820656_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quality
·-..... ~ ....... __ .. ,;
ompliance Inspection
Reason for Visit: ~utioe 0 Complaint
Date of Visit: I /Jl?'r-/71
Farm Name: Owner Email: v
J11 rkn) A-t'J,,.J!i ps J)C-Phone: Owner Name:
)
Mailing Address:
Physical Address:
Facility Contact: /Jtfrt),jj fj,; /; 1'..:$
J
Title: t2w r1 1:' ~
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Oiscbarxes and Str eam Impacts
I. Is any d ischarge o bserved fr om any part of the operation?
Di sc harge origi nated a t: 0 Structure 0 Appli cat ion Fi e ld 0 Other:
a. Was the conve ya nce man-m ade?
b . Did the d ischarge reach wate rs ofthe State? (I f yes, noti fy DWR)
c. Wh at is th e estim ated vo lume that reache d wa ters of t he State (gall ons)?
Pbone:
Integrator: &4& Jvrr> )!!; 1/r;~.,_
:?
Certifica tion Numbe r: .~.o~fr~::......c;Z...t.'J~'-I,_ ____ _
Certification Number:
Longitude :
D Yes ~o D NA ONE
D Yes 0No DNA ONE
0 Yes 0 No D NA O NE
d . Does th e di sc harge bypass the waste management system? (If yes , no ti fy DWR ) D Yes 0No DNA ONE
2. Is t here evidence of a past di scharge from any pa rt of th e o pe ra t ion?
3. Were th ere any observab le adverse im pacts or potenti al a dv erse impacts to the waters
of the State other than from a discharge?
Pag e I o/3
D Yes
D Yes
[;a-No D NA O NE
~No D NA O NE
21411015 Contin u ed
I
.'I Facility Number: I nate of Inspection: / ;::z. ~?-/ ;::::>j
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): l't
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes [B.No DNA D NE
DYes 0No DNA ONE
Structure 5 Structure 6
DYes ~No DNA ONE
DYes ~No DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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 Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes jgNo DNA ONE
DYes {8.No DNA D NE
DYes ~No DNA ONE
DYes ~No DNA ONE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. D Yes ~No 0 NA 0 NE
D Excessive Ponding D Hydraulic Overload D Frozen Ground D 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 D Evidence of Wind Drift D Application Outs ide of Approved Area
12. Crop Type(s):
13. Soil Type(s): __ ....:A;....;·;,...;/D::;..&..; _______________________________ _
I 4. 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?
23. If selected, did the facility fail to install and maintain rain breakers on irrigation equipment?
Page 2 of3
DYes l29-No DNA ONE
DYes 1!3No DNA ONE
DYes !SiNo DNA ONE
DYes ~No DNA ONE
DYes gNo DNA ONE
DYes ~No DNA ONE
DYes [3-No DNA ONE
Dother:
DYes 12J.No
DYes EtJ.No DNA ONE
21412014 Continued
~ •1Facility Number: I Date of Inspection: .//< 2-'9-: I Z I
24. Did the facility fail to calibrate waste application equipment as require d by the permit?
25 . Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
DYes ~No DNA ONE
0 Yes ~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 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 D Other:
32. Were any additional problems noted which cause non-compliance of the permit orCA WM P?
33. Did the Reviewer/Inspector fai l to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Revi ewer/In spe ctor Name:
Revi ewer/Inspector Signature :
Page3of3
0 Yes ~ No 0 NA 0 NE
0 Yes ~No 0 NA 0 NE
DYes Qg.No D NA ONE
0 Yes 0 No 0 NA 0 NE
DYes ~No DNA ONE
DYes ~No DNA ONE
0 Yes ~No D NA 0 NE
0 Yes [3 No 0 NA 0 NE
0 Yes ~ No 0 NA 0 NE
Phone: 9£J-3 03-~ !2/
Date : /?-..?J'=;iP J 7
' 11411015
Compliance Inspection Operation Review 0 Structure Evaluation
Reason for Visit: e Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ltofatf/11 I Arrival Time: I 'l ;@.., I Departure Time: I tfJ sooiid County: Region: f/!.0
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Phone:
Onsite Representative: ____ ,...;S!Jiai1.!.:.Mue ____________ _
Certified Operator: f'1Af.5~g II PI, j lbps
Integrator: 6o IJJ/wrp ~ i llt'?J
Certification Number: _..:;~.;.:8~7..:./...t.Jf_: -----
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? DYes ~o
Discharge originated at: 0 Structure 0 Application Field D Other:
a . Was the conveyance man-made? QYes 0No
b . Did the di scharge reach waters of the State? (If yes, notify DWR) DYes QNo
c. What is the estimated volume that reached waters of the State (gallons)?
d. Doe s the discharge bypass the waste management system? (If yes, notify DWR) 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 di sc harge ?
Page I of3
0 Yes [3"No
DYes [3'No
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
2/4/2015 Continued
!Facility Number: 8+ -&, 5iR [Date oflnspection: tt>/;) 7/l~,p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): l9 t9
Observed Freeboard (in): 3J. JO
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 ~o DNA ONE
0 Yes [3"No 0 NA 0 NE
Structure5 Structure6
0 Yes g'No 0 NA 0 NE
DYes g-No DNA ONE
If any of questions 4-6 were answered yes, and tbe situation poses an immediate public bealtb or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
1 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
0 Yes [B"No DNA 0 NE
0 Yes [3"No 0 NA 0 NE
D Yes [g"No D NA 0 NE
DYes ~o DNA ONE
II. Is there evidence of incorrect land application? Ifyes, check the appropriate box below. D Yes ~o DNA 0 NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN> 10% or 10 lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): Bermuda/ ovrr5ee J
I
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 fa c ility fail to have the Certific ate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? lfyes, check
the appropriate box.
Owup Ochecklists 0 Design D Maps 0 Lease Agreements
DYes 0'No
DYes G::(No
DYes [3"No
DYes @Io
DYes (2(No
DYes {3"No
DYes 0'No
DOtber:
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 NA 0 NE DYes DNo
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis D Waste Transfers D Weather Code
0 Rainfall D Stocking D 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? D Yes 0' No 0 NA 0 NE
23 . If selected, did the facility fail to in stall and maintain rainbreakers on irri gation equipment? D Yes D No 0 NA 0 NE
Page 2 of3 21412015 Continued
lFa~ility Number: 8~ -(e flo I nate of Inspection: to JC? zJitp r I
24. Did the facility fai l to calibrate waste application equipment as required by the permit?
25 . Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
DYes ~o DNA ONE
QYes ~o DNA ONE
0 Failure to complete annual sludge survey 0 Failure to develop a POA for s ludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: -------------~--------
26. Did the facility fail provide documentation of an actively cenified operator in charge? 0 Yes ~No 0 NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes 0'No 0 NA 0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and repon mortality rates that were higher than normal ?
29 . At th e time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i .e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
DYes ~o DNA QNE
D Yes [2('No DNA QNE
0 Yes (!{No 0 NA 0 NE
0 Yes DNA ONE
0 Application Field 0 Lagoon/Storage Pond 0 Other: --------------------
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
0 Yes
DYes
DYes
Phone:
Reviewer/Inspector S ignature : ---d,;.._,.~~p.:.~Le~llli-........,~~~· -..·"""""o::;._ ___________ _
Page 3 o/3
Date:
DNA ONE
DNA ONE
DNA ONE
r1
21411015
...
0 Denied Access
Date of Visit: I/8~-;3J Arrival Time:l,t 145'" Departure Time: I 0 ! 45'"'1 County,: ¥.P---' Region: f=j(i)
FarmName: __ ~·~~~i~~~~~--~~-~~~-~-------------------? GP-OwnerEmail: --------------------------------
/JZ ¢:= d-~j 1/,'~Jr~
/ ;;
Phone: Owner Name:
Mailing Address:
Physical Address: -----~--~-----------------------------------------­
Facility Contact: m~/."Ujl;Jip Title: ~LP~·""I/~4~/)""r":;...rC~::...-___ ___ Phone: -+·-----------------
Integrator: ..~..6..e.·~~:u.d~' ..:;.~_d)---=:~.:....:...' ..... ~:;..:· ~'-""':.,....__ __ _ 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 D Application Field
a. Was the conveyance man-made?
0 Other:
b. Did the discharge reach waters of the State? (If yes, notifY DWR)
c. What is the estimated volume that reached waters of the State (ga11ons)?
Certification Number: ~:...;:/-~o/'~---------
Certification Number:
Longitude:
DYes ~No DNA ONE
DYes 0No DNA ONE
DYes 0No DNA ONE
d. Does the discharge bypass the waste management system? (If yes, notifY DWR) DYes D No DNA ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of3
DYes J&l,No
DYes ~o
DNA ONE
DNA ONE
2/4/2014 Continued
I Facility Number: 9,2: -lR.?b I !Date of Inspection: /4:-ft /rl
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 Structure2 Structure3 Structure4
Identifier: I r2S
Spillway?: ~ 12::.
Designed Freeboard (in): L9-L9:.
Observed Freeboard (in): ,3/ fl ...
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 I)-No
DYes 0 No
DNA ONE
DNA ONE
Structure 5 Structure 6
DYes ~No DNA O NE
DYes ~o DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threa~ notify DWR .
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes ~No DNA ONE
DYes cgNo DNA ONE
0 Yes CtJ-No 0 NA 0 NE
D Yes ~No DNA ONE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. DYes 1;3-No 0 NA 0 NE
0 Excessive Pending 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
D PAN D PAN > 10% or 10 lbs. D Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Appl ication Outside of Approved Area
12. Crop Type(s ): J?..crl'lt~"'-/lllh'-f.jr.~J
13 . Soil Type(s): tbrn/lc /GP/Js.Jo,lJ
14. Do the receiving crops differ from those designated in the CA WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation d esign 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 componen ts of theCA WMP readily available? If y es, check
the appropriate box .
