820650_INSPECTIONS_20171231

NORTH CAROLINA
Deparbnent of Environmental Quality
Reason for Visit:
Date of Visit: LlcrPfiiig Arrival Time: I 1~oo P Departure Time: I[~ l(.S'P J County: Sf'ttfX' tJ Region: fJZo
Farm Name: Jn (_ ke-1. :z-...:.... C 1\lcS (~'1)1 Owner Email:
OwnerName: em G f{).,/1'\f:;y <Zolttc ~-c/7 Phone:
Mailing Address: 5/-rrc./i:la.-:1
Physical Address:
Facility Contact: -.-Cu __ ,___{-_,_5_i3;___a_;_q-_lu:...._c ~_{.-< __ Title:
Onsite Representative: I(
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
LIs 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 ofthe State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
DYes ~NA ONE
DYes 0No
DYes 0No
d. Does the discharge bypass the waste management system? (If yes, notify DWR) DYes DNo ~ONE
D Yes Q-1'fo D NA D NE
DYes ~DNA ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of3 114/2015 Continued
IFacili.ty Number: £f 2 -',)¢ I Date of Inspection: fZ .. -i: Pry -Iff: I
\\1iste Collection & Treatment
f Is storage capacity (structural plus. storm storage plus heavy rainfall) less than adequate?
a. lfyes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5/
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes ~NA ONE
DYes 0No ~ONE
Structure 5 Structure 6
0 Yes [LL)kr DNA 0 NE
DYes~ DNA ONE
If any of questions 4-6 were answered yes, and the situation poses ati 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. Docs any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
l 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes ~o DNA ONE
DYes~ DNA ONE
DYes ~ DNA ONE
DYes~ DNA ONE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~ D NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy M etals (Cu, Zn, etc.)
0 PAN 0 PAN> 10% or 10 lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12 . Crop Typc(s):
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 impro ve ment?
16. Did the facility fail to secure and/or operate per the irrigation design or wettabl e
acres detcnnination?
I 7. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropriate box.
OwuP Dchecklists 0 Design 0 Maps D Lease Agreements
0 Yes ~ DNA
0 Yes ~ DNA
0 Yes ffNo DNA
DYes ~ DNA
DYes ~ DNA
0 Yes 8-No DNA
0 Yes [3'No DNA
00ther:
ONE
ONE
ONE
ONE
ONE
ONE
ONE
21. Does record keeping need improv ement'! If yes, check the appropriate box below. 0 Yes ~DNA ONE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis D 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 tail to install and maintain a rain gauge? 0 Yes ~ D NA 0 NE
23. If selec ted, did th e faci lity fail to mstall and mainta in rainbreakers on irrigation equipme nt? 0 Yes ~ D NA 0 NE
Page 2 of3 2/4/2015 Continued
I FacUlty Number: 5'16-6 5 v I I Date oflospection: ,;;) q f1{J ./ 1f
~4·. Did the fac ility fail to calibrate waste application equipment as required by the permit? 0 Yes ~ D NA 0 NE
25 . Is the facili ty out of compliance with permit conditions related to sludge? If yes, check D Yes ~ NA D NE
the appropriate box(es) below.
0 Failure to c omplete annual sludge survey 0 Failure to deve lop a POA for s ludge leve ls
0 Non-c ompliant 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 sec ure 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 odo r or air quality concern?
lfyes, c ontact a regional Air Quality representative immediately.
30. Did the fac ility fail to notify the Regional Office of eme rgency s ituations as required by the
permit? (i.e ., di scharge, fr eeboard problems, over-applicatio n)
31. Do s ubs urface tile drains exist at the facility? If yes, ch eck the appropriate box below.
D Appli cation 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 ~DNA ONE
DYes ~DNA ONE
DYes ~D NA ONE
DYes ~DNA ONE
0 Yes ~DNA ONE
0 Yes ~DNA ONE
0 Ye s ~ DNA ONE
DYes [3No DNA ONE
DYes ~ DNA ONE
g,~mm~~-~ (~~.f.~ri!~4.~~~,~-~~,.#); ·.~xplain any •."\'ES ··~P.~~~r~:.~ll~~f;_an~,~dditional recomm_endati~!lfl?ti~~y,•~.!~~r:~?~mef:l~).:~;~'if~;.:j;,·~j,
us·e dra~gs-.o(:f~dUtY.:to.lbetter explain situations'(use iidditional pages as necessary). ··.: · '' •. '::· · ' : ··: · ·· · -,.' · ;· · · ~''':·•:::· '~·:,
Gt?-1• b~f~~~ -cf'J.--S--( 7 Slu..4-e. 8c. rul e=;-r:~si~vt t).-'31-/Y
Re v iewer/In spector Name:
Page 3 of3
Ph one ,(O-L.f 3.3 -333{
Da te : ~ j 1-/."1 I e
2/412 015
0 Technical Assistance
Reason for Visit: <:f"Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: IIJIA.A..f f[l Arrival Time: 11.-m "f! Departure Time: I gi~ / i) PI County: 34 fit{ Region'F{2.<)
Farm Name: ·.lft <:-I(~ f£ PM-A--<s~ {) Owner Email:
Gr1(s EAJ/'""''7 Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Re presentative: _..~.r_J/ ___ ___:lf"---------------
Certified Operator: Guy ~.,J
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
I. Is any di sc harge observed from any part of the operation?
Discharge originated at: 0 Structure 0 Application Field
a . Was the conveyance man-made?
0 Other:
b . Did the di scharge reach waters of the State? (I f ye s , notify DWR)
c . Wha t is the estimated volu me that reached waters o f the State (gallons)?
Phone:
Integrator: mas
Certification Number: 1 ff fJ Z-
Certification Number:
Longitude:
DYes ~DNA ONE
0 Yes 0No ~ O NE
0 Yes 0No ~ O NE
d . Does the discharge bypass the waste management system? (If yes, notify DWR) 0 Yes 0 No ~A ONE
2. Is there evidence of a past discharge from any part ofthe operation?
3. Were there any observable adverse impacts or potenti a l adverse impacts to the waters
of the State other than from a discharge?
Page I of J
0 Ye s
0 Yes
~0 DNA ONE
c::JNo DNA ONE
21412015 Continued
IFacili'}' Number: n -/irfo !Date of Inspection:~ llljJ 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes ~DNA ONE
DYes DNo ~ ONE
Structure 5 Structure 6
DYes ~ DNA ONE
DYes 0'"N"o 0 NA 0 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part ofthe waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
D Yes ~No 0 NA 0 NE
D Yes ffNo 0 NA 0 NE
D Yes ~o 0 NA 0 NE
D Yes LJNo 0 NA 0 NE
II. Is there evidence of incorrect land application? lfyes, check the appropriate box below. D Yes ~o 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 D Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window D Evidence of Wind Drift D Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropriate box.
DwUP Ochecklists 0Design D Maps D Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
DYes 0"'No DNA ONE
DYes ~0 DNA ONE
DYes 12f"No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes [ZJ'No DNA ONE
DYes uJNo DNA ONE
Dother:
DYes [ZfNo DNA ONE
0 Waste Application D Weekly Freeboard D Waste Analysis D Soil Analysis D Waste Transfers D Weather Code
0 Rainfall 0 Stocking D Crop Yield D 120 Minute Inspections D Monthly and I" Rainfall Inspections D Sludge Survey
22. Did the facility tail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rain breakers on irrigation equipment?
Page2of3
D Yes d.No DNA 0 NE
D Yes 0 No 0 NA D NE
21412015 Continued
IFacilit}:Ntnnber: 8b -41. j 0 I lnate oflnspection: 9. illij ffJ
24. Did the facility fail to calibrate waste application equipment as required by the permit? D Yes ~ 0 NA 0 NE
25.Isthefacilityoutofcompliancewithpermitconditionsrelatedtosludge? Ifyes,check DYes ~ 0 NA 0 NE
the appropriate box(es) below.
0 Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
D Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation 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 t ime 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 D Other:
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
DYes ~0 DNA ONE
DYes ~0 DNA ONE
DYes ~0 DNA ONE
0 Yes ~0 DNA ONE
0 Yes ~No DNA ONE
DYes ct"No DNA ONE
D Yes ~No 0 NA 0 NE
D Yes [d-No 0 NA 0 NE
DYes C}No DNA ONE
€!:loll,n~nts (refer,;•to qu¢_$tioij(#f>:::r~~l~ijl,any y,ES answers and./ or aoy~:td~~tionalrec;ommendations or any other comments;
lfSe'~rawings,oifacilitYt fiit~!fe~J~iliiailn.situa'tions (use additional:pages!'as n~essary). . • ' ; .·· ·,
.·.
C,~(:bf'.Vtt~ -
5 (~e SOt( f%(-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page3 of3
Phone: rt/J rrt{J3-3J"lff
Dat< b!~ I'Z
214 015
ompliance Inspection
Reason for Visit: efRoutine 0 Complaint 0 Denied Access
Date of Visit: I~L I Arrival Time: 1{, (~IJ? Departure Time:l6r:JD'P I County: S'ftfl{ Region : R?:l:>
Farm Name: I{ w ...._.:, ..__ f·"' ·~~ Owner Email:
- r
Owner Name: (' yi{_.S G-'""t ~
Mailing Address:
Physi cal Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Loc ation of Farm: Latitude:
Discharges and Str eam Impacts
l. Is any d ischa rge observed from any part of the operation?
Discharge origi nated at: 0 Structure 0 App li cation Field
a. Was the conveyance man-made?
Phone:
0 Other:
b. Did the di scharge reach waters ofthe State? (If yes, n otify DWR)
c. What is the estimated volume th at reac hed waters of the State (gallons)?
