HomeMy WebLinkAbout820664_INSPECTIONS_20171231NORTH CAROLINA
Department of Environmental Quality
Technical Assistance
0 Denied Access
Date of Visit: l2bk?r!ft Arrival Time: I/ 0 ! cjS
Farm Name: G,..,' n'lr(5 't;D~ ~ l'"f11-.
Departure Timed / / .' DD I County:. ¥'"-Region: £7'tJ
Owner Email:
Owner Name: tfu,.-f!P-\-L Gt'~YH"'C".j Phone:
Mailing Address: -----------------------------------------
Physical Address:
Facility Contact: ~~/" ~r-c._
Onsite Representative: -"""'''-<;;..-t=~=-=:;....;;=---------------Integrator:
Pbooe: dff1i2 I
~ d
/.o,-~7'7qc.. ~eT' Certified Operator: Certification Number: J t?l:> /£74 •
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
I. Is any di sc harge observed from any part of the operation? DY es ~ DNA ONE
Discharge originated at: 0 Structure 0 Application Field 0 Other:
a. Was the conveyance man-made? 0 Yes 0No DNA ONE
b. Did the discharge reach waters of the State? (If yes, notifY DWR) 0 Yes 0No DNA ONE
c. What is the estimated volume that reached waters of the State (gallons)?
d . Does the di scharge bypass the waste management system? (If yes, notifY DWR) DYes 0No DNA ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of3
DYes
0 Yes
r:(N'o DNA ONE
~0 DNA ONE
2/4/1015 Continued
,jFacill!y Number: @' -!; fPtf
Waste Collection & Treatment
loateoflnspection: /O;-cilo-t$t'
; 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 l Structure 2 Structure 3 Structure 4
Identifier: C.ot..V-r l'DP
Spillway?:
Designed Freeboard (in): 1'7 lCf
Observed Freeboard (in): 40 3J..-
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?
QYes ~ DNA ONE
0 Yes 0No D NA ONE
Structure 5 Structure 6
DYes~ DNA ONE
DYes~ DNA ONE
If any of questions 4-6 were answered yes., and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the pennit?
(not applicable to roofed pits, dry stacks, and /or wet stacks)
9 . Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
0 Yes
0 Yes
EfN'o DNA ONE
~DNA ONE
DYes ~o DNA O NE
0 Yes DNA ONE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes
~0
~0 D NA ONE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metal s (Cu, Zn, etc.)
0 PAN 0 PAN > I 0% or I 0 lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 App li cation Outside of Approved Area
12. Crop Type(s): J5~4L ~~7~,-J
13 . Soi l Type(s): ~vl/)-c-
14. Do the receiving crops differ from those designated in theCA WMP?
15 . Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17 . Does the facility lack adequate acreage for land application?
18 . Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily availabl e? Jfyes, check
the appropriate box.
Owup O checklists 0 Design 0 Maps 0 Lease Agreements
21. Does record keeping need improve ment? If yes, check the appropriate box below.
DYes~
0 Yes 0'No
DYes ~o
DYes EfN'o
DYes ~0
0 Yes [311o
0 Yes ~
0 0ther:
DYes ~
DNA ONE
D NA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
0 Waste Appli cation 0 Weekl y Freeboard D Waste Anal ysis D Soi l Anal ysis D Waste Transfers 0 Weather Code
0 Rainfall 0Stocking 0 Crop Yield 01 20 Minute Inspections 0 Monthl y and 1" Rainfall Inspections Osludge Survey
22 . Did the fac ili ty fail to install and maintain a rain gauge? 0 Yes ~o D NA D NE
23. If selected, did the facility fail to install a nd maintain rainbreakers on irrigation equipment? 0 Yes ~ DNA 0 NE
Poge2of3 11411015 Continued
•!Facility Number: ft? -z;z;q I IDateoflospection: /1J -,J{~~
: 24. Did the facility fail to calibrate waste application equipment as required by the pennit? 0 Yes ~ 0 NA 0 NE
t 25. Is the facility out of compliance with pennit conditions related to sludge? If yes, check 0 Yes [a--No 0 NA 0 NE
the appropriate box(es) below.
0 Failure to complete annual sludge survey 0Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
pennit? (i.e., discharge, freeboard problems, over-application)
31 . Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field 0 Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the pennit orCA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
firrm ~~~7/-~ 11;yJ ~1,-wJ.
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~ -r-co-n6 7-~.i~.,.....oyz,/ I J-t,--/t)/~
Reviewer/Inspector Name:
Reviewer/Ins pector Signature:
Page 3 of3
0 Yes c:rNo DNA ONE
DYes [3"No DNA ONE
DYes [;3'-No DNA ONE
DYes £2rN'o DNA ONE
DYes [61ifo DNA ONE
DYes ~0 DNA ONE
DYes 12J"No DNA ONE
DYes c;31'io DNA ONE
DYes @No DNA ONE
Phone: 9--tD .:3 iJ :3-iJt,S-(.