Ow up Ochecklists 0 Design 0 Maps 0 Leas e Agreements
DYes ~0 DNA
DYes !ZLNo DNA
DYes ~No DNA
D Yes ~No DNA
DYes ~No DNA
DYes ~No D NA
DYes [2}-No DNA
Oother:
ONE
ONE
ONE
ONE
ONE
ONE
ONE
21 . Does record keeping need improvement? If yes, check the appropriate box below. 0 Ye s ~ No 0 NA 0 NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis D Soil Analysis 0 Waste Transfers 0 Weather Code
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rainfall Inspections 0 Sludge Survey
22 . Did the facility fail to install and maintain a rain gauge? 0 Yes ~No 0 NA 0 NE
23. If selected, did the fac ility fai l to install and maintain rainbreakers on irrigation equipment?
Pagel of3
0 Yes ~ No 0 NA 0 NE
114/1014 Continued
e I Facility Number: I Date of Inspection: /~ -LY-1-r-l
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
-
DYes ~No DNA ONE
DYes ~No DNA ONE
0 Failure to complete annual sludge survey 0Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notifY the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field 0 Lagoon/Storage Pond 0 Other:
0 Yes j5aNo DNA ONE
QYes ~No DNA ONE
QYes ~No DNA ONE
DYes l5(No DNA ONE
DYes ~No DNA ONE
QYes [S(J_ No DNA ONE
------------------------
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page3 of3
QYes ~No DNA ONE
QYes ~No DNA ONE
QYes ~0 DNA ONE
Phone: 9fl?-/(3.?-5JVD
Date: ;;z-;g--/00
21411014
Date of Visit: I/?-H'II Arrival Time: 13 : 0 0
Farm Name: K ~ ~).... 1-Y
Departure Time: I i/,'Jo I County: .57if~ Region : t=Z-D
Owner Email: v
Owner Name: In a.,J 1 m !/; 83 • Lt-c Phone:
Mailing Address:
Physical Address: --------"7~--------------------------------
FadfityContad: ~l Phone:
Onsite Representative: Integrator: (2;;~ /c;VD
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
l. Is any discharge observed from any part of the operation? 0 Yes (2fNo
Discharge originated at: 0 Structure 0 Application Field 0 Other:
a . Was the conveyance man-made? DYes 0No
b. Did the discharge reach waters of the State? (If yes , notify DWR ) DYes 0No
c. What is the estimated volume that reached waters of the State (gallons)?
d . Does the discharge bypass the waste management system? (If yes, notify DWR) 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 of3
DYes ~No
DYes ~0
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
214/2014 Continued
!Facility Number: I Date oflnspection: 12--8,:-/ J{-
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 Structure3 Structure 4
Identifier: /(I K:J-It -3 t:S.~
Spillway?:
Designed Freeboard (in): i? L~
Observed Freeboard (in): '{o tlr
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 NA D NE
D Yes 0No 0 NA 0 NE
StructureS Structure 6
DYes ~No DNA ONE
DYes ~No 0 NA D NE
If any of questions 4-6 were answered yes, and tbe situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not a pplicable to roofed p its , 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 a lternatives that need
maintenance or improvement?
D Yes ~No
D Yes (Sg No
DYes ~No
DNA ONE
DNA ONE
DNA ONE
D Yes [5_g No 0 NA D NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. D Yes ~No 0 NA 0 NE
0 Excessive Ponding D Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn , etc.)
0 PAN D PAN > 10% or lO lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window D Evidence of Wind Drift 0 Application Outside of Approved Area
12 . Crop Type(s): lte=/121Ju. /av,..c'fr=rJ
I
13. Soil Typc(s): t!Pt hi k. j(Jpln/.jjoro
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site n eed improvement?
I 6. Did the facility fail to secure and/or operate per the irrigation des ign or wettable
acres determination?
17. Does the fac ility lack adequate acreage for land application?
18 . Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA WMP readily avai lable? If yes, che ck
the appropriate box.
D wup Ochecklists 0 Des ign D Map s 0 Lease Agreements
21. Does record k eeping n eed improvement? If yes , check th e appropriate box below.
D Yes ~N o DNA ONE
DYes ~No DNA ONE
D Yes 5 No DNA ONE
DYes ~No DNA O NE
DYes ~No DNA ONE
DYes {2tNo DNA ONE
D Yes ~No D NA ONE
0 0ther:
D Yes ~No DNA ONE
0 Waste Application D Weekly Freeboard 0 W as te Analysis 0 Soil Analys is D Waste Transfers 0 Weather Code
D Rainfall D Stocking D Crop Yield 0 120 Minute Insp ections 0 Monthly and I" Rainfa ll Inspections 0 Sludge Survey
22. Did the fac ility fail to install and maintain a rain gauge? 0 Yes ~No 0 NA 0 NE
23 . If selected, did the faci lity fail to install and maintain rainbrea kers on irrigation equipment? 0 Yes ~No 0 NA 0 NE
Page2of3 2/412014 Continued
I ..
I Facili!l: Number: 82=. . /_.,5(, I !Date oflns2ection: f:;L-8'-1 q
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes 1)21 No DNA ONE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check DYes ~No DNA ONE
the appropriate box( es) below.
D Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
D Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 D Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Rev iewer/Inspector Name :
Reviewer/In spector Signature :
Page 3of3
DYes ~No DNA ONE
DYes !B) No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes l8J No DNA ONE
DYes gNo DNA ONE
DYes ~No DNA ONE
Phone: ~~3'.r5300
Date : //-L-/o/f
21412014
ompliance Inspection Operation Review 0 Structure Evaluation
Reason for Visit: S:Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Denied Access
DateofVisit: lql(1qh.3 I Arrival Time:IO"fiOO i41'1 I Departure Time:ltO~SOAHI County: .:5chfSO,
Farm Name: Klhj 1-8'
Region: F/?!J
Owner Email:
Owner Name: HgA Phi U! rs ILL(_ Phone:
Mailing Address:
Physical Address: ~ cQv{/10 ~ {Me__
Facility Contact: HoahQ/1 fJhifl[pr Title: 0 trnf(' Phone:
Onsite Representative: ..;zS!:LJai .......... r\:'--..:.N........._.fkh&.Jo~C,.eJ=a.·,_J ---------
Certified Operator: MtJrsha fl Ph l II fp£
Integrator: Goldsht;o ·Mill~
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)?
Certification Number: ..... ~::::..~~-t_.Lj~-----
Certification Number:
Longitude:
QYes ~No DNA ONE
DYes 0No DNA ONE
DYes 0No DNA ONE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes 0No DNA ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of3
DYes
DYes
KJNo DNA ONE
~No DNA ONE
11412011 Continued
JFacility Number: CC d.. I Date of Inspection: 9 Qg I \3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure4
Identifier: K-t K-J.-.
Spillway?:
Designed Freeboard (in): 19 lq
Observed Freeboard (in): cU. 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?
D Yes ~ No D NA D NE
DYes 0No DNA ONE
Structure 5 Structure 6
DYes ~No DNA ONE
DYes 18f'No DNA D NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. 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?
~ Yes 0 No D NA 0 NE
D Yes j8 No 0 NA 0 NE
DYes 15d'No DNA D NE
DYes ~No DNA ONE
11. Is there evidence of incorrect land application? lfyes, check the appropriate box below. DYes 15a'No DNA 0 NE
D Excessive Ponding D Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
D PAN 0 PAN > 10% or 10 lbs. D Total Phosphorus D Failure to Incorporate Manure/S ludge into Bare Soil
D Outside of Acceptable Crop Window D Evidence of Wind Drift D Application Outside of Approved Area
12. Crop Type(s): UJtbial 'BfiAI4&,;SI!t:l/~m3, Of
13. Soil Type(s): fvtl&)lll.A · 6dJ,rbtto A:
14. Do the receiving crops differ from th?se designated in theCA WMP?
15. Does the receivin g crop and/or land application site need improvem ent?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reguired Records & Documents
19 . Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA WMP readil y available? If yes, check
the appropriate box.
OwuP O c heckli sts 0 Design 0 Maps 0 Lease Agreements
DYes ~No DNA ONE
DYes !Sa No DNA ONE
DYes (li"No DNA ONE
DYes jE"No DNA ONE
DYes crdNo DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
Oother: ________ _
21. Does record keeping need improvement? If yes, check the appropriate box below. DYes ~No DNA 0 NE
D Waste Appli cation D Weekly Freeboard 0 Waste Analysis D Soil Analysis 0 Waste Transfers 0 Weather Code
D Rainfall 0Stocking D C rop Yield 0 120 Minute Inspections D Monthly and I" Rainfall Inspections 0 Sludge Survey
22 . Did the facility fail to install and maintain a rain gauge? 0 Yes ~No DNA 0 NE
23. If selected, did th e faci lity fail to install and maintain rainbreakers on irrigation equipment?
Page2of3
0 Yes 0 No 18JNA 0 NE
21411011 Continued
[Facility Number: ~ -~')~ I Date of lnsl!ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes ~No DNA ONE
25. Is the facility out of compliance with permit conditions related to sludge? lfyes, check DYes ~No DNA ONE
the appropriate box(es) below.
0 Failure to complete annual sludge survey 0Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? DYes I15No DNA ONE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? DYes 0No ~NA ONE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes (81 No DNA ONE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? DYes mNo DNA ONE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the DYes ~No DNA ONE
permit? (i.e., discharge, freeboard problems, over-application)
31 . Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. DYes ~0 DNA ONE
0 Application Field D Lagoon/Storage Pond D Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? DYes ~No DNA ONE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes ~No DNA ONE
34. Does the facility require a follow-up visit by the same agency? DYes ~No DNA ONE
1, ~lea1e. Ki!€-f \'V~t~ a, mesfol:r an fllntr slof€.1 -ft9r kt q.k'.J..
~t, J'o~ "'ill sfNL Crof 'fle~ -etJt111
• J-o611 (eft-I?/" {( .s-1-&M<KllfJ fl:r"' . PI ~e mafe COfleJ o,J:tlUI-fer ~.J~Aet-&, rh
Review er/Inspector Name : Phon e :Cff~~(~
Page3 of 3
Dat e :Af!l4~~PL3
2/4/2011
Rev iewer/lnspector Signature:
..