Phone:
Integrator: l,lt(J 5
Certification Nu mber: <t M "{3 Z
Certification Number:
Longitude:
D Yes ~ DNA ONE
D Yes 0 No ~ ONE
D Yes 0 No [}m ONE
d . Does the discharge bypass the waste management system? (If yes, notify DWR) 0 Yes 0No
~0
~A ONE
2. Is there evidence of a past discharge from any part ofthe operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of th e State other than from a discharge?
Page I of3
D Yes
D Yes ~0
DNA O NE
DNA O NE
214120 15 Con tinued
I Date of lnspection'bZ~ rJW/bl I Facility Number: . .
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
·Observed Freeboard (in): l.f {.
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 O NE
DYes 0No ~ONE
Structure 5 Structure 6
D Yes ~o DNA ONE
0 Yes p.xo 0 NA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental tbrea4 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?
0 Yes ~0 DNA ONE
0 Yes ~ DNA O NE
0 Yes ~0 DNA ONE
0 Yes ~0 DNA ONE
II. Is there evidence of incorrect land application? If yes , check the appropriate box below. 0 Yes ~o 0 NA 0 NE
/
0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN > 10% or 10 lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12 . Crop Typc(s):
13. Soil Typc(s):
14. Do the rece iving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation 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 facilit y fail to have the Certificate of Coverage & Permit readily available?
20. Does the faci lity fail to have all components of theCA WMP readily available? If yes, check
the appropriate box.
owuP Ochecklists D Design 0 Maps D Lease Agreements
21. Doe s record keeping need improvement? If yes, check the appropriate box below.
0 Yes ~ DNA ONE
DYes ~ DNA ONE
0 Yes ~0 DNA ONE
DYes [}f1fo DNA ONE
0 Yes ~ DNA ONE
DYes ~0 DNA ONE
DYes ~0 DNA ONE
O other:
DYes e{No DNA ONE
0 Wa ste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Weather Code
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rainfall Inspections 0 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 ~o 0 NA 0 NE
Page2of3 21412014 Continued
/ ~ !Facility Number: rr:-l\57:> I lnate of Inspection: O'Z;J;;.J I . , ~
24. Did the facility fail to calibrate waste application equipment as required by the pennit? D Yes ~o
25. Is the facility out of compliance with pennit conditions related to sludge? If yes, check
the appropriate box(es) below.
DYes ~o
D Failure to complete annual sludge survey 0Failure to develop a POA for sludge levels
D Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than 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.
DYes ~0
DYes ~0
0 Yes ~0
DYes ~0
DYes [Z}J(o
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE 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 ~ DNA ONE
D Application Field D Lagoon/Storage Pond D Other: ------------------------
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? DYes ~ DNA ONE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? 0 Yes ~0 DNA ONE
34. Does the facility require a follow-up visit by the same agency? 0 Yes ~No DNA ONE
s~~en~s (refer to-~uestion,,t,~t .Expl~ ~y Y_ES answers ~n.dlor any addi~ional recommendations or anyo~er CO~O).~!~l~~,;w~ff,.:-~
Use drawmgs offacahty to better explam satuations (use addational pages as necessary). · ··.. · ·~)';::'f~;:G:~·~:: ·
C-tlckA '~
st11~
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of3
-cr, tf-tY
l~:yl1
Phone: l£3.3-JJ.3(
Date:, 9J;f~ / k
2/4/20JI
~)D~nce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: @-Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ~ Arrival Time:~ Departure Time: County: ~IJ:t11 Region~
Farm Name: fll t!.l(pi./l-Y·(_'< F 1 "'\._lt.4 V Owner Email: ----------------
OwnerNam., e~ 5 EaJ"<-0 Co Iv<c Phon.,·
Mailing Address:
Physical Address: --------------~----------------------------
a f.-0~( c; f3c.{ v"c#(~itle: ---------Facility Contact: Phone:
Onsite Representative: { l Integrator: __ f{J5___.!,. _________ _
Certified Operator: q~ .9{u:tte« {/Lvtll
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure 0 Application 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)?
Certification Number: ?t£7.)2 <
Certification Number:
Longitude:
DYes~ DNA ONE
DYes 0No EtNA ONE
DYes 0No ~ ONE
d. Does the discharge bypass the waste management system? (If yes, notifY DWQ) DYes 0No []"N'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
~ DNA ONE
~ DNA ONE
2/412011 Continued
!.Facility Number: ~(sol !Date of Inspection: 3D a~/' (:5!
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): /1
5. Are there any irrunediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6 . Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
0 Yes [d...ble-0 NA 0 NE
DYes 0No ~ONE
Structure 5 Structure6
DYes ~NA ONE
D Yes ~DNA ONE
If any of questions 4-6 were answered yes, and tbe situation poses an immediate public healtb or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9 . Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternative s that need
maintenance or improvement?
DYes ~DNA ONE
D Yes [3-No--0 NA 0 NE
D Yes @-Ntr 0 NA 0 NE
0 Yes B-N0 D NA 0 NE
II. Is there evidence of incorrect land application? Jfyes, check the appropriate box below. D Yes ~ 0 NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload 0 Fro zen Ground D Heavy Metal s (Cu, Zn, etc .)
0 PAN D PAN > 10% or 10 lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Appro ved Area
12. Crop Type(s): Owfj
13. Soil Type(s): (I} 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 lack adequate acreage for land application?
18 . Is there a lack of properly operating waste application equ{pment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readil y available?
20. Does the facility fail to have all components ofthe CAWMP readily available? If yes, check
the appropriate box.
D Yes (Q_blo DNA
DYes ~ DNA
DYes ~ DNA
0 Yes IT}NO DNA
DYes Q¥ci DNA
DYes ~ DNA
DYes ~ DNA
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Dother: __ ~<-------
. 21. Does record keeping need improvement? If yes , check the appropri ate box below. D Yes ~o D N A 0 NE
D WUP D checklists D De sign D Maps 0 Lease Agreements
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Tran sfers 0 Weather Code
0Rainfall 0Stocking D c rop Yield 01 20 Minute Inspections 0Monthly and I" Rainfall Inspections/ O sludge Survey
22. Did the facility fail to install and maintain a rain gauge? D Yes [::::1 ~ 0 NA D NE
23 . If se lected, did the facility fail to install and maintain rainbreakers on irriga tion equipment? 0 Yes r;a'N o 0 NA 0 NE
Page 2 of3 214/2011 Continued
I Date of lnspection:jk) dtJf""JY I .JFacility Number:
« ..
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
DYes ~DNA ONE
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 facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
DYes
DYes
DYes
DYes
DYes
DYes 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field 0 Lagoon/Storage Pond 0 Other: ------------------------
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes
33. Did the Reviewerflnspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
CtJ~ ~+~t\Ov1_ --
Sl\J--&71( 5lJ.ci ,_
DYes
DYes
p
lf,~
~ DNA
~DNA
8-NO DNA
~ DNA
g-tqO DNA
12f'No DNA
EJ'No DNA
{31Jo DNA
Q-No DNA
Reviewer !Inspector Name: Phone:
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Reviewer/Inspector Signature:
Pagel of3
Date: ~~~ rs
11411014
Operation Review 0 Structure Evaluation 0 Technical Assistance
0 FoUow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:! [!ot> I Departure Time: I (}\ !' l\) I County: ___ _ Region:
Farm Name:;,..__t\...J..._c..._K....:,:....:.V\.._~_1 =---.....~f:~,............;·i/;_;;_C/_~-~-~---
;;c 1\\6 Ff,v~·"j C.. [_,c.-
Owner Email: -----------------
Owner Name: Phone:
Mailing Address:
Physical Address: -------------------------------------------
Facility Contact: cl( 4-t-., -~ o-"""f.A.:ilt/).. Title:----------Phone:
Integrator: _.:Jf!liir.....:::::=:::...._ _________ _ Onsite Representative: ( {
Certified Operator: c-r-k-1 -:--1U-J5-. il;-t--~:n~o(-t/J......,....._____:_ __
Certification Numbe~T"? S Z.-
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: 0 Structure 0 Application Field 0 Other:
a. Was the conveyance man-made? DYes DNo ~ ONE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) DYes DNo Q-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 DNo ~ ONE
2. Is there evidence of a past discharge from any part of ~he operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
ofthe State other than from a discharge?
Page I of3
DYes
DYes
[J1o DNA ONE
~ DNA ONE
214/2011 Continued
!Facility Number: ~);_ CSD I
·Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the i~tegrity 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 ~A ONE
0 Yes 0 No [d-N1rLJ NE
Structure 5 Structure 6
DYes ~DNA ONE
D Yes ~DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 0 Yes ~ 0 NA 0 NE
8. Do any of the structures lack adequate markers as required by the permit? 0 Yes ~ NA 0 NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes ~D N A ONE
...,..,--
DYes 0No DNA ONE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~ 0 NA 0 NE
0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN> 10% or 10 lbs. 0 Total Phosphorus 0 Failure to In corporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Appli cation Outside of Approved Area
12. Crop Type(s): CU {3
13. Soil Type(s): A}, ~
I
14. Do the receiving crops differ from those designated in theCA WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Docs the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropriate box.
