30. Did the facility fail to notity the Regional Office of emergency situations as required by the DYes 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 GJ'No DNA
0 Application Field 0 Lagoon/Storage Pond D Other:
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes [krNo DNA
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes ~0 DNA
34. Does the facility require a follow-up visit by the same agency? DYes ~0 DNA
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better e:1plain situations (use additional pages as necessary).
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of3
Phone :r ~3s-s3 ~Y
Date: 13~ I S
214 014
ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: @"Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: +//<($;.._If I Arrival Time: II/J80
I
Farm Name: /K rf.T ~
Owner Name: (C-e ~ fe tJ
Mailing Address:
Departure Time: I jt:!ov I County: J;; '(,/ ~ Region~
Owner Email:
Phone:
PhysicaiAddress: --------------------------------------------------------------------------------------
Facility Contact: _lc..........,.z::;..;;..rK..;.........>.____.;.~-e---'w...,._ ____ Title: _______ _ Phone:
Onsite Representative:
((
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
a. Was the conveyance man-made?
0 Other:
b. Did the discharge reach waters of the State? {If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Integrator: _/t(___;;...:£3~---------------------
Certification Number: I! CflfZ •
Certification Number:
Longitude:
DYes ~o D NA ONE
DYes DNo @NA ONE
DYes DNo [j"'NA ONE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes DNo ~ ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of3
DYes l3i{o
DYes ~0
DNA ONE
DNA ONE
11412011 Continued
iFacility Number: fJ. -b) J.: I I Date of Inspection:
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes ~DNA ONE
DYes 0No ~ ONE
StructureS Structure 6
DYes ~ DNA ONE
DYes ~ 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?
DYes~ DNA ONE
DYes~ DNA ONE
DYes ~o DNA ONE
DYes DNA ONE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. D Yes DNA ONE
0 Excessive Ponding 0 Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn, etc.)
0 PAN D PAN> 10% or 10 lbs. D Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): {)er~ .C0/3
13. Soil Type(s): A) o./'. •
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?
Pagel of3
0 Yes [2(No
0 Yes ~No
0 Yes 0No
0 Yes 0'No
0 Yes ~0
0 Yes ~
0 Yes ~0
00ther:
DYes ~0
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
21412011 Continued
{Facility Number:
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box( es) below.
DYes ~o
0 Yes Q-1<ro
DNA ONE
DNA ONE
0 Failure to complete annual sludge survey 0Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of frrst survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? DYes ~0 DNA ONE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? DYes ~0 DNA ONE
Otber Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes ~ DNA ONE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? 0 Yes ~0 DNA ONE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notifY the Regional Office of emergency situations as required by the DYes ~ DNA ONE
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. DYes ~0 DNA ONE
D Application Field D Lagoon/Storage Pond D Other: ------------------------
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Rcviewerllnspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
DYes ~0 DNA ONE
DYes ~0 DNA ONE
0 Yes ~ 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 necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page3of3
}Or-{0~/'&
Ph~;:q3~-33~tf
Date: t\ Zf"~IA{__ tL(
21412011
·~
Compliance Inspection Operation Review Technical Assistance
Reason for Visit: ~outine 0 0 Referral 0 J<m, .... .,, .. nt•v 0 Otber 0 Denied Access
Date of Visit: hlJ'~J•'-I Arrival Time: IO"\ \ "\S" ~"" I Departure Time: IIO:lfS" AP\ I County: ~rw\ps61\ Region: fRo
Farm Name:;___..:..K...:...lll:l::...T...:..._-!~~A~\\.~f"".--=--~-=----------Owner Email:
OwnerName: \'\!.~+"""'-\t.w ,--r'h~\Oo~ -re_...,) Pbone:
MailingAddress: \'5d~ \..JWt.. O~'i. C..nv~S--h M · C:.'nrrlo.-J
Pbysical Address: -----------------------------------------
Facility Contact: \{ b..\'t--\£.\a.J Title: ....;Oio.L.J\.N(\"""""L..>....>c. ... fl.......;;._ ____ _ Pbone:
Onsite Representative: _S=~~C""\.....;...CL=----------------
Certified Operator: '(\ \\2 i' \{f._ ..I~"'-\f. w
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 Appli cation Field
a . Was the conveyance man-made?
0 Other:
b . Did the di scharge reach waters of the State? (If yes , notify DWQ}
c . What is the estimated volume that reached waters of th e State (gallons)?
Integrator: \"\ \l~$) h 'f'?:>RDWoJ
Certification Number: .-J ..._g._Y...a......:'f'-7..__ ___ _
Certification Number:
Longitude:
0 Yes [!(N-o DNA ONE
DYes DNo iZ'JNA ONE
DYes DNo E1NA ONE
d. Does the discharge bypass the waste management sy stem? (If yes, notify DWQ) · DYes DNo DNA ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any obs ervable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of3
DYes
DYes
~No DNA ONE a No DNA ONE
11412011 Continued ~ •.
,. .. .. .
I Facility Number: IDate oflnspedion: 1/aY{ I'J.'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. I f yes, is waste le vel into the strucrural freeboard?
Structure 1 Structure 2 Structure 3 Structure4
Identifier:
Spillway?:
Designed Freeboard (in): _...:\:.....~..:...._ __
Observed Freeboard (in): ~
5. Are there a ny immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
D Yes 52fNo D NA D NE
D Yes 0 No [B'NA 0 NE
Structure 5 Structure 6
DYes ~No DNA ONE
0 Yes [3'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 s tructures need maintenance or improvement?
8. Do any uf the s tru ctures lack adequate markers as required by th e 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 improvem ent ?
Waste Application
I 0. Are there any requ ired buffers, setbacks, or compli ance a lternatives that need
maintenance or improvement?
0 Yes [g'No 0 NA 0 NE
D Yes [B'"No D NA D NE
0 Yes (3"No D NA D NE
DYes ~o DNA O N E
II. Is there evidence of incorrect land application ? If yes, check the appropri ate box below. D Yes ~o DNA D NE
0 Excess ive Ponding 0 Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn, etc.)
0 PAN D PAN > 10% or 10 lbs. 0 T o tal Phosphorus 0 Failure to Incorporate Manure/S lud ge into Bare Soil
0 Outside of Acceptable Cro p Window 0 Evide nce of Wind Drift D Application Outside of Approved Area
12. Crop Type(s): CoB"-', Whf p-\ \ ~bt,~t\.C:,1
13 . Soil Type(s): ...:.N..:&J~~:o..:...fl..:.._.\......._..W-=-=~'-"=~=-----------------------------
14 . Do the receiving c rops differ from those designated in th eCA WMP?
15 . Doe s the receiving crop and/or land application site need improvement?
16 . Did the faci lity fail to secure and/or operate per the irrigation des ib,'ll or wettable
acres determination?
17 . Doc s the faci lity lack adequate acreage for land applicati on?
18. Is there a lack of properly o perating waste applica ti on equipment?
Required R ecords & Documents
19 . Did the faci lity fai l to have the Certificate of Coverage & Permit readil y available?
20. Docs the faci li ty fa il to have all components of theCA WMP read ily avai lable? If yes, check
th e appropria te box.
0WUP 0 Checklists 0 Design 0 Maps D Lease Agreements
21. Docs record keeping need im pro ve ment ? If yes, check the appropriate box below.
DYes [Si'No DNA O NE
D Yes (S(No DNA ONE
D Yes G2{No DNA ONE
DYes 0No DNA ONE
D Yes {3'No DNA ONE
D Yes [3"No D NA O N E
D Yes [Sf No DNA ONE
O other :
D Yes (g'No DNA O NE
0 Waste Appli cation 0 Weekly Freeboard 0 Waste Analysis D Soil Anal ysis 0 Waste Transfers 0 Weather Code
0 Rainfall 0 Stocking D Crop Yield D 120 Minu te Ins p ections 0 Monthly and I" Rainfall Inspections 0 Sludge Survey
22. Did the faci li ty fail to ins tall a nd maintain a rain gauge? 0 Yes ~No DNA 0 NE
23 . If se lected, did th e faci li ty fai l to install and maintain rainbreakers on irri gation equipment ? 0 Yes 0 No SNA 0 NE
Page2of3 214110 11 Continued
[Facility Number: ?>0-. -ta,;1 .. .'").. !Date of Inspection: 7h.t4/ I")
y I
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes gNo D NA 0 NE
25.1s the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes ~o DNA 0 NE
the appropriate box(es) below.
0 Failure to complete annual sludge survey 0Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
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)
DYes ~o DNA ONE
DYes 0No gNA ONE
DYes ~o DNA ONE
0 Yes [g'No DNA 0 NE
DYes ~No DNA ONE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ~es D No DNA D NE
c:s;rA.pplication Field D Lagoon/Storage Pond D Other: ___________ _
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
DYes ~o DNA ONE
DYes ~No .DNA ONE
DYes BNo DNA ONE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
0 f\~<"' -; :1.. \ t '0 i " ~~R. ~~ -\~o I') E ;J
~c.\..1..-
4-e..ot'\\:I...~Ut.... -\a ~O~t_ 0~ '~~R..2.. ~n_~~S.