'
~··:;·;:,•· .. · ~ ~<'Pz7t~;~~~ I
t~~~On, 'llq'"7:3't,35gt(
' J (}I I G dtJI.r;,o 1{/{/J. r.-:-::-=-=~~~~~,_-y.;.=~==-,...;--.....,..:--~~ J
~~~~~~~~~~~r-~-~ ~--;;...;;.;~+--..::..r;~~~~--L....LJC.,I....__--L..!.:...t...,.J.!...<~-_____.J-Bcref~ l~Jki-Sq~ 'M:!Jj;
~k~ -S'~tl/ '*' N~JtJ IOJ,Q_ :.~~rfoc()91~ 1fJf-
l--:-:---~~!-+.:i+iim+lii+-ti+-~~~~---+----.. f(};j (/of )'/f(t/_; ~ h-e 'I~£_
No P'1,41("J J)rce._ Alov
f--L-____,..:....;..~~~~-f-'-'--"-:.:.._,.;.;.~~--+---,--+--.llt'J-t 0 r:t ~iJ.')PdY-O(f/}fc/;~r .
t--------i-~~t+Ti-Ti--rm+i*t:-i-~~--+--____.:_-1-r--6r&:kt~ffb-vJ(j tiff,
. VA .. ~ffrf>C}
'FRO or Fa'rm Records
lagoon#.
Top Dike
Stop Pump
Start Pump
3000= 213 lbjac ·
-a,.,!~ t>'J 'mt-t< '· : ·
.VN tvet'cO.Jtin,~t~ 0r--~cxil plif.h -lrhry
' ' ~
.•
.•'.
Compliance Inspection Operation Review 0 Structure Evaluation
Reason for Visit: f1 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Denied Access
Region: FRO Date of Visit: 1"\ ji;)S:hd. I Arrival Time:lq!(l) AH I Departure Time:! ,j',OQ A tj I County: Sfhr(5fn
FarmName: l(~ 1-<j$ OwnerEmail: --------------
Owner Name: Mq A Phi If rps L LC.. Phone:
Mailing Address:
Physical Address: -----------------------------------------
Facility Contact: H 015 ha 11 rM I ,.~J
Onsite Representative: .~....H.~..:;D~rs~h.c:a~(.:...l....~..e..;..;'h~;1..:...J 1/ t'R'~:::;._ _______ _
Certified Operator: H Ot5 ba ( ( Ph I( r,,
Title: Owner Phone:
IJV>J
Integrator: O<'i57f 4 -G&/dJboo tg, /Pr_'i
Certification Number: ;;Jl7'11!J.L...t....:.../-1Y------
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 [}fNo DNA ONE
Discharge originated at: 0 Structure D Application Field 0 Other:
a. Was the conveyance man-made? DYes 0 No DNA ONE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) DYes 0No DNA ONE
c. What is the estimated volwne that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2.1s there evidence of a past discharge from any part of the operation?
DYes
DYes
0No
~No
DNA ONE
DNA ONE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of3
DYes jgNo DNA ONE
214/1011 Continued
I ~acility Numbcl'": j A-. -tz 5¥z I Date of Inspection: y \~Si I a
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 Struc ture 4
Identifier:
Spillway?:
Designed Freeboard (in): l'i
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
D Yes ~No DNA O N E
DYes D No DNA ONE
Structure 5 Structure 6
DYes ~N o DNA ONE
0 Yes 18'No 0 NA 0 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any ofthe structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures requ ire
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 Yes 18"No
D Yes 18-No
DNA O NE
DNA ONE
D NA ONE
DYes ~No DNA ONE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below . D Yes l)f"No 0 NA 0 NE
0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground D Hea vy Metal s (C u, Zn , etc .)
0 PAN 0 PAN> 10% or 10 lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift D A ppli cati o n Outside of A pproved Area
12. Crop Type(s): C 0 b?lq J 138"'1!1~ S071J( I fuu{r,
13. Soil Type(s): NoAj GoA
14. Do the receiving crops differ from those designated in theCA WMP?
I 5. Does the receiving crop and/or land application site need improvement?
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.
0WUP Dchecklists 0 Design 0 Maps 0 Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
DYes KJ'No DNA O N E
0 Ye s ~No DNA ONE
DYes ~No DNA O N E
DYes [g No D NA ONE
DYes ~No DNA ONE
DYes (8 No DNA ONE
DYes [81 No DNA ONE
Oother:
0 Yes ~No DNA ONE
D Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Anal ys is 0 Waste Transfers 0 W eather Code
0 Rainfall D Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Ra infall Inspections 0 Sludge Sutvey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes 8 No 0 NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation eq uipment? 0 Yes 0 No [g1' NA D NE
Page 2 of3 21412011 Continued
!Facility Number: '15 Q-I Date of Inspection: g h"Yf I d-.,
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 criNo 0 NA 0 NE
0 Yes IS$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 provide documentation of an actively certified operator in charge?
27-Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
DYes ~No DNA ONE
0 Yes 0 No ~ NA 0 NE
0 Yes i:8:No 0 NA 0 NE
0 Yes I3JNo 0 NA 0 NE
0 Yes [:BNo DNA 0 NE
DYes ~No DNA ONE 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field 0 Lagoon/Storage Pond 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?
0 Yes tgi No
0 Yes ~No
0 Yes ~No
DNA ONE
DNA ONE
DNA ONE
~5. FlfQ,e. do s{utiye svYv;/ },eftye. t?nd ()~ yt!tJ/()!'Qfft -to, &fP?(ifcn io '(2aleyA.
IJ. B~ldr 'fv-tre.. Sfto.1eJ... far weeds a~w n-Pe~ t(JO. Lime WPs Cl(fll&l Jt);f-
~ev,
We\l rnt1hl1/W fath] aJ 9cai. rercn/J ·
lJs~ Aer~a1 {b/ Off 1/ccrh~o~.
Rev ie wer /Inspector Name :
Reviewer/Inspector Signat ure :
Page 3 of3
Phone: q1D-%J-33QQ
Date: A~A\a'S"'/OlO 1)..
11411011
~ Facili~ No.'t>d~fy Farm Name __,}(c...u.:I~ ......... I'-__.[......__ ___ Date \..fb)IIJ.....
Permit .... / COC _/ Oft---¥ NPDES (Rain breaker PLAT Annual Cert Daily Pipe )
K:/
11!1
LaQoon Name, S for spillway 16<'-l 2 K-\Jb 3
Design Freeboard I Last Recorded (in) ,
Observed freeboard ~ 'J'1
SludQe Survey Date ll l2tJfD. ,f&Jill
Sludoe Depth (ft)
LiQuid Trt. Zone (ft} L7 ;). ~
Ratio Sludoe to Treatment Volume if> 0.45 10.'3 "7,J9
Date out of compliance/ POA?
Calibration Date 11¥/'I.£; 2
Rim~ Size (in} 4/1',/1~
Design Flow (gpm)
Actual Flow
Desion Diam. (ft)
·Actual Diam.
SoiiTestDate ~
pH F ields
Lime Needed
Lime Applied fJo,Q ~Qlf
Cu-I Zn-1
Needs S (S-1<25) __ _
Needs P I
Waste Date r~'J....
-60 Day
+ 60 Day
N (lb/1 000 Gal} ~.(,. 1 ,l
pH l }
Pull/Field Soil
No
bo
,
II c)IMII
;).~;,f)
~1.1!\
Crop
Bf+
3 4
CropYield /
Wettable Acres "=<.
WUP ....lVc..-.,--
Weekly Freeboard L..
1 in Inspections v
120 min Insp. v'
w th c d ea er o es --lt-.11*111 I
I :J./;)~
cf
Acres PAN
1\.::!i>r
)
k-~
I I t I I
4
5
Window
Mu -St'D
~Mtrc;, v
5 6
6 7
Transfer Sheets
RAIN GAUGE
7
8
Dead box or incinerator __ _
Mortality Records
Check Lists
Storm Water
Max Rate MaxAmt
Verify PHONE NUMBfFS ;tnd affiliations 5, r: f/~
Date last WUP FRO ~II 0\ I I FRO or Farm Records
Date last WUP at farm ~ Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion -Cu-I 3000= 1081b/ac; Zn-1 3000= 213 lb/ac
Type of Visit: ..e Compliance Inspection 0 Operation Review 0 Structure Evaluation
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Denied Access
Date of Visit: f?/15"1 I 1 I Arrival Time: lq~ OtMtf
Farm Name: i(V,j J-j?
Owner Name: H4 A-Phi I I fpsJ LJ L
Mailing Address:
Departure Time:IIO:so}4fjl County:$qt,p(h
Owner Email:
Phone:
Region: £,f0
Physical Address: -----------------------------------------
Facility Contact: Mauh41) PhflhfJ
Onsite Representative: Nan-hal/ Ph u I rpr
Certified Operator: M /){J bq{/ Ph j 1/ (pJ
Back-up Operator:
Location of Farm:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Title: Owttel"
Latitude:
Discharge originated at: D Structure 0 Application Field D Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (Ifyes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Phone:
Integrator: (ao/JJ6tJrp thy fit,.,lnc.
Certification Number: Jo.:cy~ZU--'-7..L./-+'/------
Certification Number:
Longitude:
DYes ~o DNA ONE
DYes DNo DNA ONE
DYes DNo DNA ONE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes DNo DNA ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of3
DYes L'8l No
DYes HNo
DNA ONE
DNA ONE
21411011 Continued
!Facility Number: B'a; !Date of Inspection: 7f/)/{f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3)
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes ~No DNA ONE
DYes DNo DNA ONE
Structure 5 Structure 6
DYes ~No DNA ONE
DYes [5}-No DNA D NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. 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?
J& Yes D No D NA D NE
0 Yes @"No DNA ONE
0 Yes C2-No DNA D NE
DYes rg-No 0 NA 0 NE
ll.ls there evidence of inc orrect land application? If yes, check the appropriate box below. D Yes {)l"No 0 NA 0 NE
0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn, etc.)
0 PAN D PAN > 10% or 10 lbs. 0 Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window D Evidence of Wind Drift 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 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
DYes l)gNo DNA
crr BYes ENo DNA
DYes ~No DNA
DYes IS{ No DNA
DYes QJNo DNA
ONE
ONE
ONE
ONE
ONE
19. Did the facility fail to have the C ertificate of Coverage & Permit readily available? DYes ~No DNA 0 NE
20. Does the facility fail to have all components ofthe CAWMP readily available? lfyes, check 0 Yes 18-No 0 NA D NE
the appropriate box.
