820636_INSPECTIONS_20171231

NORTH CAROLINA
Qepartment of Environmental Quality
Operation Review 0 Structure Evaluation Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 117afl4' I Arrival Time:IT~d A Departure Time:I/M g I County: sdr« Region:rJ y
Farm Name: CJ er, {c b ~ t.({_J r!/-1). Owner Email:
Owner Name: S$ 1(( l( P-c4 ~ ov1. Phone:
Mailing Address:
Physical Address:
Facility Contact: -~fta_C~C«. _ _,$"-_&1-=-+-. ;.-c.._-r_Jl..;;.o_:1-l--_ Title:
Onsite Representative: l(
Certified Operator: t(
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
l. Is any discharge observed from any part of the operation?
Discharge originated at: D Structure 0 Application Field
a. Wa s the conveyance man-made?
0 Other:
b. Did the discharge reach waters of the State? (If yes , notifY DWR)
c. What is th e estimated volume that reached waters ofthe State (gallons)?
Phone:
Integrator: ....;..·Jit~£3=------------
Certification Number:
Certification Number:
Longitude:
0 Yes [9--NOTI NA 0 NE
DYes 0No ~ONE
DYes 0No ~ONE
d . Does the discharge bypas s the waste man agement system? (If yes, notifY DWR) DYes 0No ~ON E
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a di scharge?
Page I of3
0 Yes ~DNA ONE
0 Yes ~DNA ONE
11412015 Continued
IFa.s:ility Ntmber: loate oflnspection'r-17oc1 I t" 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 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .}--1
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes ~DNA ONE
0 Yes 0 No g-m-o NE
Structure 5 Structure 6
DYes ~ DNA ONE
DYes ~DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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
DYes
DYes
DYes
.~DNA ONE
~DNA ONE
~DNA ONE
~ DNA ONE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. D Yes ~ D NA D NE
D Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Hea vy Metals (C u, Zn , etc.)
0 PAN D PAN> 10% or 10 lbs. D Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12 . Crop Type(s): CLuCS {3e.r~Nt ~ H~ SG 0
13. Soil Type(s): 0
14. Do the receiving crops differ from those designated in theCA WMP?
15. Does the receiving crop and/or land application site need improvement?
16 . Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility la ck adequate acreage for land app lication?
18. Is there a Jack of properly operating waste application eq uipment?
Required Records & Documents
19. Did the facility fa il to h ave the Certificate ofCoverage & Permit readily available?
20 . Does the facility fail to have all components of theCA WMP readily available? If yes, check
th e appropriate box.
owuP 0check1ists 0Des ign D Ma ps D Lease Agreements
21. Does record keeping need improvement? If yes, check the ap propriate box below.
DYes ~ DNA ONE
DYes ~ DNA ONE
DYes ~ DNA ONE
0 Yes £}NO DNA ONE
0 Yes ~ DNA ONE
DYes ~ DNA ONE
0 Yes a-No DNA ONE
00ther:
DYes ~0 DNA ONE
0 Wa ste Application D Weekly Freeboard D Waste Analysis D Soil Analysis D Waste Transfers 0 Weather Code
0 Rainfall 0 Stocking D Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rainfall Insp ectio ns 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23 . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page2of3
DYes
DYes
DNA D NE
DNA ONE
214120 15 Co ntinued
IFaglity Nllmber: fR3k !nate of Inspection: /7 6t!-'( I 5
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
0 Yes [4J..MO 0 NA 0 NE
DYes ~DNA ONE
0 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26 . Did the faci li ty 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 fai l 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 immediatel y.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit ? (i.e., di scharge, freeboard problems, over-application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field 0 Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP ?
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
0 Yes
0 Yes
0 Yes
0 Yes
DYes
0 Yes
DYes
[B-NO DNA
~DNA
~ DNA
~DNA
~ DNA
~ D NA
o1o D NA
0No D NA
[2(No DNA
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).
r;lc.~J7 -c5~ ~
(9-ct . s
·/J...-s--17
P-4.~
O NE
ONE
O NE
ONE
O NE
O NE
O NE
ONE
O NE
Rov;,w,,/lnspecto' Nam" \3l\ \ ~ ~~
Reviewer/Inspector Signature: --~ __ _
Page3 of3
Phone: C(f o-q33 -'3 35 q
Date: I 7 Qc( l [)
214/2015
ompliance Inspection Operation Review 0 Structure Evaluation
Reason for Visit: e-koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency
Date of Visit: lQofr<..-l]l Arrival Time: I g1J3 (fl Departure Time:! cr:tc ft I County: S1'.1t Region:~
Farm Name: V11-k \~.ra..AUlt. ,f f "2.. Owner Email:
Owner Name: 13 ; l( y Phone:
Mailing Address:
Physical Address:
Facility Contact: Phone:
. .---
Integrator: $1"\.. ~ ft'-c-{,fJ Onsite Representative:
C ertified Operator: (.
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge origi nated at: 0 Structure 0 Application Field
a. Was th e conveyance man-made?
0 Other:
b. Did the discharge reach waters of the State? (If yes, noti fY DWR)
c. Wh at is the estimated volume that reached waters of the State (ga ll ons)?
Certification Number:
Certification Number:
Longitude:
0 Yes D-*<> 0 NA 0 NE
DYes 0 No (3"N A ONE
DYes 0 No a;; A O NE
d. Do es the disc harge bypass the waste manageme nt sys tem ? (If yes, not ifY OWR) DYes 0 No rrNA ONE
2 . Is there evidence of a past di scharge fi'om a ny part of the operation?
3. Were there a ny observab le adverse impacts o r potential adverse impacts to the waters
of the State other than from a di scharge?
Page I of3
DYes @ No
0 Yes ~No
D NA ONE
DN A ONE
214/2015 Continued
Lfacilit) Number: §?.'}._ -67:1 b I nate of Inspection: 2. 0 &c ( ?I
Waste Collection & Treatment
4 . Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into th e structural freeboard ?
Structure I Structure 2 Structure 3 Structure 4
ldenti tier:
Spillway?:
Desib'11 ed Freeboard (in):
Observed Freeboard (in): 3 b
5. Arc there any immediate threats to the integrity of any of the structures observed?
(i.e ., large trees, severe erosion, seepage, etc .)
6 . Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes [3--NtJ DNA D NE
DYes 0No ~ONE
StructureS Structure 6
DYes QtNo DNA D NE
DYes~ DNA ONE
If any of questions 4-6 were answered yes. and the situation poses an immediate public bealtb or environmental threat, notify DWR
7. Do any ofthe structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the perm it?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9 . Does any part of the waste management system other than the waste stru ctures require
maintenance or imp rovement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes E:(No DNA D NE
DYes~ DNA ONE
D Yes BNo D NA D N E
DYes [ZJNo DNA D NE
II . Is there evidence of incorrect land application? lfyes, check the appropriate box below. DYes ~ 0 NA 0 NE
0 Excessive Ponding D Hyd raulic Overload D Frozen G round D Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN > 10% o r I 0 lbs . 0 Total Phosphorus D Failure to In corporate Manure/Sludge into Bare Soil
0 Outside of Acceptable C rop Window D Evi.dence of Wind Drift D Application Outside of Approved Area
12. Crop Type(s):
13 . Soil Type(s}:
14 . Do the receiving crops differ from those desib'11ated in the CA WMP?
15 . Does the receiving crop and/or lan d application s ite need improve ment ?
16 . Did th e facility fail to sec ure and/or operate per the irrigation design or wettable
acres determination?
17. Does the faci I ity Jack adequate acreage for land application?
18 . Is there a lac k of properly operating waste application equipment?
Required Records & Documents
19 . Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have a ll components ofthe CA WMP readily avail a ble? If yes, check
the appropriate box .
DwuP Dchecklists D Design D Maps D Lease Agreements
21. Does record keeping need improvement? If yes, c heck the appropriate box below.
DYes 01'1o DNA ONE
DYes ffNo DNA ONE
DYes ~0 DNA ONE
DYes r)No DNA ONE
DYes EJ1'1o DNA ONE
DYes [2t'No DNA ONE
DYes ffNo DNA ONE
00ther:
DYes lZJNo DNA ONE
0 Waste Application D Weekly Freeboard D Waste Analysis D Soil Analysis D Waste Transfers D Weather Code
0 Rain fa ll Ostocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and I " Rainfall Inspections D Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes lZJNo D NA 0 N E
23. If selected, did the facility fa il to install and maintain rainbreakers on irrigation equipment? 0 Yes ~ DNA 0 NE
Page 1 of3 1/411015 Continued
fFUili!f Number: f'~ -{:, 1 b loate of Inspection: U frc~l71
].4 . Did the facility fail to calibrate waste application equipment as required by the pennit?
25 . Is the facility out of compliance with pennit conditions related to sludge? If yes, check
the appropriate box(es) below.
DYes~ DNA ONE
DYes~ DNA ONE
0 Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of 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?
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 appropri ate box below.
0 Application Field D Lagoon/Storage Pond D Other:
32. Were any additional problems noted which cause non-compliance of the pennit 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 th e same agency?
DYes ~0 DNA ONE
DYes ~ DNA ONE
DYes ~ DNA ONE
DYes ~ DNA ONE
DYes [ffffo DNA ONE
DYes C(No DNA ONE
DYes ~0 DNA ONE
DYes ~0 DNA ONE
DYes 0No DNA ONE
Co~rii~ilts (refer to ,·q~~oo #); Expl~io ~.!l~'t~ES ,ailswers and/or any; additional recommendatio~~ o~ any other comme~~
Use --r~liviogs of fac~·~fi!t~l better ex plato! ~iigtU~~s .!( ~Se : additional pages as necessary). . : . ~wtM~ ~. rr . ' ~~::iJ: ~~-itl;.ti ;~ '.
