820634_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quality
COIDJ!liance Inspection Operation Review 0 Structure Evaluation
Reason for Visit: crRoutioe 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Otber 0 Denied Access
Date of Visit: I Jt .:ruAiE"It&!Arrival Time:l II! 3o{f I Departure Time:l u ( .s rd I County: S.tnt'"" ,A} Region:f:f'ZO _g l
Farm Name: ~ yv.J~·--y e"'C.----'~ .r e 0""' r==~V'"'V\.... Owner Email: ----------------
Owner Name : ~\M. W...i B Lv-tle-~ P"C/ko ""-Phone:
Mailing Address:
Physical Address:
Facility Contact: C. (L "-~ S B' < v-lvl'c v{( Title:
Onsite Representative: l
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Discharees and Stream Impacts
I. Is any di scharge 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 di sc harge rea ch waters of the State? {If yes, notify DWR )
c . What is the estimated volu me tha t reached waters of the State (gallons)?
Pbone:
Integrator:
Certification Number: 9 [ 7 773
Certification Number:
Longitude:
0 Yes (g.-N"OTI NA D NE
0 Yes DNo ~ONE
DYes DNo [3-NA D NE
d . Does the discharge byp ass the waste management system? (If yes, notify DWR) 0 Yes 0No C}W.: O NE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State o ther than from a di sc harge?
Pagel of3
0 Yes
DYes ~ DNA ONE
D NA ONE
21412015 Continued
!Facility Number: lnate oflnspection: /li;Ju.-"'\..L/01
~ste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .Do
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 ~NA ONE
0 Yes D No EJlifA[]. NE
Structure 5 Structure 6
DYes ~NA ONE
0 Yes c:T-NoD NA 0 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes~ DNA ONE
DYes ~DNA ONE
DYes ~DNA ONE
DYes ~DNA ONE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~ 0 NA 0 NE
D Excessive Ponding D Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn, etc.)
D PAN 0 PAN> lO% or 10 lbs. 0 Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Approved Area
12. Crop Type(s): c tv 6, (/-1 f p) c [3 ~ p g (5 0
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
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 the CAWMP readily available? If yes, check
the appropriate box .
0 WUP Dchecklists D Design 0 Maps 0 Lease Agreements
0 Yes
DYes
0 Yes
0 Yes
DYes
0 Yes
DYes
Oother:
8-No DNA
~DNA
~DNA
~DNA
Q..Nt5-o NA
[M-No DNA
~ DNA
ONE
ONE
ONE
ONE
ONE
ONE
ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. DYes ~DNA ONE
D Waste Application D Weekly Freeboard D Waste Analysis 0 Soil Analysis D Waste Transfers D Weather Code
D Rainfall 0 Stocking 0 Crop Yield D 120 Minute Inspections 0 Monthly and 1" Rainfall Inspections D Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? DYes ~ DNA 0 NE
23. If se lected, did the facility fail to install and main tain rainbrea kers on irrigation equipment? D Ye s ~ 0 NA 0 N E
Page 2 of3 21412015 Continued
!Facility Number: ~2: -b3 9 lDate oflnspection: 'Z..b \}}A'(. 18"" I
24. _Did the facility fail to calibrate waste application equipment as required by the pennit? ,
25. Is the facility out of compliance with permit conditions related to sludge? lfyes, check
the appropriate box(es) below.
DYes ~DNA ONE
0Yes B"<DNA ONE
0 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date offrrst survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field D Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
DYes
0 Yes
0 Yes
0 Yes
0 Yes
0 Yes
0 Yes
DYes
0 Yes
~NA
0 DNA
I1J.>h> 0 NA
~ DNA
[91'fo' DNA
~ DNA
~DNA
~DNA
~ DNA
Comments (refer to question#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better eJ:plain situations (use additional pages as necessary).
g/4._£7-<-s(A~v~7--II-21 -17
0-3. cr P-5.7 l( ~~
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ReviewO</Inspoctoc Nameo 0 i \1 D vV\ 'Is
ReviewO<Ilnspectoc Signatuce: '\S'J T ! ~
Phone:Cf{o-r3 )~3 Y
Date: ~ k .JV. -1 t/ { 8
Pagel of3 214/2015
Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ~utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: l'l:-5 ~ ff/ Arrival Time: I 2 ~1 u /' I Departure Time: l.f~ .Jill? I County: ~Jt-Yz.r Region: ff?O
Farm Name: Taatt.vy P ,.{~,._ 5<.?'1 C04"""-Owner Email:
Owner Name: JP H-~7 1'3 ~:-(-1-r:~ P Y"fr/ti.?..-'L Phone:
Mailing Address:
Physical Address:
Facility Contact: Phone:
Onsite Representative: Integrator: 1118 -S
Certified Operator: Certification Number: ~ ~ ] 7 7 3
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
I. Is any discharge observed from any pan 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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
Certification Number:
Longitude:
0 Yes Gf1\fo
0 Yes 0No
0 Yes 0No
d. Docs the discharge bypass the waste management system? (If yes. notif)' DWR) 0 Yes 0No
2. Is there evidence of a past discharge from any pan of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
0 Yes Q-No
0 Yes lZJNo
0 NA ONE
EJNA ONE
c:JNA ONE
~A ONE
DNA ONE
DNA ONE
21412015 Continued
I Facility Number: I nate of Inspection: &-. r a 7 ;?I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) Jess 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): .3 (>
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 I1}NO DNA 0 NE
D Yes D No CJ-NA D NE
Structure 5 Structure 6
DYes G51'fo DNA D NE
D Yes @'No D NA D NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks. and/or wet stacks)
9. Does any pan 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?
D Yes [3""No
DYes Gr'No
DYes [3'No
DNA ONE
DNA ONE
DNA D NE
0 Yes c;J-No DNA 0 NE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~o D NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
D PAN D PAN> 10% or 10 lbs. D Total Phosphorus 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Dici the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
Page 2 of3
S'f,'b
DYes
DYes
DYes
DYes
0 Yes
0 Yes
0 Yes
Oother:
0 Yes
g<o DNA ONE
CJ-No DNA ONE
p»r DNA ONE
[}No DNA ONE
CJ'No DNA ONE
~No DNA ONE
l;ZfNo DNA D NE
[d1\lo
21412015 Continued
IFacili~ Number: ~A.-6jl(_ !Date oflnseection: --:-.Js /f/7-,t;ZI
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes ~ DNA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes ~ DNA
. . the appropriate box(es) 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? 0 Yes [Lt1'fo" DNA
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes ~ DNA
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document 0 Yes ~ 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? 0 Yes [31'Jo 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 0 Yes ~0 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 Lj"No DNA
0 Application Field D Lagoon/Storage Pond D Other:
32. Were any additional problems noted which cause non-compliance ofthe permit or CAWMP? 0 Yes [d-No 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 G3 No DNA
CoD:u:ilents (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).
e_<:{.kb~i/:~ _ f-3v/(fo
S(J; .{__ Su_tu4'1 -4-n -t'
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Reviewer/Ins pector Name: Phone:CfrD Lf_3 J-_i _~ 3 r
Rev iewer/In spector S ignature : Da te : ~ 5 n<, r1
Page3 of3 21412015
I
t
r
Compliance Inspection Operation Review 0 Structure Evaluation
Reason for Visit: ~utine 0 Complaint 0 FoUow-u 0 Referral 0 Emergency 0 Otber
Date of Visit: I/P-aac--1 ~ I Arrival Time :I /, 1
/) (}
Farm Name:
Departure Time: I ,1 .' !£ I County: _5"~ Region: E'J<. U
Owner Email:
Owner Name : Phone:
Mailing Address:
Physical Address:
Facility Contact: 6J-I' r...-,.,.r 1/f!Jtflr"r::-Title: --~~~~~~~~-----------Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: 9-8':77 2?
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
I . Is any di sch arge o bserved from any part of the operation? DYes [Z}No DNA ONE
Di scharge orig inated at: 0 Structure D Applic ation Fi eld 0 Other :
a. Wa s th e conveyance man-made? 0 Yes 0 No DNA ONE
b. Did the di scharge reach waters ofthe State? (If yes, notify DWR) 0 Yes 0No DNA ONE
c. What is th e es timated volume that reached waters of th e State (gallons)?
d . Does the di sc ha rge bypas s the waste management sys tem ? (If ye s, notify DWR) 0 Yes 0No DNA ONE
2. Is there evi dence o f a pas t disc harge from any part ofthe op eration ?
3 . Were there any ob servable adverse impacts or potential adverse impacts to the waters
of the State other th an fro m a di sc harge?
Pagel of3
DYes
0 Yes
!2:9--No DNA ONE
~0 DNA ONE
2/4/1015 Continued
loate of Inspection: JP?Zo-;b
) 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): .2-I
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
0 Yes 0--No 0 NA 0 · NE
DYes DNo DNA ONE
Structure 5 Structure 6
0 Yes 2S-No 0 NA 0 NE
DYes ~No 0NA 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 ofthe structures need maintenance or improvement? IEJ Yes ~ NA 0 NE
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
0 Yes (3-No 0 NA 0 NE
0 Yes ~o 0 NA 0 NE
0 Yes ~No 0 NA 0 NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~o 0 NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN> I 0% or 1 0 lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): Corn / w/~.7'-/.5qyk-..s /Faa~ I J3rr/Jtt~~ /ut-'~.:S ~of
13. Soil Type(s):
14. Do the receiving crops differ from those designated in theCA WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure arid/or operate per the irrigation design or wettable
acres determination?
17. Does the facilir Jack adequate acreage for land application?
18. Is there a lack ~f properly opera'img waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
0WUP Dchecklists 0 Design 0 Maps D Lease Agreements
0 Yes ~No DNA
~Yes 0No DNA
0 Yes b?LNo DNA
DYes ~0 DNA
DYes ~No DNA
DYes ~0 DNA
DYes ~0 DNA
Oother:
ONE
ONE
ONE
ONE
ONE
ONE
ONE
21 . Does record keeping need improvement? If yes, check the appropriate box below. DYes ~0 DNA ONE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers D Weather Code
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? D Yes ~No D NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes 181.. No 0 NA 0 NE
Page 2 of3 2/412015 Continued
!Facility Number: @ -4?,?d [Date of Inspection: 1!.2-,?t)'Lb
~ 24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes QfNo D NA 0 NE
1 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes ~No D NA 0 NE
the appropriate box(es) 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?
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 nonnal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
lfyes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i .e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes , check the appropriate box below.
0 Application Field D Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
DYes
DYes
DYes
0 Yes
0 Yes
0 Yes
0 Yes
0 Yes
D Yes
llJ-No DNA
(2].No DNA
{2iNo DNA
~No DNA
~0 DNA
~No DNA
[gl No DNA
12?1No DNA
f.Z}-No DNA
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).