OwuP Ocbecklists 0Design 0 Maps 0 Lease Agreements Oother: _________ _
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ~No DNA 0 NE
0 Waste Application D Weekly Freeboard D Waste Analysis 0 Soil Analysis D Waste Transfers D Weather Code
0 Rainfall D Stocking D Crop Yield D 120 Minute In spections D Monthly and I" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? DYes 18] No DNA 0 NE
23 .1fselec ted, did the fa cility fail to in stall and maintain rainbreakers on irriga ti on equipment? DYes 0 No ~ NA 0 NE
Page 2 of3 214/1011 Continued
. .;. IFacili~ Number: ~i3... ~~~ !nate oflns2ection: :JI 12lfl
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes ~No DNA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes IXJ No DNA
the appropriate box(es) below.
D Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
D Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? 0 Yes ~No DNA
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? DYes 0No ISJ"NA
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes [81 No DNA
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? DYes
lfyes, contact a regional Air Quality representative immediately.
"5a No DNA
30. Did the facility fail to notify the Regional Office of emergency situations as required by the DYes ~No DNA
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? Jfyes, check the appropriate box below. DYes 0No DNA
D Application Field D Lagoon/Storage Pond D Other:
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes ~No DNA
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes lSaNo DNA
34. Does the facility require a follow-up visit by the same agency? DYes [ktNo DNA
r ~len~e rv cr It t.h bt:re, fa-ldteJ OJ J ~001S-s M1l o/f/. f!lb"f tvttll }( -~ rPd soJ#, w.
tOr fi'IJ._ bue .Jpot 0(! ~fs ide_ S W C (}f J'l(r t¥1 fr-;J.. 1
~, Pfe6 e, ltW!e.. f(eld1 CIS"" nffrifll, Svlfwac/Jrl/0'1_! ho~ hei{Jftl CttJf~
1. Pltl}e fOJ+ Crof y,'-e!dJ W ao II
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
fotrd~efre~~ s Ore lhjaxlsiJqfe €!:((>~ as ntJ'/ftl a bov<f>,
t.f 0 f•hl f 1n h llJ b-Pfh d ())e. S i)J ce "'!, I CJJ t \f I J ii-rl-J )/ove-n be /YI< HiJ h 11 itrak_ ~vels fJ~ Wlh 1e_ sarrfiU .s UfftYt h ljh evof(}'tlh.tn )o.JJ('rq., lrJOinf·
~s, Pr~ ba b J e I (9f bl'l! -6¥ S I rJJ€-Nvt;' et.Brl(fi fh tl1 bffliJ l(jtb1S.
Reviewer/In spector Name:
Rev iewer/Inspector Signature:
P age3 of3
Date ?Irs//) Facility No. '3d-(i,f{? Farm Name lfll?J /-'j$"
Permit t/ COC __.,. · 01 _ NPDES {Rain breaker PlAT Annual Cert)
Pop. Design Current FB
I I I I
Type Drops
. ~-).., i< ··I
Lagoon N ?1t'1 2·..--3 4 5 6 7
Spillway I~
Design freeboard
Observed freeboard in) ).,7 'Y1
Sludge Survey Date U<>lll
Sludge Depth (ft) .1. I Q.
Liquid Trt. Zone (ft ~~-7 r:;;-r
Ratio Sludge to Treatment Volume
" -'Q"t' Tnn r'7P'fb ~s~ ~ Ull" -"lt\1ri.P 1::1;_+-'f\n/1~.~ Q.Tn
Calibration Date 1 L:f k'-110 l 3 4
Design Flow ~lf/J
Actual Flow fo5'0
Design Width
Actual Width
Soil Test Date Lj{tlfll/
pH Fields 5 s-tat
Lime Needed Ud_=.!l
Lime Applied PIP, to\11:{(( I
Cu-I Zn-1
Needs P 1/. IJ
Crop Yield t?kJt~-
Waste Analysis Date -~
-60 Day
+ 60 Day
N Amt (lb/1 000 Gal) ~.1/~tiJh~
pH
Wettable Acres __ _
WUP
Weekly Freeboard __
1 in Inspections __
120 min Insp. __ _
Weather Codes
-Transfer Sheets
114111 t{ ,,...., l·)r)
l;;>.to 1~.1
ltt.., ~ I;,:>,{) 1. q
' J
Pull/Field Soil Crop Acres PAN
I JJnLt CJH·h. J,f (3;)J
IOl. I 16.6
~ l6.h
tf ~./
~ \I/ II.J '-..Y
lo ~oA 5rb I3J)-
17 lfrlnA '3.:> .J,
1-• 100
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Sfs-10( Date last WUP at farm
:51JIOf FRO or Farm Records
Lagoon # \< l 0;)
Top Dike .50 ] I 7
1\ Stop Pump 4~,3 r
'-)Start Pump L/ ~ )
Conversion-Cu-i :JOOO= 1081b/ac; Zn-1 3000= 213 lb/ac
5 I 6 7J 8
RAIN GAUGE
Dead box or incinerator __ _
Mortality Records
Window Max Rate MaxAmt
J1tr~ M rf'J
.../
,Sf1'-11Arb_ ..... "' /
'
App. Hardware
~~
Type of Visit s.,-compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ®:"Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: h!ll~l (O I Arrival Time: fl~N1 I Departure Time: llo:SVA!{ I County: SOm{£01
Farm Name: ~j 1-$ Owner Email: -------------
'=R.Q Region: -..~-C........;..;~-
Owner Name: N q A fh j II l ('1 LL(_ Phone:
Mailing Address: ----------------------------------------
Physical Address:----------------------------------------
Facility Contact: Hflshol/ Ph: I lip Title: D.,.-ntr Phone No: ..... ~._q,_,O::--..MO"""I/i-(---
lntegrator: Goltlr buo ~ ft:lr"" Onsite Representative: ------------------
Certified Operator: _._M..I:.tt .... J.:..IOhaL.I.li-( _...~..H.L.-_ l'A£ , I r'fl Operator Certification Number: ~::::~7..:.....:../....,'iJ-----
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D"
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: D Structure D Application Field 0 Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notifY DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
DYes ~No DNA ONE
DYes 0No DNA ONE
DYes 0No DNA ONE
d. Does discharge bypass the waste management system? (If yes, notifY DWQ) 0 Yes D No DNA D NE
2. Is the re evidence of a past discharge from any part ofthe operation? 0 Yes 9:No 0 NA 0 NE
3 . Were there any adverse impacts or potential adverse impacts to the Waters of the State DYes ~o 0 NA 0 NE
othe r than from a discharge?
12128104 Continued
{ I Facility Number: t.ba,.-tzsp I Date oflnspection II I II \ I t Q 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 Structurc2 Structure 3 Structure 4
DYes ~No DNA ONE
DYes 0No DNA ONE
Structure 5 Structure 6
Identifier: ______ -----------------------------------
Spillway?:
Designed Freeboard (in): _ _.,(__.q'---------:-&-1-lq----------------------------
Observed Freeboard (in):--~=--------!lf~Q"'-----------------------------
5. Are there any immediate threats to the integrity of any of the structures observed? DYes I:Sir-No DNA ONE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed DYes ~No DNA ONE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers , setbacks, or compliance alternatives that need
maintenance/improvement?
DYes bSJNo 0 NA D NE
DYes !R"No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
II. Is there evidence of incorrect application? lf yes, check the appropriate box below. 0 Yes ~o 0 NA D NE
D 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 0 Fai lure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Area
12. Croptype(s) (}af4t\ ~~~q ~;. ShlallJraib Ov#J-fPJ...
13. Soil type(s) Mlfolk Is 'Ga!Jcbrro I> :
J 7
14. Do the receiving crops differ from those designated in theCA WMP? DYes ~No DNA
15. Does the receiving crop and/or land app lication site need improvement? DYes ~0 DNA
ONE
ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? DYes ~NoD NA 0 NE
17. Does the facility lack adequate ac reage for land application?
18. Is there a lack of properly operating wa ste application equipment?
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of3
DYes
DYes
r:8"No DNA ONE
f;il'No DNA ONE
I Facility Number: q;a_ -j,Jt l Date oflnspection If IJid. I It)
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 appropriate box. D WUP D Checklists 0 Design 0 Maps D Other
DYes /SNo DNA ONE
DYes !RNo DNA ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. DYes [R"No 0 NA D NE
D Waste Application 0 Weekly Freeboard D Waste Analysis D Soil Analysis 0 Waste Transfers 0 Annual Certification
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and l" 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 cali_brate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit 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 quality concern?
If yes, contact a regional Air Quality rcpresentati ve 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 discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
DYes ~No DNA
DYes 0No tiaNA
DYes EINo DNA
DYes S"No DNA
DYes -grNo DNA
DYes 0No ~NA
DYes ·sNo DNA
DYes ~No DNA
DYes [;(No DNA
DYes 9""No DNA
DYes ~No DNA
DYes 3'No DNA
ls, ResfriJJel. ~f.€1c(s 4tL afflie-c{ Sv{4r. Pcr--e Sfob O/e {!.;it,~ihrve( / ,,
::)5', \"!!~~ Jo Soil svrve; ,. e.nd trf-'j'l?tr{!}r Clff7 ftr exfr1(f10'1,
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Goo&.~~ a..tl r'eccrc{r
~y, ·r1et1e. po:,i-C4 l 1 bra-h\n 'ft,, r ee I s . -c vrrerl-J vJ i" aef' mt; {)or all SfliiJ!j.