0 Yes [iJ-N'O DNA ONE
0 Yes ~DNA ONE
0 Yes ~DNA ONE
DYes ~DNA ONE
D Yes ~DNA ONE
DYes ~0NA'0NE
DYes ~DNA ONE
OwUP 0Checklists 0 Design 0 Maps 0 Lease Agreements Oother: ___ --:-------
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ~ DNA 0 NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analys is 0 Was te Transfers D Weather Code
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthl y and I " Rainfall Inspections/ 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? DYes ~ ~ 0 NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipm ent? 0 Yes [!(No 0 NA 0 NE
Page 2 of3 21412011 Continued
!Facility Number: I nate oflnspectioo: / $'4£1 C / f(
'24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes G}fflr 0 NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
0 Yes O"'No 0 NA 0 NE
D Failure to complete annual sludge survey 0Failure to develop a POA for sludge levels
D Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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, <>.ver-application)
31. Do subsurface tile drains exist at the facility? Ifyes, check the appropriate box below.
D Application Field 0 Lagoon/Storage Pond 0 Other:
DYes
DYes
DYes
DYes
0Yes
DYes
--------------------
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP? DYes
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? DYes
/J--5'-LJ
F·
Re viewer/Insp ector Name :
Reviewer/In spector Signature:
Page3 of3
~NA ONE
~NA ONE
~NA ONE
~NA ONE
~DNA ONE
~DNA ONE
[3-NO DNA ONE
~DNA ONE
~DNA ONE
mpliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ~ne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
DateofVisit: I 9~ ArrivaiTime:l/jiPV I DepartureTime:l Ja...!ODlCounty: ¥~Region: /1!:0
Farm Name: /71CJ/uc.l"' e=·~ ~~ Owner Email:
Owner Name: ffhU-Jr Phone:
Mailing Address:
Physical Address:
------------------------------------~------------------------------------
Title: ~~-~ Phone: Facility Contact: 6r.t:!'v--r )!1Dol" ~
Onsite Representative: _;?:"'--~-.......;;..._ ______________ _
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure 0 Application Field
a. Was the conveyance man-made?
0 Other:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Integrator:
Certification Number:
Certification Number:
Longitude:
DYes [8lNo
DYes DNo
DYes DNo
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes DNo
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 ~No
DYes J2S-_No
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
214/2011 Continued
!'Facility Number: !Date of Inspection: ~. 5=-l:fr I
Waste Collection & Treatment
'•4. Is storage capacity (structural plus storm storage plu s heavy rainfa ll) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure4
Identifier:
Spillway?:
Designed Freeboard (in): ,c;:r
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 [jlNo DNA 0 NE
D Yes 0 No D NA 0 NE
StructureS Structure 6
DYes 5C'JNo DNA ONE
D Yes !E.-No 0 NA 0 NE
If any of questions 4-6 were answered yes, and the situation poses a n immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
0 Yes ~No DNA 0 NE
DYes ~No DNA ONE
DYes ~No DNA ONE
D Yes fig...No D NA 0 NE
II. Is there evidence of incorrect land application? If yes , check the appropriate box below. D Yes ~No D NA 0 NE
0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn , etc.)
0 PAN 0 PAN> 10% or 10 lbs. 0 Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Approved Area
12. Crop Typc(s): ~ l!.-
13. Soil Type(s): }JP/F,tj(. ~~'7 / /-~Jt;J'JJI'Y-
14. Do the receiving crops differ from those designate; in thkA 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 fa ci lity fail to have the Certificate of Coverage & Permit readily available?
20 . Does the facility fail to hav e all components of the CA WMP readily available? If yes, check
the appropriate box.
DYes ~0
DYes Qg No
DYes l&No
0 Yes .KJ No
DYes !RLNo
DYes g) No
DYes _2g..N o
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
0WVP Ochecklists D Design 0 Maps 0 Lease Agreements 00ther: _________ _
21. Does record keeping need improvement? If yes, check the appropriate box below. DYes ~o 0 NA 0 NE
0 Waste Application D Weekly Freeboard 0 Waste Analysis D Soil Analysis D Waste Transfers 0 Weather Code
D Rainfall D Stocking 0 Crop Yield 0 I 20 Minute Inspections 0 Monthly and I " Rainfa ll Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes Q!_No 0 NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes 8}J-Io 0 NA 0 NE
Page 1of3 214/2011 Continued
[Facility Number: I nate oflnspection:
. 24. Did the facility fail to calibrate waste application equipment as required by the permit? .
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
0 Yes ~No 0 NA 0 NE
0 Yes [g No 0 NA 0 NE
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
DYes ~No DNA ONE
0 Yes 18LNo 0 NA 0 NE
DYes ~No DNA ONE
DYes ~No DNA ONE
0 Yes I25J No 0 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?
0 Yes (;&No
0 Yes ~No
0 Yes ~No
DNA ONE
DNA ONE
DNA ONE
~()m~ents (refer to question#): Explain any YES answers and/or any additional recommendations or any_ other c(I.ID~~!l~~·:~tiff~
Use drawings offacilit)r to better explain situations (use additional pages as necessary). .. · ·· .. ·. . · . -~'~;;),:;;~:;~~fJ-;
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page3 of3
Phone: ~ ~t(JJ-5J'CO
Date: 9--~Q
21412011
Reason for Visit: 0 Follow-up 0 Denied Access
Date of Visit: ILPr.lJ-!;l}Arrival Timed :J/; ¢Jtl Departure Time:l///J..fS: I County:. ~v-----Region: fZtrn-v
Farm Name: /tlc 1\ ~n-2 ja:_ , {?I' fY'\./ Owner Email:
Owner Name: V'}tn fY1 (L-Jl nt?Jv:Yt..Z.. I<::: Phone:
Mailing Address:
Physical Address: --------------------------------------------------------------------------------------
Facility Contact: Gf'c-~r-/118~ Title: Phone: ----------------------
Onsite Representative: """""''""'5'-~'--'::;;_------------------------------
Certified Operator: [/ftyt M. "l e._ 1 J1e-k~A.r 2. ', z::;.
Integrator: A1 ~
Certification Number: 2Pz:~
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 D 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)?
Certification Number:
Longitude:
DYes ~No
DYes 0No
DYes 0No
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes 0No
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 ofJ
DYes ~No
DYes ~No
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
2/4110ll Continued
-I Facility Number: I nate of Inspection: /0-ff'::r: /2'+
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): /7
Observed Freeboard (in):
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?
0Yes~o
0 Yes D No
DNA ONE
DNA ONE
Structure 5 Structure 6
0 Yes ~No D NA D NE
DYes ~No DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not 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 gl_No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes 18)_No DNA D NE
D Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn, etc.)
D PAN 0 PAN> 10% or 10 lbs. 0 Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
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): x.Jor-E-o/k 1/<sa.r~..!.> / L ./tt~<-ll'-z..--
~ ,~ rr /
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 tail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropriate box.
0 Yes g}.No DNA ONE,
i#es ~No DNA ONE
0 Yes 18l.No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
0 WUP Ochccklists 0 Design 0 Maps 0 Lease Agreements 00ther: _________ _
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ~No 0 NA D NE
0 Waste Application 0 Weekly Freeboard D Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Weather Code
0 Rainfall 0Stocking 0 Crop Yield 0120 Minute Inspections 0 Monthly and I" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page2of3
0 Yes ~No 0 NA D NE
0 Yes jLg_No 0 NA 0 NE
21412011 Continued
..
·•
!Facility Number: #" -t..OV loate oflnspection: /o---#'J-{;2----1
'
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes (3-No DNA ONE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check DYes SNo DNA ONE
the appropriate box(es) below.
D Failure to complete annual sludge survey 0Failure to develop a POA for sludge levels
D Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
D 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of3
DYes ~No DNA ONE
DYes [gNo DNA ONE
DYes [8No DNA ONE
DYes (gj_No DNA ONE
DYes ~No DNA ONE
DYes [2g No DNA ONE
DYes ~No DNA ONE
DYes {g)_ No DNA ONE
DYes (giNo DNA ONE
Phone: )Z~ -/fJJ-33 in~
Date: /o-c?-:J-~D--
21412011
9-eiffiipliance Inspection Operation Review 0 Structure Evaluation
Reason for Visit: ~tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other
Date of Visit: II D:fZ-Dl Arrival Time: I/ V .' "(!:,-I Departure Time :It/ /J 0 I County:,~1.ll"'-Region: EZ<.7)
Farm Name: /J1~j(C!"n 7-l~ p;-h't..., Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: -------------------------------------------
Title: GCCPnrr= Phone:
Onsite Representative: ~N~cL<I...J~~=------------------
Certified Operator: -;~~t_nt~rty'.r7--..z:fo::.....____.t,tY/e..:..=~;~/c.._.~=!:...t!:Z.:::..':...:t C......._ ____ _
lntegrato'' ~
Certification Number: ;J-:.......!::fr£l:.......=.!~::::_l,. _____ _
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 ~No DNA ONE
Discharge originated at: D Structure D Application Field D Other:
a. Was the conveyance man-made? DYes 0No DNA ONE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) 0 Yes 0No DNA ONE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes 0No DNA ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of3
0 Yes
DYes
,l\4. No DNA ONE
p;a_No DNA ONE
214/2011 Continued
,.
·'
Reason for Visit: 0 Other 0 Denied Access
Date of.Visit: ltQ:t?-J>l Arrival Time: I I '0 .' '( &,.-I Departure Time: I /1 ;'] [) I County: ~:S,..._. Region: Fl<._7)
Farm Name: IJ1e-,k~n :Z.; ~ Owner Email:
Owner Name: Phone:
/
Mailing Address:
f •
Ph3-·sical Address:
----------------------~--------------------------------------------------------------6.----!...n::....~.::...:..<...k;:>..:.,=~'-'m~~=:::....:..lh~:....7~t r~ __ Title: ~Q~I'....:',L:.::;!..l.~'/7;,;,,..,..L.------Facility Contac_t: Phone :
Onsite Representative: ,.; 0 ~ ~~~~~-------------------------------Integrator: ~~
Certified Operator: l ~7,.:;...~;_"'1,;,:,<;,"7=r---''Z=--!...,;t11c_._ .. /c..>o...<;;~=:...L=Z-~·· r:,__ ____ _
// '
Certification Number: /2-~5/o ~~~-------------
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure D Application Field 0 Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters ofthe State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. D~es the discharge bypass the waste management system? (If yes, notify DWQ)
2.ls there evidence of a past discharge from any part ofthe operation?