~ltLir-rJ-t:~i~~F<~ 6/ 1/L"e-. ,P-eJ/t _
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
f?r'm rc~vt/c) 17J rr?-c it~~ r-~Jm,~ ?{.. ?CJA-.
YP a tf,J )Jo+ahl>-~ 7/-1/ tJ F p v r ? .+N -bFFi> r £ifpff0 F' ,Yll" rf?<l /5,
?f;l /0 ur f-1JOtJ"-1--c-vcf Wdft A.X!-£-.pw,-n-1 7P ::!?4" /<'P?/ by ee/' /~"
--d;~ ('p..:;f r'bi<-J;:.j 77 /~"' ;JiJ..,__ C'/i7'1._//..;J 7"'" l-eu~& J-dr, I
_:C" tll'1~~"'r.::7~ /J1fl;y?tU c:J,-~/4 ?Ch,7-e _7/;zyp;/c;P _;;z..o.-"'-/.b iJ '3
:z0 p'« ,?,:~v~ you/ (?p--~«-',.,..,...J Jll' Po/:' ?'7' -7' ad 1
5 -r. ,
.... .c:;. I w·!,/ J 't" T~r~r-;-r...---1-o C:/3?1flJ~odr~ pF o.n/ frvlo/,.-/-
111 r ormt?-IJ-1 //
v:· tJf-;',i;~, jJrJ--j-..,. :-·d:::· you.. uJ~ C&M.,.rcJ ~
~ rx. )cu'r::-j/-tr.'OP~_//t:?""--;Jf~ y6'V /111/..f"} frC~r/-:T ~ y~-,pr
tO #' 5 'i?.l< ;;-. r>-c~~ ~u'ir-co~ j;_J-?/-:;?t:J/6
Reviewer/Inspector Name: ----Z::.......::?n..£.:::.-..t::~...!o ....... _,.J. ___ .... /c::..-~?Z-'~~~"'7'"""-.-----------
Reviewer/lnspector Signature: ~
Page 3 of3
Phone: C}jp-.I£?3 t.}/.5/
Date: /tJ -:?f? ~;;ze;/b
11412015
ompliance Inspection Operation Review 0 Structure Evaluation
Reason for Visit: ~tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Denied Access
Date of Visit: l//-?ffl Arrival Time:l /?.'DD I Departure Time:l ;;;.; 3u I County: 7 tr--Region: ~'{)
FarmName: ym~ P<~~ f7:?r.n-OwnerEmail:
OwnerName: ~o/ ft4,r ~~o----Phone: ~-
Mailing Address:
Physical Address: _______________________ ,__~J:...._ ___________________ _
Facility Contact: {3r z;:yv Mot~r<---Title: 7Z7 5/d-~; Phone: -~~-~~?7~-----
0nsite 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: D Structure 0 Application Field
a. Was the conveyance man-made?
D Other:
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters ofthe State (gallons)?
Integrator: ___;A....:...._'it...:z.j5:::...... ___ .....:.... ____ _
Certification Number: 9}r? 7?[>
Certification Number:
Longitude:
O Yes !!}-No DNA ONE
DYes 0No DNA ONE
DYes 0No DNA ONE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) 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
DYes
DYes
~No DNA ONE
SNo DNA ONE
21411014 Continued
' I Facility Number: @ -eqq I loate of Inspection: L/= 9:5/£ I
Waste CoUection & Treatment
"' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure2 Structure 3 Structure4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3.r
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 th ere structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
0 Yes IZJ-No 0 NA D NE
D Yes 0 No 0 NA D NE
StructureS Structure 6
0 Yes j2g.No 0 NA 0 NE
D Yes 12}No D NA D NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threa~ notify DWR
7 . Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
D Yes ~No DNA ONE
D Yes ~No DNA O NE
D Ye s ~No DNA O NE
0 Yes (B.No D NA 0 NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~o DNA D NE
D Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn , etc.)
D PAN 0 PAN > 10% or 10 lbs. D Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window D Evidence of Wind Drift 0 Application Outside of Approved Area
12. Cmp Typ,(s) c-:J:!.U/£.ti/f:-: I 1"-'r:J;&w ,L'.z>z-,-IZJ..,Lev-Y,../
13. Soil Type(s): __ IW/k .t . ~ ~-->
'
14 . Do the receiving crops differ from those designated in theCA WMP?
I 5. Does the receiving crop and/or land application site need improvement?
I 6. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility Jack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
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 the CAWMP readily avai lable? lfyes, check
the appropriate box .
O wuP 0 Checkli sts 0 Design 0 Map s D Lease Agreements
D Yes [$.No DNA
D Yes ~No DNA
DYes (3_No DNA
D Yes 0--No DNA
0 Yes !;SiNo DNA
DYes (3_No DNA
DYes ~No DNA
O other:
ONE
ONE
O NE
O NE
ONE
O NE
O NE
2 1. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes (L}No DNA O NE
0 Waste Application 0 Weekly Freeboard D Waste Analys is D Soil Anal ysis D Waste Transfers D Weather Code
D Rainfall 0 Stocking 0 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? 0 Yes ~No 0 NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Ye s ~o 0 NA 0 NE
Page 2 of3 21412014 Continued
·!Facility Number: !Date of Inspection: /,1-'l--J£ I
24. Did the facility fail to calibrate waste application equipment as required by the permit?
\
25. Is the facility out of compliance with permit conditions related to s ludge? If yes, check
the appropriate box(es) below.
DYes (21'-No DNA · D NE
DYes 0No 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 offlfSt survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28 . Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
DYes (B-No DNA ONE
[j Yes {EJ..No DNA ONE
DYes Q9..No DNA ONE
D Yes llf-No DNA ONE
DYes ~0 DNA ONE
DYes ~No DNA ONE
D Application Field 0 Lagoon/Storage Pond D Other: ------------------------
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes ~No DNA ONE
33. Did the Reviewernnspector fail to discuss review/inspection with an on-site representative? DYes [3-No DNA ONE
34. Does the facility require a follow-up visit by the same agency? DYes ~No DNA ONE
Comments (refer to question#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings offacility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
R eviewer/Ins pector Signature:
Page 3 of3
Phone: /7!)--J/ffQCJO
I
Date : ~~~~_s-
21412014
0 Denied Access
DateofVisit: R-Jl-IL/ I ArrivalTime:ICf:-oo Departure Timed /';). ~ .:J '0 I County: ~~ Region:
FarmName:~~~~~~~~~rrt~{~~~~---~~~~~~~~~~--~-/--~-----------Owner Email:
Owner Name: 1timt11f 15u Tire 7~ ~,.3 o-Phone:
Mailing Address:
Physical Address:
Facility Contact: ~~::~~~~~~,r~~~/11~~~Dv:~~~~~~~~~~~~~~-T-i-tl_e_:~~~~~:~~~~~~~~:~~-~-~-C~---·--~---_-_----P-bo_n_e_: ____________________ _
Onsite Representative: Integrator:
Certified Operator: Certification Number: ~773
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
LIs any discharge observed from any part of the operation? DYes ~No DNA ONE
Discharge originated at: 0 Structure D Application Field D Other:
a. Was the conveyance man-made? DYes 0No DNA ONE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) DYes 0No DNA ONE
c. What is the estimated volume that reached waters of the State (gallons)?
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 1 of3
DYes liZJ..No
DYes ~No
DNA ONE
DNA ONE
21412011 Continued
!Facility Number: !Date of Inspection: 9-I 1-I 4
• Waste Collection & Treatment
4 . Is storage capacity (structural plus storm storage plus heavy rainfall) les s 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): / q
Observed Freeboard (in): .J L/
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6 . Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
0 Yes ~No
0 Yes 0 No
DNA ONE
DNA ONE
Structure 5 Structure 6
0 Yes [2iNo DNA 0 NE
0 Yes rn No 0 NA 0 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9 . Does any part of the waste management sys tem other than the waste strucrures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
0 Yes ~No
0 Yes 12?l.No
0 Yes 00No
DNA ONE
DNA ONE
DNA ONE
0 Yes kl No 0 NA 0 NE
11 . Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~No D NA 0 NE
0 Excessive Ponding 0 Hydraulic Overlo ad 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN > 10% or 10 lbs. 0 Total Phos phorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outs ide of Acceptable Crop Window 0 Evide nce of Wind Drift 0 Application Outs ide of Approved Area
12. Crop Type(s): Cm:r/ t</1 ... </-/5~~ ,/J='l~ / ,h,.-~~./PVT"-'3~
13 . Soil Typc(s): N'llC.fn/~ <T 1\a ~...y
14 . Do the receiving crops differ from tho se des igna ted in theCA WMP?
15 . Does the receiving crop and/or land application s ite need improveme nt?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
22. Did the facility fail to install and maintain a rain gauge?
23 . If selected, did the fa cility fail to in stall and m ai nta in r ain bre akers o n irrigation equipme nt?
Page 2 of3
0 Yes t4No
0 Yes l)iNo
0 Yes 1)21 No
0 Yes ~No
DYes IXJ No
DYes ~No
DYes ~0
00ther:
DYes ~No
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DYes ~o DNA ONE
0 Yes ~No DNA 0 N E
21411011 Continued
[Facility Number: I Date of Inspection: Cf-11 ,.... J Lf
"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 ~No DNA D NE
D Yes ~ No D NA D NE
0 Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance :
26 . Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and" report mortality rates that were higher than normal ?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes , check the appropriate box below.
D Yes ~No D NA 0 NE
0 Yes (B.No 0 NA D NE
0 Yes (&No DNA D NE
D Yes {8._No DNA D NE
D Yes 1)4 ~o 0 NA 0 NE
0 Yes [3_No 0 NA 0 NE
0 Application Field D Lagoon/Storage Pond D Other: --------------------
32. Were any additional problems noted which cause non-compliance o f the permit orCA WMP?
33. Did the Reviewer/Inspector fail to discuss rev iew/in spection with an on-site representative?
34. Does the facility require a follow-up visit by the sam e agency?
0 Yes ~No
0 Yes I:&No
DYes ~o
DNA ONE
DNA ONE
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).
Revi ewer/Inspector Name:
Reviewer/Inspector Sig nature:
Page3 of3
..... ,·-
Phone: ?7t>:!('Yrh oo
Date : 9--//-/f'
214/2011
Reason for Visit:
LO~nce Inspection Operation Review 0 Structure Evaluation Technical Assistance
er'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Den ied Access
Date of Visit: I #9"7Jt"31 Arrival Time: I '? : Q D Departure Time: 1/ 0: J 0 I County:~~ Region: F:i' 7J
Farm Name: Mlt'!d!J' "f?,.,%,:$ ~ C~ ~ Owner Email:
OwnerName: ~~y p4f.~~ e~'$tr-' Phone:
Mailing Address :
Physical Address: --------------------------------------------------------------------------
Title: Phone: Facility Contact: ~r.,.-, IJ1opr-c_ ------------
Onsite Representative: -~"""'"'~"".....;;.. __ . _______________ _
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at : D Structure 0 Application Field
a. Was the conveyance man-made?