Page 3 of3 12/28/04
•
Facility No. ~b Farm Name ~ f-8 --...::::.L!::l-__:._ ___ Date illt d-( { t)
Permit coc 0~ i<-,1_ NPDES (Rainbreaker PLAT Annual Cert
Pop. Design Current FB
Type Dro_Q_s
'57Wl ~ r 'c -r f '(/ I I I I
Lagoon
Spillway
Design freeboard
Observed freeboard {in)
Sludge Survey Date 1
Sludge Depth (ft)
Liquid Trt. Zone (ft)
Ratio Sludqe to Treatment Volume
Calibration Date 1!.-l~¥KO
Design Flow 11/)...,n
Actual Flow tNr-
Design Width I
Actual Width I
~
Soil Test Date /
pH Fields
Lime Needed lVn
Lime Aoolie_d !"\'!),!'I lilt Cu-I __ '-'' Zn-1
Needs P Llqrr:-o .. a~ c / rop Yield
Waste Analvsis Date q,,l 10
-60 Day
+ 60 Day
N Amt (lb/1000 Gal) ~-'>...=. """"\ . ( . r~
pH Jt)tCf
7. ~ -7. ......
2
. .,, ____
11<?1 Jl1 1 2 3
it 'f I l ...,
3 4
Wettable Acres __ _
WUP
Weekly Freeboard __
1 in Inspections __
120 min Insp. __ _
Weather Codes
Transfer Sheets
IR("d.'l-.{t{l Qll~/10
. I
9.0d.7 l'ri,:t--'d.7
/ ·f, t ).tJ
/
Pull/Field Soil Crop Acres PAN
I NrY\-IIH~ .),q 11'fr-
l 1n.fa
?J-\~Gt 't,,f>+S·3
4+AQJ, ~(I+ 3.4
" I \V ~~
t. 6l'lA 01+ ty,fn l.l>)
' J, 3.~
A\\ -.,.Jl \ Sb ' f(Y}
'
4 5 6 7
5 6 7 8
RAIN GAUGE
Dead box or incinerator __ _
Morta lity Records
j
Window Max Rate Max Amt
~N-4a 0 ,) 10
J
~~~ v
-~erify PHONE NU~ERS and affiliations
3
J,O'-f fO,~ t::>j f?.cl;h
Date last WUP FRd15(0~ Date last WUP at farm App . Hardware
FRO or Farm Records
Lagoon#
Top Dike
Stop Pump
Start Pump
Conversion-Cu-I 3000= 1 08 lb/ac; Zn-1 3000= 213 lb/ac
Type of Visit ~Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 18 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
Region:~ DateofVisit: liola?liJ'('I Ar.-iva1Time:l9:304'1 I DepartureTime: 1/t:J:S'Atf I County: S~S()J
Farm Name: )(~ 1-8" Owner Email: -------------
Owner Name: Hq Jl\ J'Aj Iliff LLC.. Phone:
Mailing Address: -----------------------------------____ _
Physical Address:----------------------------------------
Facility Contact: Httsha/f fh[{f ipj. Title: ___.._.0"-'~..::....IJ-'-fr=--------Phone No:-------
Onsite Representative: Ha:r6aiJ f~~ J J'f Integrator: _,CX2...a..<:=/d=J_h..::...W~--------
Certified Operator: H.w;shafl _f.~...ll~r~..~.' f.:....:h:..t=~f;..o1 ____ _ 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 obse rved from any part ofthe operation? DYes lS;J No DNA D NE
Discharge originated at : D Structure D Application Field D Other
a. Wa s the conveyance man-made?
b. Did the di scharge reach waters of the State? (If yes . notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Docs discharge bypass the waste management syste m? (If yes, notify DWQ)
2. Is there evidence of a past di scharge from any part ofthe operation ?
3. Were there any adv erse imp acts or potentia l adverse impacts to the Waters of the S ta te
other than from a di sc ha rge?
DYes 0No DNA ONE
DYes 0No DNA ONE
DYes 0No DNA ONE
DYes ~No DNA ONE
DYes 18"No DNA ONE
12128104 Continued
11
j Facility Number: $~ -'~ Date of Inspection 11Did3f0?1
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
0 Yes f)Sl"No D NA D NE
DYes ~No DNA ONE
Structure 5 Structure 6
Identifier: _______________________________________ _
Spillway?:
Designed Freeboard (in): -~l_.9....____ I <=J
Observed Freeboard (in): -~4~( ____ lf""-"'3:....._ ________________ ------------
5. Are there any immediate threats to the integrity of any ofthe structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
DYes !Sa-No DNA ONE
6. Arc there structures on-site which are not properly addressed and/or managed DYes
through a waste management or closure plan?
9No 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 ofthe structures need maintenance or improvement?
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Docs any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes f)jfNo DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes lia'No DNA D NE
II. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes ~o DNA 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
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Area
14 . Do the receiving crops differ fi'om those designated in the CAWMP? DYes GI;No DNA ONE
15. Does the receiving crop and/or land application site need improvement? 18Yes 0No DNA ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination ? DYes gNo DNA 0 NE
17. Does the facility lack adequate acreage for land application? DYes "S'No DNA ONE
18. Is there a lack of properly operating waste application equipment? DYes S""No DNA ONE
Reviewer/Inspector Name
Reviewer/Inspector Signature:
I Facility Number: ~d.. -6W I Date of Inspection llola:~tor I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20 . Does the facility fail to have all components of theCA WMP readily available? If yes , check
the appropriate box . 0 WUP 0 Checklists 0 Design 0 Maps 0 Other
DYes DSf"No DNA O NE
DYes gNo DNA O NE
21 . Does record keeping need improvement? lfyes, check the appropriate box below. 0 Yes k}No 0 NA D NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers D Annual Certification
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 Weather Code
~
22 . Did the facility fail to install and maintain a rain gauge?
-23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26 . Did the facility fail to have an actively certified operator in charge?
27 . Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28 . Were any additional problems noted which cause non-compliance of the permit orCA WMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30 . At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31 . Did the facility fail to notify the regional office of emergency s ituations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32 . Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
'T;lves J:r'No
DYes WNo
DYes R:No
DNA O NE
a-NA ONE
DNA ONE
DYes "8fNo DNA ONE
DYes ~No DNA ONE
DYes 0No ~A ONE
DYes BtNo DNA O NE
DYes ~No DNA ONE
DYes ~No D NA ONE
DYes ~0 O.NA ONE
DYes ~0 DNA ONE
D Yes ~0 DNA ONE
7. B<teflerl-r~,ahcevera, k'-J, t-c) has s lft?e. sal sir~s~ ~b'iof b~e a--eo_,
Gcod. ~~ 1(: !
15"" ~ t..J.eedso;l a-,a{yrls hetcre... €.nd uf-,y-eO/, ~e lrme. niJet:lf1/o-r seh7efield.t~
0> 5 'o<g Sl vt!Je-s...., nf'tlitrl._ be6te. &tf d"l~-
~t--f'a-hl q.. 3_oai reclYrh.
~~~ ha1 oow , IIi; II ~ 0116-J ffll, !)e.. ;, nt'r '(l-iKe_ ,
12118/04
.. . . f4>
Facility No.~:>-~ Farm Name ~l(ja.....H-Jfu,r..q......J/'--...... __,8-~---Date JOb..3/09
Permit COC oYc NPDES (Rain breaker -------L~
Pop. Design Current
Type
Lagoon
Spillway
Design freeboard
Observed freeboard in)
Sludge Survey Date
Sludqe Depth (ft)
Liquid Trt. Zone {ft}
Ratio Sludge to Treatment Volume
Calibration Date 1~/i'I{ID
Design Flow M.5n I
Actual Flow (DW)
Desiqn Width L.l\n.wa~
Actual Width
Soil Test Date qlao)O&
pH Fields
Lime Needed Q-/, (p
Lime Applied No
Cu -I Zn-1
~
I
2
Pull/Field Soil Crop
1-'f lvo.A-!J-t.
fh-'1 GJ?A. R~
1--1 Sb
FB
1 2
1<-1 k-.)
...,, l.l..'3
Q/~~
1~,';) II ./
5·5 lt,,s-J
-=> ~ r"\
'J;:"c~l~ SoD ....I
3 4
Wettable Acres -,..---
WUP /~-­
Weekly Freeboard __
1 in Inspections .....,/
120 min Insp. --...,......
Weather Codes 7
Transfer Sheets
RYE PAN
3~
~"'
lOtrSo-t'O
Verify PH O NE NUMBERS and affili ati o ns
Date last WU P FRO -skl()f ~ ? Date last WUP at f a rm
FRO or Farm Rec ord s
Lagoon# 50
Top Di ke 4h· i ~'1/
Stop Pum p J
St art Pum p 4~ . .J /I/~)
Conver sion-Cu-I 3 000 = 108 lb /ac; Z n -1 3000 = 21 3 lb/ac
~)) ~'S
3
5
4
PLAT Annual Cert )
I I I I
5 6 7
6 7
a UGE
o r incinerator
Morta 1ty Rec ords
8
Window Max Rate MaxAmt
I ).fu,4"R ().SD f.D
J ~ .l.--
s~~ se ~-lk:t -,a
.Hl 11-HLV -w
App. Hardware Cot rJ A /
f'\q"{tt/-suYI-e_ T11Jtl'J as r ee
I Facility Number I H ~5& .II
8 Dh·is ion of Water Quality r2 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
DateofVisit: l/z-1f-ll71 ArrivaiTimediZ0:.35,Pd DepartureTime: lo2 :f~ml County: 5/t~/s•,../ Region : r/CO
Farm Name: Kf"':J I-~ OwnerEmail: -------------
Owner Name: 1/)AX'W...J I Foods J~ c.., Phone:
Mailing Address: ----------------------------------------
Physical Address:----------------------------------------
Facility Contact: PhoneNo: ________ _
Onsite Representative: ------------------Integrator: -:..::~....:t:/:.:...:~'---='W~~:::::!'/~....:.,k_.::..t>e/--=..s~---
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
Swine Capacity Population Wet Poultry Capacity
Current
Population
I l I 1-=B~---.;;,.~....;;;=n~,..;:~:..::.a"--'ye:..:..r ___.I..__,_ __ ...~-__ ___.
ID Wean to Finish
0 Wean to Feeder
0 Feeder to Fi nish 57bo
0 Farrow to Wean
0 Farrow to Feeder
0 Farrow to Finish
0 Gilts
0 Boars ......... -·· --..
Dry Poultry
0 Layers
0 Non-Layers
0 Pullets
0Turkeys
Other 0 Turkey Poults
D Other ID Other ...