Date: /Z).-~
214120 15
Reason for Visit: 0 Other 0 Denied Access
Date of Visit: llt2::&;)lf17Arrival Time:l,/.0 /3 0 Departure Time: l!d.'JO I County: ~0"""'---Region: r/( lJ
Farm Name: Gr:; m..,..1 J<?;J .;;r,..._ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ___,G ...... ,_t ..:;;r. .... c:...,_ r-.__-..<...:Jn;..;.:;o,~l>'"'f...::C...=----Title: Phone:
Onsite Representative: Integrator:
Certified Operator: -..t~"""'C---'z:::""'_;.;..j_' :..;I ~;...;;;:.._..;Q3=.:~:.....;...r' .~o.r..;>_'=.:...;t:t?::...;i ______ _ Certification Number: /D'D !..:S'l1
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 ~o
Discharge originated at: 0 Structure 0 Application Field 0 Other:
a. Was the conveyance man-made? 0 Yes 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 disc harge 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 po tential adverse impacts to the waters
of the State other than from a discharge?
Page I of3
DYes ba,_No
OY~s ~0
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
114/2015 Continued
, !Facility Number: 4 -/..t(,L{
Waste Collection & Treatment
loateoflnspection: to-J't-17 I
~ 4 . Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard ?
Structure I Structure 2 Structure 3 Structure 4
Identifier: t.tZ.u.Jer "Jqz_
Spillway?:
Designed Freeboard (in): L9:. L9
Observed Freeboard (in): ~7 37
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 QNo DNA ONE
DYes 0No DNA ONE
Structure 5 Structure 6
0 Yes ~No 0 NA ONE
DYes ~No DNA ONE
If any of questions 4-6 were answered yes, and tbe situation poses an immediate public health or environmental tbreat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10 . Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
~Yes D No 0 NA D NE
~._Yes D No 0 NA 0 NE
0 Yes f:il._No 0 NA D NE
DYes ~No DNA ONE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes @No 0 NA 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/S ludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12 . Crop Type(s): :J3rra~ /pvt=C"$r;:!"r-J
13 . Soil Type(s): $h;v-J/..c
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 irri gation 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.
D WUP Ochecklists 0 Design 0 Maps 0 Lease Agreements
21 . Does record keeping need improvement? If yes, check the appropriate box below.
0 Yes
D Yes
D Yes
0 Yes
0 Yes
0 Yes
D Yes
Oother:
0 Yes
~No DNA ONE
~No DNA ONE
~No DNA ONE
12J_No DNA ONE
~No DNA ONE
~No DNA ONE
~No DNA ONE
~No DNA ONE
D Waste Application 0 Weekly Freeboard D Waste Analysis D Soil Anal ys is 0 Waste Transfers 0 Weather Code
D Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rainfall In spect ions 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes ~ No 0 NA D NE
23 .1fselected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes {8 No 0 NA D NE
Page 1 of3 114/1015 Continued
·I Facility Number: 'f2= -k ht{ loate of Inspection: to-J?-1 7
t 24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes ~No QNA ONE
D Yes 9_No D NA D NE • 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
0 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notifY the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field D Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34 . Does the facility require a follow-up visit by the same agency?
DYes ~No
DYes [2J.No
DYes ~No
DYes ~No
DYes ~No
0 Yes [2J.No
DYes ~No
DYes fi] No
DYes ~o
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
,_,wrf.:-) V""" 10 /Sr-r""-'7 oro" ~.l 1ft oJ r ....{-1-coN J"''"), .
[urc..foSia/VJi vk t.UI l\ ..519~ CL,J~w /J!Pt kel
Reviewer/Inspector Name :
Reviewer/Inspector Signature:
Page3 ofJ
Phone : 9/P -5~.?-:IJ tSI
Date: /£)-)''')' -/{)t?
11412015
,1111111111111111-
0peration Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Follow·up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 11·rt{ij ( ll Arrival Timed !{'eo P I Departure Time: 1/! 1' jY I County: fl}-~
Farm Name: ~ hi'\v\¥ ~b Oe fo...r'""'l S Owner Email:
I
Owner Name: .J--0 \, Y\ ·}Z (-{o ~~ Phone:
Mailing Address:
Physical Address:
Facility Contact: _.Jo..C~"=c;:.:."'.....:tl-...:...; ,~5 _____:8~. _cw--____;(A.)_tc_._f(_ Title: Phone:
Onsite Representative: l( Integrator:
Certified Operator: Certification Number:
Back·up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation? DYes~
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) 0 Yes 0No
2. Is there evidence of a past discharge from any part ofthc operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Pa~:e 1 of 3
DYes [JNo
0 Yes LfNo
DNA ONE
EfNA ONE
~A ONE
~A ONE
DNA ONE
DNA ONE
214/2015 Continued
~~ty Number: @ d -l b b jnate of Inspection: tft /'11 &u( n
1 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes ~NA ONE
D Yes D No B"N""A 0 NE
Structure 5 Structure 6
DYes ~ DNA ONE
0 Yes [LJ1fo DNA 0 NE
If any of ques.tions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
11 . Is there evidence of incorrect land application? If yes, check the appropriate bo x below.