~ \: b.tev~ ~-" ·--
c;{ u_,{i ~. s\.-4? ..,.~ ..-
Reviewer/Inspector Name :
Re vi ewer/Ins pec to r Si gnature:
Page3 of3
()-L(, 5
C-t((
Phone: C"ftO· lf ·~ 5-J~J)t
Date: ?-0 0LL-l7
11412015
Reason for Visit:
C~pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
&C) Routine 0 Complaint 0 Follow-up 0 Refe rral 0 Emergency 0 Other 0 De nied Access
Arrival Time:l 8}3'0 (E l Departure Timed 'f!Jo 11 County: EfJIV R egion: FflV
Oat< l).,ro...Jz i-"2-Owner Email: Farm N ame:
Owne r Name: ~lily pr_{r~o~ Phone:
Mailing Address:
Physical Address:
Facility Contact: -..&..&....:......~.....::...._tiS::;.__f_d.....;... _</._'/_(\;;)_· _'1 __ Title: Phone:
Onsi te Representative: ({ Integrator: ft11 5-S 1
Certified Operator: Certification Numbe r :
Back-up Operator: Certification Number:
Location of Farm: Latitude: Lon gitude:
Discharges and S trea m Impacts
I. Is any d ischarge observed from an y part of th e operation? D Yes ~DNA O NE
Discharge originated at: 0 Stru ctu re 0 Appli cation Field 0 Other:
a. W as the conveya nce man -made? D Yes 0No ~ O N E
b. D id the discharge reac h waters o fthe State? (If yes, notify DWR ) D Yes 0 No ~ O NE
c. What is the estimate d volume that reached waters of the State (gallons)?
d. Does the discharge bypass th e waste management system? (If yes , not ify DWR ) DYes 0No GrfJA O NE
2 . Is th ere evidence of a past discharge from any part of the operation?
3. Were there a ny observable adverse impacts or potential adverse impacts to the wate rs
of the S ta te other than from a di sc harge?
Page I of3
0 Yes
0 Ye s
~0 DNA O NE
~ D NA O NE
214120 15 Continued
I Facility Aumber: 8" -6 3b I Date of Inspection: d?~ ,A; 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 I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DY ~s ~ DNA ONE
DYes 0No ~A O NE
Structure 5 Structure 6
DYe s~ DNA ONE
DYes~ DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental tbrea~ notify DWR
7. Do any of the structures need maintenance or improvement? D Yes t:]'No D 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
_. main~enance or improvement?
' /
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
D Yes l2fNo D NA 0 NE
0 Yes [Z(No D NA 0 NE
0 Yes [ZfNo DNA D NE
11. Is there evidence of incorrect land application? Ifyes, check the appropriate box below. 0 Yes ~ D NA 0 NE
0 Exces!!i ve Ponding 0 Hydraulic Overload 0 Froze n Ground 0 Heavy Me tals (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 D Evidence of Wind Drift 0 Application Outside of Approved Area
12 . Crop Type(s): ·0 ~-/MtVtff{_ . <;' {p i) cw:D
13 . Soil Type(s): /lo G 0 K q
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 fai l to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
the appropriate box .
Owup O checklists D Design 0 Maps 0 Lease Agreements
21. Does record keeping need improvement? If yes , check the appropriate box below.
DYes ~0 D NA O NE
DYes ~0 DNA ONE
DYes ~0 DNA ONE
DYes [3'No DNA ONE
DYes C?'No DNA ONE
DYes 0"No DNA ONE
O Yes ~0 DNA ONE
D other:
O Yes [B"No DNA ONE
D 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 I" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes ~No DNA 0 NE
23. If selected , did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes [2I'No DNA 0 NE
Page 2 of3 21412015 Continued
!Facility Number: Qh-6 .. 3-B I Date of Inspection: S7 mj;b
24. Did the facility fail to calibrate waste application equipment as required by the pennit?
25. Is the facility out of compliance with pennit conditions related to sludge? If yes, check
the appropriate box(es) below.
DYes ~ DNA ONE r ~DNA ONE
0 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
lf yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below .
0 Application Field 0 Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit 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?
{tKes
[fl~Yes
~es
[p'Yes
0 Yes
0 Yes
0 Yes
0 Yes
0 Yes
ifNo DNA
crNo DNA
~0 DNA
(2{No D NA
EJ'No DNA
Gf'No DNA
~No DNA
[2fNo DNA
E]'No DNA
Comments (refer to question #): E:xplaio any YES answers and/or any additional recommendations or any otbeJ comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
QU~(u~/D"'\-·'t)..~\ 1-(b
Sll<15-t s'lA''4 -.. l J· 11 lh
Cell or /6 -1og-t~s J
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Reviewer/Inspector Name: --=(6'-'··, .... \'-'-D.....:~~..:::;....;;.i.l_;!tp....;:;.;;--+'------------------­
Reviewerllnspector Signature: -~rt--}--bb·,..~.__._(J~ ... ~"""'"-=..IIL..,...--------------­
Page3 of3
Phone~~~¥
Date: __ ~
2/412015
,gfRs-) (13-0 •
Structure Evaluation Inspection -
Facility Number: -- 106 • Date: " /j4' g
Time in: al 30 P Time out: fault eft 7)
Farm Name: Oak gr-a 012. Farm 911 address:
Owner Name: �C( fi�� j C>1 Phone
Facility Contact: �-'^cam-r 4 e-r--0�t
Onsite Representative: Integrator: IV5
Certified Operator: L Cert. Number
Is storage capacity less than adequate? Yes No Oo ,
If yes is waste level into the structural freeboard? Yes _ No
Was non-compliant level reported to DWR .Ls _ POA received ,4
J _-
Structure: 1 2 3 4 5 6
Identifier:
Spillway?
-
Designed Freeboard (in.): 0
Observed Freeboard (in.): 2.3 •
Are there any immediate threats to the integrity of any of the structures
observed? Yes No c�
Do any structures lack adequate markers as required by the permit? Yes _ No
Does any part of the waste management system need repair Yes No ,/"
Condition of field's 9414 LJc7 1(, rrfi .
Condition of receiving crop ` tiy14-
Comments:

Date of Visit:
Owner Email:
Phone:
Mailing Address:
Facility Contact:
Physical Address:
----~----~--~--~---~-~~~~--/-0-~--T-i-tl-e:~--------------~----~---_-_-_-_-_----P-h-on_e_: __________________ _
Onsite Representative: tJ Integrator: 14l§
Jl.<,'c::.lv., ..{ ~..., .5 b.., Certlficatioo Number: _/.....;.~.....;:&';,_l_S ___ _
i1<L~c; \ t:/~ 01 Certification Number: f9K6 r 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?
D 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)?
d . Does the discharge bypass the waste management sy stem? (If yes, noti fy DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potentia l adverse impacts to the waters
of the State other than from a di scharge?
P11ge I of3
Longitude :
D Yes ~NA ONE
D Yes 0No Et"ft\0 NE
D Yes 0 No ~O NE
DYes 0No [jif: O NE
DYes (31Jo D NA O NE
DYes Ef"No DNA O NE
21412014 Continued
• IFacruty Number: I Date of Inspectionr)f t:SC;* J
Waste CoUection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the struc~l freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: -----!
Spillway?: I --------"
Designed Freeboard (in): /
' Observed Freeboard (in): /
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
~No DNA ONE
DYes ~DNA ONE
Structure 5 Structure 6
DYes ~DNA ONE
DYes ~ DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? DYes ~DNA D NE
8. Do any of the structures lack adequate markers as required by the permit? D Yes ~ D NA D NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes ~DNA ONE
DYes~ DNA ONE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~ D NA D NE
D Excessive Ponding 0 Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn, etc.)
D PAN D PAN> 10% or lO lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window D Evidence of Wind Drift D Application Outside of Approved Area
12.cropType(s): ~~~ Ob D cu..;g
13. Soil Type(s): fl ~ t&;, 1~
14. Do the receiving crops differ from those designated in theCA WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
the appropriate box.
0WUP 0Checklists 0 Design D Maps 0 Lease Agreements
DYes ~ DNA
DYes ~ DNA
DYes ~ DNA
DYes ~ DNA
DYes ~ DNA
DYes ~ DNA
DYes ~ DNA
'
Oother:
ONE
ONE
ONE
ONE
ONE
ONE
ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. DYes ~ DNA ONE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Weather Code
0 Rainfall D Stocking 0 Crop Yield 0 120 Minute Inspections D Monthly and 1" Rainfall Inspections ..,0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? D Yes B"No D NA D NE
23. If selected. did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes ~ 0 NA D NE
Page2 of3 11412014 Continued
I Facility Number: I nate oflnspection: 3t bl'C.. /.Sd
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 ~ DNA ONE
DYes ~DNA ONE
D Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
D Non-compliant sludge levels in any lagoon
List structurc(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.
DYes
QYes
DYes
DYes
0Yes
O Yes
D Application Field D Lagoon/Storage Pond D Other: ------------------------
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP? O Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes
34. Does the facility require a follow-up visit by the same agency? 0Yes
g<o DNA
~ DNA
~ DNA
~ DNA
~ DNA
ffNo DNA
~0 DNA
@N6 DNA ~DNA
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).
C4Cb~~~ ·t"-3(-/
s(..tlr~~ tJ-<31-ttt o -if./ p _ l{ 8'
So~ { si}M pies ?
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone : t{33-JJsf
Date:.31 ~J6
Page3of3 11412014
-··---\
\
\
\
\ , _______ .... ~-
Reason for Visit: 0 Denied Access
Date of Visit: 13~ ()§? "Ji Arrival Time: IC1{ X) AI Regio~
F a rm Name:_.....;C2~~~fcL..:_.....~~K'-~~~~__;/:.._-_2. ____ _ Owner Email:
ff; lly c e,J.,.--.o.-, Owner Name: Phone:
Mailing Address:
Physical Address: -------------------------------------------
Facility Contact: £-\t<-c. h 1.-#l P b-'0"'7Title: Phone:
Onsite Representative: _____ l_( ______________ _ Integrator: _...~J'l1S~~"------------
Certified Operator: t( ,..