0 Other:
b. Did the d ischarge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Int<grator: lH«~ -/
Certification Number: CZ.K 7 7 3
Certification Number:
Longitude:
DYes ~No DNA ONE
DYes 0 No DNA ONE
D Yes 0 No DNA ONE
d. Does the discharge bypass the waste management sys tem? (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 1 of3
DYes
D Yes
~No DNA ONE
!&_No DNA ONE
21412011 Continued
!Facility Number: Y'E· lhi I [Date oflnspection : fJ:'?t:/"3
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 Strucrure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any ofthe strucrures observed?
(i .e., large trees, severe erosion, seepage, etc.)
6. Are there strucrures on-site which are not properly addressed and/or ma naged through a
waste management or closure plan?
0 Yes ~No 0 NA 0 NE
0 Yes 0 No 0 NA 0 NE
Structure 5 Structure 6
DYes ~No DNA ONE
DYes ~No DNA ONE
If any of questions 4-(i 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 strucrurcs lack adequate markers as required by the pennit?
(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 requ ire
maintenance or improvement?
Waste Application
I 0 . Are there any required buffers, se tbacks, or compliance alternatives that need
maintenance or improvem en t?
DYes ~No
DYes ~No
0 Yes ~No
DNA ONE
DNA ONE
DNA ONE
DYes ~No DNA ONE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~No 0 NA 0 N E
0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN > 10% or 10 lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): &KAA t' / C{)trt / /Uj, J(.f.~k,-2.
13 . Soil Type(s): bar#;tff I t.JociPLis
I
14 . Do the receiving crops differ from those designated in theCA WMP?
15 . Does the receiving crop and/or land application si te need improvement?
16 . Did the facility fail to sec ure and/or operate per the irrigation de sib'll or wettable
acres determination?
Page 2of3
0 Yes
DYes
DYes
0 Yes
DYes
DYes
DYes
Oothcr:
0 Yes
~N o DNA ONE
~No DNA ONE
~No DNA ONE
~No DNA ONE
B[No DNA ONE
29No DNA ONE
~No DNA ONE
~No
2/412011 Continued
!Facility Number: lnate oflospection: zr-;21 -J? l
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facil ity out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
D Ye s l2a No 0 NA 0 NE
0 Yes 1M No D NA 0 NE
0 Failure to complete annual sludge survey 0 Failure to develop a POA for s ludge 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 docwnentation of an activ ely certified operator in charge? DYes (ENo DNA
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? DYes ~No DNA
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes !Zl.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 ai r 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)
3 1. Do subsurface tile drains ex ist at the facility? If yes , check the appropriate box below. DYes 18,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 ~No DNA
33. Did the Reviewer/Inspector fail to di scuss review/inspection with an on-site representative? DYes fi(J No DNA
34. Does the facility require a follow-up visit by the same agency? 0 Yes l5lJ.. No 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).
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Reviewer/Inspector Name:
R eviewer /Inspect or Si!:,'lla ture :
Phone: 'fj 0-1{3:J?.:Jt,-c?
Dat e: s--;J.)-201:3 •
Page3of3 114/201 1
Reason for Visit: Denied Access
Date of Visit: liP -Jf:tif-Arrival Time:l/0 yc Departure Time:IJl ! DV I County: ~p---Region: el;(J
Farm Name: ftm"" 1./ P -z:-Tii:r ~ 0"-f7u''f'Y\.-Owner Email:
( Tammy -s,d-1-r-;-Owner Name: Phone:
Mailing Address:
Ph ysical Address: -------------------------------------------
Facility Contact: _ __;G .... ~~.L.,:;~;...,t~...:..r_....~.@.~uO.~t?:...;,."'"k.....:... __ Title: --.~.M:.._:..~....r.;i::;...;:;·--::::>.~~~~-~-c:;....:...' __
Integrator: /?fJt f'" 4f 7T
Phone:
Onsite Representative:
Certified Operator: Certification Number: 1"8" /?? _3
Back-up Operator:
Location of Farm: Latitude:
Disch a rges a nd Stream lmpacts
I . Is an y discharge observed from any part of the operation?
Discharge originated at: 0 Structure 0 Application Field
a . W as th e conveyance man -m ade?
0 Other:
b . D id th e discharge reach waters of the State? (lfycs, no tify DWQ)
c . What is th e estimated volume that reached waters of the State (gallo ns)?
Certification Number:
Longitude:
DYes ~No
0 Ye s 0No
0 Yes 0No
d. Does the di sch arge bypass the was te manageme nt system? (If yes , notify DWQ) DYes 0 No
2. Is there eviden ce of a past discharge from any part of the operation?
3. Were there any observab le adverse impacts or potent ial ad verse im pacts to the waters
of the State other than from a di scharge ?
Page I of3
DYes 129-,No
D Yes [8-No
D NA ONE
DNA ONE
DNA ONE
D NA ONE
D NA ONE
DNA ONE
214/2011 Continued
• !Facility Number: e!";h -k ~Jf l
Waste Collection & Treatment
I Date of Inspection: /1;2--~
• 4. Is s torage capacity (structural plus storm storage plus heavy rainfall) le ss than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifie r :
Spillway?:
Designed Freeboard (in): Itt
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any ofthe struct ures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
0 Yes ~ No 0 NA 0 NE
0 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 ~·es, and the situation poses an immediate public health or env~mental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ~--;;s ~o 0 NA 0 NE
8. Do any of the structures lack adequate markers as required by the permit? 0 Yes ~No DNA 0 NE
(n ot 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 o r improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that n eed
maintenance or improvement?
D Yes ~No 0 NA D NE
0 Yes ~No 0 NA 0 NE
II. Is th e re evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes 1]1-No 0 NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 H eavy Metal s (Cu , Zn. e tc.)
0 PAN 0 PAN > 10% or 10 lb s. 0 Total Phosphorus 0 Failure to Incorporate Manure/S ludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evid ence of Wind Drift 0 Application Outside of Approved Area
12 . Crop Type(s): fr:.; C,.U=r:-/Cor-fl. / u)'&~ 1¥-?
13. Soil Type(s): /Saii'J.,f ,/;vecifz/k
14. Do the receiving crops differ from those designated in theCA WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secu re and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility Jack adequate acreage for land app li cation?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the faci lity fa il to have a ll components of theCA WMP readily available? I f yes, check
the appropriate box.
owuP O c heckl ists D Des ign 0 Maps 0 Lease Agreements
2 1. Does record keeping need improvement? If yes, check th e appropriate box below.
0 Yes pzJ No
0 Yes ~No
0 Yes [2Sl No
0 Yes O?J No
0 Yes 12J.No
DYes (&No
DYes mNo
0 0thcr:
0 Yes L&) No
DNA O NE
DNA O NE
DNA ONE
DNA O NE
D NA O NE
D NA O NE
0 NA ONE
0 Was te Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Anal y sis 0 Waste Transfers
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute In spections 0 Monthly and I" Rainfall In s pections
D NA O NE
0 Weather Code
0 Sludge Survey
22. Did the faci lity fa il to in stall and m ainta in a rain gauge?
23 . I r selected, did the facility fail to install and maintain rain breakers on i rrigation equ ipment ?
Page1of3
0 Yes ~No 0 NA 0 NE
0 Yes (2l No 0 NA 0 NE
11411011 Continued
· I Facility Number: loate of Inspection: J~-Jt-.?J>t't-
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 (g_No DNA D NE
DYes !23-No DNA D NE
D Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
D Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
lfyes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes IS{! No DNA ONE
DYes [i:J No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
D Application Field 0 Lagoon/Storage Pond D Other: ------------------------
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes l8{No DNA ONE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes ~No DNA ONE
34. Docs the facility require a follow-up visit by the same agency? DYes 0-No 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).
R eviewer/Inspe ctor Name:
Reviewer/Inspector Signature:
Page3of 3
Phone: 91()--pr3;Joo
Date: /.:?J-Lj'--~/ .,;::;._
214/10II
ompliance Inspection Operation Review
Reason for Visit: ~tine 0 Complaint 0 FoUow-up 0 Referral 0 Emergency 0 Other
Date of Visit: Departure Time:! N!?P I County~~­, , 19:-19:1/l Arrival Time:l '/.'J V
Farm Name: fa.ql/ll v &trl-~rP-rar,.,.._, --~~~7/L-~~~~----~---------------Owner Email:
Owner Name: ?:imoy Dui&r ,&'TEC<o--Phone:
Mailing Address:
Region: /7?v
Phys ic a l AddrHs: ------------------------------------------------------------------------------------------------------------------------------------------
Facility Contact: bor~c 11/Mc'!:::--Title: IE·' *C-Phone:
Onsite Representative: 5~
--~--~--~~-----------------------------------------------7
Certified Operator: z:ii<mT &4r
Integrator: /l&...LF ~
Certification Number: 9"-P?? 3
Back-up Operator:
Location of Farm: Latitude:
Di sc harges and Stream Impac ts
I. Is any discharge observed fr om any part of the operation?
Discharge ori ginated at: 0 Structure 0 Application Field
a. Was the conveyance man-made?
0 Other:
b. Did the disc harge reach waters of the State? (If yes , notify DWQ)
c. What is the e stimated vo lume that reached waters of th e Stat e (gallons )?
Certification N umber :
Lo ngitude:
0 Yes Q!l.No
0 Ye s 0No
0 Yes DNo
d. Do es th e di scharge bypass th e waste mana ge ment syst em? (If yes , noti fy DWQ) 0 Yes D No
2 . Is there evidence of a past di scharge from any part of th e ope ration?
3 . Were th ere any observable adverse impacts or potential ad verse impacts to the waters
o f the Stat e othe r than fro m a di sc harg e?
Page I of3
0 Ye s [8No
D Yes ~No
D NA O NE
DNA O NE
D NA O NE
D NA O NE
D NA O NE
DNA O NE
2/4/20 II Continued
IFjlcility Number: !["/-lnate of Inspection: H'TJ?vll
Waste Collection & Treatment
.. , 4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than a dequate?
a . If yes, is waste level into the structural freebo ard?
Structure I Structure 2 Structure3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): I:Z
Observed Freeboard (in):
5. Arc there any immediate threats to the intebrrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc .)
6. Are th er e s tructures on-s ite which are not properly addressed and/or m a nage d through a
waste management or closure plan?
DYes j8.No 0 NA 0 NE
0 Yes 0 No 0 NA 0 NE
StructureS Structure 6
DYes ~No 0NA 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 pennit?
(not applicable to roofed pits , dry stacks, and/or wet stacks)
9 . Docs a ny part of th e waste management syste m other than the waste structures require
m a intenance or improvement?
Waste Application
10. Are there any required buffers , setbacks, or compliance alternatives that need
maintenance or improvement?