¥r De.,\ \Zey-r ~~ll-1'1'. ~ ~~~d\LoS.
k {\)f_.f..D ~h.)~~" ~uRu"t.-..t ::1.~ ~a'~
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page] of3
Phone: q\ ~. ~~--L. <iS'
Date : -'~\~,'dl~~::::lo\--.ll..\·~-=----
214/1011
Lo,.,liance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Rea son for Visit: 0'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emerge ncy 0 Other 0 Denied Access
Dote ofVbh: fl!:.5iiifitJJ.•rival T;me:ll(til(2 Departu" TDne:lf)l <5 I Couoty~"V ""-Regioo :FI:fJ
FarmName:~--~lt!~~-=L~~~~--~-rf~~~4~-~>~---------------------'Owner Email:
Owner Name: Phone:
Mailin g Address:
Ph ysical Address:
--------~------------------------------------------------------------------------------l/(;~e::....::.v......!..&~___;~~2 ___ Title: ~ Facility Contact:
Onsite Representative: (
Certified Operator: (
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
1. Is any di scharge observed fro m any part of th e opera tion ?
Di sc harge orig inated at: 0 Struc ture 0 Applicatio n Field 0 Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of th e State? (If yes, noti fy DWQ )
c. What is th e estimated volwne th at reached waters of the State (gallons)?
Phone:
Integrat or:
Certification N umber: / !'f'fZ ._~~~r~----------
Certification Number:
Longitude:
D Yes ~ D NA O NE
0 Ye s Q No ~A O NE
0 Yes Q No [g'N A O NE
d. Does the d ischarge bypass th e waste manag ement system? (If yes , noti fy DW Q) 0 Yes 0 No (B"NA O NE
2. ls there evidence o f a pa st d is charge from any part of the operati on?
3 . Were there any observa bl e adverse impac ts or potential adverse imp ac ts to the waters
of the Stat e other than fr om a di scharge?
Page I of3
0 Yes ~0
D Yes ~0
D NA O NE
D N A O NE
Z/411011 Continued
[Date of lnspectio~ I Facility Number:
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 s tructural freeboard?
Structure 1 Structure 2 Structure3 Structure4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees , seve re erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management o r closure plan?
DYes D No DNA ONE
DYes 0No D NA ONE
StructureS Structure 6
DYes ~DNA ONE
DYes ~ DNA O NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public healtb or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? DYes [B'1fo 0 NA D NE
8. Do any of the structures lack adequate markers as required by the p ermit?
(not applicabl e to roofed pits, dry stacks, and/or wet stacks)
9 . Does any pan 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?
12 . Crop Typ c(s):
13 . Soil Type(s):
14 . Do th e receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation des ign or wettable
acres determina ti o n?
17. Does the facility lack adequate acreage for land application?
18 . Is there a Jack of properly operating waste application equipment?
Required Records & Documents
19 . Did the facility fail to have the Certificate of Coverage & Permit readi ly available?
20. Does the facil ity fail to have all components of theCA WMP readily available? If yes, check
the appropriate box .
OwuP Dchecklists 0Design 0 Maps 0 Lease Agreements
DYes GJ..xO DNA ONE
DY es ~ DNA ONE
DYes ~o DNA ONE
DYes ~0 DNA ONE
DYes ~0 DNA ONE
DYes ~0 DNA ONE
DYes ~0 DNA ONE
DYes [?No DNA ONE
0 Yes [B'No DNA 0 NE
DYes ~o DNA ONE
Dother: ________ _
21. Does record keeping need improvement? lf yes, check the appropriate box below. 0 Yes [](No 0 NA 0 NE
D Waste Application D Weekly Freeboard 0 Waste Ana ly sis D Soil Analysis D Waste Transfer s 0 Weather Code
D Rainfall 0 Stocking D Crop Yield D 120 Minute Inspections 0 Monthly and 1" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23 . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Pagelof3
0 Yes {JtNo
QYes ~o
DNA ONE
DNA ONE
21411011 Continued
IFacmf Numbe" gil -(;;}); Joate of lnse"rion' 'l?-sd= ~ (j
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Y cs ~
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes ~o
DNA ONE
DNA ONE
the appropriate box(es) below.
0 Failure to complete annual sludge survey 0Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively c e rtified 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 ofthc inspection did the facility pose an odor or air quality concern?
If yes , contact a regional Air Quality representative immediately.
D Yes
DYes
DYes
DYes
0 Yes
~0
cr'
~
~0
~0 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 ~urface tile drains exist at the facility? If yes, check the appropriate box below. ~0No
11:t'Application Field D Lagoon/Storage Pond D Other: ------------------------
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP? D Yes ~
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 ~0
DYes ~
DNA
DNA
DNA
DNA
DNA
DNA
DNA
DNA
DNA
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawin s of facility to better explain situations (use additional pages as necessary). -I o-r o-ti-
l ")--.5-~~~
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Reviewer/lnspector Name:
Reviewer/lnspector Si g nature:
Ph~ 0 -'63-3~3
oaf// ScJ :J.o 13
Page3 of3 11411011
Operation Review 0 Structure Evaluation
Reason for Visit: l9" Routine 0 Complaint 0 FoUow-up 0 Referral 0 Emergency
DateofVisit: 17/loiJf I Arrh·aiTime:lfliOOA-t(l Dt>partureTime:IQ;IOPtt I county: .9Jnft"'
Farm Name: K <\-T t="or m~ Owner Email:
Owner Name: l<ei}n T-fhj 'Theldo, Teh.-' Phone:
Mailing Address:
Physical Address: ]O(qo Hc'<fllJ,/f RJ. Clrh!:cn
)
Facility Contact: .....;K....:.-e..:::....>..i""".:......&.--.....:''--'e ... w"'--______ Title: o...,n.,.. Phone:
Region : FI<Q
Onsite Representati,·e: -~....;.e~f...l.~.....a...-T~€...;lv=-------------Integrator: --------------
Certified Operator: .._A_.l ..... \il,._0........,_V{.=·~ ..... · -'-;T'-f\.,1.........._ ___________ _
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
I . Is any di scharge observed from any part of the operation?
Discharge ori g inated at : D Structure 0 Application Field
a . Was the conveyance man-made?
D Other:
b. Did th e discharge reach waters of the State? (If yes, notify DWQ)
c . What is th e estimated volume that reached wa ters of the State (gallons)?
Certification Number : 1_'8_'/.....;'1.:..7"--------
Certification Number:
Longitude:
DYes ~No DNA ONE
DYes 0No DNA ONE
DYes 0No DNA 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 discharge?
Page I of3
0 Yes
0 Yes
fi3) No DNA ONE
5No DNA ONE
214/2011 Continued
IFI}Cility Number: I Date of Inspection: -"1lb/t /
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 structura l freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _..:..,q.....:.... __
Observed Freeboard (in): '3Cf
5. Are th ere any inunediate threats to the integrity of any ofthe 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 ISCNo 0 NA 0 NE
D Yes D No 0 NA 0 NE
Structure 5 Structure 6
DYes ~No DNA ONE
DYes ~No DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not a pplicable to roo fed pits, dry stacks, and/or wet stacks)
9. Does any part of th e waste management system other than the waste structure s require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
D Yes ~No 0 NA D NE
DYes fg No DNA D NE
DYes ~No DNA ONE
DYes 18}No DNA D NE
ll.ls there evidence of incorrect land application? If yes, check the appropriate bo x below. ~Y es D No 0 NA D NE
D Excessive Ponding D Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn, etc.)
fiS PAN D PAN > 10% or 10 lb s. D Total Phosphorus 0 Failure to In corporate Manure/S ludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evidence ofWind Drift . D Application Outside of Approved Area
12.cropType(s): Cnro, JvfJtu~Scybmns; ~p,jg) rkrmJn. Hor;. S®II!JQ]Ib Ovl.lPer)
13. Soil Type(s): Nocfolk \5 No~ ; YvoJrlkh \5 Wo. B
14. Do the receiving crops differ from those designated in the CAWM P? 0 Yes ~No 0 NA 0 NE
15 . Does the receiving crop and/or land applicati on site need improvement?
16. Did the facility fail to secure and/or operate per the irrigati on des ign or wettable
acres determination?
Page 2 of3
0 Yes fBl No
0 Yes ~N o
DYes 18fNo
DYes l8 No
D Yes ~N o
D Yes D}No
Oother:
D Yes ~No
DNA ONE
DNA ONE
DNA ONE
D NA ONE
DNA O NE
DNA ONE
214/2011 Continued
l~acilinr !Somber: ~d -h:;la. !Date oflnsl!ection:7lG,l1,
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(cs) below.