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
I. Is any discharge observed from an y part of the operation? DYes ~NA ONE
Discharge originated at: 0 Structure 0 Application Field 0 Other:
a. Was the conveyance man-made?
b. Did the discharg e reach waters ofthe State? (If yes, noti fy DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d . Docs th e dis charge bypass the waste management system ? (If yes , notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse imp acts to the waters
of the State other than from a discharge?
Page I of3
DYes 0 No [9-NA. ONE
0 Yes 0 No IZ}MA ONE
DYes 0No [5NA. ONE
DYes [!tNo D NA ONE
DYes ~0 D NA O NE
214/2014 Continued
lFaciliJy Number: lDate of Inspection:, 'b ·[)B:_.Il{l
Waste Collection & Treatment
4': Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J2.
5. Are there any immediate threats to the integrity of any ofthe structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes ~DNA ONE
DYes DNo ~ ONE
Structure 5 Structure6
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 DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
0 Yes [g.Ho DNA D NE
DYes G;}MO 0 NA D NE
0 Yes c::rN"o 0 NA D NE
I
DYes ~ DNA ONE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. D Yes ~ DNA D NE
0 Excessive Ponding D Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN D PAN> 10% or 10 lbs. 0 Total Phosphorus D 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Docs the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
the appropriate box.
0WUP Ocbecklists 0 Design 0 Maps D Lease Agreements
DYes [I).No DNA
DYes rrNo DNA
DYes ~0 DNA
DYes ~0 DNA
DYes ~ DNA
DYes ~ DNA
DYes ~ DNA
00ther:
ONE
ONE
ONE
ONE
ONE
ONE
ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. DYes ~ DNA ONE
0 Waste Application D Weekly Freeboard D Waste Analysis D Soil Analysis 0 Waste Transfers 0 Weather Code
D Rainfall 0 Stocking D Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rainfall Inspections D Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes ~o 0 NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes ~ DNA 0 NE
Page2 of3 Z/411014 Continued
IFacili~ Number: f\l:-63 (; I Date of lns2ection:
,,~
Jo~7TI
24. Did the fac ility fa il to cali brate waste application equipment as required by th e perm it? D Yes ~ DNA .. ~s 25 . Is the facility out of compliance with permit conditions related to s ludge? If yes, check 0No DNA
the appropriate box(es) below.
~ilure to complete annual sludge survey 0 Failure to develop a POA for slud ge levels
0 Non-compliant sludge levels in any lagoon
Li st structurc(s) and date of firs t survey indicating non-compl iance:
26. Did th e facility fail to prov ide documentation of an actively certified operator in charge? DYes 0 No D NA
27 . Did the facility fai l to secure a phosphorus lo ss assessments (PLAT) certification? DYes 0No D NA
Other Issues
28 . Di d the facility fail to properly dispose of dead animals with 24 hours and/or document DYes 0No DNA
and report mortali ty rates that were higher than normal?
29. At th e time of the inspection did the facility pose an odor or air quality concern ? D Yes QNo D NA
If yes, contact a regional Air Q ua lity representati ve immediately.
30. Did the facility fail to notify the Regio nal Office of emergency situations as required by the DYes 0 No DNA
permit? (i.e., discharge, freeboard problems , over-application)
31 . Do s ubsurface tile drains exist at the facility? If yes, check the appropriate box below . DYes 0No DNA
0 Appli cation Field D Lagoon/Storage Pond D Other:
32. Were any additional problems noted w h ich caus e non-compliance of the permit orCA WMP? 0 Yes 0 No DNA
33. Did the Reviewer/Inspector fail to discuss review/inspection with an o n-site representati ve? DYes 0No DNA
34. Does the facility requi re a follow-up visit by the s ame agency? DYes 0No 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).
-/-3 (, 12
Al ~ I. l3 0 -?, '( Sl~-e. £~ 'l-/(9-JO
fD A -C,., 3 e 1''d ,'-..,. .fv-e~ ~ ~ I)J JJ • -r,; .. ~ /( ~
O NE
ONE
ONE
O NE
O NE
ONE
ONE
ONE
ONE
O NE
O NE
Revi ewer/Inspector Name:
Revie wer/Ins pecto r Si i,'llature :
Phone : tf~s-3J3f
o ... :b D,;:c_ /~ J
Page l of3 21412 014
Date of Visit: I dJPt'c.JJ Arrival Time:IBI,J'O Departure Time: I /0~ tO I County:..{~~
Owner Email:
RegionFif.Q
Farm Name: (} ~\< lS ~h / d: ":L
Owner Name: ~ ~ \(1 Pe..-+e*" ''""' Phone:
Mailing Address:
Physical Address: rl
FacilityContact: ~~~~-~~~~~·~4~~~~~~~~~.~~-~e~~~~~~~~~~~Tt~.tl~e:~~.~~~~~~~~~~~~~~~~~~~~P~h~on~e~:~~~~~~~~~-~-~~~~
Onsite Representative: ___ l_£ ________________ ~ Integrator: 0'\ ~ l( 7 z__::}
Certified Operator: \[ -----~-----------------------Certification Number: J1!6S
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation? DYes~ DNA ONE
Discharge originated at: D Structure D Application Field D Other:
a. Was the conveyance man-made? DYes 0No []}1fA ONE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) DYes 0No [J}NA ONE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes 0No ~A ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of3
DYes
DYes
~0 DNA ONE ~0 DNA ONE
114/2011 Continued
..
I nate oflnspection: 1/Df/;, /J I Facility Number:
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 Structure3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes [DXo" DNA D NE
DYes ~DNA ONE
Structure 5 Structure 6
DYes ~ DNA ONE
DYes EJNo DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
DYes
DYes
DYes
DYes
[l]..Ho DNA ONE
~ DNA ONE
~ DNA ONE
~DNA ONE l 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. DYes ~DNA ONE
D Excessive Ponding D Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn, etc.)
D PAN D PAN> 10% or 10 1bs. D Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window D Evidence of Wind Drift D Applic ation Outside of Approved Area
12. Crop Type(s): ( F Ff,(~-~~)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in theCA WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation des ign or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19 . Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
the appropriate box.
DYes ~
DYes (]1-ffo
DYes ~0
DYes ~0
DYes Cir'
DYes ~
DYes ~0
DNA
DNA
DNA
DNA
DNA
DNA
DNA
ONE
ONE
ONE
ONE
ONE
ONE
ONE
OwuP Ochecklists 0 Design 0 Maps D Lease Agreements 00ther: _________ _
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ~o DNA D NE
0 Waste Application D Weekly Freeboard 0 Waste Analysis D Soil Analysis 0 Waste Transfers 0 Weather Code
D Rainfall 0 Stocking 0 Crop Yield D 120 Minute Inspections D Monthly and I" Rainfall Inspections p Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes ~o 0 NA D NE
23. If se lected, did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes ~ 0 NA D NE
Pagelof3 214/2011 Continued
IFflcility A umber: 8}; -b S b I Date of Inspection: lJ Ott: {1
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
DYes ~o
DYes~
DNA ONE
DNA ONE
D Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
D Non-compliant sludge levels in any lagoon
List struct:ure(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 [B"No DNA
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? DYes·~ DNA
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes ~ 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 1/J'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 ifNo 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.
~lication Field 0 Lagoon/Storage Pond D Other:
~ 0No DNA
------------------------~DNA 32. Were any additional problems noted which cause non-compliance of the permit orCA WMP? 0 Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
DYes ~0NA
DYes 0 DNA
Comments (refer to question #): Explain any YES anslnrs and/or any additional recommendations or any other comments.
Use drawings offacility to better explain situations (use additional pages as necessary).
~-b
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phon~ IV~ '1S31~s£1
Date: J.l MC\ 1
Pagel of3 21412011
Operation Review 0 Structure Evaluation
Reason for Visit: 0 Follow-up 0 Referral 0 Emergency 0 Other
Date of Visit: I/O /n/1 ~ I Arrival Timed Of,.· 55'" Departure Timed ,\\10 ~I County: SArnp:i:ttJ Region: F'l<o
Farm Name: Of\~ ))Rc::us .. h \-?-Owner Email:
Owner Name: :Jn,\ \'f b, ?t..~£.~5o('V Phone:
Mailing Address:
Physical Address: -----------------------------------------------------------------------------------
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: D Structure 0 Application Field
a. Was the conveyance man-made?
0 Other:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Phone:
Integrator: \I\0R.~='\~Rov..H'J
Certification Number: lQ.~Lo.S
Certification Number:
Longitude:
DYes [lt'No DNA ONE
DYes 0No DNA ONE
DYes 0No DNA ONE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes 0No DNA ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of3
DYes
DYes
[3No DNA ONE
g'No DNA ONE
21412011 Continued
I Facility Number: !Date of Inspection: 10}1\/t?--
Waste Collection & Treatment
4. Is storage capacity (structura l plus storm storage plus heavy ra infall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: :!!~
Spill way?:
Designed Freeboard (in): \"
Observed Freeboard (in ): ay
5. A re th ere any immediate threats.to the integrity of any of the struc tu re s observed?
(i.e., la rge trees, severe erosion, seepage, etc.)
6 . A re there structures o n -site which are not properly addressed and/or managed through a
waste manageme n t or closure plan?
0 Yes 5(No 0 NA 0 NE
D Yes r:;:r'No DNA O NE
Structure 5 Structure 6
0 Yes IJJ No 0 NA 0 NE
D Yes rn No D NA D NE
If any of questions 4--6 were answered )'es, and the situation poses a n immediate public health or cn\'ironmental threat, notify DWQ
7. Do a ny of the s tructures need maintenance or improvement?
8. Do an y of the structures lack adequate markers as requir ed b y the permit?
(not app li cable to roofed pits, dry s tacks, a n d/or wet stacks)
9 . Does a n y part of the waste management system other than the waste stru ctures require
maintenance or improvement?