0 Yes !Z(No D NA 0 NE
0 Yes C2{No DNA D NE
DYes ~o DNA ONE
DYes IL(No DNA 0 NE
DYes ~o DNA ONE
0 Excessive Ponding 0 Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn, etc.)
0 PAN D PAN > 10% or 10 lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Approved Area
12. Crop Type(s): (t{; Jtd-
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 prop er ly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
the appropriate box.
0WUP Dchecklists 0Desihrn D Maps D Lease Agreements
21 . Does record keeping need improvement? If yes , check the appropriate box below.
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DOther:
DYes
~ DNA ONE
~ DNA ONE
0"No DNA ONE
~0 DNA ONE
[31fu DNA ONE
~ DNA ONE
~0 DNA ONE
[31fo DNA 0 NE
0 Waste Application D Weekly Freeboard D Waste Analysi s 0 Soil Analysi s 0 Waste Transfers 0 Weather Code
0 Rainfall DStocking D Crop Yield 0120 Minute Inspections 0 Monthly and I" Rainfall Inspections D Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? D Yes [d"No D NA D NE
23. If se lected, did the facility fa il to inst a ll and maintain rainbreakers on irri gation equipment'! D Yes ~ D NA 0 N E
Page 2 of3 Z/412015 Continued
!Facility Number: rq( -l7 t:, {; I Date of Inspection: /fa I'Yey I 7 I
" 24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box:(es) below.
DYes [a1'fo
D Yes [2l"'No
DNA ONE
DNA ONE
D Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
D Non-compliant sludge levels in any lagoon
List structure(s) and date offrrst survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a ref,rional 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 D Other:
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
0 Yes ~0 DNA ONE
DYes ~0 DNA ONE
DYes [9"N'o DNA ONE
DYes ~ DNA ONE
DYes 6 DNA ONE
DYes ~ DNA ONE
DYes ~DNA ONE
DYes ~DNA ONE
DYes ~DNA ONE
~o?mtents (refer to-question#): Explain anyYE~answers and/or any additional recommendations or,.lloy,otber comm~ntS:; : ~-'' .-
ufe-draWings offacllity to better explain situatio~s (tis~ additional pages as necessary). ,. ' .:, ;, ··. ' ' --:·> :~ ' ' ' w~~~
c~c b.~ · ( 0..-"\ -'t-1'2. --{(v
Reviewer/Inspector Name:
Reviewer/Insp ector Si gnature :
Page3of3
~ ~~~~~~~~~~~~~====~ Type of Visit: Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ." ~ne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1/t'±-J .t I
Farm Name:
Arrival Time: I zr 'v 0
;
Departure Time:l I .' 26 I County: z~tr-Region: fl?J
Owner Email:
Owner Name: Phone:
~. . .
: .\"·.
;• Mailing Addres,s: · _____ ,_:--:-:--------------------------------------r
Physical Address: •• ·"ill._ ... -. .
j J,,.
Facility Contact: ..
~}~~. O~site. Representati~e.: ._·....,D ... &'""~::::;..:;..;;;=:::;....--------------
'(/ :~ce~fled Oper~t~r: .:.:;..·~ ·__,· ..:;./--&.'t2"''ri..___._r;"'-_7....._··+z__,g,__"""""---'cA~&~c__,-z::::::::.L..fWP...=::;..~L:.-=-----
~-;' :j .' • , _"; ' . .~ '' : .-• _;: ,• • -I
t ·:;. Ba~k,iup'9P.erator: :....;:'-: ..• _:"";--:-·,--:-.'------------------~?. ;·~~cation of F~rm/"·~!j<·~ I:;~~.
~·:: ·.·1 .
:_;:> : . -~-
~~~-~~; !.· ... ,. . .
. , .
-~ .. ,
~ .i.
~~: ... · ._ .... _-:
{
!, .,
~:
,i.
I .,
"". !.
(" ·, \.
Latitude:
.. · . . !
~-• f
~~·· Discharges and Stream lmoacts
(:",'. ·Lis any discharge observed from any part of the operation?
·-:,·'., . I·, , .
f;') ·:' .
~· .
t\=
Discharge originated at: D Structure 0 Application Field
a. Was the conveyance man-made?
D Other:
b. Did the discharge reach waters of the State? (If yes, notifY DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
Phone:
Integrator:
Certification Number:. /t?Oif?i
j
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 0No DNA ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of3
DYes
DYes
[EJ No DNA ONE
~0 DNA ONE
2/412015 Continued
~ • •••• J-. '.
• I Facility Number: p---/,( k v( I nate oflnspection: /( E.col+-
Waste Collection & Treatment
~ 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure3 Structure 4
Identifier: y;[_ /-rJc.u..,r
Spillway?:
Designed Freeboard (in): If t_q.