({2iYes 0 No DNA D NE
DYes ~o DNA ONE
0 Yes (29-No 0 NA 0 NE
D Yes ua.No 0 NA 0 NE
II . I s there evidence of incorrect lan d applicatio n ? I f yes, check the appropriate box below. 0 Yes (2}-No 0 NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload D Frozen Ground D Heavy Me tals (C u, Zn, etc.)
0 PAN 0 PAN > 10% or 10 lbs. 0 Total Phosphorus D Failure to In corporate Manure/Sludge into Bare Soil
0 Outside of Acceptabl e Crop Window D Evidence of Wind Drift D Application Outside of Approved Area
12. Crop Type(s): det•n JvJ-~~ "j fiPOcA-':-7 ;
13. Soi l Type(s): Y12ifQ,IIc / &.r;,)
J
14. Do the receiving crops d iffer from those designated in theCA WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secu re and/or operate per the irrigation desib'll or wettable
acres determination?
17. Does the fac ility lack adequate acreage for land application?
18. Is there a lack of properly operating was te application eq uipment ?
Required Records & Documents
19. Did the faci lity fail to have th e Certifi cate of Coverage & Penn it readil y available?
20. Does the fa ci lity fail to ha ve all components of the C A WMP readi ly available? If yes, ch eck
the a ppropriate box.
OWUP O checklists D Design 0 Maps 0 Lease Agree m ents
DYes r8J No
(Sg._y es 0 No
DYes ~o
DYes lkl_No
DYes ~0
D Yes ~No
DYes ~0
Oother:
DNA ONE
D NA ONE
D NA ONE
DNA ONE
DNA ONE
DNA O NE
D NA ONE
2 1. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ~No 0 NA 0 NE
0 Waste Application 0 Weekly Freeboard D Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Weather C ode
0 Rainfall D Stocking 0 Crop Yield 0 120 Minute Inspection s 0 Monthly and I " Ra infall Inspect ions D Sludge Survey
22. Did the fac ility fail to install and maintain a rain gauge? D Yes 1:8-No 0 NA 0 N E
23. If selected , did the facility fail to in s ta ll and maintain rainbreak crs on irrigation equipment? D Yes I&L No D NA 0 NE
Page 2 of3 21412011 Continued
I Facility Number:
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
0 Yes {&:No 0 NA 0 NE
DYes fiJNo DNA ONE
the appropriate box(es) below.
0 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
0 Non-compliant sludge leve ls in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provi de 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
DYes
DYes
DYes
DYes
DYes 31. Do subsurface tile drains exist at the facility? 1 f 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/inspection with an on-site representative? 0 Yes
34 . Does the facility require a follow -up visit by the same agency? DYes
~No DNA
~No DNA
~No DNA
jg.No DNA
(2g.No DNA
[8..No DNA
!2lNo DNA
13No DNA
3No 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).
( ~ ~/r-C3/'t:J3~ ~'i-~r·t..Pe'l'-ch-,
SR»&nte' '"3 £,.,..."' e'l:Yff/i,fi,.,J .,-; rr ~,,..-Ji{_s fr/V
It@ t"'-<ft<h!-e -M ;I j .,._-_ c-1~ Tt5 /W..) cmr
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Rov;ewer/Inspector Namo: fGv-c-~
Reviewe r/Ins pector Signature:__.~, :.....!:-....:::....:s..._--lo~....::::~;....-~<;.L..,;'--~----.,.--7--------------
Phone: <J;/?-1!'J.f:f]OO
Date: 7J.::-;j",--;::ib//
'
Page 3 of3 214/lOll
..
ompliance Inspection 0 Operation Review
Reason for Visit ~ne 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I I o-7-JOI Arrh·al Time: 18:! 3'D Departure Time: I f/, · OV I County: 5~ ~ Region:~
Farm Name: 7dJ~~ 7' ?e 1Tei'..5'D ""'-~ rl'l'\--
1 OwnerEmail: ----------------------------
Owner Name: rPm 7 73ufi-z::;:;,~zC~::.....----J8:.....~::..~;.!...~:::...:...~.£.-1~£-----Phone:
Mailiog Address:
Physical Address:----------------------------------------------------------------
Title: .......... @w...::.Jo:-..rr~c:......:.v _________ __ PhoneNo: ____________ ___ Facility Contact: ~ "lrt:;...cjo--
Onsite Representative: h).,....,..-t!t&t?cr::.._ Integrator: ----"/11-=--k--,~_,.1!'-#z-'-:l~""-----------------
Certified Operator: _.,./ ..... a"""""''fld'l::lt:L...t.7:a;;r__ ___ ....:1_0
_.c,"'"'?";'--"''f'!'.:..:.'-.... :::....,~""'-~---------Operator Certification Number: 91tz?Z3
Back-up Operator: --------------------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D" Longitude:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? DYes ~o DNA ONE
Discharge originated at: D Structure 0 Application Field D Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notifY DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? {If yes, notify DWQ)
2. Is there evidence of a past discharge from any pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
DYes 0No DNA ONE
DYes 0No DNA ONE
DYes 0No DNA ONE
DYes ~No DNA ONE
DYes 8-No DNA ONE
Page 1 of 3 12/28/04 Continued
[!."acility Number: ,Q=-/, ztfl Date of Inspection l JO::Z::JVl
Waste CoUection & Treatment
4 . Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. lf yes, is waste leve l into th e structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
DYes IS-No DNA ONE
DYes 0No DNA ONE
Structure 5 Structure 6
Identifier:---------------------------------------
Spillway?:
Designed Freeboard (in): _.......::l__z.? ___ ------------------------------
Observed Freeboard (in): _.......;::?K::L.. ___ ------------------------------
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large tree s, severe erosion, seepage, etc.)
DYes Qg.No DNA ONE
6. Arc there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
DYes ~No DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8 . Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Docs any part of the waste management system other than the wa ste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
~Ye s DNo DNA ONE
DYes 18lNo DNA ONE
DYes ~o DNA ONE
DYes ~No DNA ONE
11. I s there evidence of incorrect application? Ifyes, check the appropriate box below. DYe s ~No 0 NA 0 NE
0 Excessive Ponding D Hydraulic Overload D Frozen Ground D Heavy Metals (Cu , Zn, etc .)
D 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 D Application Outside of Area
12. C roptype(s) Cot'n_ /wJ~ .. tier~</eZH::-«-t:= ~Jiv~ G-~
13 . Soil type(s) f.. JoA: ,I(<. a -?:::?
14. Do the receiving crops differ from those designated in theCA WMP? DYes ~No DNA
15 . Does the receiving crop and/or land application site need improveme nt ? DYes ~No DNA
ONE
ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wetta ble acre determination ? DYes m NoD NA 0 NE
17. Docs the facility lack adequate acreage for land application? DYes ~No DNA ONE
I 8. Is there a lack of properly operating waste application eq uipment? DYes ~0 DNA ONE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
{j) rfx~ ~r'p-v 75-qe J,~~rcp.. ... ff'~r~.,l rl-~pi;~ .6er~ ..z;:;c-e: :51 ~10 • f-
f-....
Reviewer/Inspector Name [ ~,-~ ~~ I Phone: ~p-J/>3-~~~
Reviewer/Inspector Signature: ~} ..-z.:,c_ Date: t_D-/'-1 D
Page 2 of 3 12118104 Contmued
j Facility Number: 6;J..:-?ilfl Date of Inspection I /D -z-d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20 . Does the facility fail to have all components of the CA WMP readily available? If yes, check
the appropriate box. 0 WUP 0 Checklists 0 Design D Map s 0 Other
DYes piNo DNA ONE
DYes ~No DNA ONE
21 . Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes gNo 0 NA 0 NE
0 Waste Application D Weekly Freeboard D Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Annual Certification
0 Rainfall 0 Stocldng D Crop Yield 0 120 Minute Inspec tions 0 Monthly and 1" Rain Inspections D Weather Code
22. Did the facility fail to install and maintain a rain gauge? DYes {BNo DNA ONE
.23 . If selected, did the facility fail to install and maintain ra inbreakers on irrigation equipment? DYes liQ.No DNA ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes [ilNo DNA ONE
25. Did the facility fail to conduct a sludge survey as required by the permit? DYes lijNo DNA ONE
26. Did the facility fail to have an actively certified operator in charge? DYes jgNo DNA ONE
27 . Did the facility fail to secure a phosphorus lo ss assessment (PLAT) certification? DYes lid No DNA ONE
Otber Issues
28 . Were any additional proble ms noted which cause non-compliance of the permit or CAWMP? DYes ~No DNA ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes !&_No DNA ONE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? DYes ~No DNA ONE
If yes , contact a regional Air Quality representative immediately
31 . Did the facility fail to notify the regional office of emergency situations as requ ired by DYes Da_No DNA ONE
General Permit? (ie/ di scharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes jilNo DNA ONE
33. Does facility require a follow-up visit by same agency? DYes ~0 DNA ONE
• ...,., • ... -; : • .A; • • • -.""' ~ • • • ..y ..
• • ... -"' ......... v • ~J • '
12118104
1/-Z 3 -2 O/) c;
Type of Visit c-compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit G}«i)utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
l>atcofVisit : (L;-1~-01 I Arriva1Timcd3;/0p"" I DeparturcTime: l9.'otJLJm I County: Ss.=e-s-~.J
Farm Name: ~ f W S ~; ,.J L (T-,.~,.,.1 Pc.-k't"3CW ;:;,,.._) r Owner Email: --------------
Region: Fk.o
Owner Name: -,-a_....,._ 'J ?.:...-+......-s-oJII Phone:
Mailing Address: -----------------------------------------
Physical Address:-----------------------------------------
Facility Contact: PhoneNo: ________ ___
Onsite Representative: G:.vuy-Mo~ Integrator: _.,..,M..:.....;..~U....::v.;p~::...~l.g~-B'"""""-tlil-J""-= .... tJ;._;_ ___ _
Certified Operator: Su..<-e ~~+f~ -----------
Back-up Operator: ...-~ ...... 1 B.a \ lpc f:>G-~c:·I'J
Operator Certification Number: _.;..11....~.......:3:::....:::0~9:..._ __
Back-up Certification Number: 9S7 .773
Location of Farm: Latitude: D OD'D" Longitude:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: D Structure D Application Fie ld 0 Other
a . Was the conveyance man-made ?
b. Did the discharge reach waters of the State'! (If yes, notifY DWQ)
c. What is the estimated volu me that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is th ere evid ence 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 I31'Jo 0 NA D NE
DYes 0No B"Y'fA ONE
DYes 0 No (31qA O NE
I
DYes 0No om ONE
DYes ~ DNA ONE
DYes ~DNA ONE
12128104 Continued
Facility Number: g2—/o3
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
Identifier: Z.,& ;i ¢/
Spillway'?: NO
Designed Freeboard (in): 5
Observed Freeboard (in): Z g
Structure 2 Structure 3 Structure 4
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?