Waste Application
I 0. Are th ere any re quired butTers, setbacks, o r compliance alternatives tha t need
maintenance or improvement?
D Yes
D Yes
i3'No D NA 0 NE
~No D NA O NE
0 Yes ~No 0 NA 0 NE
0 Yes ~ N o 0 NA 0 NE
II. Is there e vidence of incorrect land application? I f yes, c heck th e appropriate box below . 0 Yes ~N o 0 NA 0 N E
0 Exce ssive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 H eavy Metals (Cu. Z n, etc.)
0 PAN D PAN > 10% or 10 lbs. 0 Total Phosph o rus 0 Fa ilure to Inc orporate M anure/S ludge into Bare Soil
0 Outsid e o f Acceptable Crop Window 0 Ev idence of Wind Drifi 0 Application Outside o f Approved A r ea
12 . C rop Ty pe(s): C -~~(L~uDf> L~~'1J ~.G . 0 ;c_~f\, Co!U\
13 . Soi l Type(s):
14 . Do the receiving crops differ fro m those des ig n ated in th eCA WMP?
I 5. Does the receiving crop and/or land application si te need improvement?
16 . Did the faci li ty fail to secure and /or operate per the irrigation de sign or wettable
acres determination?
Page 2 of3
0 Yes
0 Yes
D Yes
DYes
0 Yes
0 Yes
0 Yes
0 0the r :
0 Yes
g No
gNo
lS2J No
G2J No
g No
E:f No
(g No
0No
D NA O NE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
21411011 Continued
I Facility Number: I Date of Inspection: /Q.. {I c h?...
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
DYes
!3"No
E]"No
DNA ONE
DNA ONE
0 Failure to complete annual sludge survey 0Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of 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.
0 Application Field 0 Lagoon/Storage Pond 0 Other:
DYes ~No DNA ONE
D Yes [21 No 0 NA 0 NE
DYes 0'No DNA ONE
DYes gNo DNA ONE
DYes EJ No DNA 0 NE
D Yes ~No D NA 0 NE
------------------------
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'No
DYes [2] No
0 Yes ~No
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 fa~ility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page3of3
Phone: <=\ 0\-~C>'jy\.sl'iS$)
Date: \0\\,\ \~
r \
21412011
Compliance Inspection Operation Review Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 FoUow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: IL V:lfidu I Arrival Time :I ].3d Ad'\ I Departure Time: [!C ; . .> a bA County:~Seyz Region: r~¥J
Farm Name: () t\, K {':, R ~'""'-( ~ \ E ,).. Owner Email:
Owner Name: ~r l\ '( \)LJ. f \1S 0 rJ Phone:
MailingAddress: )l..\ 0\() ~\.::.hoc\ WR~-<'d' Rol\\) (ivO\.l....II-4
Physical Address: '\t)... c, 0 t JfU .. I\]cb Svha'J Ae:aO, c~cdwJN
Facility Contact: i\1\'t·\t.s;. i\ .. .\C..~~-·~ Phone:
Onsite Representative: Integrator: fn V ~ f? h '/ 13;7(;1.-VI.J
Certified Operator: Ml \'-'i: Vt_ -~ ( {~So;V Certification Number: _1_0-'· ~,._-_·...,S::....·------
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation? DYes ll] No DNA ONE
Di sc harge originated at: D Structure D Application Field D Other:
a. Was the conveyance man-made? 0 Yes 0 No ~NA ONE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) DYes 0 No I)] NA ONE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Doe s the discharge bypass the waste management system? (If yes, notify DWQ) DYes 0No fXl NA ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of3
DYes
DYes
~No D NA ONE
I&J No DNA ONE
214/101 I Continued
!Facility Number: I Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity {structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural fi"eeboard?
Structure I Structure 2 Strucrure 3 Structure 4
Les ~ • Identi tier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ,
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes ~No
DYes IXJ No
DNA ONE
DNA ONE
Structure 5 Structure 6
D Yes [XI No 0 NA 0 NE
0 Yes 00 No D NA D NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any 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 Aoplication
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes
DYes
DYes
DYes
ElJ No DNA ONE
[i] No DNA ONE
rtJ No DNA ONE
gJNo DNA ONE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes 00 No 0 NA 0 NE
D Excessive Ponding 0 Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN> 10% or I 0 lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): ~ t \'t \'"'-.1 ,'1 ~ \-\~h ~ rni\ 11
13. Soil Type(s):
14. Do the receiving crops differ from those designated in theCA WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Pennit readily available?
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
the appropriate box.
Owup Ochecklists 0 Design 0 Maps 0 Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
:,~.t)
DYes [KJNo DNA ONE
DYes IXJ No DNA ONE
DYes (XJNo DNA ONE
DYes lXJ No DNA ONE
DYes &J No DNA ONE
0 Yes IXJ No DNA ONE
DYes ~No DNA ONE
Oother:
0 Yes [i] No DNA ONE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Weather Code
0 Rainfall 0 Stocking 0 Crop Yield 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? D Yes ro No DNA D NE
Page 1 of3 2/412011 Continued
I Date of Inspection: 11 /·~c id.o i/ yv I
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes 00 No DNA ONE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
0 Yes [X] No 0 NA 0 NE
0 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 t he
permit? (i.e., discharge, freeboard problems, over-application)
DYes ~No DNA ONE
0 Yes [II No 0 NA 0 NE
0 Yes I[] No 0 NA 0 NE
0 Yes &]No DNA 0 NE
DYes ~No DNA ONE
0 Yes [B No 0 NA D NE 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field 0 Lagoon/Storage Pond 0 Other: ------------------------
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
DYes II} No
0 Yes BJ No
0 Yes I:!;J No
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).
(t,i.\
Reviewer/Inspector Name: Phone: 9/C , 4).3·· 3 J :;.:~
Reviewer/Inspector Signature: Date: _..J...I..I..Ir/....:.J.L..:t.4.j~a=(.....!...\ _, _
Page 3 of3 21411011
Type of Visit ()..eO'"'"mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ~ine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
DateofVisit: I j-S-.1/0I Arrival Timed L'D D I DepartureTime: 1;;,:;.5=--I County._s;,:'~~ Region: t=:FZ V
Farm Name: CJa.. k ill Cg ,c_J.... t-,2--Owner Email:--------------
Owner Name: _ ___,.B"""'-'-~..LI~! ,._Y_----'(;,-=· ____ -_ =f~ l&2. C.:$1r---
l Phone:
Mailing Address: -------------------------------'-------------
Physical Address:-----:---------------------------------------
Facility Contact: lr/tr!ft:tv ( ?~"3o;--... Title: -----------
PhoneNo: ________ __
Onsite Representative: ------'-'....;1 _____________ _ Integrator: /f1u~
Certified Operator: _____ II ____ -----------Operator Certification Number: -------
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D" Longitude:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? 0 Y es 13-No 0 NA 0 NE
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 ev idence of a past di scha rge from any pa rt of the operation?
3. We re there any advers e impacts o r pot ential adverse impacts to the Waters of the State
oth er th an from a discharge?
DYes 0No DNA ONE
DYes 0No DNA ONE
DYes 0No DNA ONE
DYes j2(No DNA ONE
DYes ~N o DNA ONE
11128104 Contin ued
J Facility Number: g;2.-kJ (e] Date of Inspection It-s:-tt>l ,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
DYes [&No DNA ONE
DYes L3-No DNA D NE
Structure 5 Structure 6
Identifier:------------------------------------------
Spillway?:
Designed Freeboard (in): __ ...L/_9'-'-------------------------------------
Observed Freeboard (in): ---6¢~3....._ __ ----------------------------------
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion , seepage, etc.)
DYes ~No DNA ONE
6. Are there structures on-site which are not properly addressed and/or managed DYes l8No 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 12iN"o DNA D NE
DYes ~No DNA ONE
DYes ~o DNA ONE
DYes ~No DNA ONE
II. Is there evidence of incorrect application? If yes , check the appropriate box below. DYes [21 No 0 NA D NE
D Excessive Ponding D Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn , etc.)
D PAN D PAN> lO% or 10 lbs D Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window D Evidence of Wind Drift D Application Outside of Area
12. Crop type(s) ....;:;p;J::J:..,..:..t.I".LJ.nt~u~Jz.so..:..!......_....J/.u.D.L!(I~r-:...!./"....;5u.:c::.z::r::~J~L/.....!c:;O:::.IZ.~L..L..!::....:....~/~· l!..=-.a.A!...I"~~:::::_ ____________ _
13. Soil type(s) _..t....:=.:.....:o::....!.;it!...._ ______________________________ _
14. Do the receiving crops differ from those desit,rnated in theCA WMP? DYes IB-No DNA ONE
15. Does the receiving crop and/or land application site need improvement? DYes []-:No DNA ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? DYes CB NoD NA D NE
17. Docs the facility lack adequate acreage for land application? DYes 129. No DNA ONE
18. Is there a Jack of properly operating waste application equipment? DYes [&No DNA ONE
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):
....
c;21. Ta-t\ e i0-ev.J 6"">~ l .5 ,,-e"...S f-
fd-yv i.J r e~t~d:fro-v-~sL.v.J;r :rvv-v7 J"\ yovv-rc--c~.
I-.....