Observed Freeboard (in): 'f:r-d-Z
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 D No 0 NA D NE
Structure 5 Structure 6
DYes 1ZJ.-No DNA ONE
DYes !ZtNo 0 NA 0 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any 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 require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
,8-Yes D No 0 NA 0 NE
0 Yes [B.No DNA 0 NE
00--Yes 0 No 0 NA 0 NE
DYes ~o DNA ONE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes 12J-No 0 NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN> 10% or 10 lbs. 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
l2.CropType(s): br~ /f,Jocr?r--r;/
13. Soil Type(s): .~ 1/r fL r
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 lac k of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropriate box.
OwuP 0 Checkli sts 0 Design D Maps 0 Lease Agreements
21. Does record keeping need improvement? lfyes, check the appropriate box below.
0 Yes f2l.No DNA ONE
DYes [8_No DNA ONE
DYes [RJ No DNA ONE
DYes i)a_No DNA ONE
DYes £2lNo DNA ONE
DYes ~0 DNA ONE
0 Yes Sl'Jo DNA ONE
Oother:
DYes tzf--No DNA ONE
0 Waste Application D Weekl y Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 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?
23. If s elected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 2 of3
0 Yes gl-No DNA D NE
0 Yes 12}--No 0 NA 0 NE
21411015 Continued
• I Facility Number: 42': -?; l ~t I Date of Inspection: //-3-Qlo(t,; I
24. Did the facility fail to calibrate waste application equipment as required by the permit?
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
D Yes (21-No D NA D NE
DYes ~o DNA ONE
0 Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than 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 appropriall: box bduw.
0 Application Field D Lagoon/Storage Pond D Other:
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name: .· (
Reviewer/Inspector Signature:
Page3 of3
0 Yes f9.-No
0Yes ~o
DYes &:l No
DYes 0-No
DYes ~No
0 Yes 3-No
0 Yes gNo
0 Yes ®No
DYes ~o
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
Phone: 91v-303-0 [57
Date: //-3-..;:vI~
21411015
·-·~-~~~-!!!!!~~~ 0 Technical Assistance
Reason for Visit: 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: l/1-rc/;rArrivaiTime:l;/;'D~ I DepartureTime:l 1/: ]t) I County: ... {76'-L-Region: ~0
G-d "'Y'L ~:? 7?.. t>c~ J &~1?-1....6 Owner Email: Farm Name:
Owner Name: L. Phone:
Mailing Address:
Physical Address: -------------------+--.-------------------------'G:.......:;.._f":_-c-_.,.._r~/lf.<..:......:.-'-tJp~~<--~------Title: _. ..... d.L..:....o.......::.J'----=~0-=:..r'P--=-t:'-c.;:_ __ , __ Facility Contact:
Onsite Representative: __ 7..,£_~---=:.....=:::...._ _____________ _
Certified Operator: __ L_o_r_-c;:;;.....;/_1._a.. __ --=.Z~~=-~--=:.....:~-P~7:....' ____ _
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
Phone:
Integrator: --------------
Certification Number: /oo 15'/tf
Certification Number:
Longitude:
DYes ~0 DNA ONE
DYes DNo DNA ONE
DYes 0No DNA ONE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) 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
DYes
i5!No DNA ONE
[il_No DNA ONE
l/4/1014 Continued
loate oflnspection: 11:17-tr
I
I Facility Number:
Waste CoUection & Treatment
._;\ 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure4
Identifier: Il.P p~ ,
Spillway?:
Designed Freeboard (in): ir {t
Observed Freeboard (in): ;l-( ~(:,
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes (l}No DNA 0 NE
DYes 0No DNA ONE
StructureS Structure 6
DYes SNo DNA ONE
D Yes I)J-No D NA 0 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes ~o DNA ONE
DYes ~No DNA ONE
DYes ~o DNA ONE
0 Yes [28.-No 0 NA 0 NE
II. Is there evidence of incorrect land application? Ifyes, check the appropriate box below. D Yes [L}No 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 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): ~/'m{,~ ~~-r::r /
13. Soil Type(s): .,zfu/?;ttXf/-r::: ])
14. Do the receiving crops differ from those designated in the CA WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reguired Records & Documents
DYes ~0 DNA
DYes 0-No DNA
0Yes ~No DNA
DYes ~No DNA
DYes 12JNo DNA
ONE
ONE
ONE
ONE
ONE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? 0 Yes ~ No 0 NA 0 NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check D Yes 1:8--No 0 NA 0 NE
the appropriate box.
OwuP Dchccktists 0Design 0Maps 0 Lease Agreements Oother: _________ _
21. Does record keeping need improvement? Ifyes, check the appropriate box below. 0 Yes [B..No 0 NA 0 NE
0 Waste Application 0 Weekly Freeboard D Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Weather Code
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes ~No 0 NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page2 of3
DYes ~No DNA ONE
214/2014 Continued
•I Facility Number: p;J--(;e:, '( lnate oflnspection: J fl--J.;L-/£ I ....
~-24. Did the facility fail to calibrate waste application equipment as required by the permit? D Yes [2J" No DNA ONE
DNA ONE I
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check DYes ~No
the appropriate bo~(es) below.
0 Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
D Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? DYes G!J:No DNA ONE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? DYes j5No DNA ONE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes
and report mortality rates that were higher than normal?