❑ Yes B No
❑ Yes 2
El NA 0 N
El NA EINE
Structure 5 Structure 6
❑ Yes 2 vo ❑ NA EINE
❑ Yes LTNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �B<o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes E No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,��,,��
9. Docs any part of the waste management system other than the waste structures require El Yes E'_TNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks. or compliance alternatives that need ❑ Yes E7rvo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Qq<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 His ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) /Ct.'.'CuGRs shr✓c_ Ly Sw-...mow 4 tJi.��-.� .4N✓3�
$w.k.11
�o�.-; .✓
13. Soiltype(s) /Veh �4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2<0 ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
0 El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�B
E7 No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E NNo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
B No ❑ NA
❑ NE
IReviewer/Inspector Name „ % �jfG . � ". �c:.vgr�fS' ' Phone: 9/0, y133. 3300 I
Reviea,er/Inspector Signature: ��..,./�� Date: l/—/L- --ZOO
77/7R/Od

I Facility Number: 8:z.. -(g3lf I Date of Inspection ltt-Jl, -·o j I
Required Records & Documents
19 . Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
the appropriate box . 0 WUP 0 Checklists 0 Design 0 Maps 0 Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
DYes ~o DNA ONE
0 Yes l3"'No 0 NA 0 NE
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 0 Crop Yield 0 120 Minute Inspections 0 Monthly and In Rain Inspections D Weather Code
22. Did the facility fail to install and maintain a rain gauge? DYes ~ DNA ONE
.23 . lf selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes B'N'o DNA ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes 81ifo DNA ONE
25. Did the facility fail to conduct a sludge survey as required by the permit? DYes £3"No DNA ONE
26. Did the facility fail to have an actively certified operator in charge ? DYes [3-r(o DNA ONE
27 . Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? DYes ~0 DNA ONE
Other Issues
28 . Were any additional problems noted which cause non-compliance of the permit or CA WMP? D Yes f.d"No DNA ONE
29 . Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes ~0 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 ~ DNA ONE
If yes , contact a regiona l Air Quality representative immediately
~ 31. Did the facility fail to notify the regional office of emergency situations as required by DYes DNA ONE
General Permit? (ie/ di scharge, freeboard problems, over application)
~ 32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes DNA ONE
33. Does facility require a follow-up visit by same agency? DYes ~DNA ONE
12118104
1-oe-oct -
)Facility Number I tusctl( @"6ivision of Water Quality
~2 H '0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit e-Co'mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit @-'R'Outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
Region: Date of Visit: 1/z-oz -o&l Arrival Timed//q:J"on I Departure Time: I z~ 0..}4·--~ County: ~$CIA./
Farm Name: ~ """'''''] Pe-,.J'-'V..:w',J ;:::;.,#--,..-., :;wner Email: --------------
Owner Name: ~,..::/ P ~4,..) Phone:
Mailing Address: --------------------------------------------
Physical Address:-----------------------------------------
Facility Contact: c M ~ II ~ ---=~::;...._r....;~;;..c...r~--=-..;;.o...::o:....:r_L~...._---Title: -..!1.-!e.:=:~~· =-,_. __....,4,De.=:::..;:C=-·.........:.. __ Phone No: __________ __
Onsite Representative: -------------------Integrator: i'Uuv-pk~ 'tv:pWN
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
D Dairy Cow
0 Dairy Calf
0 Wean to Finish
0 Wean to Feeder
10 Layer I I I 0 Non-Layer
(E Feeder to Fini sh 1~7Z-0 Dairy Heifer
D Dry Cow
0 Non-Dairy
0 Beef Stocker
0 BeefFeeder
0 Beef Brood Cow
0 Farrow to Wean
0 Farrow to Feeder
0 Farrow to Finish
0Gilts
0 Boars
Dry Poultry
0 Layers
0 Non-Layers
0 Pullets
0 Turkeys
0 Turkey Poults
0 Other
Other
ID Other Number of Structures: rn
Discharges & Stream Impacts
I. Is any di scharge observed from any part of the operation? DYes [J"N"'o 0 NA 0 NE
Di scharge originated at: D Structure 0 Application Fi e ld 0 Oth er
a. Was the co nveyance man-made? DYes 0No c:rN'A ONE
b, Did the di scharge reach waters of the State? (I f yes , notify DWQ) DYes 0No [h(A ONE
c. What is the estimated volume that reached waters of the State (gallons)? I
d , Does di scharge bypa ss the waste management system ? (If yes. noti fy DWQ)
2. Is there evidence of a past dis charge from any part ofthe op eration?
3. Were there an y adverse imp ac ts o r po tential adve rse impac ts to th e Wa ters of the S tate
o ther than from a di sc harge?
Pa ge 1 of 3
DYes 0No
DYes [3-f(o
DYes ~
11/28104
I:J"NA ONE
DNA ONE
DNA ONE
Continued
I Facility Number: &'2-6 3.fll Date of Inspection 1/z ~IJJ-P 61
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
DYes ~o DNA ONE
DYes B"'No DNA ONE
Structure 5 Structure 6
Identifier:----------------------------------------
Spillway?:
Designed Freeboard (in):----.....,...-----------------------------------
-:> /-,, ObservedFreeboard(in): __ ..:!!:__,::.....::!f.P::...._ __________________________________ _
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? 0 Yes ~ DNA 0 NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
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 g.,qo· DNA ONE
DYes ~DNA ONE
l I. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes Q..Hc) DNA 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 Jbs 0 Total Phosphorus D Failure to Inc orporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window D Evidence of Wind Drift D Application Outside of Area
I
12. Crop type(s) _h~e.::::..::.:S"W=.· ~<-=--!.fA.!....!:i!~~:.!....~.!::-..:.."'~c.._)L.....,._S.::::....::;u:..::ut::..:..A<1....:.........;.ev;___,_f~W::...:1~·,.;~:&y=:.:::. L-.LA~w~~=:=::' ;.::(s:L.r--=S:~J~Y&Ji.=a::.Jo.........::G~rzt=l;_.rJ...;;...__
13. Soil type(s) No A 'Ra_
1 1
14. Do the receiving crops differ from those designated in theCA WMP? DYes B'No DNA ONE
15. Does the receiving crop and/or land application site need improvement? DYes B"'FJO DNA ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ac re de termination?D Yes la1fo DNA ONE
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
Reviewer/Inspector Name Phone: 9/0.¢33. 3300
Reviewer/Inspector Signature: Date: /2-PZ-z..ou~
Page 1 of 3 12118104 Continued
. '-
j Facility Number: g'z -63!'1
Required Records & Documents
Date of Inspection !1z -oz -~ 81
19 . Did the facility fail to have Certificate of Coverage & Penn it readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes , check
the appropirate box . D WUP D Checklists D Design 0 Maps 0 Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
DYes ~o DNA ONE
DYes ffiro DNA ONE
D Yes ~ D NA O NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis D Soil Analysis 0 Waste Transfers 0 Annual Certification
D Rainfall D Stocking 0 Crop Yield 0 120 Minute In spections 0 Monthly and I" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? DYes 0'No D NA ONE
23 . If selected, did the faci li ty fail to install and maintain rainbreakers on irrigation equipment? D Yes ~ DNA ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit? D Yes ~ 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 ~DNA O NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? DYes ~DNA ON E
Other Issues ~ 28. Were any additional problems noted which cause non-compliance ofthe pennit or CAWMP? D Yes D NA O NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes ~ DNA ONE
and report the mortality rates that were hi gher than nonnal?
ffNo 30. At the time of the inspection did the facility pose an odor or air quality concern? DYes D NA ONE
If yes, contact a regional Air Quality represen tative immediately ~ 31. Did the facility fai l to notify the regional office of emergency si tuations as required by D Yes D NA ONE
General Permit? (ie/ discharge , freeboard problems, over application) m: 32. Did Reviewer/Inspector fail to discuss review/in spec tion with an on-site representative? DYes DNA ONE
33 . Does facility require a follow-up visit by same agency? DYes ~ DNA ONE
~
Page3 of 3 12128/04
# ~Dh•ision of Water Quality ~\~ IFacility Number ~~-:l_. H {p~'f II 0 Division of Soil and Water Conservation I) 0 Other Agency ~\v\cr1
Type of Visit ~ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit~ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: f\ \ }"'\ \ oJI
j
Arrival Time: 19 '3iJ I Departure Time: I J I~ I County~~\'
"'
Region:~
Farm Name: --,---C>,.Xnmu.. (J ..e_~ ~ t<Lv "'-
Ownor Nameo (o,...._~~V\..4\w 8:-kr&...V
Owner Email: -------------
Phone:
MailingAddress: ----------------------------------------
Physical Address:-=----------::--------------------------------~-
Fadlity Contac" G fW ty'\~ {'c... T;d:;l"<_ch, ~<;.. Phone No8\.'G ~'j.';;" (J>'f~
Ons;te Repmentativ" ~r !t.« ~ ('(.. Integra to" "i=kro ~~
Certified Operator: -JCi .m ~ ( 4-./;(50\o...... Operator Certification Number: cp l)Tl73
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD 'D" Longitude: D OD 'D "
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
ID Wean to Finish I I I 10 La~er I I I ODairy Cow
0 Wean to Feeder :0 Non-Layer D Dairy Calf
I? ,_,u--eeder to Fini s h :rc. 1)... :1~ol D Dairy Heife1
ITFarrow to Wean Dry Poultry D DrvCow
0 Farrow to Feeder 0 Non-Dairy
0 Layers 0 Farrow to Finish D Beef Stocker
D Non-Layers 0 Gilts D BecfFeeder
D Pullets 0 Boars D Beef Brood Cow
0 Turkeys
Other 0 Turkey Poults ID Other I I I D Other Number of Structures:
Discharges & Stream Impacts
l . Is a ny discharge observed from an y part of the operation ? DYes ~N o
Di scharge originated at : 0 Structure D Application Field 0 Other
a. Wa s the conveyance man-made? D Yes 0No
b. Did the di scharge reach waters of the State? (If yes, notify DW Q) D Yes 0No
c. What is the estimated volu me that reached waters of the State (gallons)?
d . Docs discharge bypass the waste management system? (If yes, notify DWQ)
2. Ts there evidence of a past di sc harge from any part of the operation?
3 . W ere there any adverse imp acts or poten tia l adverse impacts to the Waters of t he State
other than from a discharge?
D Yes 0No
DYes ~o
0Yes ~o
/2/2 8/04
[jJ
DNA ONE
ONE
O NE
~A ONE
DNA ON E
D NA ON E
Continued
!Facility Nurhber~ =c;-~'j I Date of Inspection
Wast~ Collection & Treatment
4 . Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structura l freeboard?