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 ~No DNA
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? DYes 0No ~NA
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes ~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 subsurface tile drains exist at the facility? If yes, check the appropriate box below. ~Yes 0No DNA
g)' Application Field D Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes gj"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? DYes ~0 DNA
Comments (refer to question#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
1. flleDJe.. )vor { lh \a j001 CDvfY' o, -tDf ~u[ '*" J rd e tJf-wa lis,
}\, (')vetfvlf1(fl:'b'J 1 lb h Che_ f.teft}._ lt1>-t ~~hftr-,
~~. Oro~ ti lt>1 !A tt-~ sn--Befd_ -~tofflelc{
'1/~ tv{'(\ 111t1Vrl-aJhel -fu,.., ~.JOCd-rect:rriJ.
~ tofYlbfh~ lR({d._ fahJ,
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Reviewer/Inspector Name: Phone: Cflo-433-J:b? {~
Date ~ ~ <\! 0 1/ Reviewer/Inspector Signature:
Page 3 of3 1'1211
·Fa~i;ity. No. <t' Cfi:01. Farm Name _k_.;_ct_T,__ ____ Date-~-'---_._]..L.J/0~{+} 1-1 _
/ ,
Permit COC ~ OIC_ NPDES (Rainbreaker PLAT Annual Cert)
Pop.
Type
Design Current
Lagoon
Spillway
Design freeboard
Observed freeboard in){40
Sludge Survey Date 1
Sludge Depth (ft)
Liquid Trt. Zone (ft}
Ratio Sludge to Treatment Volume
Calibration Date 1ill0[/{) ~·,
Design Flow lOb bD
Actual Flow
Design Width
Actual Width
SoiiTestDate ;))) Y/11 ,/I
pH Fields
Lime Needed 0 .]/0c.c
Lime Applie_tj
FB
Drops
'VI /1 'C.
"
1:3rlftl
.-:l.lfl
II A. I I '_l
1
,t.jD
3
, ........ ,
i?fJ/Jt!
2
4
Wettable Acres ~
WUP :.;;;""
Weekly Freeboard~
1 in Inspections ........-:
120 min lnsp \.../"'
I I I I
3 4 5 6 7
5 6 7 8
RAIN GAUGE
Dead box or incinerator __ _
Mortality Records
Cu-I v'. Zn-1 ..........-
Needs P--Nl)
CropYield L Weather Codes .../'" r... _ I I. "?/ I.
Transfer Sheets YVt;i"€ c:;ttf II dO tl D~ v /1 I 1
Waste Analysis Date·
-60 Day _1ln 11 7ljt~lt()
+ 60 Day
N Amt (lb/1 000 Gal) ~~.~-
pH ,,
Pull/Field Soir Crop Acres PAN Window Max Rate MaxAmt
\
I StH llfD
1 _om 11~
3 _
_ 'l !S~ 1'\l/
v I
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
Jo-draq lo\~ \ Q 'f
FRO or Farm Records 4-lb--Ol ~ri_
App. Hardware
Lagoon#
Top Dikea :5 u') 11'1
Stop Pump '4"'1 lq I/
Start Pump
Conversion-cli.73000= 1081b/ac; Zn-1 3000= 213 lb/ac
2 -ol.f-2o1o
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ~tine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
DateofVisit: 12-~3-/ol ArrivaiTimed ?:IrA-I DepartureTime: lq,·~.r;,,., I County: Sc.v-ps-"'"' Region: _r-:;_-_~_0_
I
Farm Name: K f r Fa.~r,..,..s Owner Email:----------------.
Owner Name: K~,'fl. f TA~I<IcN /~ , ~~--------------------Phone:
Mailing Address: -----------------------------------------------
Physical Address:--------------------------------------------____ _
Facility Contact: ..;;;~=r:........:....f.;....;/s~_B.:::_a_r._-w_;....;c-'::__.::::._ ___ Title: __ 7---.:::e....:~:....::...:·-=-· _S:-1-,Re=-'--· _, __ _ Phone No: -----------
1 ntegrator: _...::Co:.....:......;it..;;.Ot---"lr:-'''-• ....:c_.=-_h_CA_V_"Vl---'..5~---Onsite Representative: ---------------------
Certified Operator:-------------------------------Operator Certification Number: -------------
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?
Discharge originated at: D Structure D Application Field D Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notifY DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notifY DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
DYes ~o DNA ONE
DYes 0No [3"NA ONE
DYes 0No B1f;\ ONE
I
DYes 0No sNA ONE
DYes ~DNA ONE
DYes ~DNA ONE
12128104 Continued
l
I Facility Number: 82 -~zz.l Date oflnspection lz-D3-/0 I
~Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. lfyes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
DYes ~DNA ONE
DYes ~DNA ONE
Structure 5 Structure 6
Identifier;------------------------------------------
Spillway?:
Designed Freeboard (in): ----------------------------------------
"1 a,
Observed Freeboard (in); -----!!:::~:::::..::0::::_ ___ ----------------------------------
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
DYes ~DNA ONE
DYes ~ DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes ~ DNA ONE
DYes [3"No DNA ONE
DYes ~DNA ONE
DYes I3"'No DNA D NE
11. Is there evidence of incorrect application? lfyes, check the appropriate box below. DYes ~ DNA D NE
0 Excessive Ponding 0 Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
D PAN D PAN > 10% or 10 lbs 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge in to Bare Soil
D Outside of Acceptable Crop Window D Evidence of Wind Drift D Application Outside of Area
12. Crop type(s) -=R...;:t!''-'-ne.=· ="';..::d'.=~'------'(.:;..;ih___,7~J..,., --'~='----=-t?t/;__::(9.::;_;__YZ>.~1.:.::'.v;__.;.tl._o_. _s_. )~7__.;;..0:,;;........;,.-"'~--w._l-,-=-~-'-"...;.·1_-&_e_Q<.;_N_s ______ _
13. Soil type(s) No A Wc:tB
14. Do the receiving crops differ from those designated in theCA WMP? DYes B"No DNA ONE
I 5. Docs the receiving crop and/or land application site need improvement? DYes B"No DNA ONE
16. Did the facility fail to secure and/or operate per the irrigation desit.rn or wettable acre dete rmin ation? DYes ~0 D NAO NE
17. Does the facility lack adequate acreage for land application? DYes ~DNA ONE
18. Is there a lack of properly operating waste application equipment? DYes ~DNA ONE
Comments (refer to question #): Explain anyYES answers and/or any recommendations or any otber comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
...
r--
f--...
Reviewer/Inspector Name I /'?/~ R~v~/.s I Phone: ~/D. ~73, 3'?tJO
Reviewer/Inspector Signature: /?~ /£~ Date: Z-03-2-0IO
11118104 Continued
·' ..
I Facility Number: 82.. -~ZZ.I Date of Inspection lz.-o3 -I 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropriate box. 0 WUP 0 Checklists 0 Design 0 Maps D Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
DYes ~DNA ONE
DYes ~DNA ONE
DYes ~ DNA ONE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Annual Certification
0 Rainfall D Stocking D Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
DYes ~ DNA ONE
DYes ~DNA ONE
DYes ~DNA ONE
DYes ~DNA ONE
DYes ~DNA ONE
DYes ~DNA ONE
DYes [31i(o" DNA ONE
DYes ~DNA ONE
DYes ~DNA ONE
DYes ~DNA ONE
DYes ~DNA ONE
DYes ~DNA ONE
.... -
-..
12128104
10 -o z -'2-oo 9
. . ~ision of Water Quality I Facility Number I 82 H e:,22 II 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
Date of Visit: I CJ ·z 3 -0 91 Arrinl Time: 12: I) RM Departure Time: 12: 5" ~"..., I County: .Sc_~_,..,....,.f'_· _l.·~_.v __ , Region: F /20
I
Farm Name: k f r Fa,,...,. .r Owner Email:-------------
Owner Name: K ~ ,'~ i. 71-tc.l deAl _ . .-..;_I....;;.L_..,J ______ _ Phone:
Mailing Address: -----------------------------------------
Physical Address:-----------------------------------------
Facility Contact: C ;;.~r.ll '.s D ,~.,. .... ,·'-~ Title: ·-r;. ci... Sp~c..