3. W11ere there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of3
..
Longitude:
:·.r,.
!-·· '
DYes ~No, QNA (JJ~NE
DYes 0No D NA ONE
DYes 0No D NA ONE
DYes 0No D NA O NE
0 Ye s ~No DNA ONE
0 Yes ,(;a_ No DNA ONE
•'·
21411011 Continued
...
· ..
,.l
·.
•.: {~
!Facility Number: fd). -Z:£P I
I 0-I 7 -_;;1eJt(
I Date of Inspection: 9 ;1; T=J e-I
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): f Cf
Observed Freeboard (in): ..3_)
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
0 Yes ~No
0 Yes 0 No
DNA ONE
DNA ONE
Structure 5 Structure 6
DYes gjNo DNA ONE
DYes Qg No DNA 0 NE
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 of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the pem1it?
(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 ~No DNA ONE
D Yes ~ No D NA 0 NE
D Yes g) No D NA D NE
D Yes ~ No 0 NA 0 NE
ll.ls there evidence of incorrect land application? lfyes, check the appropriate box below. DYes ~No DNA 0 NE
D Excessive Ponding 0 Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn, etc.)
D PAN 0 PAN> 10% or 10 lbs. D Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window D Evidence of Wind Drift 0 Appl ication Outside of Approved Area
12. Crop Type(s):
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 ofproperly 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 theCA WMP readily available? If yes, check
the appropriate box.
0WUP 0Checklists D Design D Maps D Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
DYes [B.. No DNA
IZJ.Yes 0No DNA
DYes !25-No DNA
DYes ~No DNA
DYes ~No DNA
DYes IR] No DNA
DYes ~No DNA
00ther:
~Yes 0No DNA
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
D Waste Application 0 Weekly Freeboard ~Waste Analysis 0 Soil Analysis D Waste Transfers 0 Weather Code
D Rainfall 0 Stocking 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 [81 No D NA D NE
23. If selected, did the facility fail to install and maintain rain breakers on irrigation equipment?
Page2 of3
DYes ~No DNA ONE
214/2011 Continued
~-..
;·:
·,-.
!Facility Number:
1 o-17 -?l>'l
IDate oflnspection: t;;;;)' 'it? :Je-1
Waste Collection & Treatment
'4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
I
l
Identifier:
Spillway?:
Structure 1 Structure 2 Structure 3
Designed Freeboard (in): tCf
Observed Freeboard (in): ..3_)
Structure 4
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? 1•• ··~
DYes
0 Yes
Structure 5
0 ),'es
DYes
,.
~No DNA ONE
0No DNA ONE
Structure 6
\ ·i
'-.
· ..
---;r
g) No DNA ONE
[B No DNA ONE
:.: If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
0 Yes ~No 0 NA 0 NE
0 Yes lKJ No DNA ONE
0 Yes ~ No DNA 0 NE
0 Yes ~No DNA 0 NE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~ No D NA 0 NE
0 Excessive Pending 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN> 10% or 10 lbs. 0 Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window D Evidence of Wind Drift D Application Outside of Approved Area
12. Crop Type(s): _f__:_~ ...... '>~,.c....-==-----------.------------------------
13. Soil Type(s): N'Ot-flek/"?--/i,r'l ~ / L~orL £tdj-•
14. Do the receiving crops differ from those designated m 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?
1 ~-Is there a lack of properly operating waste application equipment'!
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? Ifyes, check
the appropriate box .
. , . owuP . Ochecklists 0 Design 0 Maps 0 Lease Agreements
DYes [l!No DNA ONE
~Yes DNo DNA D'NE
DYes (ljNo DNA ONE
0 Yes ~No DNA ONE
0 Yes IZJ·No DNA ONE
0 Yes [&]No DNA ONE
0 Yes fi2]No DNA ONE
00ther:
2!.pocs record keeping need improvement? lfy'es, check the appropriate box below. DNA 0 NE ~Yes 0No
0 Waste Application D We~kly Freeboard ~Waste Analysis 0 Soil Analysis D Waste Transfers 0 Weather Code
·o Rainfall 0 Stocking 0 Crop Yi~ld 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 ~ No D NA 0 NE
23. If selected, did the facility fail to install and maintain rainhrcakers on irrigation equipment?
Page 2 of3
0 Yes 62) No DNA 0 NE
21412011 Continued
·~
I Facility Number: I Date of Inspection: ro-17-?eJII I
24 . Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with penn it conditions related to sludge? If yes , check
the appropriate box(es) below.
0 Yes jgl No 0 NA D NE
0 Yes 6{1 No D 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 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 appropriate box below.
0 Application Field D Lagoon/Storage Pond 0 Other:
0 Yes (gJ No 0 NA 0 NE
DYes ~No DNA ONE
0 Yes ~No DNA ONE
0 Yes fiJ No DNA ONE
0 Ye s ~No DNA ONE
@5I Yes D No DNA ONE
----------------------
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 ~No
0 Yes Kf No
~Yes 0 No
DNA ONE
DNA ONE
DNA ONE
I f). F'"'/)'n.-~~ ;z..,/c ~ ; "' ~sea ~. { ,._;.,-«.> {71/_.,-o/o;-}'-Fj..::/ .h
Ji/ c:.--r-L,,_.,_k <r .rf-P.J ~cv.~ t J: ~ "'T tv oW·
)_ J /I ;F ;T c~,-r..--~r-f' ~~~-r r:r~~ ,1{./-r-c-~ ~ h-e ~~/'~"" /
Vf/i r!l7£ '7:._7?'" G-r~_5,.S I
?i ~ ~/Jr\-Olaf ;vo-1-dvc: c.t_ U/a-s~r~af-5/_S f=br ~~~·
)Je-R~ : Ill Fai"/'Yl-(j-lr~r-e-1a/ /.S;,If~5 ; / rno *--~p~l:tT/
I,?-3 o -II <;; "-7},..7""" J;(r, In 5,/*';/J-lJ ~
Fz;-/rn-i/~5 ;-f~ !0-17-Rl-OH
, ) -'--J -. r-Jov.---?1 . £-~ 5 tJ7"1., ~~ .3 , "'-~, ... ~
ofl €',".5 I,.,_ :Dc:c~~r ...
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page3of3
Phone: '2zt?-tJ3-:YoO
Date: /;l -.3 ()--~ 1/
21411011
.
'
,_
' '
! ····,J ~ ................. ·"'
-I Facility Num~~r: 8:2--/,50 [Date of Inspection: I v-J7-,2t?lf I
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes -.
25 . Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes
the appropriate box(es) below.
0 Failure to compl~te annual sludge survey 0 Failure to develop a POA for sludge levels
0 Non-compliant siudge 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? D Yes
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? DYes
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes
and report mortality rates that were higher than normal?
I8J No
~No
I8J No
KJ No
~No
29. At the time of the inspection did the facility pose an odor or air quality concern? DYes ~No ·
If yes, contact a regional Air Quality representati ve immediately.
30. Did the facility fail to notifY the Regional Office of emergency situations as required by the 0 Yes ,b(J No
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ~Yes 0 No
0 Application Field D Lagoon/Storage Pond 0 Other: ---------------------/
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP? 0 Yes ~No
33 . Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative'! D Yes KJ No
34. Does the facility require a follow-up visit by the same agency? IRJ Yes 0No
DNA ONE
DNA ONE
D NA O NE
D NA O NE
DNA O NE
DNA ONE
D NA O NE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
Reviewer/Inspector Nam e:
Re vi ewer/In s pe c tor S ignature :
Page3of3
'!;
. ~-~~or.{
'."i'
·~'.
Phone: 2fp-~_33-3JoO
Date: /,;t-3 O-~ 1/
11411011
. ~-
'·.
,
ompliance Inspection 0 Operation Revi ew 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ~ne 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1/f-;i)f'e>l Arrival Time: If".)) ou I Departure Time: I/ ~ 3 0 I County:· 9~"1'<'"=-Region : ~
Farm Name: /11 C k .ef".-b I r; f=b ~ Owner Email: --------------
Owner Name: h¢ m i ~ E Me. k ~rt z. i l; Pbone :
Mailing Address: -----------------------------------------
Physical Address:-----------------------------------------
Facility Contact: Wrn 7 1!1c.k gc..-z,; c Title: ----------Phone No: _________ _
Onsite Representative: ~Gx::::,..J' ...L..<rc""-'":z:::=::::;....(OL~:.-... __ ...:..n-1....;....;;....~~o~r---lc:::~or:::... ____ _ Integrator:----------------
Certified Operator: Cct:y:J.k'fc m t:: lcl:!'VI.. z u= 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'! DYes ISNo DNA ONE
Discharge originated at: 0 Structure 0 Application Field 0 Other
a. Was the conveyance man-made?
b . Did the discharge reach waters of the State? (If yes, noti fy DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d . Does d ischa rge bypass the waste management system ? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any pa rt of the operation?
3. Were there any adverse impacts or potenti al adverse impacts to the Waters of the State
other than from a discharge?