(ig,No DNA ONE
29. At the time of the inspection did the facility pose an odor or air quality concern? DYes ~No DNA ONE
If yes, contact a regional Air Quality representative immediately.
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)
0 Yes li?J.No DNA ONE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. DYes 64No DNA ONE
0 Application Field D Lagoon/Storage Pond 0 Other: -----------------------
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
7-?-ot.S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page3 of3
DYes ~No DNA ONE
DYes DNA ONE
DYes DNA ONE
Phone: q//)--:(~Y-3::?-00
Date: ;'/-/,:Z -~1~
214/2014
ompliance Inspection Operation Review 0 Structure Evaluation
Reason for Visit: e'Routine 0 Complaint 0 Follow-u 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit : Arrival Time: I lf/)41 Departure Time:l71 IQ I County: cS.1}'1(
Farm Name :_---.G"'-!.,r_;_r...,.:s:,..._.f'<....:..:."...:!!!a=)--fi.:....4t_~---';....._----Owner Email:
Owner Name: Hvter, G rl~s Phone:
Mailing Address:
Physical Address: -~.;;.........5"_0-...J{?"""'· ~f"'"....;.\~~u~I1J..:;;a.--nP~-;;;:~~";S-ht-----------------
n /J --(Mie (tl Facility Contact: 'fW!i (;~ ~c.-Title:----------Phone:
\( t{
Oosite 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 0 Other:
a. Was the conveyance man-made?
b . Did the discharge reach waters of the State? (If yes, notify DWR)
c . What is the estimated volume that reached waters of the State (gallons)?
Integrator: --------------
Certification Number: 1:::__("--'J.~'-{=-----
Certification Number:
Longitude:
DYes ~DNA ONE
DYes 0No cr'A ONE
DYes 0No @NA ONE
d . Does the discharge bypass the waste management system? (If yes, notify DWR) DYes 0No Q'NA ONE
2. Is there ev idence 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?
Pagel of3
DYes
DYes
gNo DNA ONE
[!(No DNA ONE
114/2014 Continued
IFicility Number: I nate oflnspection: / 7{Jet--I
i". Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes~ DNA ONE
DYes 0No ~ ONE
Structure 5 Structure6
DYes ~o DNA ONE
DYes ~o DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
11. Is there evidence of incorrect land application? lfyes, check the appropriate box below.
DYes ~o
DYes ~o
DYes ~o
DNA ONE
DNA ONE
DNA ONE
DYes ~o DNA ONE
DYes~ DNA ONE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN D PAN> 10% or 10 lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12. Oop Typqs) -C;f ee 0$
13. Soil Type(s): Aw v•tff ~
14. Do the receiving crops dirrer om those designated in theCA WMP?
I 5. Does the receiving crop and/or land application site need improveme nt?
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 fa il to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readil y available? If yes, check
the appropriate box.
Owup O c hecklists 0Design 0 Maps 0 Lease Agreements
DYes
DYes
DYes
[g1fo
~0
B"No
DYes ~o
0 Yes B'No
DYes ~0
DYes (3""N"o
00ther:
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
21. Does record keeping need improvement? Ifyes, check the appropriate box below. 0 NA 0 NE DYes ~0
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis D Waste Transfers 0 Weather Code
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute In spections D Monthly and 1" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and m aintain a rain gauge? DYes ~o 0 NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes QrNo 0 NA D NE
Page2of3 21412014 Continued
IFaemty Number: az -''L 1 ~ate of Inspection: /7 E;)~l.-( I
i4. Did the facility fail to calibrate waste application equipment as required by the permi t?
25 . Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box( es) below.
~es 0 No DNA ONE
[9'fes 0 No D NA 0 NE
0 Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
0 Non-compliant s ludge 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 ~0 DNA
27 . Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? DYes ~ DNA
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes B1'fo DNA
and report mortality rates that were higher than normal?
29. At the time of the ins pection did the facility pose an odor or air quality concern? D Yes ~ DNA
If yes, contact a regional Air Quality representati ve immediately.