Structure I Structure 2 Structure 3 Structure 4
DYes ~o
DYes IJ No
Structure 0
DNA ONE
DNA ONE
Structure 6
Identifier:---=~-----------------------------------
Spillway?:
Designed Freeboard (in):~----------------------------------­
Observed Free board (in): ~
5. Are there any immediate threats to the integrity of any of th e structures observed?
(ie /large trees, severe erosion, seepag e, etc.)
DYes fljNo DNA ONE
6 . Are there structures on-sit e which are not properly addressed and/or man aged
through a waste management or closure plan?
DYes )ilNo DNA 0 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or impro vement?
8. Do any of the stucturcs Jack adequate markers as required b y the permit?
(Not applicable to roofed pits , dry stacks and/or wet stac ks)
9 . Does any part of the was te management system other than the waste stru ctures require
maintenance or improvement ?
Waste Application
I 0 . Are there any required buffers, setbacks , or compliance a lternatives that need
rna i ntenanceli mprovem ent ?
)8.Yes DNo DNA ONE
DYes J'3No DNA ONE
DYes ~No DNA ONE
DYes _.@No DNA ONE
I I. Is there e vidence o f incorrec t applicati o n? If ye s, chec k the a ppropriate box below. D Yes ~N o DNA 0 N E
0 Exce ssi ve Ponding 0 Hydrauli c Overload 0 Frozen Ground D Heavy Metals (C u, Zn, etc .)
0 PAN 0 PAN > 10% or 10 lb s 0 Total Pho sph orus D Failure to Incorporate Ma nure/Slud ge into Bare Soil
0 Outs ide of Acce ptable Crop Window 0 Ev iden c e o f Wind Drift D App li cati on Outs ide of Area
12 . Croptypc(s) F~-Pf SA J WA 1 ~br
13. Soil type(s ) "Ro.. I tJo-z\
14. Do the receiving crop s diffe r from tho se des igna ted in th e CAWMP ? DYes .JY N o
15 . Does the receiving crop a nd/o r land appli cation site need improve ment ? DYes ~o
16. Did the facili ty fail to secure and/or opera te per th e irri gation desihrn or wettable ac re de terminati on?D Yes ~o
17. Does the facilit y lac k ad equate acreage for land a ppli cation? D Y es~o
18. Is there a la ck of properl y opera ti ng waste app licatio n eq u ipment? D Yes ~o
Comments (refer to question #): Explain any \'ES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
DNA
D NA
DNA
DNA
D N A
ONE
ONE
ONE
ONE
O NE
Reviewerflnspector Name
Reviewer/Inspector Si gnature:
Phone: I · 33GO
Date: St--pr J 1 2l:V7
1212.8104 Continu ed
•
Date of ln•pection ~ I FaciUtY Numbe:td.. 3',=&{ I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Pennit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropirate box. 0 WUP 0 Checklists 0 Design 0 Maps D Other
21. Does record keeping need improvement? If yes , check the appropriate box below.
0 Yes 16-No DNA D NE
DYes ,/BNo DNA ONE
D Yes-2rNo D NA D NE
D Waste Application D Weekly Freeboard D Waste Analysis D Soil Analysis D Waste Transfers D Annual Certification
D Rainfall D Stocking 0 Crop Yield 0 120 Minute Inspections D Monthly and I" Rain Inspec tions D Weather Code
22. Did the facility fail to install and maintain a rain gauge? D Yes l!qNo DNA ONE
23 . If selected, did the facility fail to install and maintain rai nbreakers on irrigation equipment? DYes 0No ~A ONE
24. Did the facility fail to calibrate waste application equipment as required by the pennit? DYes jgNo DNA ONE
25. Did the facility fail to conduct a sludge survey as required by the pennit'? DYes ~No DNA O NE
26. Did the facility fail to have an actively certified operator in charge? DYe~No DNA ONE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? D Yes 0No ~A ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the pennit orCA WMP? DYes ~0 DNA ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes }a No DNA ONE
and report the mortality rates that were higher than nonnal?
~No 30. At the tim e of the inspection did the facility pose an odor or air quality concern? DYes DNA ONE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notifY the regional office of emergency situations as required by DYes ~N o DNA ONE
General Pennit? (ie/ discharge, freeboard problems, over appli cation)
32. Did Reviewer/Inspector fail to di scuss review/inspection with an on-site representative? DYes ~No D NA ONE
33. Does facility r equire a follow-up visit by same agency? DYes ~o DNA ON E
Additional Comments and/or Dra"iogs:
.....
f-
-~
12/28/04
Facility ~o' ~ Time In ___ _
Fa~ Nam~~V\ \>~q,ysro W'!\'\.
Time Out Date <=t l f1 /0,
Integrator '\=) (e.vY\ S.J J '
SiteRep ~
No. 9~TIJ3
-\ n ( Owner IQ.p.rn....... X> .--.tl...la( ~1\.-
--+-...)
Operator I,.._~
Back-up-----------------No.--------
COC Circle: General or NPDES
Design
Wean~ Feed
Wean l=inicoh
~-Teed~ Finish ..) "3<.o.., :>-
Farrow -Wean
FREEBOARD: Design -----
SluO::gc Sur.;e11'{n 'S :~
Current
Farrow-Feed
Farrow Finish
Gilts I Boars
Others
Calibration/GPM
Design
Crop Yield ____ Waste Transfers ____ _
Rain Gauge____ Rain Breaker __ _
Soil Test __ .,.------__ -_ PLAT __ .....,.,.-____ Wettable Acres ____ _
Weekly Freeboard __ /_ Daily Rainfall______ 1-in Inspections ____ _
Spray/Freeboard Drop _"'L-I,._(q...____t+/ t=-•-'-'5 /i..!.,___t-4/_6 __ -s-_._f__;'(.._.....,k'-Ll't-...;:::_O --------
Weathe r Codes __ _
Waste Analysis :
Date
120 min Inspections ___ _
Nitrogen (N)
L>
l.J
{.~
Date Nitrogen (N)
l{t I 'l...?....
Current
Pull/Field Soil Crop Pan Window
f'l
1-'( 1\o._ 1--e ~c..U&L ~(" I_S'Q . A,_\-_1" l "
l
I Nc f'c_ =::>~,_.-c. ( ~ ~ ~ ~-Av~
' -
~""" <;,y ~,. ... \. (~ ~o -.Jl. 0 .I .. ' (-, ~·"'""'"' ~y d-~o ~-~
\l
-~ ...
~G..y-(b., ~D ~ ~r' 'V'
'
L
I 1~ ~~
J~i -(_,~ -..;
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 : I g-31-"'' Arrival Time : l/0.'~5 ad Departure Time : I 2 ~3 0 .nJ County: ~Lo Region.: _,;;'......;... '..;;;..;;._ r~
FarmName: "/qlt1MY Pe~v"SoAI /iiv~ OwnerEmail: -------------
Owner Name: Tali1/t1'1 fJ~/e..;so~ Phone:
Mailing Address: I()~~~ N • US ~2/
Physical Address:-----------------------------------------
Facility Contact: ---------------Title: -----------PhoneNo: __________ __
Onsite Representative: feiU-Jk"' ~kr-foN -/ " Certified Operator: _-~.L:....a=:.....;.;II1=1U:~...:7~-B~. _ I"'LI~S6 AI
Integrator:-----------------
Operator Certification Number: .4-WA-CJ 11777 3
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: 0 Structure 0 Applicati on Field 0 Other
a. Was the conveyance ma n-made?
b. Did the discharge reach waters of the State'! (If yes, notify DWQ)
c . What is the estimated volume that rea che d waters of the State (gallons)?
d. Docs di scharge bypass the waste managemen t system? (If yes, notify DWQ)
2 . Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impac ts or potenti a l adve rse impacts to the Waters o f the State
other than from a di sc harge ?
Page 1 o/3
D Yes ~No D NA O NE
D Ye s 1;a No DNA ONE
D Ye s ~No D NA O NE
D Ye s '11 No D NA O NE
D Yes ~No D NA ONE
D Yes ~No D NA ON E
12128104 Continued
I Facili; Number: ~ Z. -&3~ I Date of Inspection I '8-31-o(J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) Jess than adequate?
a. If yes, is waste level into the structural freeboard?
DYes ~No DNA ONE
DYes ~No DNA ONE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:------------------------------------------
Spillway?:
Designed Freeboard (in): ---1/L-Cf....Ll.,.....,L:...,,,,----------------------------------
Observed Freeboard (in): ___ l/L·_::-0:....._ __ -----------------------------------
5. Are there any immediate threats to the integrity of any of the structures observed? DYes QtNo DNA ONE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed DYes ~No DNA ONE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes ~No DNA ONE
DYes fa'No DNA D NE
DYes (fPNo DNA 0 NE
DYes !MNo DNA ONE
II. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes ~o 0 NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
D PAN 0 PAN> 10% or 10 lbs 0 Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Area
12. Croptype(s) tf5?-Yt:=-{6~J<d,). B~~Lld"'-(Gr<:J~)
7 j
13. Soil type(s) f<a.i N No ~-fl> I k
)
14. Do the receiving crops differ rrom those designated in theCA WMP?
15. Does the receiving crop and/or land application site need improvement?
0 Yes r;JfNo DNA D NE
DYes [)jNo DNA ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? D Yes [}J No D NA D NE
[WNo DNA ONE
~0 DNA ONE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
DYes
DYes
Comments (refer to question#): Explain any YES answers and/or any recommendations or any other comments.
Use drawings offacility to better explain situations. (use additional pages as necessary):
R;-cl?~ R.'~>J~ .. .. l Phone:(:J;o)f_33-3'530 Reviewer/Inspector Name
Reviewer/Inspector Signature: R;;i A~~~~-Date: 'i/-3/-Z()() ~
Page2of3 12128/04 Continued
....
f-
I-...
I Facility Number: 12.. -&351 Date of Inspection IY-31-o(p I
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
the appropriate box. 0 WUP D Checklists 0 Design D Maps D Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
0 Yes !g'No 0 NA 0 NE
DYes !lfNo DNA ONE
DYes ~No DNA ONE
D Waste Application 0 Weekly Freeboard D Waste Analysi s D Soil Analysis 0 Waste Transfers 0 Annual Certification
D Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rain Inspections D Weather Code
22 . Did the facility fail to install and maintain a rain gauge? DYes !»No DNA ONE
23. If selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment? D Yes Df'No DNA O NE
24 . Did the facility fail to calibrate waste application equipment as required by the permit? DYes ~No DNA ONE
25. Did the facility fail to conduct a sludge survey as required by the pennit? DYes rlJNo DNA ONE
26 . Did the facility fail to have an actively certified operator in charge? DYes [jtNo DNA ONE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? DYes ~No DNA ON'E
Other Issues
28. Were any additional problems noted which cause non-compliance of the pennit orCA WMP? DYes If' No DNA ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes ~No DNA O NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? DYes jdtNo DNA ONE
If yes, contac t a regional Air Quality representative immediately
31. Did the facility fai I to notify the regional office of emergency situations as required by DYes 1;11 No DNA ONE
General Permit ? (i e/ di scharge, freeboard problems, over appli cation)
32. Did Reviewer/In spector fail to discuss review/inspection with an on-site representative? DYes jBNo DNA ONE
33 . Does fa cility require a follow-up visit by same agency? DYes (la::No DNA ONE
Additional Comments and/or Drawings:
.... -
f-....