Discharges & Stream Impacts
I . Is any di scharge observed from any part of the operation?
Discharge ori gin ated at: D Structure 0 Application Fi eld D Other
a. Was the conveyance man-made?
b. Did th e discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
0 Dairy Cow
0 Dairy Calf
D Dairy Heife1 I
0 Dry Cow I
D Non-Dairy
D Beef Stocker
D Beef Feeder
0 Beef Brood Cow
··--·. . ... -·-
Number of Structures: 0
DYes ~No DNA O NE
DYes ~N o DNA ONE
DYes ~N o DNA ONE
c . Wh at is the estima ted volume that reached waters of the State (gal lon s)?
d. Does discharge bypass th e wa ste management system? (If yes, notify DWQ)
2. Is there evide nce of a past di scharge from any part o f the operation?
3. Were there any adverse impacts or potenti a l a dverse impacts to th e Waters of the State
othe r than fro m a di sc harge?
DYes ~N o
DYes l1J No
DYes ~No
11128104
DNA ONE
DNA ONE
DNA ONE
Continued
,J
I'F-ac-il-ity-Nu_m_b-er_:_Y. __ 2 __ ~~-:Sj----~:--tl Date of Inspection 112-23-0 71
Waste Collection & Treatment
4 . Is storage capac ity (structural plus storm storage plus heavy rainfall) less than adequate?
a . If yes, is waste level into the structural freeboard?
Structur& StructureO Structure 3 Structure 4
Identifier: IL I V 2.--
Spillway?:
0 Yes [2JNo DNA 0 NE
0 Yes .@No DNA 0 NE
Structure 5 Structure 6
Designed Freeboard (in):----------------------------------------
Observed Freeboard (in): __ .If~~'-----___ .y:L..-:5~--------------------------
5. Are there any immediate threats to the inte&rrity of any of the structures observed?
(ie/ large trees , severe erosion, seepage, etc.)
DYes ~No DNA ONE
6. Are there st ructures on-site which are not properly addressed and/or managed DYes ~No DNA ONE
through a waste manageme nt 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 nee d maintenance or improvement?
8 . Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
0 Yes !:;iNo DNA ONE
I I. Is there evidence of incorrect application? If yes , check the appropriate bo x below. 0 Yes ~No 0 NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Meta ls (Cu, Zn, etc.)
0 PAN 0 PAN > 10% or 10 Jbs 0 Total Phosphorus 0 Failure to Incorpo rate Manure/Sludge into Bare Soil
0 Outside of Acc epta ble Crop Window 0 Evidence of Wind Dri ft 0 Application Outside of Area
12 . Croptype(s) 3~o ..... l.1..d~ {b)
1
SA~,;/ fly;;,i-J (o . .s .)
I 3. Soil type(s) ~/dJ>DYO }/ orFoi f<
14 . Do the receiving crops differ from those designated in theCA WMP ? DYes ~No DNA
15 . Does the receiving crop a nd/or land appli cation site need improvement? DYes ~No DNA
16. Did th e facility fail to secure and/or operate per the irrigation desi gn or wettable acre determination?D Yes (]No DNA
17. Does the facility lack adequate acreage for land application? DYes E;dNo DNA
18. Is there a lack of properly operating waste application equipment? DYes (dNo DNA
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):
ONE
ONE
ONE
ONE
ONE
.... .....
-....
Reviewer/Inspector Name Rrc.Kt j<._;_vel S Phone: 'flo, i.f33 . 33oo
Reviewer/Inspector Signature: R....J.,... R~ Date: 12-28-zoo;
12128104 Contmued
_,./:
I Facility Number: ~2. -65~1 Date of Inspection I t~ -zY-bil
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fai l to ha ve aU components of theCA WMP readily available? If yes, check
the appropirate box. D WUP 0 Checklists 0 Design D Maps D Other
D Yes ~No DNA O NE
D Yes ~No DNA O NE
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ~No 0 NA D NE
D Waste Application D Weekly Freeboard D Waste Analysis D Soil Analysis D Waste Transfers 0 Annual Certification
D Rainfall D Stocking D Crop Yield 0 120 Minute Inspections D Monthly and 1" Rain Ins pections D Weather Code
22. Did the facility fail to install and maintain a rain gauge? DYes ~No D NA ONE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes It! No D NA O NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? D Yes ipNo D NA O NE
25. Did the facility fai l to conduct a sludge survey as required by the permit? D Yes ~No DNA O NE
26. Did the facility fail to ha ve an actively certified operator in charge? D Yes ~No D NA ONE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? D Yes ~No DNA ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit orCA WMP? D Yes ~No D NA ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
D Yes B;No D NA ONE
30. At the time of the inspection did the facility pose an odor or air quality concern? D Yes ~No D NA ONE
lfyes, contact a regional Air Qua li ty 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)
rEJNo 32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? D Yes DNA ONE
33. Does faci lity require a follow-up visi t by same agency? D Yes ~No DNA O NE
.
Additional Comments and/or Drawings:
.... -
f-....
12118104
j •
Type of Visit @ Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: jb-~'1-Ot,j Arrival Time:lu: ~.~J Departure Time: 1/z; ~~~~) County: ~o/.lUJY Region: r;eo
f 7:1 7
Farm Name: N AI:J /-)/' Owner Email: -------------
Owner Name: lfiAKwe.tl fiad.s, INC<, Phone:
Mailing Address: -----------------------------------------
Physical Address:-----------------------------------------
Facility Contact: c. eo VJ f' P~th..t ..$
Onsite Representative: G ~VS e..-P <-&.S:.
Title: -----------Phone No:---------
Integrator: _:_;/6....:...._~.:....~~~;,.;;,...:1-.....;~~o;;;,c:/..~· F"+--=:k}~~!..:·_C....::........: • ....:...._ __
Certified Operator:--------------------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 !l'lNo DNA ONE
Discharge originated at: D Structure 0 Application Field D Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
c. What is the estimated volume that reached waters of the State (ga llons)?
d. Does discharge bypass the waste management system? (If yes , notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of3
DYes 0No ~NA ONE
DYes 0No ~NA ONE
I
DYes 0No r1NA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
12/28104 Continued
I t
Date of Inspection IP=z9-o4d
~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?
---:-:~~ctur@ Structure 2 Structure 3 Structure 4
DYes ~No DNA ONE
DYes ~No DNA ONE
Structure 5 Structure 6
Identifier:----------------------------------------
Spillway?:
Designed Freeboard (in): __ --'/----~.9;.___., _____ ....:f:...'l"--'-' _______ ------------------
ob d ~A ~/ h>-h serve Freeboard (in): ___ r_L......I.L:.....---____ T_L...:;. ________________ -------------
5. Are there any immediate threats to the integrity of any ofthe 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 lj1No 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 tbreat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes
DYes
DYes
DYes
~No DNA ONE
!~'No DNA O N E
'}iaJNo DNA ONE
~No DNA ONE
II. Is there evidence of incorrect application? Ifyes, check the appropriate box below. DYes ~No DNA D NE
D Excessive Ponding D Hydraulic Overload D Frozen Ground D 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 D Evidence of Wind Drift D Application Outside of Area
12. Croptype(s) &.rN~ch.< d'j' , S#t.e;t/ Gua:-w (D,Jy=S~cc£J
13. Soil type(s) GoA A/, A
) :.
14. Do the receiving crops differ from those designated in the CAWMP? D Yes ~No DNA D NE
15. Does the receiving crop and/or land application site need improvement? DYes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre de te rmination ? D Ye s
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
D Y es
DYes
~No DNA ONE
l}iP No D N~ D NE
~0 DNA ONE
~No DNA ONE
r-----~------~--------------------~~~------------~==~ Commeri~ '(refer to question #;): Explain any YES answers and/o~ . . or any otber
:usedl"a-Mn'gs"offacility to better explain situations. (use additional pa2~~(~5ill{i~~e~sah:l::',
Reviewer/Inspector Name J-
:...._~~~~~~~~~--------~~~~--~--·
Reviewer/Inspector Signature:
Page1of3 Continued
I Facility Number: ~ Z -6S(p I Date oflnspection jt;;---z.f-o~l
Required Records & Documents
19 . Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropriate box. 0 WUP 0 Checklists 0 Design 0 Maps D Other
DYes ltfNo DNA ONE
0 Yes 12FNo DNA ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. D Yes ~ No 0 NA D NE
0 Waste Application 0 Weekly Freeboard D Waste Analysis D Soil Analysis 0 Waste Transfers 0 Annual Certification
D Rainfall D Stocking 0 Crop Yield D 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23 . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24 . Did the facility fail to calibrate waste application equipment as required by the permit?
25 . Did the facility fail to conduct a sludge survey as required by the permit?
26 . Did the facility fail to have an actively certified operator in charge?
27 . Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28 . Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead anima ls 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? (ie/ discharge, freeboard problems, over appli cation)
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?
Addition~I .. Commel#s~il,~dl~rD rawiog s:
Page 3 of3
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~N o DNA ONE
DYes ~No DNA ONE
D Yes ~No DNA O NE
DYes ~No DNA O NE
DYes ~No D NA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes (gPNo DNA ONE
·:~{fJ.t-~~:r.. ....
f-
12118104
Type of Visit st"compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
D~te of Visit: 11 /z..y,:;-J Arrival Time: I~-. 1..0 I Departure Time: ._1 ___ __.1 County: S."t1P~ ;;,.J' Region: Fft'D
Farm Name: k,'J S:.,. £~ J i S H-i ,J C:r Owner Email: --------------
Owner Name:------------------------Phone:
Mailing Address: -------------------""""'--
Physical Address:-----------------------------------------
Facility Contact: ______________ Title:-----------PhoneNo: ________ __
Onsite Representative: C~ 12-G,£. '?£.;IT\l..$ Integrator: ___ G=-t:.=L,...'P~£_;e~~,;_£_~ _____ _
Certified Operator:--------------------Operator Certification Number: {9 1 5 i
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D" Longitude: D ODID"
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
ID Wean to Finish I I
Avb ··
I I D Dairy Cow
;
I
D Dairv Calf '
' D Dairy Heife1 I
D Wean to Feeder
t2r'Feeder to Finish SI6D .:f.t.. ~L
10 Layer
Dry Poultry 0DryCow
D Non-Dairy '
I
D Beef Stocker i
D Beef Feeder i
D B eef Brood Cow I
I .. .. -· --· ""'
D Farrow to Wean
0 Farrow to Feeder
D Farrow to Finish
D Gilts
D Boars -·-. -~ ---..., ...