I <ie~-..
j Phone: '}7p-~?5 .:f300 Reviewer/) nspector Name /"'-.-t..u 7 ~ -~ ~ /-s--~/0 Reviewer/Inspector Signature: ....................... Date:
1" I 12/28104 Continued
I Facility Numbel": @""-kikl Date oflnspection 11---s-!1> 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 CAWMP readily available? Ifyes, check
the appropriate box. D WUP 0 Checklists D Design 0 Maps D Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
DYes ~No DNA ONE
DYes 13-No DNA ONE
~es ~DNA ONE
D Waste Application D Weekly Freeboard D Waste Analysis jgSoil Analysis 0 Waste Transfers D Annual Certification
D Rainfall D Stocking D Crop Yield D 120 Minute Inspections D Monthly and 1" Rain Inspections D Weather Code
22. Did the facility fail to install and maintain a rain gauge? DYes ~No DNA ONE
23. If selected, did the facility fail to install and maintain rain breakers on irrigation equipment? DYes 1:81No DNA ONE
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 permit? DYes ta.No DNA ONE
26. Did the facility fail to have an actively certified operator in charge? DYes ISia.No DNA ONE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? DYes Ui.No 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 DYes l&l.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 l8.No DNA ONE
lfyes, 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 !:a No DNA ONE
33. Does facility require a follow-up visit by same agency? DYes ~0 DNA ONE
12128/04
~
[Facility Number I II 0"iiivision of Water Quality ~,r-? !-/
ff?-H(p3h 0 Dhision of Soil and Water Conservation ~-~-ocr 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 2-chnical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Other 0 Denied Access
Date or Visit: I ,Y;l-9-t:ff-I Arrh·al Time: I .3 :0 t) r3 Departure Time: I o/.' J 0 I County: ~B?::-=
J5C4Ktcj 1-;;z..__. Owner Email: -------------
Region: E'l:D
Farm Name: (JaiS
Phone: Owner Name: $ 1' f/; c:;:._ ?e /d-~tr>---
MailingAddress: 3 I{ t!J/c/ tU /"trY1kj_ ?'choo/ 10J~·~G.::......t:~~wu..:.irv:...__--=-tJ_c ._tJ-0¥ £,1
Physi cal Address:----------------------------------------
F acility Contact: J{; J/ ~ B-'Pcr/]:y5 u----Title: ----------7
PhoneNo: ________ _
Onsite Representative: /21c. !Jf~rt,u 2 f'e t;;;-13 cr----"
Certified Operator: 111/ ~ '< { ? ~/'5 ;r:--:
Integrator:----------------
Operator Certification Number: /119-~.s-
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD 'D " Longitude: D OD 'D "
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
I I 10 Layer ID Wean to Fini sh I I 0 Da iry Cow
0 Dairy Calf 0 Wean to Feeder
0 Feeder to Finish 0 Dairv Heife1
0 DrvCow
0 Non-Dairy
0 Beef Stockel
0 Beef Feeder
0 Farrow to Wean
0 Farrow to Feeder
0 Farrow to Finis h
0 Gilts
Dry Poultry
0 Laye rs
0 Non-Layers
0 Beef Brood Cow 0 Boars D Pullet s
0 Turkcvs
Other 0 Turkey Poults
0 Other Number of Structures: OJ . ID Other
Discharges & Stream Impacts
I . Is any discha rge observed from any part of the operation?
Discha rge originated at; 0 Structure D Application Fie ld 0 Other
a. Wa s the conveyance man-made?
b . Did the discharge reach waters of the Stat e? (Tf yes, notify DWQ)
c. What is the estimated volume tha t reached waters of the State (gall ons)?
d . Does discharge by pass the waste management system? (If yes. notifY DWQ)
2. Is there evidence of a past di scharge from any part of the operat ion?
3. Were there any adverse impacts or potential adverse impacts to th e Waters of th e State
other than from a di sc harge?
D Yes i2g No D NA O NE
D Yes 0No DNA O NE
DYes 0 No DNA O NE
D Yes 0No D NA O NE
D Yes rn.No DNA O NE
D Yes [QNo DNA ONE
12128104 Continued
!Facility Number: f?;l.-(,3k I Date of Inspection I ~· F J-otT
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus h eavy rainfall) less th a n adequate?
a. If yes , is waste level into the structural freeboard?
Structure I Structure2 Structure 3 Structure 4
DYes 13No DNA ONE
DYes 0No DNA ONE
Structure 5 Structure 6
Identifier:---------------------------------------
Spi llway?:
Designed Freeboard (in): __ ._1_.9.__ __
Observed Fre eboard (in): _ ...... ...cJ'-'V~--------------------------------------
5. Are there any immediate th reats to the integrity of any of the structures observed? 0 Yes 2J No DNA ON E
(ie/large trees, severe erosion, seepage, etc .)
6. Are there structures on-site which are not properly addressed and/or managed 0 Yes 0No DNA ~NE
through a waste management or closure plan?
If a ny 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 struct ure s need maintenance or improvem ent?
8. Do any of the stuctures Jack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any re quired buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes 0No DNA jgNE
DYes IS-No DNA ON E
DYes 0No DNA ~NE
DYes 0No DNA ~N E
II. Is there evidence of incorrect application? lfyes, check the appropriate box below. S Yes 0 No DNA 0 N E
0 Excessiv e Ponding ~Hydrauli c Overload 0 Frozen Ground D Heavy Metals (Cu, Zn , etc .)
0 PAN D PAN > 10% or 10 lbs 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outs ide of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Area
12. Crop type(s) r-Y\_ --~~~~---------------------------------------------------------------
13. Soil type(s)
14. Do the receiving crops differ from those des ig nated in theCA WMP? DYes 0No DNA .8NE
15. Does the receivi ng crop and/or land application site need improvement? ~Yes D No DNA ONE
16. Did th e faci lity fail to secure and/o r operate per the irrigation design or wettable acre determination?D Yes ~No DNA ONE
17. Does the facility lack adequate acreage for lan d application? DYes 0No DNA I&N E
18 . Is there a lack of properly operating waste application equipment? DYes ~N o DNA O NE
Comments (refer to question#): Explain any YES answers and/or any recommendations or any otber comments.
Use dra\lings of facility to better explain situations. (use additional pages as necessary):
/I ci-15 ftJ?'J}; JJ-W'L!J ~3~ {;j j {) /1> ~cf; ~ rJ-cJtt~ ,Pd£ d ~ Ca.v~-.J ....
~
rl~ W,c~ft, lo rr~~L lo TWO Lvw ~p~ )'l -rir .P:~t-1,/, w4'zi"1 ?7/?-
tv·rflt FtrLd Ce->-tcl.--J,rr--1-;fr-.e_ rl0 /Jt~;-/tlr-m~~ eto~~ f
1-...,
Reviewer/1 nspector Name 5'71;~ g.kuf~ Phone: 9-J t?-'/JJ-33-oo
R eviewer/Inspector Si~nat ure : /' r; ~~-Date: s--L-£Mt8
/ 12128104 Continued
.. I Facility Number: ;"';J.-:£,-y t..l Date of Inspection I Jf-dtDfr
R equired Records & Document'>
19 . Did the facility fail to have Certificate of Coverage & Pennit readi ly available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropirate box. 0 WUP 0 C h ecklists 0 Design 0 Maps 0 Other
D Yes 0No DNA e_NE
D Yes 0No DNA ~N E
21. Does record keeping need improvement? If yes, check th e appropriate box below. 0 Yes 0 No 0 NA ~ NE
0 Waste Application D Weekly Freeboard 0 Waste Analysis D Soil Analysis D Waste Transfers 0 Annual Certification
D Rainfall D S tock ing D Crop Yield D 120 Minute Inspections D Monthly and I" Rain Inspections D Weather Code
22. Did the facility fail to install and maintain a rain gauge? D Yes 0No DNA KINE
23 . If selected, did the facility fail to install and maintain rain breakers on irri gation equipment? DYes 0No D NA 29NE
24. Did the facil ity fai l to calibrate waste a ppli cation equipment as r equired by the pennit? D Yes 0No DNA 18J-NE
25 . Did the faci li ty fa il to conduct a s lud ge survey as required by the pennit? DYes 0No DNA ~NE
26. Did t he faci lity fa il to have an actively certified operator in charge? D Yes ~No DNA O NE
27. Did th e facility fa il to secure a phosphorus Jo ss assessment (PLAT) certification? D Yes 0No DNA i2}NE
Other Issues
28. Were any additi o nal 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 wi th in 24 hours and/or doc ument
and report the mortality rates that were higher than normal ?
DYes 0No DNA ~NE
30. At the time of the inspection did the facility pose an odor or air quality concern? DYes f.2jNo DNA ONE
I f yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notifY the regional office of emergency situations as required by DYes D No DNA ~NE
General Permit? (ie/ discharge, freeboard problems, over app li cation)
32. Did Reviewer/In spector fai l to discuss review/inspection with an on-site representative? D Yes ~No DNA O NE
33. Does faci lity require a follow-up visit by same agency? D Yes (3-No DNA O NE
tJM) f71'r yJ de. U/4.:7/c ~ J,r:-av-.-·:;;;-d~ n '"J!;-LA w~ d-ft ri--e.
t/3 e oF"' !J,' r,n._ _.) ~d~ ;r Uf1 r/-c _ rr..-I 71 17:-).,. ~"' d <--
tUY!~Ft-1/.~jh be-'ycy//'e--~
Page 3 of 3 12128/04
'
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ~tine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 other 0 Denied Access
Region: r-"J( 0 DateofVisit: l.t}Z"k'"WJ Arrival Tire: I/; ?0 I Departure Time: I. 1.' DD I County: ~
Farm Name: {Qa)C. d>J'(!l.+f ~ I -OJ-Owner Email: -------------
Owner Name: ~J3.L.:.1-~.I...!..\ +{____,;/J-..-.-__ ----4J.?i\ft q?-fj-P<-e --Phone:
Mailing Address: -----------------------------------------
Physical Address: f--
Facility Contact: .,.QZ+-'-'""'7/l.~'"": ........ ..z:.L_--.r...G""""'"....;.'M..:::~""r:2......,;P"::... __ Title: -----------Phone No: _________ _
Onsite Representative: __ $'--~----------------Integrator:----------------
Certified Operator: ___ ,.....&::...~----------------Operator Certification Number: --------
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm : Latitude: D OD'D" D oo· r-1 " Longitude: L__J
Design Current ·
Capacity Population
Design Current -::
Capacity Population . Wet Poultry Swine Cattle .. . .... ··'-•'-. ....... ~-
0 Wean to Finish
0 Wean to Feeder
D Dairy Cow
· D Dairy Calf
10 Layer I I r D Non-Layer
I:Sfeeder to Finish !#ijO ~-D Dairy Heife r
0 Farrow to Wean PtVV
0 Farrow to Feeder
D Farrow to Fini sh
0 Gilts
0 Boars
· ODrvCow
0 Non-Dairy
D Beef Stocker
D Beef Feeder
D Beef Brood Cow
-
Dry Poultry
] Layers
. D Non-Layers
0 Pullets
D Turkeys
Other D Turkey Poults
D Other lO Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation? 0 Yes .ti?J.No 0 NA
Di sc harge originated at: 0 Structure D Appli c ation Field 0 Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If y es, notify DWQ)
c. What is the estimated volume that reached waters of the State (ga ll ons)?