I Phone No:---------
Integrator: __ C_c_'-._ ... _· _ .. _. i_<-;;:.___l=_c;.;.;:;:.;;..-_-.._. ------On site Representative: ___;C.::;..~..:v.;.:d....L... ·:...t ... 5.___;8~·-·"_.,.._.....,_1_. "-_JL _______ _
Certified Operator:--------------------Operator Certification Number: -------
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
I I ID Layer I I 0 Dairy Cow
0 Dairy Calf I
!O Wean to Finish
IB'Wean t o Feeder 326D :1352
0 Dairv Heife1 t
i 0 Dry Cow i
0 Non-Dagy f 0 Beef Stockel
0 BeefFeeder i
0 Beef Brood Cow j
0 Feeder to Finish
0 Farrow to Wean
0 Farrow to Feeder
0 Farrow to Finish
0 Gilts
0 Boa rs
Dry Poultry
0 Layers
0 Non-Layers
0 Pullets
0 Turkevs
Other 0 Turk ey Poults
D Other Number of Structures: []]· !D Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? DYes ~o DNA ONE
Discharge originated at: D Structure 0 Appli ca tion Fi e ld D Other
a. Was the conveyanc e man-made? DYes IB'N o DNA ONE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) D Yes 0No ffiA ONE
c. What is the es tim ated volume that reached waters of the State (gallons)? I
d. Does di scharge bypass the waste management system? (If yes, notify DWQ)
2. Is the re evidence of a past discharge from any part of the operation?
3. Were th ere any adverse im pacts or pot entia l adverse impacts to the Waters of the State
~ . o th <' tha n fmm a di,;c h,gc'!
DYes DNo B"'NA ONE
DYes ~-DNA ONE
D Yes ~-DN A O NE
12118104 Continued
I Facility Number: 82-6·zz I Date of Inspection I</-Z.:J -o Y 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 I Structure 2 Structure 3 Structure 4
DYes ~DNA ONE
D Yes ~DNA ONE
Structure 5 Structure 6
Identifier: ________________________________________ _
Spillway?:
Designed Freeboard (in): ----::-:---------------------------------------,,
Observed Freeboard (in): __ 2...=--_9 _____________________ ------------
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
DYes ~ DNA ONE
DYes B<o DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 0 Yes ~ DNA 0 NE
8. Do any of the s tuctures Jack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
DYes ~·DNA ONE
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
D Yes ~DNA ONE
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes ~DNA ONE
II. Is there evidence of incorrect appli cation? Ifyes, check the appropriate box below. 0 Yes ~ 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 Evidenc e of Wind Drift 0 Application Outside of Area
12 . Crop type(s) B f?,..r,.,._ '-<. cf,__ (If.· 5:.,c,fi ~ ..... '..J (o. s J C.v..v-wt. ~ .... 1-t?c'({,.;.:;
13 . Soil type(s) Nc/f t,Jc..B
14 . Do the receiving crops differ from those designated in theCA WMP? DYes EfNo DNA
15. Does the receiving c rop and/or land application site need improvement? D Yes ~ DNA
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determ ination?O Yes ~DNA
17 . Does the facility lack adequate acreage for land application? DYes ~ DNA
18. Is there a lack of properly operating waste application eq uipment? DYes B1'Jo DNA
~ ~· -,. -,.
Comments (refer to qoestio~ #): Explain any YES·answers and/or any recommendations-or any other comments.
·Use dra~ings ·or rac:~lity t~ bett(!r explai~ situations. (use additional pages as necessary):
ONE
O NE
O NE
O NE
ONE
..... -
~ ....
Reviewer/Inspector Name r ~-l~~ I Phone: CJto. 9 33 .333Y
Reviewer/Inspector Signature: Date: 9 -23-2601
Page 2 of 3 12128104 Continued
I Facility Number: fJ z -" z'lj
9 ~z.3 -·o9
Date oflnspection Ffz 3 -o 7 I
Required Records & Documents
19 . Did the facility fail to have Certificate of Coverage & Permit readily available?
20 . Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropriate box. D WUP 0 Checklists D Design 0 Maps 0 Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
DYes
DYes
~DNA
~DNA
ONE
ONE
DYes ~ DNA O NE
0 Waste Application D Weekly Freeboard D Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Annual Certification
0 Rainfall 0 Stocking D Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? DYes ~ DNA ONE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes [31(o' DNA ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit? D Yes [!J1( DNA ONE
25. Did the facility fail to conduct a sludge survey as required by the permit? DYes [d1( DNA ONE
26 . Did the facility fail to have an actively certified operator in charge? DYes ~DNA ONE
27 . Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? DYes ~DNA ONE
Other Issues ~DNA 28. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes ONE
29 . Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes
and report the mortality rates that were higher than normal?
~DNA ONE
30. At the time of the inspection did the facility pose an odor or air quality concern? DYes [31(o DNA ONE
J f 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 [3-l(o DNA ONE
General Permit? (ie/ discharge, freeboard problems, over application)
Q£0NA 32 . Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? D Yes ONE
33 . Does facility require a follow-up visit by same agency? DYes ~NA ONE
Additional Comments and/or Drawings: ... -
~ ...
12128/04
0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit e-6utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visi t : 1$-y~o t31 Arrinl Time:l2': 12 ~h
Farm Name: K iT nYM...S '
DepartureTime: 12~36..,-l County: £.-~scry....
I
Region:
Owner Email: --------------
Owner Name: ---=~=----e.=-:...r ·..:...~~-h_e..-_o.J ___ ------------Phone:
Mailing Address: -------------------------------------------
Physical Address:------------------------------------____ _
Facility Contact: {,'llrf<s B~r-w/c....K.. Title:/~. Phone No: ________ _
Onsite Representative: C<.t.,..j,t S 'f?t:t. v WI '"/::_ Integrator: _Ce;;;;,.,.;:;...;lt;..:_a_~--=..;.--=<:._=-....:.;=,;_.;.::~:...:r_M...:..;;....S.;:;... ___ _
Certified Operator:---------------------------Operator Certification Number: --------
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 th e operation'?
Discharge originated at: 0 Stru cture 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 . Wh at is the estimated volume that re ached waters of the State (gallons)?
d . Docs discharge bypa ss the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part ofthe operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
DYes ~ DNA ONE
D Yes 0No B'NA ONE
DYes 0No erN A ONE
I
DYes 0 No 0'NA ONE
DYes E1'No DNA ONE
DYes ~ DNA ONE
11128104 Continued
!Facility Number: ~z-(,ZLI Date of Inspection 18-zt-aSI
Waste Collection & 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?
DYes ~o DNA ONE
DYes ~ DNA ONE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure6
Identifi er:---------------------------------------
Spillway?:
Designed Freeboard (in):----------------------------------------
Observed Freeboard (in): ---=3:;;;___.t7.__ __ -------------------------------
5. Are there any immediate threats to the integrity of any of the structures observed? DYes ~0 DNA ONE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed DYes ~ 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 eovironmeotal threa4 notify OWQ
7 . Do any of the structures need maintenance or improvement?
8. Do any of the stuc tures lack adequate markers as required by the permit'!
(Not applicable to roofed pits, dry stacks and/or wet sta cks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks , or compliance alternatives that need
maintenance/improvement?
DYes
DYes
DYes
DYes
G11fo DNA ONE
ffNo DNA ONE
~0 DNA ONE
~ DNA ONE
11. Is there evidence of incorrect application? If yes, check the appropriate box below . 0 Yes ~ DNA 0 NE
D Excessive Ponding D Hydrauli c Overload 0 Frozen Grou nd 0 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 0 Evidence of Wind Drift 0 Application Outside of Area
14. Do the receiving crops differ from those de signated 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 irri gation design or wettable acre dctermination?D Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
!
DYes
DYes
ifNo DNA
~ DNA
~ DNA
~ DNA
~DNA
Comments (refer· to qu~«m #): ·Explain any YES answers and/or any recommendations or any other COJDments.
(.!se drawings of f~cility to· better ~xpla!.n sitUations. (use additional pages as n~ty):
• __ ...... 1:-• -t-
·-
GaveL Fc-v-I ,
6,-c:..,cL p~!"Yd~ I .
--··--.. ~· -··
ONE
ONE
ONE
ONE
ONE
..
... -
1-...
Reviewer/Inspector Name ! g· .. -----z;. ,~;::., I!:. c. I/ :s "I Phone: '110, i/,33,333 0
Reviewer/Inspector S ignature: ~~., A"v .... L Date: ~ -21-2tJ08
Page 2 of 3 12/28104 Continued
I Facility Number: f'Z -6U.I Date of Ins p ection I B -21-o el
Required Records & Documents
19 . Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. D WUP D Checklists 0 Design D Maps D Other
DYes ~-DNA ONE
DYes ~ DNA ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. DYes ~ 0 NA 0 NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis D Soil Analysis 0 Waste Transfers D Annual Certification
D Rainfall 0 Stocking D Crop Yield 0 120 Minute Inspections D Monthly and I" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? DYes ~0 DNA ONE
23 . If selected, did the facility fail to install and maintain rain breakers on irrigation equipment? DYes ~DNA ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes ~ DNA ONE
25 . Did the facility fail to conduct a sludge survey as required by the permit? DYes ~0 DNA ONE
26. Did the facility fail to have an actively certified operator in charge? DYes ~0 DNA ONE
27. Did the facility fail to secure a phosphorus Jo ss assess ment (PLAT) certification? DYes ~DNA ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? DYes ~0 DNA ONE
29. Did the faci lity fail to properly dispose of dead a nima ls within 24 hours and/or document DYes ~ DNA ONE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose a n odor or air quality concern? DYes ~ DNA ONE
If yes, contact a regional Air Quality repres entative immediately ~ 3 1. Did the facility fai l to notifY the regional office of emergency situations as required by DYes DNA ONE
General Permit? (ie/ discharge, freeboard proble ms, over applicati on) ~DNA 32. Did Reviewer/Inspector fail to discuss review/in spection with an on-site representati ve? DYes ONE
33 . Does fac ility require a follow-up visit by same agency? DYes ~DNA ONE
Additionai Comments and/or Drawmgs:
.... -
-....