Page 3 of3 12128/04
Type of Visit B 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 ❑ Denied Access
Date of Visit: Arrival Time: �1 ••/,jam Departure Time: County: S,2�nSa A-' Region:
i
Farm Name: 14"ta6A . /.a ... (4 14 r r e Owner Email:
Owner Name: T� A 4a ew , " Phone:
Mailing Address: /D 51 4v/ /V //s .52P
Physical Address: Wi'v
Facility Contact:
Title:
Phone No:
Onsite Representative: /nt", /.tJaPc,'C Integrator: / le
Certified Operator: S u r &.4le.r Operator Certification Number: �I43o5
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [AU [ ----- 1, [ --- A" Longitude: F710FJ EA"
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish oe,
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Laver
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: �.!
b. Did the discharge reach waters of the State? (If yes. notify, DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Uf No ❑ NA EINE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12/28/04 Continued
i
ms

l~cili~~umber: k2 -(,3'( I Date of Inspection 1..:2/J'/od
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
DYes [i!No DNA ONE
DYes 0No DNA ONE
Structure 5 Structure 6
Identifier: __ __:..../ ___ -----------------------------------
Spillway?:
Designed Freeboard (in): _ __.;;:1.......:...1=-, .;,:;~_''_ -----------------------------------/
Obsen;ed Freeboard (in): _ _._3"":2=-_''--------------------------------
5. ,fue there any immediate threats to the integrity of any of the structures observed? pel large trees, severe erosion, seepage , etc.)
DYes ~No DNA ONE
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
DYes 00No DNA ONE
If any of questions 4-6 were answered yes, and tbe situation poses an immediate public bealtb 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?
~Yes 0No DNA ONE
D Yes 00 No DNA D NE
DYes rgJNo DNA ONE
DYes []No DNA D NE
II . Is there evidence of incorrect application? lfyes, check the appropriate box below . 0 Yes [X] No DNA D NE
D Excessive Ponding D Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
D PAN D PAN > 10% or 10 lbs D Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Ev idenc e of Wind Drift 0 Application Outsi de of Area
13 . Soil type(s)
14. Do the receiving crops differ from those designated in theCA WMP? DYes !AI No
15. Does the rec eiving crop and/or land application site need improvement? DYes
16 . Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination 'i O Yes
rnNo
~No
¥JNo
~No
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properl y operating waste application equipment?
DYes
DYes
.... • rf _ • ., •• . .... ' • -
~ommeois (refer: to question #):'·.Explain aoy 'Y:ES ·aoswen andlor.ariy recomm~ndation~ or any o~er comments •.
Us~ drawiogs of facility tc?;better exJ»Iafu situations. (use additional pages as neces5ary):· •
";,1 ,,. ~ ,~ .< ....; • A '
DNA
DNA
DNA
DNA
DNA
ONE
ONE
ONE
ONE
ONE
. •./-. . ·, ~ ..
...
1:1
Reviewer/Inspector Name r-· .. :·. Z."~;..,. v :-'· '"Ea~/e.;
Reviewernnspector Signature: 7~ r Y/,.._,A I
· ·l Pbone: 'j fl> <jf6-;.s-y I Gt )~
Date: -2 /¥/e>r
I '.J 11128104 Continued
I
I Pacili~umber: J=.2.. -'-lt'l Date of Inspection I,J/~f/.ift
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropirate box. D WUP D Checklists 0 Design 0 Maps 0 Other
DYes PlJNo DNA ONE
DYes ~No DNA ONE
21. Does record keeping need improvement? If yes. check the appropriate box below. (X] Yes 0 No 0 NA D NE
D Waste Application GrWeekly Freeboard D Waste Analysis 0 Soil Analysis D Waste Transfers 0 Annual Certification
D Rainfall ~eking [d.e(op Yield Cl-no Minute Inspections ~onthly and 1" Rain Inspections ErWeather Code
22. Did the facility fail to install and maintain a rain gauge? DYes [Q'No DNA ONE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes ~No DNA ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes [YNo DNA ONE
25. Did the facility fail to conduct a sludge survey as required by the permit? DYes [}!No DNA ONE
26. Did the facility fail to have an actively certified operator in charge? DYes [XI No DNA ONE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? DYes 00No DNA ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes ~No DNA ONE
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?
DYes !)a No DNA ONE
30. At the time of the inspection did the facility pose an odor or air quality concern? DYes Ill No DNA ONE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by DYes ~No DNA ONE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes l;lJ No DNA ONE
33. Does facility require a follow-up visit by same agency? DYes ~No DNA ONE
Additional Comments and/~r Qrawfugs: . < ,, ..
. < ... ; ....
P ... oJv...L~ (.kc:.-\ ~ Y' c: J<Jfl.. \'' ........ <-. \.... ~~ b-<,c.."'-C.f>p\',~Q. .
J;
.) 1-p L::a. ~ e. 6 ~"\·~""-+c .\'o~ ~.s c....S. v-c_ l/''-l .,. <.. cfl._ \.::,'1 t-~~ p<~ r•·-',+. \A,.:>C.
~
12128/04
Reason tor Visit G).f(outine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other 0 Denied Access
IDateofVisit: 1"£/.sJ/"t !Time: I 2: I~ Facility Number I ~~ H "~'+ '---:------------------_... lo Not Operational 0 Below Threshold
GPennitted ll'tertified [] ConditionaUy Certified C Registered Date Last Operated or Above Threshold: -----------------
Farm Name: ..... ..W.~_!_.::(~-}--~W~-----------------------------------------------------County: ---~--------------------------·--·
Owner Name: ____ 6!~~--~~~----· ---·-·----·-·······--·····-·------------····--··------·-····· Phone No: ...... .1.1.'?..::.~~-'f._-::_.f£, j_?._ ____________________ _
Mailing Address: ...... JQ ~!J:. ....... ~L.-.. -~.?. .. 'J.P-.{jj~~~-1-·---·-·······-······ -----~-'1~---·--·---·---------lj__(;,__________ L!"$~J ..... .
Facility Contact: ··---~~----~~---·-·--···-·--·······-·-Title: ....... 0~~------·-··-·-·-···-···· Phone No: -·---·-·-·-·-------··
Onsite Representative: ------~~-----·----~!'~---------·-·-··········-·····--··--·· Integrator: ...... &~-~~----S--1-ek_~-------------
Certified Operator:·--------~·-·····--·······-... ·· ...... bJ..~~----················-·-····--Operator Certification Number: ______ !f'f_S!t_ _______ _
Location of Fann:
~e 0 Poultry 0 Cattle O Horse Latitude ,__ _ _,I• ._I _ __,j' ._I _ ___.I" Longitude
Discharges & Stream lmpacts
1. 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 gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2 . Is there evi dence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste CoUection & Treatment
4. Is storage capacity (freeboard plus storm storage) les s than adequate? D Spillway
Structure 1
Id entifier: ·········-····L ............... .
Structure 2 Structure 3 Structure 4 Structure 5
Free board (inches): __ ...::'?;...:~:..~.~;.;.....;;;.c._
12n2mJ -----------
DYes ~
DYes DNo
DYes DNo
DYes 0No
DYes [!;{No
DYes 6:}No
DYes ~
Structure 6
Continued
[Facility Number:~ Date of Inspection 8/-' I /oq. I
5 . Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees , severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(H any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11 . Is there evidence of over application? If yes, check the appropriate box below.
D Excessive Ponding D Hydraulic Overload D Frozen Ground D Copper and/or Zinc
12 . Crop type r'tvt J
DYes ~
DYes MNo
DYes !i{No
DYes ~No
DYes 13"No
DYes oNo
DYes ~0
13 . Do the receiving crops differ with those designated in the Certi
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
Animal Waste Management Plan (CAWMP)? DYes ~o
DYes lffNo
DYes fi1No
DYes I!f'No
DYes 0'No
DYes B'No
17 . Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liqu id level of lagoon or storage pond with no agitation ?
18 . Are there any dead animals not disposed of properly within 24 hours?
19. I s 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 .
l#tl( ~J ~
q f ( tu~ ) .. oJ. •? \A. II 4S c~
Reviewer/Inspector Name
Reviewer/Inspector Signature: .-------Date:
12112103
DYes [JJ1(o
DYes ~
DYes ~
DYes ~0
Continued
j Facility Number: ~;2 -Ll'± I Date of Inspection Qlpr/qt!l
'
Required Records & Documento;
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?
(iel WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
0 Waste Application D Freeboard 0 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. D id Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified A WMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31 . If selected, did the facility fail to install and maintain 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 0 Crop Yield Form 0 Rainfall D Inspection After 1" Rain
D 120 Minute Inspections 0 Annual Certification Form
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
~es
DYes
DYes
DYes
DYes
DYes
1121 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
-~~ 5-rks l ooJl J" J
-s/14 ~ ~ -r C4lil,.-cr+:o~ cl.c
-"-J ~---J (! ) ·~ ~ ., rcr~
12112103
£i1No
(i?No
[i{No
[!{No
li(No
~0
~
i:6No
~
ONo
~No
~No
eNo
~No
[!(No
~~~~~~~~~~~~~~~\;
.cO Df"ision or W~t~r Q~ality · . .
;;Jo ·oiviSion·~orSOii'&o:J ·watei:;Cons~rvatioo "~~·. Other · · .~ · ·
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for VIsit e Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other 0 Denied Access
ll>atcof Visit: I/J-1/-0jTime: I (,t}:t7t7qd
Facility Number I 8d. H h 31{ ----------------------"" IO Not Onerational 0 Below Threshold
II Permitted Bl Certified [J Conditionally Certified C Registered Date Last Operated or Above Threshold:
Farm Name: (l}gJe f. h"'PcJ Klat'/"evz County: .5qyJoa
Owner Name: _...~/.J.~M:;s..:..,e...:::;,_ ___ -~uJ~a......,(....;r....;e~n...._ ____ _ PboneNo: Cf/()-,21¥-~6/_s-
Mailing Address: 104-t.ft.f .tJ UJ tfJ I H,jtwCA v I
C{,{dnn #(.... ;? S.J~J>
Facility Contact: ______________ Title: -----------Phone No: ---------
Onsite Representative: Integrator: freMt'rJtf1 tfq,,k rd
Certified Operator: _.z;tJ.....,e..,J.,e..::;..._ ___ --'li""""'h""'-Lt~C(......,;:,.V}......_ ___ _ Operator Certification Number: /8 '( ..)".y'
Location of Farm:
l!!il Swine 0 Poultry 0 Cattle 0 Horse Latitude ..___ ...... I• L.l _ __.l• ._I _ ___.I .. Longitude ._____,1•1 ._ _ _.I , L-1 _ _,I"
Design Current Design Current Design Current
Swine Capacitv Population Poultry Capacitv Population Cattle Capacitv Population
0 Wean to Feeder 10 Layer I I I IODairv I I I
IE Feeder to Fini sh 3~7-J 3~7...l. 10 Non-Layer I I I 10 Non-Dairy I I I
0 Farrow to Wean
.. -
0 Farrow to Feeder ID Other I I I
I I 0 Farrow to Fini sh Total Design Capacity
0 Gilts I [ 0 Boars Total SSLW
'······ ----....