30. Did the facility fail to notifY the Regional Office of emergency situations as required by the DYes (B"No DNA
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. DYes ~ DNA
D Application Field 0 Lagoon/Storage Pond 0 Other: ---------------------
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP? DYes ~0 DNA
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes ~0 DNA
34. Does the facility require a follow-up visit by the same agency? DYes ~0 DNA
Comments (refer to question #): Exphiilrany';YES,answers and/or any additional recoiii'*~nd.ations .or any otb'et~,comme -·
"--,._ ': '.":_;·~;:~··.~,~.: •, ,'_{~'!l''~·~~-t=.! ... , '• •' •:T'J;:.""lt~.•:t....':~
Use drawings of facility to better explaiti situatiQ_~'f(lise additional pa es as necessacy):J~~t:\:. · •. ':.~:~.:;0;~,~
N.,ec£ &c (,~.~., o~ ~..-:( l~-i~-l3
{\k~ (;{~e ~4 · f ~~ ? {d--(b-1]
M top'u}
~~\\ P~ -flLD~R
Sv.A-e. 1 t 5 _'II
d-J-5 c,~~(\_ ~~
~~11.\1~ NL--z...s5 o\
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Revi ewer/Inspector Name: ..::~Z\..L·-'-, .... \ .... \~D....q..,rJ-'-~c~::-==t-----------------
Reviewer/Inspector Signature : --~.li::0:.4o~""Wt-_O:: _ _,~~x:;;¥---------------
Page3of3
Phon e: 433-333
Date : /J ~c~l q
11411014
Operation Review Structure Evaluation
Reason for Visit: ~Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other
Date of Visit: lloh I J 13
FannName :~(;~r~~~~--~~~--~WL~~~
Owner Name:
Mailing Address:
. r' ~ t-:' Physical Address: (050 lO!VllfJ ~ ra I .SOc
7
Time: U 1; SS:Nf I County: Sotnym
Owner Email:
Phone:
Facility Contact: "illlm.f r Ro €.StJJ Title: ---------Phone:
Region: fRo
Onsite Representative: "Jot(lfJ Rl>ekl) Integrator: .....:...M.:..-~B:;.._ _________ _
Certified Operator: \1t'chCI£( lJfrdf/\
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: IE' 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: ~=%~._f _____ _
Certification Number:
Longitude:
~CIJ
8J Yes S)No DNA ONE
~Yes 0No DNA ONE
DYes l:i"No DNA ONE
d . Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes 0No DNA ONE
2. Js 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
8No DNA ONE
18'-No DNA ONE
2/412011 Continued
'I Facility Number: $ d, I Date of Inspection: I 0 I (I , n
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
Identifier:
Spillway?:
Designed Freeboard (in): I '1
Observed Freeboard (in): ~ l{f5Q
Structure 2
4 I
Structure 3 Structure4
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 0No DNA ONE
StructureS Structure 6
DYes ~No DNA ONE
DYes ~No DNA ONE
If any of questions 4..{) 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 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?
j8 Yes 0 No D NA 0 NE
DYes ~No DNA ONE
0 Yes ~No DNA 0 NE
0 Yes ~No D NA 0 NE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~No 0 NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN D PAN> 10% or lO lbs. 0 Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12.cropType(s): U,,ial 8,-rnuda -Hay;.SrroUgcorb (JmtetJ
13. Soil Type(s): ~ 111/fe.. B
14. Do the receiving crops~er from those designated in the CA WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
1 7. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
the appropriate box.
OwuP 0Checklists 0 Design 0 Maps 0 Lease Agreements
DYes
QYes
DYes
DYes
DYes
DYes
DYes
Oother:
~No
1)1 No
~No
I8J No
(Sa No
~No
6'fNo
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 Yes ~No DNA 0 NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers D Weather Code
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rainfall Inspections D Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? D Yes ~ No D NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes 0 No [2f'NA 0 NE
Page 2 of3 21411011 Continued
lFacility Number: I Date of Inspection: JlJ Itt lf 1
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
~No DNA ONE
SNo DNA ONE
~ailure 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 D Lagoon/Storage Pond IE Other: NhtsfD!-fleldf
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
DYes 5SJ No
DYes DNo
DYes ~No
DYes l)d No
DYes 15jtNo
~Yes 0No
DYes JKI No
DYes ~-No
DYes ~.No
DNA ONE
~NA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
1. Small dlsdtttje at CO!Mr of f!9h()1e. ~ n~/O~Yir ltyto'l. Thf.r har bee, YV()r~fl th {¥-ftJJ'tMf
h.-t-~at-i-oo svccecsf'<-f}. Pre4fe d !J ar,..J tJd-s ,i/e IJf fo.;,/lfh 6, <1-~ l-ea lc.
. Ple.1,e. t~~ue-~~JJ.~bJ lJn lott~r J~1_olr] to-eoc;llfale rNJw0J J, ~. Plt~e ~~'-
Or Sft!J 8 ro.JJ i}) ~~"' k behv-Pe~ ~u1e OtvL f 0 hfB-1 yoo, , Rert of J djofh rArl
1-of ltyoa-. have 8fX't'L81'1lJf covtr l~) 0/IJ. thtrrao~
CtriH;arle df-cotJ{f'!Je ftrmlt q. chedti(J'b ]eft d u'~1 ~-f~t"ho". SfttJ.! retarl.l ~Pi'J
8 t»J._ shbffJ (l}c[q{ a.r rosW. 'Nth -k-()14~ 1-I..) .. ,J\·trifen_, IJof-y-e+i.rzcfr [nD\-tlJ.....li, PAt{),
. PleaJe_get-ca/ihral,~a-, ~Wtt-e e.J at-yeor (new ~eetJ,
. No &/,~e. s wo/ wo.s dOJe ,',.. ~ 01;). , f1to1e do 01-e ~ Ol 013 • ~ 011 sw •e; s h1l>'f'tl
pltnfy af-Hfvl'cL wah)Je.t-Vo/v,e_ ~oh~.