d. Does discharge bypass the waste manag ement system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part ofthe operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
D Yes 0No DNA
DYes 0 No D NA
D Yes 0No DNA
D Yes 12Q.N o DNA
D Yes IR.No DNA
ONE
ONE
ONE
ONE
ONE
ONE
Page I of 3 12128104 Continued
t'
t
I Facility Number:&fZ--Li3 l, I Date of Inspection
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 1 Structure 2 , Structure 3 Structure 4
DYes .5.dNo DNA ONE
DYes DNo DNA ONE
Structure 5 Structure 6
Identifier:------------------------------------------
Spillway?:
Designed Freeboard (in): __ J-1--:"-r------------------------------------
Observed Freeboard (in): --r:,.($...__1-4------------------------------------
5, Are there any immediate threats to the integrity of any of the structures observed? DYes JXNo DNA ONE
(ie/large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed DYes lli.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 pennit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0, Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes ~o DNA ONE
DYes Bl.No DNA ONE
DYes ®No DNA ONE
DYes ~No DNA ONE
II, Is there evidence of incorrect application? lfyes, check the appropriate box below. 0 Yes ~No 0 NA 0 NE
0 Excessive Ponding D Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn, etc.)
0 PAN D PAN> 10% or 10 lbs D Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Area
12. crop type(s) ___,&~t.:.ll'hwJ,~-1-4./JS:....l./.:p,l/~t;...+f~~~~;c:&...L..Stt..fr""-_.....:...;//}1~; t~'k...:..f-_' ____ ..:..__ ______ _
13. Soil type(s) N
14. Do the receiving crops differ from those designated in theCA WMP?
15. Does the receiving crop and/or land application site need improvement?
DYes
DYes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination?O Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Pagel of 3
DYes
DYes
j21.No DNA ONE
l21-No DNA ONE
[SlNo DNA ONE
1)1-No DNA ONE
~No DNA ONE
I Facility Number: t'J--~3/J,
Required Records & Documents
Date of Inspection J /IJ--J:tO«
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? I f yes, ch eck
the appropirate box. 0 WUP 0 Checklists 0 Design 0 Maps 0 Ot her
21. Does record keeping need improvement? If yes, check the appropriate box below .
DYes i8No DNA D NE
DYes ~N o D NA ONE
4Yes 8-No D NA ONE
~Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Anal ys is 0 Was te Transfers 0 Annual Certific a tion
0 Rainfall D Stocking 0 Crop Yield 0 120 Minute Inspections D Mont hly and I" Rain In sp ec tions D Weather Code
22. Did the facility fail to install and maintain a rain gauge? D Yes 0 No DNA O NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation eq ui pment? DYes ~N o D N A ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit? D Ye s J81 No D NA ONE
25. Did the facility fail to conduct a sludge survey as required by the permit? DYes I2SI. No D NA ONE
26. Did the facility fail to have an actively certified operator in charge? DYes ~No DNA ONE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? DYes l;ia No DNA O NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit orCA WM P? D Yes ~No DNA O NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or doc um ent D Yes Ia 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? D Yes ~No DNA ONE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notifY the regional office of emergency situations as required by D Yes 181No DNA ONE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site repres entati ve ? DYes 00No DNA O N E
33. Does facility require a follow-up visit by same agency? D Yes P'JNo DNA ONE
Additional Comments an~or Drawings:
....
1--
f--.,.,
Page 3 of 3 1212 8104
' J
.} IFacility Number I &J: II ~ision of Water Quality ..>lf6 ·l/""
Hc:3b 0 Division of Soil and Water Conservation t' / --;r?--i) 7
0 Other Agency
Type of Visit ~pllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ~e 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
Date of Visit: I /:J:/f?JP Arrival Time: I J :v 0 I Departure Time: I 1/: J{) I Count}~ Region: (=}? U
Farm Name: {])a{;( Br~"'C h-1-d?: Owner Email: -------------
Owner Name: :p;tly ref!t;..,r..!.cs--Phone: 9Jcro~Z-to307 /I1:1A-:
Mailing Address: ----------------------------------------
Physical Address:----------------------------------------
Facility Contact: (D ;//t~ ? ~T;-/,so-.-
1 Title: -----------
PhoneNo: _____________ _
Onsite Representative: ___ .... '2:'"".?'-~...;;_.......;;;=-------------Integrator:----------------
Certified Operator: __ .... S:~~:_.....;~..=;;....... __ -----------Operator Certification Number: -------
Back-up Operator: ----------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D" Longitude: D OD 'D "
De sign Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
JD Wean to Finish l l 10 Laye r
0 Wean to F eedcr 0 Non-Laye1 I I 0 Dairy Cow
D Dairy Calf
~Feeder to Finish /¥00 /9-Vt? 0 Dairy Heife1
0 Farrow to Wean
0 Farrow to Feeder
0 Farrow to Finish
0 Gilts
0 Boars
0 D_!YCow
0 Non-Dairy
0 Beef Stocket
0 BeefFeeder
0 Beef Brood Cow --.
Dry Poultry
Other
0 Layers
D Non-Layers
0 Pullets
0 Turkeys
0 Turkey Poults
0 Oth er Number of Structures: [lJ ID Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation? 0 Yes 18f:.No DNA D NE
Discharge originated at: 0 Structure 0 Application Field 0 Other
a. Wa s the conveyance man-made? DYes D No DNA O NE
b. Did the discharge reach waters of the State'' (If yes , notify DWQ) DYes 0No DNA O NE
c. What is the estimated volume that reached waters of the State (ga ll ons)?
d. Does discharge bypass the waste management system? (If yes , notify DWQ)
2. Is there evidence of a past discharge from any part of the operat ion ?
3. Were th ere any adverse impacts or potentia l adverse impacts to the Waters of the State
other than from a di scharge?
DYes DNo
DYes g No
D Yes ~0
12128104
D NA O NE
DNA O NE
D NA ONE
Continued
i
\
!
jFacilityNumber:Q-k3 Q Date of Inspection I'Gl-1'7"3?7
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. If yes, is waste le vel into the structural freeboard?
DYes f3_No 0 NA D NE
DYes 0No DNA ONE
Structure I Structure 2 Structure 3 Strucrure 4 Structure 5 Structure 6
Identifier:-----------------------------------------
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in): /9
5. Are there any immediate threats to the integrity of any ofthe structures observed? DYes ~No DNA ONE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed D Yes ~No DNA ONE
through a waste managem en t 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 structure s need maintenance or improvement?
8. Do any of the stuctures lack adequate markers as required by the penn it?
(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 improvemen t?
Waste Application
I 0. Are there any required buffers, setback s. or compliance alternatives that need
maintenance/improvement?
DYes &No DNA ONE
DYes CX'No 0 NA 0 NE
DYes 12SJNo DNA ONE
DYes ~No DNA ONE
I I. Is there evidence of in correct app li cati o n '! If yes, check th e appropriate box below. DYes _lgl No 0 NA 0 NE
D Excessive Ponding 0 Hydrauli c Overload 0 Frozen Ground D Hea vy Meta ls (Cu, Zn, etc.)
0 PAN 0 PAN> 10% or 10 lbs 0 Total Pho sphorus D Failure to Incorporate Man ure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Applicat ion Outside of Area
12 Croptype(s) ~qnu}~fX,._~J ~_k,U
13. Soil type(s) _ _J-1-}j_.=......::lO::...!.ft_..L.. _______________________________ _
14 . Do the receiving crops ditfer from th ose designated in theCA WMP?
15. Does the receiving crop and/or land application site need improvement?
0 Yes OlNo
D Yes ®,No
16 . Did the facility fail to secure and/or operate per th e irri gatio n desi gn or wettable acre detennination?O Yes ~ No
17 . Ooes the facility lack adequate acreage for land application? 0 Yes §?J No
I 8. Is there a lack of properly operating waste application equipment? 0 Yes ~o
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):
DNA
DNA
DNA
DNA
DNA
1\~c-f /Jk-r'f1 frcr'~ ~ U/1!'~5 Jl./r~mi~'?-J;vJ-;Jo~;7
/IV~.fJ~
Reviewer/Inspector Name
Reviewer I I nspector Signature: Date :
12/28104
ONE
O NE
ONE
ONE
O NE
i ..,
\
I
I Facility Numbe r : r~-b3tJ Date of Insp ectio n II/). -;t'-~ 7
Requir e d R e c o rds & Documents
19. Di d th e fac ili ty fa il to h ave Certi ficate of Coverage & Permit readi ly available?
20. Does the fac ility fa il to have all components of theCA WMP readi ly ava il able? If yes, check
the appropirate box. D WUP D C hecklists D Design 0 Maps D Other
D Yes QiNo D NA O NE
D Yes gj No D NA O NE
2 1. Does record keep ing need improvem ent? If yes , c h eck the ap p ropriate box below. [ilYes D No D N A D NE
D Waste Appli cati on ~We e kl y Freeboard 0 Waste Ana lysis D Soil Analysis D Waste Transfers 0 Annual Certi fi cati on
D Rainfall D Stocking 0 Crop Y ie ld 0 120 Minute In spections D Monthl y an d I" Ra in Inspections 0 Weather Code
22. Did the faci li ty fai l to ins tall and mai ntain a rain gauge? D Yes 3,No D NA O NE
23. If selected, did the fac ility fa il to in stall and maintain rain breakers on irrigation equipment? D Yes ~No D NA O NE
24 . Did the faci li ty fail to calibrate waste a pp lication equipment as required by the permit? DYes ~No D NA O NE
25. Did the fac ility fa il to cond uct a s ludge survey as required by th e permit? D Yes JiJ...No D NA O NE
26. Did the facility fail to have an ac ti ve ly c ertified operator in charge? D Yes .Qa_No D NA O NE
27. Did the faci lity fa il to secure a ph osphorus loss assessment (PLAT) certificati on? D Yes ji.No DNA O NE
Othe r Issues
28. Were any addit iona l pro bl ems noted which cause no n -compliance of th e permit or CAWMP? D Yes JQNo D NA O NE
29 . Did the fac ility fa il to properly di spose of dead an imals wit hin 24 hours a nd/o r document D Yes ~No D NA O NE
and report t he mortality rat es that were higher than normal?