DYes 0No DNA ONE
DYes 0No DNA ONE
DYes DNo DNA ONE
DYes JB1 No DNA ONE
DYes !&No DNA ONE
11/28104 Continued
~ I facility Number: v-"6j)l Date of Inspection
I • Waste Collection & Treatment
4 . Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
DYes DI.No DNA ONE
DYes 0No DNA ONE
Structure 5 Structure 6
Identifier:-----------------------,,...------------------
Spillway?:
Designed Freeboard (in): I q
Observed Freeboard (in): t:f b
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
DYes r2iNo DNA ONE
6. Are there structures on-site which are not properly addressed and/or man aged DYes ~No DNA ONE
through a waste management or cl osure 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 re quired by the pennit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste manageme nt system other than the waste structures require
maintenance or improvement?
Waste Application
I 0 . Are there any required ~uffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes jg}No DNA ONE
DYes iaNo DNA ONE
II . Is there evidence of incorre ct application ? If yes, check the appropriate box below. DYes l8-No 0 NA 0 NE
0 Excessive Ponding D Hydra uli c Overload 0 Frozen Ground 0 Heavy Metals (Cu , Zn, etc.)
D PAN 0 PAN > 10% or I 0 lbs D Total Phosphorus 0 Failure to In corporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Area
12 . C rop type(s) -LF.....:~~~~GY'<:::~es;,._ ______________________________ _
13. Soil type(s) Llln;?o;.k /;R.a .o ~ s /L ..... ~ c.£/u,-~-
• ~ /
14 . Do the receiv ing crops differ from those designated in the CA WMP? DYes [il No 0 NA 0 . NE
15 . Does the receivin g crop and/or land app li c ation site need improvem ent ? DYes ~No 0 NA 0 NE
16. Did the facility fail to sec ure and/or operate per the irrigation design or wettable acre detennination ? D Yes IE. No 0 NA D N E
17. Does the facility lack adequate acreage for land application?
I 8. Is the re a lac k of properly ope rating waste application equipment?
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of3
reeomriieridati~·~s
· · n~essa JiJ~~i .. · ·.
0 Yes 13-No DNA D NE
DYes ~o DNA ONE
Pbooe:
Date:
Continued
• I Facility Number: f52:: b?i) Date oflospection I/F3 0-llJ
t~ Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Pennit readily available?
20. Does the facility fail to have all components of the CA WMP readily available? If yes , check
the appropriate box. 0 WUP 0 Checklists D Design 0 Maps D Other
DYes (2iNo DNA 0 NE
DYes ~o DNA ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. DYes ~No 0 NA D NE
D Waste Application D Weekly Freeboard D Waste Analysis D Soil Analysis D Waste Transfers 0 Annual Certification
0 Rainfall D Stocking 0 Crop Yield 0 120 Minute Inspections D Monthly and 1" Rain Inspections D Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the pennit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the pennit orCA WMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31 . Did the facility fail to notify the regional office of emergency situations as required by
General Pennit? (ie / discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative ?
33. Does facility require a follow-up visit by same agency?
Page 3 of3
DYes I{JNo DNA ONE
DYes .Ji<l.No DNA ONE
DYes El_No DNA ONE
DYes (XlNo DNA ONE
DYes ~No DNA ONE
DYes ~0 DNA ONE
DYes ~0 DNA ONE
DYes Q$No DNA ONE
DYes laNo DNA ONE
DYes ~0 DNA ONE
DYes ~No DNA ONE
DYes No DNA ONE
12/28104
Type of VIsit ~mpllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ~ne 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Region:
Owner Email: --------------
Owner Name: hM.•·'-.. ) /l(~~Jj c:... ___________ _ Phone:
Mailing Address: -----------------------------------------
t•h:l'sical Address:-----------------------------------------
f'acility Contal't: _....=G:.._r-_c.._e¥" __ M_u-._o_~_<--____ Title: _Tt._t-_cJ.__.;;_. """l~~/)_I!:C-__ , __ _ Phone No: ---------
Onsite Rcpresentarh·t-: ------------------
Certilicd 01)crator: T"""'-~ Mc:G.tlfu..~
Integrator: _ __:_M_-___;B;;.....nrc.J_..:N-=----------
Operalor Certificalion Number: A"--A-II 8 (, 5
Back-up Operator: --------------------Bal~k-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 Finish
0 Wean to Feeder
lXI Feeder to Finish ~89tJ, '19 'Ito_
PNon-Layer
ODairyCow
ODairyCalf
D Dairy Heife1
D Farrow to Wean
D Farrow to Feeder
D Farrow to Finish
0Gilts
0Boars
0DryCow
0Non-Dairy
D Beef Stocker
D Beef Feeder
D Beef Brood Cow
Dry Poultry
D Layers
D Non-Layers
D Pullets
D Turkeys
Otber D Turkey Poults
00ther Number of Structurae: m IOOther
DYes ~0 DNA ONE
Discharges & Stream lmp:tcts
1. Is any discharge observed from any part of the operation?
Discharge originated at: D Structure 0 Application Field D Other
a. Was the conveyance man-made? DYes DNo ifN"A ONE
b. Did the discharge reach waters of the State? (Jfyes, notifY DWQ) DYes 0No ~ ONE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notifY DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
DYes 0No ~ ONE
DYes ~ DNA ONE
DYes ~DNA ONE
12128/fJ.I Continued
I Facility Number: 82..-{p50 I Date of Inspection [ 12 -07-o 9[
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 ~o DNA
DYes ifNo 0 NA
ONE
ONE
Structure 5 Structure 6
Identifier:---------------------------------------
Spillway?:
Designed Freeboard (in): i't
Observed Freeboard (in): 3"
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
DYes ~o DNA ONE
DYes ~o DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? DYes ~o DNA D NE
8. Do any of the stucturcs 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?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
DYes ~o DNA ONE
DYes ~o DNA ONE
DYes ~0 DNA ONE
DYes ~o DNA ONE
D Excessive Ponding D Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
D PAN D PAN > 10% or 10 lbs D Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Area
12. Crop type(s) --------------------------------------
13. Soil type(s)
14. Do the receiving crops differ from those desib'llated in theCA WMP? DYes No DNA ONE
DYes ~0 DNA ONE 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 acre determination ? DYes ~NoD NA D NE
DYes ~0 DNA ONE
DYes ~0 DNA ONE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reviewer/Inspector Name !.....~~~U::~~~.;::!.--......;~~:z::;:~±~:il:£::.:.....::2:.2,;£~ Phone :
Reviewer/Inspector Signature: Date:
/2128104
1 t-01 -o9
I Facility Number: 82---~Z)j Date of Inspection I 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? If yes, check
the appropirate box. 0 WUP 0 Checklists D Design 0 Maps 0 Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
DYes cCa DNA ONE
DYes ~0 DNA ONE
DYes ~ DNA ONE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis D Soil Analysis 0 Waste Transfers 0 Annual Certification
0 Rainfall D Stocking 0 Crop Yield D 120 Minute Inspections 0 Monthly and I" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment {PLAn certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
12128/fU
~0 DNA· ONE ~ DNA ONE
~0 DNA ONE
No DNA ONE
~0 DNA ONE
~0 DNA ONE
G?N'o DNA ONE
~0 DNA ONE
~0 DNA ONE
~0 DNA ONE
~ DNA ONE
~ DNA ONE
..... r-
-....
L
Type of Visit O"'C'Ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ~utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1/Zrc(f-Ogl Arrival Time: I J; c rp,._
Farm Name: Mc.-Jc~~J j c.. ~vN'\.
Departure Time: It: 3o Dm I County: $71¥ -sc .. ./
I
Region: P/Za
Owner Email: --------------
OwnerName: ~'-""=) ~~,'-~..;:<--=-----------Phone:
Mailing Address: ------------------------------------____ _
Physical Address:-----------------------------------------
Facility Contact: Phone No: ___________ _ _..::S.;......;.r_<-_~..;;.-_ ___._~....;;..;;...::o;.:.~--c_,~----Title: I~­
Onsite Representative: __ C_..-.... __ <-...;tr __ Moc__,;;;;;..;;;;..T.:....'=--------Integrator: ~ ""f '6 B r')n.J ~
Certified Operator:--------------------Operator Certification Number: --------
Back-up Operator: --------------------Back-up Certification Number:
Location ofFarm: Latitude: D OD'D"
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: D Structu re D Application Field D Other
a. Was the conveyance man-made?
b. Did the di sc harge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
DYes B'No DNA ONE
0 Yes D No 13'NA D NE
DYes 0No ~ ONE
d. Does discharge bypass the waste management system? (If yes, notify DWQ) 0 Yes D No B"NA 0 NE
2. Is there evidence of a past discharge from any part ofthe operation? D Yes B"N"o DNA 0 NE
3. Were there any adverse impacts or potential adverse impacts to the Waters ofthe State DYes ~ DNA 0 NE
other than from a discharge?
Page I of 3 12128104 Continued
I Facility Number: g'z-~6o I Date of Inspection kz-&-oBI
Waste CoUecdon & 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 ~DNA ONE
DYes ~DNA ONE
Structure 5 Structure6
Identifier: -~L::.:1?~....J/L..--------------------------------
Spillway?: /10
Designed Freeboard (in): __ ....:1_9~-------------------------------------
2 ,/ lo
Observed Freeboard (in):----=-"""..;;;._-------------------------------------
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properl y addressed and/or managed
through a waste management or closure plan?