Number of Lagoons I l 1-ID Subsurface Drains Present liD Lagoon Area -IQ ~l!nl\'_Fitld Area I ID No Liguid .\\'astc Managemt'nt S\'Ste~ .. Holding Ponds I Solid Traps I I I ~
Discharges & ~ Impacts
I . Is any discharge observed from any part of th e operation?
Disch arge originated at : 0 Lagoon 0 Spray Field D Other
a. I f di sc harge is o b served, was the conveyance man-made ?
b. If discharge is obse rve d . did it reach Water of the State? (If yes. not ify DWQ)
c. If di scharge is o b se rved. what is the estimated fl ow in gal/min ?
d. Docs di scha rge bypass a la goon syste m? (lfycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adv erse impacts to the Waters of the State other th a n fro m a discharge ?
~ Collection §1. Treatment
4 . Is storage capacity (free board p lus storm s torage ) le ss than adequate? D Spill way
Identifi er :
Freeboard (inc hes):
05/03101
Structure I
;;).8 ,,
Struc ture 2 Structure 3 Structure 4 Structure 5
DYes fi1 No
DYes 0 No
D Yes 0 No
DYes 0No
DYes 1(1 No
DYes IRI No
D Yes IKJ No
Struc ture 6
Continued
·~
l Facility Number: j> ..l-63f I Date of Inspection 1707-lf-PJI
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees , severe erosion.
seepage . etc.)
6. Are there structures on-site wh ich are not properl y addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-() was ans~·ered yes, and tbe situation poses an
immediate public health or environmental threat, notify DWQ)
7 . Do any of the structures need maintenance/improvement?
8. Does any p art o f the waste management system other than waste structure s require maintenance/improvement?
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings?
Wa~e Application
10 . Are there any buffers that neeri maintenanceiimprovement?
11 . Is th ere evidence of over application? 0 Excessive Ponding 0 PAN 0 Hydraulic Overload
i2. Crop f)-'j>e tMslo.L Er5cve . L£>f'";· wtl&at b
)
l ~. Do the recei\·ing c rops 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 fa ci lity need a wettable acre determination?
c) This facility is pended for a wenable acre determinat ion?
15 . Does the r ece i,·ing c rop need improvement?
16 . Is there a la ::k of adequate waste application equipment?
Required Records & Documents
17 . Fail to haYe Certificate of Co\'erage & General Permit or other Permit readily available?
· :_ 18. Does the facility fail to haYe all components of the Certified Animal Waste Management Plan readily a\'ailable?
(i e / W'UP, checklists. design, maps. ett:.)
19 . Does record keeping need improvement? (ie/ irrigation, fre eboard, wast e analysis & soil sample reports)
20. Is fadlity not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to ha\'e a actively certified operator in charge?
22 . Fail to notify regional D\\'Q of emergency situations as required b y General Permit?
(ie1 discharge. freeboard problems, ov er application)
23 . Did Reviewer:1nspector fail to discuss reYiew.'ir.specrion with on-site representative?
24 . Does facility require a follow-up 'isit by same agency?
25 . Were any additional problems noted which cause noncompliance of the Certified A WMP?
D Ye s
D Yes
D Yes
D Yes
DYes
DYes
DYes
DYes
D Yes
DYes
DYes
D Yes
D Yes
D Yes
D Yes
D Y es
DYes
D Yes
D Yes
D Yes
D Yes
DYes
IIQ !lio "iolations or deficiencies were noted during this visit. You will receive no further correspondence about this "isit.
~No
IE No
fl}No
II(! No
~No
IR!No
li8l No
~No
lij1 No
liJ No
~No
i8JNo
Iii No
!2lNo
li!No
~No
Lti No
W No
g}No
IR!No
12!No
IKI.No
coDiDie.ds{reiertO·q~ii'ii):'E~iaiiiiiim ;UiW~~~c¥~:~n>f~~~~--~~~~~riim·~~~~~~t~~~:t~~~·
.l!~~ ~~~. ~r fs~~i~ t~ ~~~ .~xp~~~t"!~ .(11se :"~d!~n..al .~~te;;,s ~ ~~.~~~~):~ ... ? ·_ [j Field Copy 0 Final Notes .~,:·,~·<:: ~~ ":', ,_ .. -. ~ • 'f" 1 ~~::-·· ~:~..;..~~!t ..... ~.~ ..... ~.:.,!!~ ...... ~r:-.::!· -·,;Jf :•. •4:.,...-:-._.::...":';P,":'~~· ......... ~ ;'~~ .•• ~ .... ,. .• f~....-::--:!-"..r-,~'\~ .... ~~,:;~ ~~.-.,. -.~·· ~~~----------':'...-_ '-l:,J.":J ·"•
Reviewer/Inspector Name ~+:1fF.GjaJ;j~Zf§i.f{~!JJK.fe:..~~~~%}![~~"/.~~"fi:Wif..{.~~~
Reviewer/Inspector Signature: ...._. nl/. 11.: u.llll5"ii7 --Date: /J-f ~t),J
05103/01 Continued
•
------..:..·----'---·---------· --
---·~~--
L .5"/.d~ I . 1-
Date of IDspection
Fadllty Namber I ~~I I ~J:~ 1-Time or bspedion I II: oe> I Use 24 hr. Clme .
Farm StalaJ: ,~6&tJ Total11me (In boan) Spat oDRmtw I .2.. lk. I
or Iaspecdon (IDdudes travel and proc:essla&)
Fum Name: tJ~ + &-7 Ma~ CoiUity: :5 t9 ,.... ~ S7l,.) I
0waer Name: &kid£ 64/{ R...,l£~41;..._.. _____ _ Pbou No:'t'{Z-..:.t..;;:o;.,.J'-------. ,
MaDlDg Address: R-1--I 13tf?£ //Y-£ C/--L.J,.A/C_:<..;..cP_..;;.'J...;..2...;..:,?"-----__ _
Onstte Repramattve: WI"? A ~.<.££,../
CerCIWOperator: 4?-A-Uk~~~
IDtegratGr: .~~ G,t;~ £_e,-.~
Operator Ca11fkatlon Number: I 8 f5Y
Location of Farm:
I fu r.21-' .4 a-o~~~ * c;.~ ~a RJ,"""...r &-M"'4<2"' -=<,:;._.,_,.M2'm
~de I 1•1 1•1 IM Longitude I I• I I' I IM
(D Not Operational I ~Lan~md: ______________________________________ __
Cnepl
1. M lbcre any buffers tbat oeed maiotenaDcefmmrovement?
2. h any discharge obserwd from any part of the operation?
L If clischqe is observed, was !be cooveyance tnmHDilde?
b. If discharge is observed, did it racb SurlBc:e Watl:l'l (lfyes. notify DWQ)
c. lf discharge is observed, what is 1be estim•ud flow iD pllmin?
d. Does discharge bypass a lagoon system? (If yes, DOtify DWQ)
3 . Is~ evidc:oce of past discharge fiom uy part oftbc operation?
4. Was there any adverse impacts to lbe waters of !be State other than from a discblqe?
5. Docs any pan of the waste management system (other dlan Jasoonslboldiug ponds) require
maintc:DancefmJPI'OYI:IDellt?
DYes JitNo
DYes ,E!No
DYes ~No
DYes lS)No
[JYes ~No
~JiiNo
0 Yes .J!il No
[JYes ~No
Coftli,u~>.A 1.,, /tn,./r
6. h &diity DDt in compliaDcc with my applicable ldback critEria?
1. Dicl the facility &.il to have a c:atificd operatuz iD NSpODtible duqe Of iDspcc:cion after tn/91)?
· 8. Are there Jaaooqs or 110rage pcmck OD site wbida aced 10 be property closed?
Strurtares <Lagoon! ancl!or Holdlpg Pollds)
9. Is llrUctUral fm:board less abau adequate?
fndard (ft)~ hpn. I
tA-5"'
10. II seepaae obsa Yed fiom lillY of tbe IU\dUit:S?
Lagocm2 Lagoon3
11. Is erosion, or IDY other tbrcats to the intqrity of any or 1he structura obsc:rvecl?
12. Do uy of the structures ueed mainrc•ncelimptovement?
(If uy or quesdons 9-12 was answered yes, ud the situation poses an
immediate public beaJtb or euriroumeatal tbnat, DOdfy DWQ)
13. Do my of the structures Jack adquate markers 10 idclltify mrt IIDd stop pumping levels?
Waste Applleation
14. Is there physical evidence of over application?
. (If in excess ofWMP, or nmoff e:Dtering waters of the Slale, notify DWQ)
15. Crop type e.t>IL.V 1 e .. 14 ,.// k ~ .(/ C44 ~/ by_._../,
16. Do the active crops diifcrwitb those designated iu the Animal W~ ManagemeDt Plan?
17. Does the facility have a lack of adequate acreage for land application?
18. Does tbe cover crop need improvellic:nt?
19. Is there a lack of available iniption equipment?
for Certified FacUlties Oply
20. Does the D.cility fail to bave a copy of the .ADimaJ Waste Management Plan readily available?
21 . Does the facility fail to comply wicb the Animal Waste Mmagemcnt Plan iu my way?
22 . Does record keeping need improvemt:Dt?
23. Does facility require a foUow-up visit by amc qem:y?
24. Did R.eviewcrllnspector fail to discuss reviewfmspectiou wilb owner ar opaidOl in cbqe?
Rmewerlluspectar Name ~-~?~~;~:: ... ~;-~ ·1
,. ·_,;·:if •.. ,~~~:., -~:. :-~:f.-~flS~tim;~~};(.~~~
Reviwerllnspector Slpatun: ~ f-~ Date:
[]Yes 'E!No
[JYa lSI No
[]Yes fiaNo
DYes EINo
lagooll4
DYes !JNo
·DYes rs!~No
IIYcs ONo
DYes EaNo
DYes EINo·
DYes fijNo
DYes SNo
[]Yes Ji~No
[]Yes ~No
[]Yes SNo
[JYa lraNo
faYa []No
DYa IJNo
CYa ~No
....
-~
5/?(77
..