30. At the time of the inspecti on di d the faci lity pose an odor or air quali ty co ncern? D Yes ~No D NA O NE
If yes, contact a regional Air Qua li ty representative inunediately
31. Did the faci lity fai l to noti fy the regiona l office of emergency situations as required by D Yes (&t No D N A O NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss revi ew/i nspection with an on-site representative ? D Yes J&lNo D NA O NE
33. Does facility req uire a follow-up visit by same agency? D Yes t)jl No D NA O NE
Additional Comments and/or Drawings:
..... -
f-...
12128104
'
lr~·cil!t)f;~·~.l11~~~j 82:_ H _~:Jt; U
: ::.:· -~~ ··· ..:· .. : ·~ ·:· :YJ-.~~:.:.:f!~i)·§tJ~~;..:~_::
iV:ision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Eva l uation 0 Technical Assistance
Reason for Visit ~ine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Dot• or v''"' I ~ A"'"' 'r•d J ~·"""Tim" 13": :£:::2::::1 County' ~
Farm Name: C>a.k. <f){IM-dv J-_J::::_ OwnerEmail: -------------
Region:Ff?O
Owner Name: "f? j J / V Pr~..,___.._.o?"'-;r--= _____ _
(
Phone:
Mailing Address:
Physical Address:--~---------------------------------------~oPl~Jq..u.O..._.t:"._,L=---+-~.Lo(.;.-~~..~...'f-'~=fr"/--Titl e: ---------Facility Contact: PhoneNo: ___________ ___
Onsite Represen tative: --=&':jl.j<..,M,;,:;.o,r:::c .... A,..::-r::><::::;__ ___________ _ Integrator: ....,,~-.l:f.!..~.:::....;...m;..;..;..)~J4---_-_~.L.L£..;;..~ ------
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
S:wine · · ·. · CapaCity Population Wet Poultry Capacity
Current
Population
:·lr;:::D::;-W-e_a_n -to ...... F-'-i-nt-. sh-rl _....;:.......,;_-___:_.,lr--=-----.1 10 La yer .l.
-~D~N~o~n~-=L~ay~e~r~+------~------~ D Wean to F ceder
l,lgl Feeder t o Finish /if I/{) /t/00
D Farrow to Wean
D Farrow to Feeder
D Farrow to Finish
D Gilts
D Boars
.. -. -.. .. ----
Dry Poultry
D Layers
D Non -Layers
D Pu ll ets
0 Turkeys
D Turkey Poults
0 Other
Other .
·lo Othe~
-~ < ·. 'i • --·· .. --··· -.
Discharges & Stream Impa cts
I . Is any di sch arg e observed from any part of the opera tion ?
Di scharge originated at : D Stru ctu re 0 Application F ie ld D Other
a. Was the con ve ya nce man-mad e?
b . Did the discharge re ach waters of the State? (If yes, notify DWQ)
c . What is th e estimated volume that reac hed wat ers of the State (gallons)?
d . Does discharge bypass the waste managemen t system? (If ye s . n otifY DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were th ere any adverse impacts or potential advers e imp acts to the Waters of the Sta te
other than from a di scharge?
Page 1 ofJ
DYes ~o D N A O NE
D Yes 0 No D NA O NE
D Yes 0 No D NA O NE
DYes 0No D NA O NE
D Yes SNo DNA ONE
D Yes ~0 D NA O N E
12128104 Continued
Date of Inspection
\ Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adeq uate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Struc ture 4
DYes jRNo D N A ONE
0 Yes ia.No 0 NA 0 NE
Structure 5 Structure 6
Identifier:------------------------------------------
Spillway?:
Designed Freeboard (in): __ /f.-J.Cf:._ __ --------------------------------
Observed Freeboard (in): -~J""'tf~--------------------------------------
5. Are there any immediate threats to the integrity of any ofthe structures observed?
(ie/large trees, severe erosion, seepage, etc.)
DYes iia._No DNA ONE
6. Are there structures on-site which are not properly addressed and/or managed DYes f)a_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)
DYes j)iNo 0 NA D NE
D Yes ~No DNA ONE
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
DYes 6Q.N o DNA O N E
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
0 Yes f8 No 0 NA D NE
11. Is there evidence of incorrect application? If yes. check the appropriate box below. 0 Yes ~o DNA 0 N E
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground D Heavy Meta ls (Cu, Zn. etc.)
0 PAN 0 PAN> 10% or 10 lbs D Total Phosphorus D Failure to Inc orp orate Manure /Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Appli cati on Outs ide of Are a
12. Croptype(s) ~~;~~ Ja.,.../11~
13. Soil type(s) ~ --~~~--------------------------------------------------------
14. Do the receiving crops differ from those designated in the CA WMP? D Yes [&N o DNA ONE
15. Does the receiving crop and/or land application site need improvement? D Y es Jia No DNA ONE
\
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determin ation ? DYes .1i'J No 0 NA 0 NE
17. Does the facility lack adequate acreage for land application? DYes ~N o
18. Is there a lack ofproperly operating waste application equipment? DYes ~N o
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 neeessary):
Reviewer/Inspector Name ----___,::Z.-I-~~:J;;;.-..L.:;;,1;:~~'.Lt.~---------Phone:
Reviewer/Inspector Signature: Date:
Page 1 of3
DNA ONE
DNA O N E
I Facility Number: g;? -@{J Date of Inspection I 1(-i!O=tJ ~ •
L Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readil y available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropriate box. D WUP 0 Checklists 0 Design 0 Maps 0 Other
DYes ~o DNA ONE
0 Yes )ZJ-No 0 NA D NE
21. Does rec ord keeping need improvement? If yes, check the appropriate box below. 0 Yes ~o 0 N A 0 NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analys is 0 Soil Analysis 0 Waste Transfers 0 Annual Certification
0 Rainfall 0 Stoclcing 0 Crop Yield 0 120 Minute Inspections D Monthly and I" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certi fied operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other~
28. Were any additional problems noted which cause non-complian ce of the permit orCA WMP?
29. Did the faci lity fail to properly dispose of dead animals within 24 hours and/or do cument
and report the mortality rates that were hi gher than nom1al?
30. At the time of the inspection did the facility pos e an odor or air quality concern?
If yes, contact a regional Air Quality representative immedia tel y
31. Did the facility fail to notifY the regiona l office of emergency situat ions as required by
General Permit? (ie/ di scharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33 . Doe s facility require a follow-up v isit by same agency ?
~dditiona(Comnien~:an'Jior .Drawings :
Page 3 of3
DYes ,0.No DNA ONE
DYes 12J.No DNA ONE
DYes j8No DNA ONE
DYes {SNo DNA ONE
DYes ~No DNA ONE
0 Yes Jij.No DNA ONE
DYes 5No DNA ONE
DYes RSJ.No DNA ONE
DYes $)No DNA ONE
DYes ..£nNo DNA ONE
DYes .til No DNA O NE
DYes A_No DNA ONE
. :;: ... :.:rr;;;.~·~~;~~,,.~Ft.
• 1--
12128104
e Division onvater <iu~liiy
'0 Division of Soil and \Vater Conservation
0 Other Agency . .
Type of Visit Wcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit e Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
Date of Visit: I tJ /lo /toOSj Arrh·al Time: I /: "() I Departure Time: Ll ___ ___.I Coun~·: 5o..-f~0 AJ Region: Feo
Farm Name: r3'• i I "t G. f.:A·c.. r .5o JJ F~r"""' ( ~ OL Owner Email: --------------
Owncr Name: r1 ·~ i I y G Pe ±c. r .{ o t-.J Phone: S" ~ 7-t. 3" 7
Mailing Address: 3 4 0 \ aJl.... W ~ <!. n-c...l. J<.cSL_
Physical Address: ____ . ~-·.L.!oic.~""'=~<--5c<__.!:c;....._.,,');t__~oCV~b~o~"·__!c.-=:._ _____ ---------------____ _
Facility Contact: ______________ Title:-----------PhoncNo: ________ __
Onsite Reprcsen tative: _----.~.rn_:_.:....:.i..llc:...=:::Jb!..L..:"~c:..:..:.!..l _ _.&_r_s..wf...!:e::-..:~!..:.s~o;.:u:::_ ___ _ Integrator: PrG~·· ....._"""" 5+ """" €'2.a ..... J2.