DYes l31fo DNA D NE
0 Yes c:ri'Jo D NA D NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threa~ notify DWQ
7. Do any ofthe structures need maintenance or improvement? DYes l3'ffo" 0 NA D NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures requ ire
maintenance or improvement ?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
0 Yes 131'10 DNA 0 NE
DYes l31f<> DNA ONE
0 Yes Ehiro 0 NA 0 NE
I I. Is there evidence of incorrect application? lfyes, c heck the appropriate box below. 0 Yes [31iro DNA D NE
0 Excessive Ponding 0 Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn , etc .)
D PAN D PAN > I 0% or 10 lbs 0 Total Phosphorus 0 Fail ure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Appli cation Outside of Area
12 . Croptype(s) _..lfi.:::!:;::::S~C«~L<-~~(..!.P.~tl.l~fSI-!::~·:j(.......:..:.:J!~fb~~)~------------------
13. Soil type(s) tJoA . Row . LIV
> I
14 . Do th e receiving crops differ from those designated in theCA WMP?
15. Does the receiving crop and/or land application site need improv ement?
DYes
DYes
16. Did the facility fai l 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 Na me
Reviewer/Inspector Signature:
Pagel of 3
D Yes
DYes
~DNA ONE
[31\fO DNA ONE
crr:lo DNA ONE
[J1ro DNA ONE
~DNA ONE
..
I Facility Number: i'Z -~5"0 I Date of Inspection !12 -c$1 ·o Bl
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropirate box. 0 WUP 0 Checklists 0 Design 0 Maps D Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
0 Yes 8-wo 0 NA 0 NE
DYes ~o DNA ONE
0 Yes B"No DNA ONE
D Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis D Waste Transfers D Annual Certification
D Rainfall 0 Stocking 0 Crop Yield D 120 Minute Inspections D Monthly and 1" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? DYes 13-Mo DNA ONE
23. If selected, did the facility fail to install and maintain rain breakers on irrigation equipment? DYes 8-No DNA ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes B-No DNA ONE
25. Did the facility fail to conduct a sludge survey as required by the permit? DYes 8-No DNA ONE
26. Did the facility fail to have an actively certified operator in charge? DYes 13-No DNA ONE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? DYes ErNc: DNA ONE
Otber Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? DYes ~0 DNA ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes B"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 ifN"o 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 l3'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 [31To DNA ONE
33. Does facility require a follow-up visit by same agency? DYes I:J..N'r>TI NA ONE
..... .--·. -!'•• ' -.. -·' .. ' . ' ',--·"~ :~ ;tij~f6~~i::~t~·~~~ .. :·~ :~;~. ~;li
Page3 of 3 12128104
. $J::/Jf <; !Z/;q/zotJ 7
IFacility Number I __ ?__?. H __ ~~oil 8 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit e Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ~Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I;Z-IO-tJ7j Arrival Time: lt.z,'4~pM I
Farm Name: AfcK~ASJ /c k.~
Owner Name: :r; ""-~ /Uc:.l<c;.'t} t(
Departure Time: j!z: 3.£ I County: SfM/'S•N Region:
Owner Email: -------------
Phone:
Mailing Address: ----------------------------------------
Physi cal Address:----------------------------------------
Facility Contact: G..-~ c.. r Moor<_ Title: ~ LC..l... • S~, •
PhoneNo: _________ _
Onsite Representative: G r~ r /l{o-,lc( Integrator: ---=M~· ..:..(.(..:..::.:....vf,.:...::.t,~--=B==-ruw;==..tN~----
Certified Operator:--------------------Operator Certification Number: -------
Back-up Operator: ---------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'·D " Longitude: D OD'D"
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
10 Layer ID Wean to Finish
1 r
ODairyCow
0 Dairy Calf i
D Dairy HcifeJ !
;
10_ Wean to F ceder '
llii! Feeder to Finish !It~ 'Jio _L/Kl.rD_
0 Dry Cow
D Non-Dairy
D Beef Stockel
D Be ef F ceder i
0 Beef Brood Cow I .. , __ -1
0 Farrow to Wean
0 Farrow to Feeder
D Farrow to Finish
0Gilts
0 Boars ~ -·---~
Dry Poultry
Other
0 Layers '
0 Non-Layers
0 Pullets
0 Turkeys
0 Turkey Poults ;
OOther
··~ . -~
Number of Structures: [~] I_Q Other t
Di sc harges & 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. Wa s the conveyance man-made? DYes ~N o DNA ONE
b. Did the discharge reac h waters ofthe State? (Tf yes, notify DWQ) DYes (lf'No DNA ONE
c. What is the estimated vo lume that reached wate rs of the State (gallons)?
d . Does di scharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evi dence of a past discharge from any part of the operation?
3. Were there any adverse impac ts or potential adverse imp ac ts to the Waters of the Stat e
other than from a discharge?
DYes l;fiNo
DYes ~No
D Yes IJNo
12128/04
DNA ONE
DNA ONE
DNA ONE
Continued
jFacility Number: 9Z-~SO I Date of Ins pection l1'Z-1o-oil
Waste Collection & Treatme nt
4 . Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. If yes, is waste leve l into the structural rreeboard?
Structure 1 Structure 2 Structure 3 Structure 4
DYes ~No DNA ONE
DYes Jaf'No 0 NA 0 NE
Structure 5 Structure 6
Identifier: __ __.. ____ --------------------------------
Spillway?: No.
I
. a ,,
Designed Freeboard (in): ---""--,-l-1-------------------------------------
O bservedFreeboard(in): ___ £.....,.Z=-"-'-------------------------------
5 . Are there any immediate threats to the integrity of any of the structures observed?
(ie/large trees, severe eros ion, seepage, etc.)
6 . Are there structures on-sit e which are not properly addressed and/or managed
through a waste management or closure plan?
DYes ~No DNA ONE
DYes fliNo DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threa4 notify DWQ
7. Do any of the structures need maintenance or improvem ent? DYes llf'No 0 NA D NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not appli cable to roofe d pits, dry stacks an d/or wet stacks)
9. Does any part of the waste management system other th an the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, o r compliance a lt e rnatives that n eed
maintenance/improvement?
DYes l11No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
11. Is there evidence of incorrect application? If yes, che ck the appropriate box below. 0 Yes ~No 0 NA 0 NE
D Excessive Ponding 0 Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn, etc .)
D PAN 0 PAN > 10% or 10 lb s 0 Total Pho sphorus 0 Failure to Incorporate Manure/S ludge into Bare Soil
D Outside of Acce ptable Crop Window 0 Ev iden ce of Wind Drift 0 Appli cat ion Outside of Area
12 . Croptype(s) -~~-~~S-=C;.::;-<-t.....::C:..=--~(:..J:A-!tl~S>4.,~t:::!K..~)~---'-------------------
13. So il type(s) ,../er{O(k._) Kq/gS ) LyNcAkut:j
14. Do the receiving crops diffe r rrom th ose designated in theCA WMP?
15. Does th e receiving crop and/or land application site need improvement?
D Yes
DYes
~No DNA ONE
QJJNo DNA O NE
16 . Did th e facility fail to secure and/or operate per th e irrigation design or wettable acre determinati on?O Yes Q'No DNA ONE
I 7. Does the facility lack ade quate acreage fo r land a ppli cation ?
18. Is th ere a lack of properly oper ating waste appli cat ion equipment?
D Yes
D Yes
c;J'No
~N o
DNA ONE
DNA ONE
Comments (refer to question#): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): '
1,.-);.j.{_ (;,.-~ ( r(_ Jl{creJr<-) fC.L 5jc '-• • AJt>k .r ct;z NC.l:>lt ~. TiM ~tl ,...$ u ~r/L..~j f--
~0 cl { ~ 't... ...:1-'In-~ i>.A<rJ rr.-k_ r ( Gla:..lc/14, J I ON Wv.. p ()N r<se-~ l..
~ •
Reviewer /In sp ector Name Kt ·c.-t;; ~ flAJ d.S. Phone: 'J/o. ¥33.33tJO
Reviewer/Inspector S ignatu r e: R~ J< ~ Date: /Z..//o /~a 7
12/28/04 Contmued
. . . ...
I Facility Number: $2 -6.9ol
Required Records & Documents
Date of Inspection l12 -/(}-0 71
19. Did the facility fail to have Certificate of Coverage & Pennit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropirate box. 0 WUP D Checklists 0 Design 0 Maps 0 Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
DYes l1fNo DNA ONE
DYes ~No DNA ONE
DYes f&No DNA ONE
D Waste Application D Weekly Freeboard 0 Waste Analysis D Soil Analysis D Wast e Transfers 0 Annual Certification
D Rainfall 0 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 ~No DNA ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes [J'No DNA ONE
25. Did the facility fail to conduct a sludge survey as required by the permit? DYes !»No DNA ONE
26. Did the facility fail to have an actively certified operator in charge? DYes It! No DNA ONE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? DYes [i!No DNA ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes l;iJNo DNA ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes ~No D NA 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)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative ? DYes ~No DNA ONE
33. Does facility require a follow-up visit by same agency? DYes ~No DNA ONE
Additional Comments and/or Drawings: ..
...
1-
r-....
12128/04
. ' l '•
~;~Facility N~~§cr, I E2.