0 Lavers
0 Non-Layers
D Pullets
D Turkeys
IO Other .l
0 Turkey Poults
0 Other
--.. -~ -··
Number of Structures: D Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? DYes ~No DNA ONE
Discharge originated at: 0 Structure 0 Application Field 0 Other
a. Was the conveyance man-made? DYes 0No DNA ONE
b. Did the discharge reach waters of the State? (If yes, notifY DWQ) DYes 0No DNA ONE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
DYes ~No
DYes jtJNo
12/28104
DNA ONE
DNA ONE
DNA ONE
Continued
t
j Facility Number: IQ, '--,t $ LJ . "
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
DYes fiNo DNA ONE
DYes 0No DNA ONE
Structure5 Structure 6
Identifier:--------------------·------------------
Spillway?:
Designed Freeboard (in): __ ----:":' ___ ---------------------------------
Observed Freeboard (in): ___ q....L· _·-z-____ ;.-{..:...,,3.L----------------------------
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 ~No DNA ONE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? DYes i;tNo DNA 0 NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks) DYes tzjNo DNA ONE
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement? DYes pNo DNA ONE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes JANo DNA ONE
II. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes JZl No 0 NA 0 NE
D Excessive Ponding D Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
D PAN 0 PAN> 10% or 10 lbs D Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window D Evidence of Wind Drift D Application Outside of Area ·'1 z.. -r;-
12. Crop type(s) c~~ota.-~M 5. (,.. ~~
/rlr:.. 13. Soil type(s)
I
14. Do the receiving crops differ from those designated in theCA WMP? DYes
15. Does the receiving crop and/or land application site need improvement? DYes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination! 0 Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
DYes
DYes
/lf-f£P> ~-~ c. ~ ~ J ~ A C..i.l ,-"""t'l-~ 1'Jl-.t s-A~ L '7
~ 'TI'lL{.. f\~1'o~. "IH"'-S \JCil--tt '1\-1-'t:..~ s;'('~"""' ~ 1 ~~-....J.J-
i ~ c/Z-e p Po£...S rio"r ~ .. )_:LC.ov~ f ·.Jc C~TA-7"'-~N'e. /M.Pf)...::,J'\._111\~
/l'lA-t 13 ~ ,.r ~ (..0 £.D
Reviewer/Inspector Name
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
' . " l Facility Number: ij "2....-(,~{)I
Required Records & Documents
Date of Inspection 11/§} 1:1 tl
r
19 . Did the facility fail to have Certificate of Coverage & Permit readily available?
~ k~ fot-
20. Does the facility fail to have all components of the C.AIWMP readily available? If yes, check
the appropirate box. 0 WUP 0 Checklists 0 Design 0 Maps 0 Other
D Yes 2JNo DNA ONE
0 Yes f;J'No 0 NA 0 NE
DYes ~No DNA ONE 21. Does record keeping need improvemynt? If yes, chec~ the approp_rjate~box below.
f('l.' l.> 1-'-7;. /. ~ l·'f $(.-z5 L 'i '· ~ nfs ~J /
D Waste ~lication ~eekly Freeboard 0 aste Analysis 0 Soil Analysis 0 Waste Transfers 0 Annual'lle~ificftfo;";
p'Rainfall· 0 St_?lking D Crop Yield D 120 Minu~spections D Monthly and I" Rain Inspections D w~~ Code
22. Did the facility fail to install and maintain a rain gauge? 0 Yes [Z( No 0 NA 0 NE
23. If selected, did the facility fail to install and maintain rain breakers on irrigation equipment? DYes ~No D NA ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes 0No DNA ONE
Did the facility fail to conduct a sludge survey a s required by the permit? t I z.1 ( o'( 6 · '2. I'
DYes EJNo DNA ONE 25 .
.,~ u y ,
DYes (2(No DNA ONE 26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? DYes (2(No DNA ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes .efNo DNA ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes ,tjNo DNA ONE
and report the mortality rates that were higher than normal?
JZfNo 30. At the time of the inspection did the facility pose an odor or air quality concern? DYes DNA ONE
If yes, contact a regional Air Quality representative immediately
!Z1No 31. Did the facility fail to notify the regional office of emergency situations as required by DYes DNA O NE
General Permit? (ie/ discharge, freeboard problems, over application)
f5No 32. Did Reviewer/Inspector fail to discuss review/in spection with an on-site representative? D Yes DNA ONE
33. Does facility require a follow-up visit by same agency? D Yes C1'No DNA ONE
'f'-· "; -• .. •
. 'i'"l.·~ . . •
·~~L'Fr~ t,o'.I\A C ~€.-C~f"'f\1\.~0'8?
·+-£... C ~ ,y.. fW\ F-/'1 ~f.O ~ ~-L (,,"~ J DA-I!,.$ f~'.N\At-'t (_~i' ~tL ~C..OI\ )tl~L 'IUT PA
..Jo l>P..~P-~(L. ..>...,, ''Mi'..,l \ (~'\ Jv..S.:<r
C..\ .• {\
12128104
t-., . •
0 Complaint 0 Follow up 0 Emergency Notification OOther 0 Denied Access
[ ~?-=:H ~-<Z 1 DatcofVisit: lU/?Jj4SITime: I 1_36{)
L.,..~==:::..:.::=:.....::=~=~_:::!:~:!:;:: __ _J IO Not Ooerational 0 Below Threshold
P..-mJtt•d C /:!ofi"' C Cond;Jfooally C•.-tifi"'
Farm Name: 0 r/L 1/n y" ~t'/
C Registered Date Last Operated or Above Threshold:
County:---------------
o~~erName: ---------------------------------------PhoneNo: ----------------------------
Mailing Address:
Facility Contact: Title: ____ .....:..,. _________ _
Onsite Representative: ~Jtr r L e~ ili4.S
Certified Operator: /):;:( J_,"h wh .f-f"/ t1 ;d_
PhoneNo: -------------~
Integrator: --------------------
Operator Certification Number:
Location of Farm:
D Swine 0 Poultry 0 Cattle 0 Horse Latitude ....___~1•1 ~.-_ __.I• ._I -~'" Long itude .._____.I• .._I _ _,I · ..... 1 _ _.I"
Design Current Design Current Design Current ··
Swine Capacitv Population Poultry Capacitv Population Cattle Capacitv Population
~B::;-.;:~e e==e~~:~:0::..to.:...;F;:::~n:=~e==s~-l----+----l; IB ~:~~aycr : --.. ___ l --r 18 ~~~~Dally I --J. t
0 Farrow to Wean
0 Farrow to Feeder IO Other I ..... I _ I
D Farrow to Finish
0Gilts
D Boars
Total Design Capacity
Total SSLW _I
Number of Lagoons _.· ~~ ===~I
Holding Ponds I Solid Traps I _I_
I[] _Su~surf~~~-Drain_s Pres~!'! _ UP _L~goon Ar~a .. IO S prav Field Area 1::-
IO No Liquid Waste Management Svstem li--. ; r :' ~;:<:'. :·:
Ojschan:es & Stream Impacts
I. Is any discharge observed from any part o f the operation ?
Di scharge o ri gi nated at: 0 Lagoon D Spray Field D Other
a. If dis charge is observed , was th e con veyance man -made?
b . If discharge is observed. did it reach Water of th e State? (I f yes, not ify DWQ)
c . If disc harge is ob served . what is the estimated flow in gal! min ?
d. Docs disc harge bypass a lagoon system? (If yes, notify DWQ)
2 . Is there evidence of past di scharge fro m an y p art of th e o peration ?
3. Were th ere any adverse impacts or potentia l adverse impacts to the Wate rs o f the State othe r than from a di scharge?
Waste Collection ~ Treatment
4 . Is storage capa city (freeboard plus storm stora ge) less than adequate? 0 Spillway
Identifier:
F reeboard (inc hes):
05103/01
Structure I
A ~~cturc 2 Structure 3 Struc ture 4 Structure 5
DYe s·~
~-
~::~
ov~~
~:=w 0Y e~o
Structure 6
Continued
I '
Date of Inspection 14T¥Jil
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4...(; was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stucturcs lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any butTers that need maintenance/improvement?
0 Excessive Ponding 0 PAN 0 Hydraulic Overload
12. Crop type
designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pendcd for a wettable acre determination?
15 . Docs the receiving crop need improvement?
I 6. Is there a lack of adequate waste application equipment?
Regujred Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
I 8. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists , design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil s ampl e r e ports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of des ign?
21. Did the facility fail to have a actively certified operator in charge?
22 . Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23 . Did Revie wer/Inspector fail to discuss review/in s pection with on-s ite representative?