Certified Opera tor: _ _.ln~Lc...i_.,c.,.._),u.;r,4,_.c;I:O<z::...IL·__ -~&.__,~:;;...-f,'-=~"-r-=-''-'o"'-A.J=------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 C~pacity Population Cattle Capacity Population
[O Wean to Finish
0 Wean to Feeder
10 Layer
0 Non-Layer I I DoairyCow
0 Dairy Calf
[]I Feeder to Finish l'l<./0 J'/qtJ D Dairv Heifer
0 Farrow to Wean
0 Farrow to Feeder
0 Farrow to Finish
0 Gilts
0 Boars
0 Dry Cow
D Non-Dairy
;
0 Beef Stockel I
0 Beef Feeder i
0 Beef Brood Cow
---
Dry Poultry
Other
0 Lavers
0 Non-Layers
0 Pullets
0 Turkeys
0 Turkev Poults
D Other Number of Structures: [ZJ ID Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? DYes ~No DNA ONE
Discharge originated at: 0 Structure 0 Application Field 0 Other
a. Was the conveyance man-made? DYes 0No DNA ONE
b. Did the discharge reach waters ofthe State? (If yes. notify DWQ) DYes 0No DNA ONE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'J (If yes. notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
DYes DNo
DYes (]No
DYes ~No
12118104
DNA ONE
DNA ONE
DNA ONE
Continued
jFacilityNumber: (/~-G>?l Date of Inspection I ;2 }lo /@
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
DYes ISZINo DNA ONE
0 Yes DNo DNA ONE
Structure 5 Structure 6
Identifier: ___ .;../ ___ ----------------------------------
Spillway?:
1'"")0 • /fIt Des ignedFreeboard(in): _ _.:;ot......;;;;;......;;._..., ________________________________ _
.....,3 It ObservedFreeboard(in): __ ..::cY=--..;::._ ___________________________________ _
5 . Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees , severe erosion, seepage, etc .)
DYes lpNo DNA ONE
6 . Are there structures on-s ite 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 )''es, and the situation poses an immediate public health or environmental threat, notify DWQ
7 . Do any ofthe structures need maintenance or improvement?
8 . Do any of the stuctures lack adequate markers a s required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9 . Does any part of th e w aste management s ystem other than the was te s tructures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improve m ent ?
DYes [ENo DNA ONE
DYes flJNo DNA ONE
DYes OC}No DNA ONE
DYes ISZ)No DNA ONE
II . Is there evidence of incorrect application? If yes, check the appropriate bo x below. 0 Yes lXI No 0 NA 0 NE
14.
15 .
16.
17 .
18 .
0 Ex cessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PA N> 10% or 10 lbs 0 Total Phos phorus 0 Fa ilure to Incorporate M anure/Sludge into Bare Soil
0 Outside of A cceptable C rop Window 0 Evidence of Wind Drift 0 Application Outs ide of Area
Do the receiving cro p s diffe r from thos e des ig nated in the CA WMP? DYes ~No DNA
Does the receiving c rop a nd/or land application site ne ed imp ro veme nt? DYes ~No DNA
Did the facility fail to secure and/or operate per the irrigation d esig n or wettable acre determination'i O Yes ~No DNA
Does the fa cility lack ade quate acreage for land application? DYes ~No DNA
Is there a lac k of properly operating was te application equipment? DYes t]No DNA
. '
Comments (refer to qu~tion #): EI.plaiil any YES answers and/or any reeominendations or ~y o~er comments.
U~~ ctrawings o~facility t~ ~e~ explain situations. (nse'addition&l p~es ·as nee~): :· · · ·
.·
ONE
ONE
ONE
ONE
ONE
.. . :.1
,., '
1:1
~
Reviewer/Inspector Name r -· z~rry ~~~..{7' ,. I Phone: C(JO '-1~' /.)~/ I
Re\iewerllnspector Si g nature: ~ ~.-J./.£ Date : ..:l /ltJ /~.J
c;r-· '/ 12118104 Continued
Date of Inspection l~ffi Ju1
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? lf yes. check
the appropirate box. D WUP 0 Checklists 0 Design D Maps 0 Other
DYes 00No DNA ONE
0 Yes ~No DNA ONE
21. Does record keeping need improvement'! Ifyes, check the appropriate box below. IXJ Yes D No 0 NA 0 NE
D Waste Application if weekly Freeboard 0 Waste Analysis D Soil Analys is D Waste Transfers D Annual Certification
0'Rainfall ~eking [d-Crop Yield (3'120 Minute inspections ~onthly and 1" Rain Inspections 9-\Veather Code
22. Did the facility fail to install and maintain a rain gauge? DYes lji No DNA ONE
23. If selected, did the facility fail to install and maintain rain breakers on irrigation equipment? DYes 0 No 00NA ONE
24_ Did the facility fail to calibrate waste application equipment as required by the permit? DYes 0 No (iNA ONE
25. Did the facility fail to conduct a sludge survey as required by the permit? DYes 0 No IXJNA ONE
26. Did the facility fail to have an actively certified operator in charge? DYes IXJNo DNA ONE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? DYes 0No ~NA lJNE
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 DYes CXN o 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 required by DYes ~No DNA ONE
General Permit? (ie/ discharge, freeboard problems, over application) ~No 32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site represent ative? DYes DNA ONE
33. Does facility require a follow-up visit by same agency? DYes ~No DNA ONE
Addif!onaJ Comments andl~r Dra\yiligs:. ~. -~~ ,,
' '
•. -. -. ' . .
;2 J-p) e()_.> <-b~,-·~ -\-o u~e... -\-~ e. ~r;o .... o-.~~& .c~~.-~ t-t> ~
-\-"' e. p~ ... """"""',-\--th~ c.,"' ~ c___,\cc:..& b -l o c.JL:::. \"lc.J --\-0
U~~\.4)~V
\oc. k~p+ C\,..) \("'c._ b v....:.. -r ~J2 .
;)3-T~L ..C.:.-..-. <-.r ~10 .. \.-""""4"-~ s.. 0 ........ ~ ¢ .... <=.-o..--. s\-\-c ~L<.v-~ ..... '{ ~\\
q p F'··c.o-be>f..J~~
s~: 1 Sa....._~\c: ""\C-1,-+4 ¥-~-"'--'i c.---\.
~ c \... < ce.~\ u:R.. +o b~ cor.-r I~ -\--r:c-Q__ .-W~~~......__
:;..>--2) }..._~<-_!>~.t.r-J.tt ~.!:>
"~ \~ ~a-\-<=..
+""-'o vJe~~~ o
~
12128104
Reason for Visit Moutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other 0 Denied Access
I Facility Number 1 %9' H '$ I Date of Visit: I d: IJIJ I Time: Is J'f /"'f I
. . lo Not Operational 0 Below Threshold
~rmitted ttCe""rtified C Conditionally Certified C Registered Date Last Operated or Above Threshold: ·----------------... -·
Fann Name. __ _$._i!LJ---~/. ... f'~'!:!~---&!.!!:!_.L!.2._________ County: ---~~-------·-----·---
:: N:::--·---P-!7~!: -~~~~-t:J:----Pbone~~:f!2~:~-~ ---~~-~-
g ······-···----·-·········----------·-···········-------·--·-------·--·----··-----····----------·--------·----··-·---1---~----·-------------·····
Facility Contact: ..... __ .{!!!. ~L ..... ~<:f:f.~.f~~---·-··· Title: .. -.... P.-~~~---···-····---···-·-.. ·-·-·· Phone No: -·----------··----··-·
Onsite Representative: ____ /.!J.[rA~J ...... -..... fd!~..!~---····--·-·----·-·-·-·· Integrator: ... f~.~':: __ ?:_~J~_4 _________ _
Certified Operator: ............. l!J.!.fh.~.L ................ ?..~~-~........................... Operator Certification Number: l.~~Ct$.. _______ ...... .
Location of Farm:
Q'(wine 0 Poultry 0 Cattle D Horse Latitude '---__.1• ~.-I _ _.I• L...l _---JI" Longitude .___..I• .... I _ _.I· .._I _ ...... I"
Discharges & Stream Jmpacts
I. Is any discharge observed from any part of the operation?
Discharge originated at 0 Lagoon D Spray Field 0 Other
a. If discharge is obser ved , was the conveyance man -made?
b. If disc harge is observed, did it reach Water of the State? {If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min ?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a disc harge?
Waste Collection & Treatment
4 . Is storage capacity (freeboard plus storm storage) less than adequate? D Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier : ·········---·..1. ............... . I?•'' Freeboard (inches): _ ___:::>0;;...._ __ _
12112/03 ------
DYes eNo
DYes DNo
DYes DNo
DYes DNo
DYes [B'No
DYes ~0
DYes s-N'o
Structure 6
Continued
[Facility Number:~ -"~ I Date of Inspection rs14/D&:I I
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10 . Are there any buffers that need maintenance/improvement?
11 . Is there evidence of over application? If yes, check the appropriate box below.
0 Excessive Pending D PAN D Hydraulic Overload D Frozen Ground D Copper and/or Zinc
12. Crop type ~ whta-1-1' ~ 1/ ; ..
13. Do the receiving crops differ with those designa in the Certified Animal Waste Management Plan (CA WMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facil ity need a wettable acre determination?
c) This facility is pended for a wettable acre determination ?
15 . Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17 . Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
12112/03
Date:
DYes ~0
DYes ti;J.No
DYes [id'No
DYes 9"No
DYes [iJ'No
DYes ~0
DYes ~0
DYes 0
DYes 00No
DYes ~0
DYes ~0
DYes ~0
DYes ~0
DYes ~
DYes ~0
DYes ~0
DYes 9'No
Continued
• I Facility Number: ~ -b~hl
l
Date of Inspection I sz'fP f I
Required Records & Document.;
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
0 Waste Application 0 Freeboard 0 Waste Analysis 0 Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26 . Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified A WMP?
l\TPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, sldp 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.
0 Stocking Form D Crop Yield Form 0 Rainfall D Inspection After I " Rain
0 120 Minute Inspections 0 Annual Certification Form
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
[] No violations or deficiencies were noted during this visit. You will r~eive no further correspondence about this visit.
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