Page 3 of 3 12/18104
/
IFacility Number I II 8 Division of Water Quality /
~z. H 4-2Z... 0 Division of Soil and Water Conservation ' 0 Other Agency -
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ktt -01-/)7 Arrival Time: l2: ~, Departl.lre Time; l3:~oA....., I County: »
Region: F~
Farm Name: t< ~ T Fa."W!>S Owner Email: --------------
Owner Name: ~£ ~ Tl--.c..lde...J --r<.....J Phone:
Mailing Address: ------------------------------------____ _
Physical Address:-----------------------------------------
Facility Contact: _K'-'' '""'c.."-';--J<H,.I..Ello.__,T:'-'~==------Title: ----------Phone No : ________ ___
Onsite Representative: Cuv-\\s B"-v-~l~t<. Integrator: Cob,a.v-1 <-
Certified Operator:--------------------Operator Certification Number: --------
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D" Longitude: D OD 'D"
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
ID Wean to Finish 10 Layer .lEI Wean to Feeder 3200 D Non -Layer I I
D Feeder to Finish
D Farrow to Wean
D Farrow to Fee der
D Farrow to Finish
D Gilts
D Boars
Dry Poultry
0 Lavers
0 Non -Layers
D Pullets
D Turkeys
Other 0 Turkey Poults
O Other ID Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge origi nated at: D Structure 0 Application Field 0 Other
a. Was the con veyanc e ma n-made ?
b. Did th e di scharge reach wat ers of t he Stat e? (If yes, notifY DWQ)
Cattle
D Dairy Cow
D Dairy Ca lf
D Dairy Heife1
0 DryCow
0 Non-Dairy
0 Beef Stocker
0 Beef Feeder
0 Beef Brood Cow
-
Design
Capacity
Current
Population
~:,
(
I
;
i
'
Number of Structures: [JJ
D Yes rn No D NA ONE
D Yes [lNo DNA ONE
D Yes 00 No D NA O NE
c . What is the estima ted volume that reached waters of the State (gallons)?
d. Does discharge bypass the wa ste management system ? (If yes , noti fy DWQ)
2 . Is there evidence of a past discharge from any part of the operation ?
3 . W ere th e re any adverse impact s or potenti al adverse im pacts to the Wa ters ofthc Stat e
other than from a discharge?
DYes rlfNo
DYes ~No
DYes ~N o
12128104
DNA ONE
DNA ONE
DNA ONE
Co ntinued
IFacili;y Number: 82 -hZ2.1 Date of Inspection j/c -~/-~ 71
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) Jess than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
DYes ~No DNA O NE
DYes ftlNo DNA ONE
Structure 5 Structure 6
ldentifier: ---------------------------------------
Spillway?:
Designed Freeboard (in):---------------------------------------
ob d . n2';
served Freeboar (m): ___ :r.L...;:~------------------------------------
5. Are there any immediate threats to the inte~:,rrity of any of the structures observed?
(ic/ large trees, severe erosion, seepage , etc.)
0 Yes !!]No DNA O NE
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan ?
DYes ll)No D NA 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 Jack adequate markers as required by the permit?
(Not applicable to roofed pits , dry stacks and/or wet stacks)
9 . Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers. setbacks, or compliance alternatives that need
maintenance/improvement?
DYes ~No DNA ONE
DYes ~No DNA ONE
0 Yes liJ No 0 NA 0 NE
DYes ~No DNA ONE
I I . Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes [JI No 0 NA 0 NE
0 Excessive Ponding 0 Hydraulic Ove rload 0 Frozen Ground D Heavy Me ta ls (Cu, Zn , etc.)
0 PAN 0 PAN > 10% or 10 lbs 0 Total Pho sphorus D Fai lure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Ev idence of Wind Driti D Application Outs id e of Area
14. Do the receiving crops differ from those des ignated in theCA WMP ?
15 . Does the receiving crop and/or land appli cation site need improvem ent ?
DYes ~No
DYes ~No
DNA
DNA
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre de te rrnination ?D Yes f&l No
~No
l;i] No
DNA
17. Does the facility lack adequate acreag e for land application?
18 . Is there a la ck of properl y operating wa ste a pplication equipment?
DYes
D Yes
DNA
DNA
Comments (refer to question#): Explain any YES answers and/or any recommendations or any other comments.
Use drawings offacility to better uplain situations. (use additional pages as necessary):
Reviewer/Inspector Name R~ R .. "e.ls Phone: '110. '1-33 , 3300
Reviewer/Inspector Signature: __:__ R...,~. • ~~ Date: /0 -IJ/-ZtJl) 7
ONE
ONE
ONE
ONE
ONE
• I-
t-...
12118104 Contmued
..
I Facility Number: 1?2 -~2z..l
Required Records & Documents
Date of Inspection l/o-O/-o71
19. Did the facility fail to have Certifi cate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
the appropirate box. 0 WUP D Checklists 0 Design D Maps 0 Other
DYes IJ)No DNA ONE
0 Yes f2! No DNA 0 NE
21. Does record keeping need improvement? If yes, check the appropriate box below. D Yes llJ No D N A 0 NE
D Waste Application D Weekly Freeboard 0 Waste Analysis 0 Soil Analysis D Waste Transfers 0 Annual Certification
D Rainfall D Stocking D Crop Yield D 120 Minute Inspections 0 Monthly and 1" Rain Inspections D Weather Code
22. Did the facility fail to install and maintain a rain gauge? DYes 1511 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 re quired by the permit? DYes ~No DNA ONE
25. Did the facility fail to conduct a sludge survey as require d by the permit? DYes ~No DNA ONE
26. Did the facility fail to have an actively certified operator in charge? DYes ~No DNA ONE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? DYes ~No DNA ONE
Otber Issues
28. Were any additional problems noted which cause non -compliance of the permit orCA WMP? DYes l;fl No DNA ONE
29. Did the facility fail to properly dispose of dead animal s within 24 hours and/or document DYes ij!J 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 [l)No DNA ONE
lfyes, contact a regional Air Quality representative immediately
3 1. Did the facility fail to notifY the regional office of e mergency situations a s required by DYes l;il No DNA ONE
General Permit? (ie/ discharge, freeboard problems, over appli cation)
32 . Did Reviewer/Inspector fail to discuss revie w /ins pection with an on-site representative? DYes [l)No DNA ONE
33. Does facility require a follow-up vis it by same agency? DYes ~No DNA ONE
Additional Comments and/or Drawings: ..
r-
-....
11128104
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason tor Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
D:ltC of Visit: I S"-02 --o(p .I Arrh·al Time: It: 1./0 fJ M I Departure Time: IL ___ ___.I County : sal!(, S()cJ Region: rl!lJ
Farm Name: K ~ T F~\r\IV\ Owner Email: --------------
Owner Name: _.._1<.=-e.=..:...i _,_~.::....>...-r~-T,__~..._.c.,..l..,.J .... c .... t=J-_-__,1~-=t..:....~---------Phone:
Mailing Address: -------------------------------------____ _
Physical Address:--------------------------------------------
Facility Contact: --!...4~!J~1-~...;!,.;=--uK:..!... -..!..'~"'~w=-___ Title: ---------Phone No:--------------
Onsite Representative: --==L~'-l~r'-..:.f...:.i..,.S!..___~Bo<!..ka~y=~wt:!!!...ll_!o,~:2..;K.:._ _____ _ Integrator: __ ....;;C= ... a.ho.vi e...
Certified Operator: 41/uJ K, 0 perato r Certification N u m her: ---'-;_...gL...LLf-..... f,__,7'------
Back-up Operator: ----------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D " Lon gitude: D OD 'D "
Design Current Design
Swine Capacity Population Wet Poultry Capacity
Current
Population
=lo=-w_c_a_n-to-F-in-is-h---..1-----'----.1----------.,.ID L ayer I I
~~~N~o n_-_L~a~y~e ~~~---~---~· ~ Wean to Feeder 3 2CJO I (#07J
.
i
· D Feeder to Fini s h
I
D Farrow to Wean ~
· D Farrow to Feede r t
D Farrow to Finish
D Gilts
D Boa rs I ..