24. Does facility require a follow-up visit by same a g ency?
25. Were any additional problems noted which cause noncompliance of the Certified A WMP?
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
~·
0
DNo
DNo
DYes 0No/
DYes~ ~
ov~~
0Yes~~o
DYes Jd1'iy
DYes ffy
0
· ·
DYes flNo
DYes~
DYes £fo/
DYes flNNyo
DYes ~o
I~, t'l--c ~a t-n 1 7 6u 1 Jsbt> 0/fv__s ht r"' ,y
h-ttt , v r 'lJ' ~-,... _ n "~ J I ,.. • .., (J,.. d t (' .r.r" ~ 73" 1 i1._s r~. t1 .... r.
r-:11 .... -Sh q..,-a.y ~Lv11 f c... .,J If ~c. 1. f 1 If-.p· ¥2 -o.3 19"' d I' rdhtJ61y
fh (I\..< I J h .(._. (.} I ( (,.(. #l J ;.._ . ( ,. 1"2..-... ;. f-'
Reviewer/Inspector Name
Reviewer/Inspector Signature:
05103101 Continued
of Visit e Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
1 RE~aScm for Visit e Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other D Denied Access
IDateofVisit: lu-J•-o"f !Tune: lit: Jo j,o:]D ~~~
Facility Number I 8~ H (, sr, I
'------------------..., lo Not Operational 0 Below Threshold I ~rmitted ~rtified D ConditionaDy Certified C Registered Date Last Operated or Above Threshold: ---
FannName: _____ _J.U~-·~i~----------------County: $4m..., SP'J ---•
Owner Name: _/!l~.lrd.lL-Curh ~---·-----­·Phone No: _?t..:/;._,j?._---=7~_?..aS':....· ..... 3..._./~3.c...liQo;..._ __ _
Mailing Address: __ e. o. G<vr foop'J
FacilityContact: Geerr-~e Pe..HvJ Title: ------PhoneNo: --------
Oosite Representative: ?~,.~P~'-----=-tD...::e~ii.,~:.=...,_S --------·· Integrator: ~/rLshot:o Ha' fi,.,..s_
Certified Operator: Operator Certifieation Number: _____ _
Location ofFann:
~ne D Poultry D cattle 0 Horse Latitude ..__ _ _.1• '-1 _ ..... ~ ._I _ ___.I" Longitude ._______.I• L..l _ ..... ~ ..... I -~'"
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated a1: D Lagoon D 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 gallmin'?
d . Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? 0 Spillway
Structure 1 Strucrure 2 Structme 3 Structure 4 Structure 5
;;_
DYes 914'o
DYes ~
DYes B'N~ ·----· DYes @:No
DYes sffo
DYes )91fo
DYes ~
Structure 6
Identifier: -·-------· ---------------u t'/ 1..144 , Freeboard (inches): _--~.J..::3:..-_____ !....,.1,1J_ ____________________ ------
12112103 Contiluwl
• (!;'acifity Number: 9¢.-4: f"V I Date of Inspection I II~ 30 ?f ]
5. Are there any immediate threats to the integrity of any of the structures observed? (ieJ trees, severe erosion,
seepage, etc.)
6 . Are there structures on~site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questious 4-6 was answered yes., and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancefunprovement?
8 . Does any part of the waste management system other than waste strucnues require maintenancefunprovement?
9 . Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance{unprovement?
11. Is there evidence of over application? If yes, check tbe appropriate box below.
D Excessive Pending 0 PAN 0 Hydraulic Overload D Frozen Ground 0 Copper and/or Zinc
3~5"' ,or>
12. Croptype [l~r'l?y/IJS ) .SmAll <ioa,'n
13. Do the receiving crops differ with those designated in tbe Certified Animal Waste Management Plan (CA WMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
IS. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor~
17 . Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge allor below
liquid level of lagoon or storage pond with no agitation?
18. Axe there any dead animals not disposed of properly within 24 hours?
I 9 . Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
Reviewer/luspec:tor Name
Reviewerlluspec:tor Signature:
12112103
DYes gNo
DYes ~0
DYes gNo
DYes [J1(io
DYes ~0
DYes ~0
DYes ~
DYes [ci1?o
DYes DNo
DYes DNo
DYes DNo
DYes ~0
DYes IWNO
DYes 0No
DYes 9-No
DYes G}t(o
DYes (3-NO
Date of I.Dspec:tion I /1-Jo-Oj
Required Records & Documents
21. Fail to have Certificate of Coverage & General Pennit or other Pennit readily available?
22. Doe~~~ility fail to ha, all co~nents of the Certified Animal Waste Management Plan readily available?
(ie/~, ch.;pkfuts, ~gn, ~.etc.)
23 . Does record keeping need improvement? If yes, check the appropriate box below.
0 'Wa!te Applieafiaa 0Fn~:9wan1 0 \~.taste Amd)sis 9-Soii Siunpliag-_ ~~-~-? ~t:t·", ~r tt·;J:J-' ,_ Lf '-·s ·7<2~--> ,_t, t.t
24. Is facility not in compliance with any applicable sttb~K cnteria in effect at the tim~ 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 Pemrit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewerllnspector fail to discuss reviewfmspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance .of the Certified A WMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31 . If selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
D Stodcing Fbtm D~ YieJe ~ 0 RsiufaH ~on After 1" Rain
12112/03
DYes ~
DYes ~
DYes ~
DYes g.N'o
D Yes ·Jiiii.Ko
DYes [;}No
DYes~
0 Yes G::ft(o
DYes [3-No
eofes DNo
DYes @NO
DYes· B'No
DYes ~o
DYes [iJ.NO
[3-Yes 0No
I
~ i
...,. .. ~ .. -.,,__, • ··-·--•--·· • . • .,, __ ..,. .... •• "'"''"'~•·•~~. . ........,,....,.,,. •• ·•·••---..---.•-•~•··· ... •--. •••··-·-·¥•-,._.v,-. . •·••·•-·'' _..,..
0 DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
0 Follow-u of DSWC review 0 Other
Date of Inspection ~
Facilit)' Number 81. H G>sf I Time of lnspt:etiou ~ 24 hr. (hh:mm)
C Registered C Certified []Applied for Permit II Permitted f[] Not Operational I Date Last Operated: ......................... .
Farnl Name: ...... :P.ar.k ..... \1.~.~-~---········································:.................................... County: ........... S.~s:eAt .................................. : ............ .
Owne~ Name: ..... ~l~a ...... Q.v.l.c.tt....... ........................................................................ l'honc No: .... ,29J::: .. .7J?..'/..7 .............................................. ...
Facility Contact: ..... ~.\9.~ ...... Q~-~-~-"'-.............................. Title: ..... l1J~........................................ Phone No: ..... S~ ............................ .
Mailing Address: .Z.J.~ ..... f?..l~ ... stc~t .............................................................................. w.~r.~~ .. , ... t-J.~ .............................. ?.i.J..~.g. ....... .
·onsitc Rcprescntati ve: .......... Lo\o.~ .... Q~~-;-~0 ............................................................. Integrator: ....... C.~):dt., ... !.Q .... f".a.r:~ .. t ......................... .
Certified Operator~ ....... ~{"-~:~ ....... ~-~~ ............ :................................................... O~rator Certification Numbt-r~ ........................................ .
Location of Farm:.
·l·::m =~~;; &~~ ~:N~:~£ t:.i;::t~: : : : : : :: :-. ·:: -=~· :: : -~ · : : : ~ :· ~ : : :: : .:-.-.~~ ~
Latitude I 1•1 I• I I" Longitude I ·I• I I• I I"
• lio ~-·v.o;.;· •·
"('"•" ; .. ·swm.e ·· , ·Design Current ·· · · ' Design . Current ···· DeSigii · :Current·
~"'). ,, ' . ~. .. -~ . Capacity Population ·' Poultry ~:-Capacity Population .. <::attle , .. Capacity. Population .,
IDDairy I I . r : . 0 Wean to Feeder
~ ·!ill Feeder to Finish
'· 0 Farrow to Wean "'
1
0 Layer I I I 0 Non-Layer D __ Non-Dairy -... • ~
' . < '
0 Farrow to Feeder ID Other I .
, · 0 Farrow to Finish
:_ . D Gilts
.. Total D~sign Capaci~y .1 I
:====~ ..
.. ··· D Boars ' -Total SSLW I J
~;~·:Numb~r ·or .Lagoons./ HoldingP~~dsl L __,2,ar.,... __ _,l ID Subsurface Drains Present no La~oonArea IOspray fi~ld Area 1 ·.~
r~-.~~q~~ _~:: .. ·-::-~-·.. ·:;, : .. :· '·_;_ . ID No Liquid Waste Management S:ystem I ~ ·-" .. :, .::· ,;,. . ~
General
I . Are there any buffers that need maintt:nance/improveme n t?
2. Is any discharge observed from any part of the operation?
Di sc harge originated at : 0 Lagoon D Spray Field 0 Other
a. If d isc harge is ob:;erved . \\o·as the conveyance man-m ade?
b. If di ~t·hargc is L'bsc rved . did it n::tc h Surface Water~ (lf ye ;;. notify DWQ)
c . If di sc harge is observed, what is the estimated flow in gal/min?
d. Does disc harge bypass :1 lagoon system ·' (If yes, notify DWQJ
3. Is there evidence of past di sc harge from any part o f the operation ?
4 . Were there any adve rse impacts to th e wa te rs o f the State o ther than from a discharge'!
5. Docs any part of the waste manage me nt system (ot he r than lagoons/holding pond s) require
maintenance/im prove ment'!
6. Is facility not in c omplian ce with any appli ca ble setback criteria in effect at th e ti me of desi gn?
7. Did the f ac ilit y fail to have a certified operator in respons ibl e charge?
7125/9 7
DYes Ill No
DYes Ill No
DYes Ia No
DYes ~No
DYes .filNo
DYes ~No
DYes 11:1 No
DYes 9ft No
DYes IJNo
DYes 1!1 No
Continu ed on back
!Facility Number: g~-'~ I
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures {La~:oons.Holdin~: Ponds, Flush Pits, etc.J
9. Is stordge capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
0 Yes til No
0 Yes iii No
Structure 5 Structure 6
Identifier: ......... 7..-.. ~---············· ·············-~·-············· ........................................................................................................................................... ..
Freeboard (ft): .......... J .•. S. ............................... 7.::-............................................................................................................................................................. ..
10. ls seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or em:ironmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
DYes IMNo
0 Yes fjg No
DYes lliNo
DYes ~No
DYes ENo
15. Crop type .. ~ .... , .. J3er.tn~.~ .......................................................................................................................................................................... -................. .
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified A WMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 : ~~:~i~Ia~i~ns.·or _defidenc~es ~ere~ iu)ted: dud_ng _this: visit~· You :wm r~e~~e : ito :furi~er:::
.··:-correspondence about this :visit-:-:-: ·: · :-· _ .....
DYes fBNo
DYes Iii No
DYes tiBNo
DYes Ill No
DYes til No
DYes lA. No
Ill Yes DNo
DYes 8faNo
DYes @No
DYes ill No
~ -h-o,~ ~Ne~ kD Lo· (~w P~)
~~
~ ~\A)t~ r t-eo r-!..s )c-... ~ ll\J~-h~
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,-l 7/25/97