0, serveJ _ai a_ ntftite of-dl'flciP~CJ fiT ~t. fegJ( er,L 'ftlilve 1o 'ta~ ~
s lA'v-ey, \:_uon-~l}-bv-Ooo.r; P.l~~'0 wh~ 1't~''s"h't.«f. .. 1 • ...,_,,
5
}
lii\--H~IfnutNJ ~vam..tv. sfhoi>O-;' f+ffl't}tl,iR: byn..,/ )I~~J,. ~ ~v
Rev ie wer/Inspector Name :
Rev ie wer/Ins pec tor Signa ture:
Page3 of3
Phone : CfllHJ3-33DO /llf6i:e)
Date:({-} I~ ~0 13
214110IJ
. ~acility No. 'S()-{r;~'f Farm Name _.!G~t:....t.:)~~es::::.....:..PJ"""'-~--Date )O \1 I\ \3
Permit COC ___ OIC_ po~ NPDES {Rain breaker PLAT Annual Cert Daily Pipe )
FB Drops l10 "P ) ·()I(_
I .....
, I.
m-n ...
lOb.:riL
lagoon Name, S for spillway . 1 2 3
Desicm Freeboard /last Recorded (in} [JqJ 41 ll'f/.34
Observed freeboard
Sludge Survey Date bh'\/lJ
SludQe Depth (ft} ,t:f\ LJ
LiQuid Trt. Zone (ft) -s-.. ~ /083
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
Calibration Date 1J-tP11 2 3 4
Ring Size (in} l.,:,r
DesiQn Flow (gpm) ~
Actual Flow "'J.Qfi k
Design Diam. (ft) w<;-
Actual Diam. 'lfio
Soil Test Date ~h /f3 Lff~1ll~
pH Fields ~I( Crop Yield
Wettable Acres --
WUP / Lime Needed _()___ SJ:""" a.~
Lime Applied _12___
Cu-I ~ Zn-1 ~ f-1{-'tb-11~
Needs S (S-1<25) Jn;/iiu ~
Weekly Freeboard 7
1 in Inspections ......-
Needs P --rr--~
120 min Insp. __ _
Weather Codes
Waste Date IJ.lltl.ID.. 'l.!fo If-,. lt.lll/t3 !Ub.?ln 'll:nlt.l
-60 Day i>
+ 60 Day
N(lb/1 000 Gal) .lo'tl-11 It 'tit* II .. ;)"( 1;~3 .~(/I "1'1 [;);;, L 1
pH ) / 17,~ ,/
A.
/
··.&.J. .111.
Pull/Field Soil Crop Acres PAN
\ Al,.le (_ Q t\1,.-$6-~l" lA J!r' jq)
d. I' 13. .1 '
J t..~ y G.3
L I .. Venfy PHONE NUMBERS and affiliations ~~5~1
Date last WUP FRO 1-· II -&7 FRO or Farm Records '
Date last WUP at farm Lagoon # i qi{'(Jq()
'App. Hardware Top Di ke 50.0
Stop Pump 4 fo . 0
Start Pump 48, ·~
Ia-\ 1
Conversion-Cu-I 3000= 1081b/ac; Zn-1 3000= 2131b/ac
4
..
5
Window
5 6
-
·.
6 7
Transfer Sheets
RAIN GAUGE
7
8
•
Dead box or incinerator __ _
Mortality Records ·
Check lists
Storm Water
Max Rate Max Amt
IH4r-&r:~ t'J, c_., I ,r{)
F/ U ~
l6 .. P
~
t53XIs.J
~o.o
4 '3t"3
4~.'}
IJ'\V>
Vo
'\!/
'1;f:JOJ:t. -//0)013
I
Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 FoUow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: IJ las-J 1~ I Arrivai.Time:l<{i: SOA-fil
. "\
Farm Name:~(a.JJ-r.~-:.1 I)'I...L..:..::;-e=:J....:R~tkJd!:::llaol~._-....1..t-"O.~'IIl~( -------
Departure Time:IJO ;aJAij County: Scmpo,
Owner Email:
Owner Name: H vrtb &1 'meJ
Mailing Address:
Physical Address: t?5D Gtf!Jffs }Qd. ) Falrrrq
Facility Contact: 'JQmeJ · l<oe.ec6
Phone:
Title: <0 kY n'ft= Phone:
Region: F~O
Onsite Representative: ---l.R...=....;;<})....L......lGJ~o~a.-"JmeLL.l!'+'f------------
Certified Operator: M; chtlf l Ooalf/)
Integrator: --LH4--....JB~::::... _________ _
Certification Number: .... a:;;;..~.::..=a...;:6_!,__ ____ _
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation? 0 Yes 'f):SI 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 DNo DNA ONE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes 0No DNA ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of3
DYes
DYes
~No DNA ONE
~No DNA ONE
214/2011 Continued
JFacility Number: $ ~ I Date of Inspection: 7/~ y 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 I Structure 2 Structure 3 Structure 4
Identifier: Botkhl '¥ Spillway?:
Designed Freeboard (in): l:l l'l
Observed Freeboard (in): 40 ;;x(
5. Are there any immediate threats to the integrity of any ofthe structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes r;i{No
DYes 0No
DNA ONE
DNA ONE
Structure 5 Structure 6
0 Yes ~No DNA ONE
DYes g-No DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. 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 or improvement?