Dry Poultry
D Lavers
D Non-L ayers
D Pullets
D T urkevs
.ID Oth er
D T urk ey Po ult s
0 Other
Othe r
Dis charges & Stream Impacts
I . Is a ny d is charge observed fro m any part of the operat ion?
Di scharge origina te d· at : 0 S tru cture D Appli cation Field D Other
a. \V as the co nv eya nc e man-made?
b. Did th e di scharge reac h wate rs o f the State? (If ye s. noti fy DW Q)
Cattle
Design Current .·
C apaCity Population
D DairvC ow I
D Da iry C al f I
D Dairy Hei fe1 .
D Dry Cow
D No n-D airy
I D Bee f Stoc kel
D B eef Fe eder I
D Bee f Brood Cow
I
.. -"
Number of Structures: D l
::.;
DYes ~No D NA ONE
D Yes ~N o D NA ON E
D Yes ~N o D N A ONE
c . Wh at is th e est ima ted Yo!ume th at reac hed w at ers of the State (ga ll ons)?
d . Does di sc harge bypass the waste ma nageme nt sys tem? (lf ycs , no ti fy DWQ)
2 . Is t he re evide nc e of a past d isc harge from any part o f the op erati on?
3. Were the re any ad verse impac ts or pote nti a l adverse impacts to th e Waters of the State
oth er than from a discharge?
D Yes lXI No
D Y es ~N o
DYes IE! No
12128104
D NA ONE
D NA O NE
DNA O NE
Co ntinued
!Facility Number: ~2. -~zz.! Date of Inspection ls-o-z -o~l
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 Stru cture 4
DYes ~No DNA ONE
DYes ~No DNA ONE
Structure 5 Structure 6
Identifier:-----------------------------------------
Spillway?: ,,
Designed Freeboard (in): __ _._/~9..__ __
Observed Freeboard (in): ----'3=-'tL. _'_' __ -----------------------------------
5. Are there any immediate threats to the integrity of any of the structures observed? DYes
(ie/large trees, severe erosion, seepage, etc.)
[ENo DNA ONE
6. Are there structures on-site which are not properly addressed and/or managed DYes MNo 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 ofthe stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
DYes IE No DNA ONE
DYes IE No DNA ONE
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
D Yes Iii No 0 NA 0 NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes ~No DNA ONE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes Iii No 0 NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn. etc .)
0 PAN 0 PAN> 10% or 10 lbs D Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Area
12. Crop type( s) _ __;:C:::.o:::::...:.•--.:..:ol'lit:....r-....::B:::....::(.~O!.:t~!dwu;Ju""-L!./Ic~zu;~,_ • ....,.... .... S"'~~Qu:OL'/-"fiio..L!:.-:t=.~:t~·,y~--=0:.....":...' t::..:ir:...S~~.;!WI...L...,......=~:..:u;.,:y~b~,:~ON..,..s......._,--=w:.=.Jfi<.J1u.<-..:a..::>o....Jt~----> r 1 J T 1
13. Soil type(s) /Var{'oll< i,Vaeca/44
I I
14. Do the receiving crops differ from those designated in the CA WMP?
15. Does the receiving crop and/or land application site need improvement?
DYes r5?! No
DYes [il No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'! 0 Yes rKI No
17. Docs the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
DYes ~No
DYes ~No
•• • , '· .. -. -' ' , I , '.-.V ~., ·--, -~ "-"·. '' • •
. Commeii.ts (refer to question #): ExpliUn any YES answers and/or any' reconimen«Jations ~r any"other comments.
Use drawings of,fadlity to'better explain situations. (use addit;ional pages as necessary):
" " " . --~-~ . -., .
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
Reviewer/Inspector Name rRic.~~ Reve:.t s-
Reviewer/lnspector Signature: ~ J?~
, I Phone: ('1/0) i.JV{g-/5'f/
Date: 5-o 2.-2.oo<C
12128104 Continued
I Facility Number: ~Z. -6221
Required Records & Documents
Dateoflnspcction IS-02-0~
19 . Did the facility fail to have Certificate of Coverage & Pe rmit 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 D Checklists 0 Design D Maps D Other
21. Does r ecord keeping need improvemen t? If yes, check the appropriate box below.
DYes ~No DNA ONE
DYes (1g No DNA D NE
DYes rjNo DNA ONE
0 Waste Application D Weekly Freeboard D Waste Analysis 0 Soil Analysis D Waste Transfers D Annual Certification
D Rainfall 0 Stocking D Crop Yield 0 120 Minute In spections 0 Monthly and I" Rain Inspections D Weather Code
22. Did the faci lity 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 0No ~NA ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes 0No 18JNA ONE
25. Did the facility fail to conduct a sludge survey as required by the permit? DYes 0No !&) NA ONE
26. Did the faci lity fail to have an actively certified operator in charge? DYes ~No DNA ONE
27. Did th e faci lity fail to secure a phosphorus loss assess m ent (PLAT) certificati on? DYes ~No DNA ONE
Other Issues
28. Were a ny additional problems noted which cause non-compliance of the permit orCA WMP? DYes 8No DNA ONE
29. Did the facility fail to properly dispose of dead animal s within 24 hours and/or document DYes KINo DNA ONE
and repo rt 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 Iii No DNA ONE
If y es, contact a regional Air Quality represen tative immediately
3 1. Did the facility fail to notify the regional office of emergency s ituations as required by DYes !»No DNA ONE
General Permit? (ie/ discharge , freeboard problems, over applica ti on)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site re presentati ve? DYes ~No DNA ONE
33 . Does fac ility require a follow-up visit by same agency? DYes f&1 No DNA ONE
A~ditio'nai corPment5 aod/or 'brawb.i:S: v.• ~ -~ (f ...
.0 Q " .
g
11128104
Type of Visit • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit e Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
Date of Visit: I ;J /JtfoJi Arrival Time:! 1;: L/5" I Departure Time: ._l ___ __.l Count~·: Sat""p ~.:-s .... Region:
Farm Name: 1-< "i T ~ o ~,...... Owner Email: --------------
\
Owner Name: .
> Phone:
Ph~·sical Address: c..bt;.Jc-
Facility Contact: ______________ Title:-----------PhoneNo: ________ ___
Onsite Representath·c: C .... ~-'-i..s. B~~Y.,~·, c..\c.. Integrator: -~C==:.o:;.._~-="'::;...,;,..• ·.:..:, ~=----------
Certified Operator: 0 1/e...., )(. __ h.:..-=~....:.z..._J----·----Operator Certification Number: --"J--'.i;__-L/.:._:LJ'-7 __ _
Back-up Operator: --------------------Back-up Cer tifica t ion Number:
Location of Farm: Latitude: D OD 'D" Longitude: D OD 'D "
Design · C~rrent Design Current
Swine C a pacity Population Wet Poultry Capacity Population
ID Wean to F in ish I I . .. 1110 l ayer I I I
D Non-Laver . . .
Cattle
Design · C~rre·n't ·.;
Capacity Popul~tlcin. ·
D Da iry Cow I
I
D Da iry Cal f r
I
liJ Wean to Feeder s..2o0 3110 l
Dry Poultry
D Dairy Heife1
I DDrvCow
D Non -Dairy I
I
D Beef Stocker ~ D Beef Feeder ;
D Beef Brood Cov. I I
-~
·• D Fee der to Fini sh
· D Farro w to Wean
D Farrow to Feeder
D Farr ow to Fini sh :
D Gi lt s I
D Bo ars
D layers
D Non-Lave rs
D Pull ets
D Turkeys
.. lQ Oth er J
D Tur key Po ult s
D O th e r
-
Number of Structures: wr Otber
I
Di scharges & S tre am Impa r ts
1. Is an y di sc harge o b se rved fr o m any part of th e o pe rat ion? D Yes liJ No D NA 0 NE
D is charge o rigi nated at: 0 Stru cture D Appli cation Field 0 Other
a . Was th e conveya nce man-m ade? D Yes 0 No D N A O NE
b . Di d the d isc harge reach wat ers of th e S tate? (If yes, notify DWQ) D Yes 0No D NA O NE
c . Wh at is the es tim ated volume that reac hed wate rs o f th e State (gallons )?
d . Does discharge bypass th e waste man ageme nt system? (I f yes , noti fy DWQ )
2. Is th ere eviden ce of a pas t di s charge from any part of th e operatio n?
3 . Were there any ad ve rse im pacts or potential adve rse im pacts to the Wa ters of the State
oth er tha n fr om a d isc harge ?
D Yes 0No
D Yes Jl1 N o
DYes ~No
1212810 4
D NA O NE
DNA O N E
D NA O NE
Co ntinued
!facility .Number: f;l -(,;) ~ Date of I nspcction 1.~ /1' I cf l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rai nfall) less than adequate?
a . If yes, is waste level into the structural freeboard?