~H--. ·. · .·_·. -.:~.t;.zf,;~~5~~:-:+.:;._: · -· ··
0 Divisi~rifofWater Quality
0 Divisi(m:i~f Soil and Water Conservation
. ~ O,:()tfie~rA'~~ncy -~··:: ._;.o• . .-.-~::';-:t.:·-~-;
Type of Visit • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit e Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
Date of Visit: I lUll•/ tJ(j, I Arrival Time: 111 ,' 20 A!& I Departure Time: I /Z. ,'?aRM I County: Region:
I sc, I
Farm Name: &ttn~l<; e.. M~K.~J;J' <...... Fav~ Owner Email: ------------
Owner Name:------------------------Pbone:
Mailing Address: ------------------------------------____ _
Physical Address:-----------------------------------------
Facility Contact: PboneNo: _______________ __
Onsite Representative: ------------------Integrator: /Jfu~ £~N
Certified Operator:--------------------Operator Certification Number: --------
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: r-roD'D" Latitude: L__J Longitude: D OD'D"
Current
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? DYes ~No DNA ONE
Discharge originated at: D Structure D Application Field D Other
a. Was the conveyance man-made? DYes ~No DNA ONE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) DYes ~No DNA ONE
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) DYes ~No DNA ONE
2. Is there evidence of a past discharge from any part ofthe operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of3
DYes ~No
DYes f1No
11118104
DNA ONE
DNA ONE
Continued
'I Facility Number: ff2:" (,50J Date of Inspection l1#t;H~ I
\. ~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 ~No DNA ONE
Structure 5 Structure 6
Identifier:-----------------------------------------
Spillway?:
Designed Freeboard (in): ----.....,.....------------------------------------
Observed Freeboard (in): __ 3.&.J...OL-rr __ -------------------------------
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
DYes ~No DNA ONE
DYes ~No DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the 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
DYes
DYes
DYes
r'pNo DNA ONE
~No DNA ONE
rpNo DNA ONE
~No DNA ONE
I I. Is there evidence ofincorrect application? If yes, check the appropriate box below. 0 Yes JE'No 0 NA 0 NE
0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN> I 0% or I 0 lbs 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Area
12. Crop type(s) ~::;he<.. .
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA WMP? DYes lYNo DNA
15. Does the receiving crop and/or land application site need improvement? DYes l:!No DNA
ONE
ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? DYes ~No 0 NA 0 NE
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:
Page 2 of3
DYes l;i'No DNA ONE
DYes ~No DNA ONE
Phone:
Date:
{ Facility Number: 82. -<t?~l
~~~ Required Records & Documents
Date of Inspection I// -14-iij7
19. Did the facility fail to have Certificate of Coverage & Permit readi ly available?
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
the appropriate box. D WUP 0 Checklists D De sign 0 Maps 0 Other
DYes ~No DNA ONE
DYes ~No DNA ONE
2 I . Does record keeping need improvement? If yes, check the appropriate box below. D Yes (j No 0 NA 0 NE
0 Waste Application D Weekly Freeboard 0 Waste Analysis D Soil Analysis 0 Waste Transfers 0 Annual Certification
0 Rainfall D Stocking 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the penn it?
26. Did the facility fail to have an actively certified operator in charge?
27 . Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29 . Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air qual ity concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discu ss review/inspection with an o n-site representative?
33. Does facility require a follow-up visit by same agency?
:;('dditional Comments aoiJ.}or Drawings:
Page3of3
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes 9'No DNA ONE
DYes j&' No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes l;» No DNA ONE
DYes I:;» No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes l}iJ No DNA ONE
··~;:'.~/,'(;>:;·.,. .. ,.· .:.: ·;~ ~:-.:~~ ·: ;·~;r~;::_~::.-~-~~~~~~~~_:A:~1 " .. ~ ..
....
1-
12/18104
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
Jimmy B McKenzie
McKenzie Fami
1137 White Oak Church Rd
Clinton, NC 283281014
December 1, 2006
Michael F. Easley, Governor
William G. Ross Jr., Secretmy
North Carolina Department of Environment and Natural Resources
Alan W. Klimek. P.E. Director
Division of Water Quality
RECEIVED
DEC 06 DB
DENA-FA't'E1lEVILLE REGIONAl. OffiCE
Subject: Application for Renewal of Coverage for Expiring NPDES General Permit
Dear Permittee:
Your facility is currently approved for operation under one of the Animal Waste Operation NPDES General Permits, which expire on
July 1, 2007. Due to changes in federal rules, facilitie s that do not discharge nor propose to discharge may choose whether or not to
retain coverage under an NPDES General Permit. Copies of the draft animal waste operation NPDES general permits and the State
Non-Discharge General Permits are available at htto://h2o.enr.state.nc.us/aps/afouldownloads.htm or by writing or calling:
NCDENR-DWQ Animal Feeding Operations Unit
1636 Mail Service Center
Raleigh, North Carolina 27699-1636
Telephone number: [phone]
In order to assure your continued coverage under one of these two types of general permits. you must s ubmit an application for permit
coverage to the Division. Enclosed you will find a 'Reguest for Certificate of Coverage Facility Currently Covered by an Expiring
NPDES General Permit.' The application form must be completed and returned by January 2, 2007. Please note. you must include
two (2) copies of your most recent Waste Utilization Plan with the application form.
Failure to request renewal of your coverage under a g eneral permit within the time period specified may result in a civil penalty.
Operation of your facility without coverage under a valid general permit would constitute a violation ofNCGS 143-215.1 and could
result in assessments of civil penalties of up to $25,000 per day.
If you have any questions about the draft general permits, the enc losed application, or any r elated matter please feel free to contact the
Animal Feeding Operations Unit staff at 919-733-3221.
Sincerely,
~ ---~ .. ···-·-.... __ ~-6 -£. ~4-AP
Enclosures
cc (w/o enclosures):
Ted L Bush, k, Chief
Aquifer Protection Section
Sampson County Soil and Water Conservation Dis trict
Fayetteville Regional Offic e , Aquifer Protection Section
AFO Unit Central Files-820650
Murphy Family Farms
Aquifer Protecti on Section
Internet: ~w .n cwatera ua lity.org
1636 Mail Service Center
Location: 2728 Capital Boulevard
Raleigh, NC 27699-1636
Raleigh. NC 27604
An Equal OppOrtunity/Affinnative Action Employer-50% Recycled/1 0% Post Cons umer Paper
Telephone:
Fa x 1:
Fa x 2:
Customer Service:
N.?JlhCarolina
(919) .()'_fl!f!!.all!l
[phone]
(919 ) 715-6048
[phone]
I e DiVision of Water Quality ~ · .. ·.~~ nFacifiey Number I H II JlJ ~ra · 0 Dhision of Soil and Water·Conservation
0 Otber Agency .·. ..... ···::''• -.. ~ :·'· :': .... ~-: -: :-·_. : ·.·c .. -.. '•;.. ;~--~: .. '. ·'···· -··· , .. .. " .. --~· . '-..
Type of Visit e Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit e Routine 0 Complaint 0Follow up 0 Referral 0 Emergency 0 Other D Denied Access
Date of Visit: 17 · ;J 1-or-l Arrival Time: I ;I : t>O f" Departure Time: Ll ---~' County: 54'o/'~ Region : ffi 0
Farm Nam e: r Owner Email: --------------
Owner Name: /'1c ltu z,t---=-h:._...t:cc..__.,..=--------Phone:
Mailing Address: //3 7 w6:k /II
Pbysical Address:-----------------------------------------
Facility Contact: Phone No : ---------
Onsitc Representative : C,,.(!~ Integrator: 1'1"'-;P~_Ea~ ....... ~._,.,.._;:,;~..,,.,,o..:"Y:..{,._ ___ _
Certified Operator:--------------------Operator Certification Number: -------
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D" Longitude: D OD'D "
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
I I I 10 La yer I I 1:
. 0 Non-Layer _ _ .
ID Wean to Finish 0 Dairy Cow I
0 Dairy Calf
0 Dairy Heife1
0 Wean to Feeder
f.i}(ccder to Finish L( ~ <1~ 1'11/CJ;'J
Dry Poultry 0 OryCow ;
D Non-Dairy ' !
0 BeefStocket
i 0 Beef Feeder
0 Beef Brood Cow i
'
·-· . ·-·-I
0 Fa rrow to We an
0 Fa rrow to Feeder
0 Farrow to Finish
D Gilts
0 Boars
--
0 La ye rs
0 Non-Layers i 0 Pull ets I
D Turkeys i
I
Other 0 Turkey Poults
O Other ·--
Number of Structures: OJ ; ID Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'! DYes ~ DNA O NE
Discharge originated at: 0 Structure 0 Application Field 0 Other
a. Wa s the conveyance man-made'? D Yes 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 reac hed waters o f the State (gallons)? I
d. Does di sc harge bypass the waste management system? (If yes, noti fy DWQ)
2. Is there evidence of a past discharge from any part of the operation '!
3. Were there any adverse impacts or potential adverse impact s to the Waters of th e State
other than from a di sc harge?
DYes 0 No
DYes ~0
D Yes B'No
12/28104
DNA O NE
DNA O NE
DNA ONE
Continued
'·
jFacility Number: 8J-t ~0 I Date of Inspection I '7. ;)}.-o rrl
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?
DYes ~ DNA ONE
DYes 0No DNA ONE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:----.,~--------------------------------------
Spillway?:
Designed Freeboard (in): __ ... L.,;.Cj,__h ___ ----------------------------------
Observed Freeboard (in): _ __..2~:....~~:7_.,._. __ ---------------------------------
5. Are there any immediate threats to the integrity of any of the structures observed? DYes ~0 DNA ONE
(ie/large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed DYes ~0 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 12J"No DNA ONE
DYes G?'No 0 NA D NE
DYes B'No DNA ONE
0 Yes 13"No DNA 0 NE
II. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes E:31'so DNA 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 0 Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Area
/'f)
12. Crop type(s) ...J:.~!:L..----------------------------------
13. Soil type(s)
14. Do the receiving crops differ from those designated in theCA WMP? DYes B"No DNA ONE
15. Does the receiving crop and/or land application site need improvement? DYes 0'No DNA ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination!D Yes 0No DNA [31rE
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:
DYes 0No DNA B'N'E
DYes ~0 DNA ONE
' . drE!qmrrr~. ':. .