St ructure I Structure 1 Structure 3 Structure 4
DYes 00 No DNA ONE
DYes 0No DNA ONE
Structure 5 Structure 6
Identifier :-~..:_::.~-/ ____ ---------------------------------
Spillway?:
Designed Freeboard (in): _---'i:?!L..:O:..:';....<I..:... __
"13 II Observed Freeboard (in): __ ... ~L.Io:-~------------------------------------
5. Are there any immediate threats to the inte~:,'Tity 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 DYes !.CJNo 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 heallh or environmental threat, notify DWQ
7 . Do any of the s tructures need maintenance or improvement ?
8. Do any of the stuctures lack adequate markers as requ ired b y 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. Arc then: any required buffers, setbacks. or compliance alternatives that need
maintenance/improvement?
DYes ltJ,No DNA ONE
0 Yes [gNo 0 NA ONE
DYes ~No DNA ONE
DYes CiNo DNA ONE
I I. Is there evidence of incorrect application? lfyes, check the appropriate box below. 0 Yes IX] No DNA 0 NE
0 Excessive Ponding 0 Hydraulic Overload D Fro zen G round 0 Heavy Metals (Cu, Zn, etc .)
0 PAN 0 PAN > 10% or 10 lbs D Total Phosphorus 0 Failure to [ncorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Area
12 . C rop type(s) _..!:f3::::..s;:e:..!:r:£Jm!:Z..!:i.+<=!::J!.fA-!:::...._..t:.tl:r..a~'t4J___.,.S~G!.I-/:...lo"-=.s~;--'C.....£<,:£.r..cai.....L/~wll.iJ.!:l...S:GP-e.:!.:+:;_,j/t......-S~..o~A..~.-____________ _
13 . Soil type(s) N.r ,4
1
4.!.:. /3
14. Do the receiving crops differ from those designated in theCA WMP ? DYes []INo DNA ONE
15. Does the receiving crop and/or land application site need improvement? DYes
16. Did the facility fail to secure and/or operate per the irrigation design or wenable acre deterrninatio n ~O Yes
17 . Does the facility lack adequate acreage for land application? DYes
[]!No
llJ No
l1J No
DNA ONE
DNA ONE
DNA ONE
18. Is there a lack of properly operating waste application eq uipme nt? DYes 0No DNA ONE
u .. ; .. ~ ·• ,. "' . -....
Comments (refer"to ques~on #):'ExPlain any YES apswers ~nd/or ~ny ·reco.D:unendations or I!:DY otb_er ~~eiits.
Use drawings offacility to·better exp~ situations. (use additioolil p~ges ~ ~eeessary):· ·.-'u ~ ~-; . • ·-•
'· 'I • '\.; #. ., ,~ • •: • • r~ ,.. . (: • .. ~ * A+ t-~ -. .J -\-~~c... L::::.."i c (U.... c. .... \(_~,..)
c.~~C.c..r,..>. \~·..> .,...._..,1 c.k4-~-c. ~~
t~v' c.-\ l .) ...J.D I 't
'.t c s i>~~: I+ 1
' i~
{'.:;. ,-_(' ..-<:-<... b G <"2.-c:?-.
c:o ._ f lc..+c~. ;It
C o ,. ...... ""'\--c.Q._
T"'\_ c::.. '{' A ).4
(>A)-l .,...,.,\-c::.. Co.-.ic.~b-c c::. .... ..), YYll". T~...., h •. ,,Q """'-~-\-e...__ J..cv-"'
.c.-,.. v-J~< ... ~, No ov~""'FIOI~<-o-\-i~ 1\...~ h".J:L + ... ~c.~ to I-=~ c...
,. .. · . . . .;~ ...
Re\iewer/lnspector Name !..r __ ....:...._.:..;• z=-=-:· 77~~.;:o~Jt':::....:;.A....;·c,~~~--· __ ·;..· _....._ _______ . _. ~· I Phone: 9 I 0 <tfrl.,-1.5 .I.((
Reviewer/Inspector Signature: Y ~ -zj,.._ .£!., Date: 3/1(. /6S
12128/04 Continued
I.:.Facilit);.Number: ~ .,2.. -G.iiJ Date of Inspection 13/t~ Jt.a.rl
Required Records & Documents
I 9. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
th e appropirate box . 0 WUP D Checklists 0 Design 0 Maps D Other
DYes [JNo DNA ONE
DYes [}JNo DNA ONE
21. Does re cord keeping need improvement? If yes, check the appropriate box below. 00 Yes 0 No 0 NA 0 NE ,; ~ ,;) ·"-
0 Waste Application D Weekly Freeboard 0 Waste Analysis D Soil Analysis 0 Waste Transfers 0 Annual Certification
0 Rainfall D Stocking 0 Crop Yield D 120 Minute Inspecti ons Ill Monthly and 1" Rain Inspections D Weather Code
22. Did the facility fail to install and maintain a rain gauge? DYes lXI No DNA ONE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes 0No ISZI NA ONE
24 . Did the facility fail to calibrate waste application equipment as required by the permit? DYes 0 No DNA I.KJ NE
25. Did the facility fai l to conduct a sludge survey as required by the permit? DYes 0 No DNA ~NE
26. Did the facility fail to have an actively certified operator in charge? DYes !XI No DNA ONE
27. Did the facility fa il to secure a phosphorus lo ss assessment (PLAT) certification? DYes 0No DNA ~NE
Other I ss ues
28. Were any addit ional problems noted which cause non-compliance of the permit orCA WMP? DYes CiJ No DNA ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes [1] 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 (jNo DNA ONE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of e me rgency situation s as required by DYes 00No DNA ONE
General Permit? (ie/ discharge. freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes [i) No DNA ONE
33. Does facility require a follow-up v isit by same agency? DYes I!JNo DNA ONE
-. .,. ··-..
Ad_ditionaJ <;omm~ts and/or DraWi,ngs:· · ·_.
;J 1-(.\ h-oc.:.'"'~\"\ wG\o+c:-.s.i-'·h:: .. .....-,. ..:_\...c.<.-\::... W\..~~ h<-co .... .o:2v....d~ ~~
d..Dc:...'-'--. '"""t c:-~ .. •~bo a.~"\ (>"'.::.~,~·.+~+\:., .... ~ ~vc...~...# o..C. i \ ...._~\,
~~ \-'\...<--'-' ..,.:4-co ...... rolc....+c. L-V.o..~+c..
;.~:.+-.ct I ~ ..... 1 ..
..... <·tJ ......... , .... G.. --""' ' .... ..} r c:: '"+ · . .,,_
c."c)t clo~tAw..~.o\-a.{.t()loo.. b ·1.
0Y' ~;+<:.. ..-c...f"'"-'c::.""'\-.,..-\-i.·...t-L s.\-~e..,.> ,or-ooR~c..c....-.
V<-~ .::.., -1--r_ c. f f' \ ~ c.o-\--1 t. ~~ •
11118104
Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ~utine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other D Denied Access
'----F-ac_i-lity_N_um_b_e_r_l_f_:J. __ H __ ,_~_~ ___ __.I Date of Visit: IO Not Operational 0 Below Threshold
B'Permitted EtCertified [] Conditionally Certified [] Registered Date Last Operated or Above Threshold: ·····-····-···-·-····
Farm Name: ..... --~-~ ... I._ ...... f~~.................................................................................. County: ..... ~~!:!.. ....... ----·-·-----.. -·---·-··-·
Owner Name: ......... '(!;ft. .... ~ ..... ~JJ~.IIJ .... Ji.~......................................................... Phone No: ....... .'-.!.~::.£~. 4 .~ . .!:J:.-~22 ................................ .
Mailing Address: ..... Lf!:~ ......... (Nh.;.~ ....... O.~K ....... f!.J!:4 ....... ~~-=----·--·-·-..... a~~-~_.,. ___ f!.(;.. ................ _____ ............ ~-~-~~ ......... .
Facility Contact: ........... Kr..~ ......... ~.~---··-·-····-·-·-·-····-·-Title: ........ ~~~---·· .......... _ ............ -.......... Phone No: ................................................. ..
Onsite Representative: ____ (1:._-ii~-------~!:~~.................................................... Integrator: ........ C..!.~I!:.t:..~ ........... 6~~----------·---
Certified Operator: .......... 1(.(0. ............ l.: ........ Ji~......................................................... Operator Certification Number: _.J.~':tf..?_ ............... .
Location of Farm:
~ne D Poultry D Cattle 0 Horse Latitude L.....-___.1• ~-....1 _...JI• L...l _.........JI" Longitude
I
Discharges & Stream Jmpacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: D 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 gaUmin ?
d. D ocs 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?
\\t'aste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? D Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
I
u••••n---.. •••••••n••ao••••••• Identifier:
Freeboard (inches): ~ J ----=---12112103
DYes ~0
DYes ONo
DYes ONo
DYes ONo
DYes [9'111o
DYes B'No
DYes B'No
Structure 6
Continued
jFacilit!.; Number: <j). -(, 'J.;..j Date oflnspection I S"ho /of I
5. Are there any immediate threats to the integrity of any of the structures observed? (ieJ 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 maintenanceJimprovement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
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 maintenancelimprovement?
11. Is there evidence of over application? H yes, check the appropriate box below.
D Excessive Ponding D PAN D Hydraulic Overload 0 Frozen Ground 0 Copper and/or Zinc
12. Crop type ~ .... -J.. lfJ 1 ),.."1/ f·.;~ ~rsu:JJ Cw-"' , 5ryL~-s 1 c.okaf
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.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
12112103
_;'"·->
DYes B1ifo
0 Yes [91'i[o
DYes ~o
DYes [i}No
DYes GJ'No
DYes [3-No
DYes @'No
DYes [!J-No
DYes [}No
DYes [J..No
DYes [J.No
DYes O'No
DYes [!tNo
DYes [J'fjo
DYes GlNo
DYes [ii'No
DYes 0'No
Continued
I Facill.tv Number: <i:z -''' I Date of Inspection I fl~/o+l
Required Records & Document-.
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. ~s record keeping need ~rovement? If y~ check the appropri~ box below.
0 Waste Application 0 Freeboard D Waste Analysis D Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design ?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel 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 Pennitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 3 I -35)
3 I . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
D Stocking Form D Crop Yield Form 0 Rainfall D Inspection After I" Rain
D 120 Minute Inspections D Annual Certification Form
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
[] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
-
12112/03
~0
g"No
[31iio
[:(No
[31-lo
I!( No
[!J'No
[!(No
[3No
EJ'No
DNo
0No
ONo
ONo
0No
. . •
, Site Requires Immediate Attention : P()
Facility No. -----
DMSJON OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: ~ ze , 1995
Time: )!3£
Farm Name/Owner:~JL'-="'..r.-r___,J;y....,.-==---._____,,t:::.J:;;=-« ... 4 kb=-... ..... -d=~T-N..:o;. -::-db~"--"v_.di'<=....;:Cc.J=------------
Mailing Address: ~ Rc ~ Ary z. 7C ,. c,.LL g c
County: ~N 7
·
Integrator: ~ ~ Phone: ______________ _
Phone: _____________ _ On s .ite Representative:~~:*= ~"!J<..
PhySJcaJ Address/Locabon: _ _;~~ .. ·~---L~~;;;...,~,4------......._--------------•
Type of Operation: Swine~ Poultry__ Cattle----------------
Design Capacity: l ~ ~ Number of Animals on Site: 32.® A.loc<c:st
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) Yes or No Actual Freeboard: 7Ft. --6...-Inches
Was any seepage observed from the lagoon(s)'? ~or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Ys the cover crop adequate? Yes or No
Crop{s) being utilized : _ _____.~-~~~-------------~~------­
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Y or No
100 Feet from Wells? <§or No
1s the animal waste stockpiled within 100 Feet of USGS Blue Line Stream'? Yes or NO')) ~
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue~: Yes or 't!Q)'
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 (volumes of manure, land applied ,
spray irrigated on specific acreage with cover crop)? @or No
Additional Comments: ________ --:--------:--------------:---r---
5a-"P C:ecX«J to ~AtL~.J •c-a•roQ ~U ~
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.
,
Site Requires Immediate Attention: N
Facility No. ____ _
OMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
OA TE: -;r~ lc:> , 1995
Time : 1:,~
Farm Name/Owner: __ -TJ..::='L::...+.x..__~T..__...c..h-=~:;....._-=----------------Mailing Address: _____________________________ _
County: s~
Integrator: ________________ Phone: ______________ _
On Site Representative: Phone: _____________ _
Physical Address/Location : ____________ ~--------------
Type of Operation : Swine Poultry __ Cattle-----------------
Design Capacity: -------Number of Animals on Site: -------------'--
OEM Certification Number : ACE.___ OEM 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 I Foot + 7 inches)~ or No Actual Freeboard : ') Ft. _Q_Inches
Was any seepage observed from the~n(s)'? Yes or @vas any erosion observed? Yes ~O.lt
Is adequate land available for spray? ~r No Is the cover crop adequate? Yes or No ~
Crop(s) being utilized: ______________________ _,_ ______ _
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelli~.<@or No
100 Feet from Wells? \:(9 o~
Is the animal waste stockpiled within 100 Feet of USGS Blue . Line Stream? Yes or~
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes ore
Is animal waste discharged into water~ 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 r s (volumes of manure , land applied,
spray irrigated on specific acreage with cover .crop)? Y or No
Additional Comments: Co-:,· J
Inspector Name Signature
cc: Facility Assessment Unit Use Attac hments if Needed.
...... ,
P1•••• r•tU%21 th• eamp1ete4 for= to the l)i.vi•ion of lttl.viroc::I&Zltal Hlu:lag-=-nt at
the addr••• em th• r•v-=•• •ide of thi.a fa%:Zl.
Name of f ann ( P 1 ea.se print)...: ~__.._k~J-.,.._~/--'h~.:...,...,.....:........:.....~;.S-~-:--=--....:...M;;.::!_; ~_l-,_"-__;1_1....:.:c(.;;.::~::.. ... .:....:..~_,.<-...;'"";...._---
Address: ~t 6 Rv£27') C/,-""'h=:> ..J (, ,?i']l("
Phone No.: s-' '1 -'tS7 7
County: ..5., -.... ~ :;,·""
Farm location : Latitude and Longitude:~~jU '~n/~:~1 ~··(required).
please atta=h a copy of a county road map with location identified.
Also,
Type of operation (swine, layer, dairy, etc.)=---""""""·;..;·..,.._~~------------
Design capacity (number of animals): J:Joo ,.,,.,,.ferz: P·~J
Average size of operation" (12 month population avg. )1
: ~.;o .;) " .. ,..,? e· >J
Average acreaQe needed for land application of waste (acres)• w •&'(>
••m••••••••••••••••••••••••••••••••••z•••••••••••••••=••••••••••••••••••••••••
Technical Speeiali•t C•rtifieaticm
As a technical specialist designated by the North Carolina Soil and Water
Conservation Commission pursuant to lSA NCAC 6F .0005, I certify that the new or
~anded animal waste manaQement system as installed for the farm named above
has an animal waste management plan that meets the design, construction,
operation and maintenance standards and specifications of the Division of
Environmental Management and the t1SDJ..-Soil Conservation Service and/or the North
Carolina Soil and Water Conservation Commission pursuant to lSA NCAC 2H.02l7 and
lSA NCAC 6F .0001-.0005. The following e~ements and their co~responding minim~
criteria-ha~en_verified by me or other designated tec~~i cal specialists and
are included in the plan as applicable: minimum separations (buffers): liners or
~ivalent for lagoons or was~e storage ponds ; waste storage capacity: adequate
quantity and amount of la.."'ld for waste utilization (or use of third party); access
or ownership of proper waste application equipment: schedule for timing of
applications; application rates; loading rates; and the control of the discharge
of pollutants from stor::IWater runoff events less severe than the 25-yea.:::-, 24-hour
stor.n.
Bam• o~ '1'echni cal Sp•ciali•t (Please Print) : __ C. __ "'_--_h_._.l> __ B_a_r_-v_> ... c--lf.-------
Affiliation:' wt..s.-,·e.. h.r.-.. ~
Address (Agency),~,. ~i'"' h ;1<1>S Phone No. 'ltcz> £:1.-'-"~' S~gnature: __ ~~,-~~~~~~~~~~~--~---------------Date : __ ,~---/_-~f~S-~ ______ __ ··········-························-··························-----··· OW:Q•r /Kar.a gar Ag:-•emant
I (we) ~~derstand the operation and maintenance procedure~ established in the
approved animal waste management plan for the failll named above and will implement
these procedures. I (we) know that any additional expansion to the existing
design capacity of the waste treatment and storage system or construction cf new
facilities will require a new certification to be submitted to the Division of
Environmental Management before the new animals are stocked . I _(we) also
understand that there must be no discharge of animal waste from this system to
surface waters of the state either through a man-made conveyance or through
runoff from a storm event less severe than the 25-year, 24-hour storm. The
Approved plan will be filed at the farm and at the office of the local Soil and
Water Conservation District.
Name of Land OWner (Please Print): ___ ~ __ ~_e_/._V._~-'~~-ar1t __ ~_e_•_v ______________________ ___
Signature :_-+,/_./U~-~=-;.J.....,jtJ~-""t_~z&-.::::>.._""_/ _________ Date : £-/-9~
Dame of Kanager, if different from owner (Please print): ____________ _
Signature: Date: __________ _
~: A change in land ownership requires notification or a new certification
(if the approved plan is changed) to be submitted to the Division of
Environmental Management within 60 days of a title transfer .
~-11. 11, f-~ ~d le
t1 c. /{e., z,/ (_
OEM USE ONLY:A~~------------------
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