"!~'-··_~:~:·.· ' .... t.'~. .
·.•'' t ' • • " ~
12/28104 Continued
t • • ·•
I Facility Number: 8) -'-~J
Required Records & Documents
Date of Inspection I ?.JJ-or I
19. Did the facility fail to have Certificate ofCoverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? lfyes, check
the appropirate box . 0 ~ 0 ~ists 0 ~ O ~ D,.PM{er
21 . Does record keeping need improvement? If yes, check the appropriate box below.
DYes ~DNA ONE
DYes ~ DNA ONE
DYes Gd--No DNA ONE
D W85te AtJpli•atien D Weeltl~· free~eer4--0 Waste An1l~·si!!-D Soil Analysts-D Waste Tr:aasfers D Atmual CentncatitJtr-
0-R:eiafell 0-51ocldng-D Crop Yield Q.uQ Miflttte IH:sf!e~tiQAi D MentiJly and I" R1sinlnspcetieR& D Weather Eefle
22. Did the facility fail to install and maintain a rain gauge? DYes [i)..H() DNA ONE
23. If selected, did the facility fail to install and maintain rain breakers on irrigation equipment? ~ 0No DNA ONE
24. Did the facility fail to calibrate waste application /q6ifr;:ent as required by the permit? D Yes IJJ.NO D NA ONE
25. Did the facility fail to conduct a sludge survey as required by the permit? DYes ~ DNA ONE
26. Did the facility fail to have an actively certified operator in charge? DYes [iJ1qO DNA ONE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? DYes 0 No DNA ~
Otber Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? DYes ~0 D NA ONE
29. Did the facility fail to properly dispose of dead animals within ·24 hours and/or document IJJ..<es 0No 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 emergenc y situations as required by DYes ~0 DNA ONE
General Permit? (ie/ di scharge, freeboard problems, over applicat ion)
32. Did Reviewernnspector fail to discuss review/inspection with an on-site representati ve ? DYes GJ1(io D NA O NE
33 . Does facility require a follow-up visit by same agency? DYes [31(io DNA ONE
.; .) . PleQSL
JV18104
e Compliance ·l~ction 0 Operation Review 0 Lagoon Evaluation
Reason for Visit e Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other D Denied Access
IDateofVisit: I f·./l/~ jTwe: I Facility Number I fe H '-SO --------~---------.....j lo Not Operational 0 Below Threshold ~rmitted r:3'Ce'rtified . [] Conditionally Certified C Registered Date Last Operated or Above Threshold: ----
FarmName: __L!_c.kenz.·'e . hJcm County: ,$4_,.e.SotJ
'Phone No: q 10-S:~'t-'i'f(, Owner Name: ~·im"'1' ,t1, &nz ,'g
Mailing Address: _ ll 37 W ~/h Oa.lt C!Htr<6 ~-_..;:C:;.,:/.._.. 'nwl~~'~u..n~..-+4 ..;.N~(_=-----.2 IJp 8'
I • .,.
Facility Contact: U;rar ,_,,J£r-f:~ ·,"~t~m..·cntle: ----------Phone No: --------
Onsite Representative: 6:1"t.u f!!.(JtC./r,..,J.,., llc.lt, 1. •'£ m~ror:~~~~~~~\v~-----------------
Certified Operator: __ .....lO:;I;...:•:a'm:ue~t~-­
Loc:ation of Farm:
Operator Certification Number: _____ _
.,,J
~e O Poultry 0 Cattle 0 Horse Latitude L------'1• ~....I _ _,~1~.-_---J.I" Longitude
Discharges & Stream Jmpacu
1. Is any discharge o~ed from any pan of the operation?
Discharge originated at: D Lagoon 0 Spray Field 0 Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system ? (If yes, notify DWQ)
2. Is there evidence of past discharge t.roin any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the Swe other than from a discharge?
Waste Collection & Treatment
4 . Is storage capacity (freeboard plus storm storage) less than adequate? 0 Spillway
Identifier:
Structure 1
.I
Freeboard (inches): _ _,J."""-"4.._·· _ .. , __
12112103
Structure 2 Structure 3 Structure4 Structure 5
DYes ~
DYes ~
DYes 81ro'
DYes .[J.Nt>
DYes [31'1b
DYes [3'N'o
DYes em-
Structure 6
Contiruud
Date of Inspection l q · .;l!f TJ&t I
5 . Are there any immediate threats tO the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or IIUlllaged 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 euvironmental threat, notify DWQ)
7 . Do any of the structures need maintenancefunprovement?
8. Does any pan of the waste management s ystem 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 maintenanoefunprovement?
11 . Is there evidence of over application? If yes, check the appropriare box below.
0 Excessive Ponding 0 PAN D Hydraulic Overload 0 Frozen Ground 0 Copper and/or Zinc
12. Crop type E'"rd (f,.,....,J)
13 . Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA WMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wenable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of '8ocquate waste application equipment?
~IsSues
17. Does the discharge pi pe 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 dming 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.
IS",
F.eiJ.
Re~ewer~rNmne
Re~ewer~r Signatun:
12112103 ,. -,
Date:
..
DYes ~
DYes 91G
DYes (31fc)
DYes ~
DYes ~
DYes g.No
DYes ~
DYes (gJile
DYes DNo
DYes DNo
DYes 0No
DYes 0No
DYes 13"N'o
DYes 0No
DYes B"Ro
DYes a-No
DYes 8NO
Date of Inspection I 4 ·.}LJ-otl
Required Records & Documents
21 . Fail to have Cenific:a1e 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?
(ieiJIMP. c~, ~~·etc .)
23. Does record keeping need improvement? If yes, check the appropriate box below.
0 Waste Ap_plication 0~ ~aste Analysis 0 Scii Sampliug
7~,-)/.8 1-t)-/.J,( '
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25 . Did the facility fail to have a actively certified operator in charge?
26 . Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
27 . Did Reviewer/Inspector fail to discuss reviewfmspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were ao1y additional problems noted which cause noncompliance of the Certified A WMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
0 Stocking Farm Q-Crop Yield Form 0-PeinNJ 0 1Mp1=.9ft l.a:.:ter I" Itatu
0 1%6 Miudte IB&pKIIiMIS 0 lmaual Cet'tifiee!ieB FORB-
DYes g.NO'
DYes GN6
a-m 0No
DYes GNb
DYes ~0
DYes GiG
DYes @-No
DYe5 0No
DYes ·t:mo
~s ONo
DYes em
DYes Q-MO
DYes (gKc)
0 Yes .liJ..M()'
9-'Yes ONo
'3 Gl,,.k.i,#j &v ;f~ 6-rt>#r fY/t~o~t 1-c J,.vt. ,. -~ <:,,,,,~t-~0 ;J 4•-.1' k ... r;~ ~
C. urn .. + WQ_..J~ Cl~ta~s:~.
3s, w.,/1/,, w,·u 6 rur ~"~e +, VS.l (. v,..,,,..,... JIPOf~ ~,, .-..s.
~
12112103
,, ____ _
Division of Environmental Tt{anagemeat
Animal Feedlot Operations Site V"JSitatlon Record
·. Dare: &LJfl'' ·.
I .LJ
Tame:// :tv
Physical AddressiLoca!ion:...___ ______________________ _
I •
Latitude: I I Longitude:
Operation Description: (based on desip daaracteristics)
~of SwiM No. Dj AllimiiU
OSow
ONuncry
OFeedc:
Other~ DjUwmd::
I I
Typ1 tJj Ctutk
DDairy
DBeef
tf?1L. -S'O(A)
No. D/ Animllls
I
. i
iD abc Drawings and Observations the freeboard of each Jaaooa) ·.
Facnity Inspection;
. ~goon :
·Is lagoon{s) freeboard Je.U than 1 foot+ 2S year 24 hour storm storage?: · . . . . . .
. Is seepage observed from the.laaocm?:
Is erosion obsem:d?:
Is any discharge obServed?
0 Mtua-IUM 0 NotMtm...U
0J11er Crop
DOes the facility need more acreage for sprayi!)g?:
Does the cover ~rop need improvemem?:
(list IM CTOJII wlaida Mid impl'tltiGMtlt)
Crop~: \=~.s~e. ~:'--· __ ?.~........ __ _
.. ·• · .
Is a dwelling located withiri 200 feet ~fwa.Ste application?
·Is a wen located within _100 feet of waste applicatiOI!'? . .
I$ ~imal wa.Ste stocq,ned within 100 feet of USGS Bl.u~ Line Stream?
'Is aniinal waste land applied or spray inigated within 25 feet of Blue Line Stream?
AOI-JanaarJ17,DH ·
A
YesC N~
YesC N~
YesC N~
YesC N~
YesC Nop
Y~C .Nof:iJ
YesC
.-YesC
YesC
YesO
-~------... -------·---· ------~-.. ~--------------·
;.,
MtzinUIUIIIU
Does the facility maintenance aeecl improvcmmt?
Is there evidence of past cfischarie from any part of the operation?
Does record keeping need improvement?
Did the facility fail to have a eopy of the Animal Waste Management Plan on lite?
--YesC
)'esC
YesC
YesC
NoD" No~ No'-
No_9'
Explain any Yes answm·'------------------------
Signan= Q~
«: Fadlity AssUS1M111 Vllil
DrawJnp or Obsemtions;
Dale= C /;f ;r(p
7
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Frc.e bO" r J ~ tP R-
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