'BJ Yes 0 No 0 NA 0 NE
0 Yes [8"No 0 NA D NE
DYes ~No DNA ONE
0 Yes jRNo 0 NA 0 NE
II. Is the re evidence of incorrect land application? lfyes, check the appropriate box below. 0 Yes ~No 0 NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn , etc.)
0 PAN 0 PAN > 10% or 10 lbs . 0 Total Phosphorus 0 Failure to Incorporate Man ure/Sludge into Bare Soil
0 Outside of Accepta ble Crop Window 0 Evidence of Wind Drift D Application Outside of Approved Area
12. Cro p Type(s): Cmr/o) r?f'lmwiOx Ha,; SmoJ/ Grarb Ovfcreed.___
13. Sod Type(s)o Azt2vllle_ \ ~
14. Do the receiving crops d. er 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 ope rate per the irrigation desi~:,'ll or wettable
acres determination ?
Page 2 of3
DYes
DYes
0 Yes
DYes
DYes
~No DNA ONE
~No DNA ONE
g}'No DNA ONE
j2No DNA ONE
(g-No DNA ONE
DNA ONE
DNA ONE
21412011 Continued
4
....
(Facility. Number: q;o-. -h&Cf_ !Date of lns~ection: 1l.r'l· f ()....
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? If yes, check DYes ~No DNA ONE
the appropriate box(es) below.
0 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? DYes ~No DNA ONE
27. Did the tacility fail to secure a phosphorus loss assessments (PLAT) certification? DYes DNo I)?NA ONE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes ~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 ~No 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 f&f No DNA ONE
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? Ifyes, check the appropriate box below. DYes ~No DNA ONE
0 Application Field D Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP? 0 Yes l&f"No DNA ONE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? 0 Yes 5aNo DNA ONE
34. Does the facility require a follow-up visit by the same agency? 0 Yes j8"No DNA ONE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page3 of3
<
~ l ·· J')/]
Facility No. ~6~-~~'1 Farm Name {; f ~J f<IY...._
I
Date _____ _
Permit ., COC OIC\.._......-"' NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
J
FBD roos
~II
.
J
-: FTTTI
Lagoon Name, S for spillway
DesiQn .Freeboard I Last Recorded (in)
Observed freeboard
SludQe Survev Date
SludQe Depth (ft)
Liquid Trt. Zone (ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
Calibration Date tl!r>lll 2
RinQ Size (in) kiT'
Design Flow (qpm) "l£h
Actual Flow l*q
DesiQn Diam. (ft) :\4~
Actual Diam. '3Wo
~
1
/Q 1~~-.
·Q ~8'
j;) Q-lh1.
15,5()
l~
3
-.n~v
So•l Test Date Y Ifni G... Y ()q It! Crop Y1eld
2 3q 3
I }':;l()l..
~
JO/i>
{~
4
pH Fields Wettable Acres __ _
Lime Needed 0 WUP ......__--
Lime Applied Weekly Freeboard __
Cu-I J Zn-1 \../ c..kl 1 in Inspections
Needs S (S-1<25) ~ -t• 11 Uof) 120 min Insp. _-_-_-=_-=_
Needs P 0 . Weather Codes
Waste Date 1\.lL:nlr:\.. 1/:ltw/ J 1-,/JliJJ
-60 Day
+ 60 Dav
N (lb/1 000 Gal)
pH
Pull/Field Soil Crop Acres PAN
i .J\.JB C"t;~· \,q
~ I "3 ... 3
) ( . .)
4 \I-1!?3
All YroiiG,~-~ 'H)
4
5
Window
,
v \j
Verify PHONE NUMBER.S and affiliations l)oxrSJ
Date last WUP FRO \I Ill 0') FRO or Farm. Records lor:;> I
Date last'WUP at farm Lagoon# ftl~: IQUltl'«>
App. Hardware Top Dike .so l~/~
Stop Pump 4 ~
Start Pump 'J!d__ ) ~ "JJ
. 1.10 {, 7
Convers1on-Cu-I 3000= 108 lb/ac; Zn -1 3000= 2 13 lb/ac
5 6
6 7
Transfer Sheets
RAIN GAUGE
7
8
Dead box or incinerator __ _
Mortality Records
Check Lists
Storm Water
Max Rate MaxAmt
o.rn I f)
J"-!f s £~Jd1 u( l..f*r
,_-;n-0'1 CIA?) 1'AOI3CifiOt-'XJ.(JiY>t'o L,~,-~ ltrMCflitl~
0-11-( {) }Joy hceftr fKVI1
N&-i e Kth1-lJ1.,(] crl b ll\v'rS 11/111 Q
/ JP~ I~ Q_ T veJ r: !ry ) Tth'J 10 I q lrd
~ ed }1+-0iw(dft.!e k'm /)o...,j C(/q:Jf-/) d(J
'i I d IJ d!rn 'fVfl
a\} co/fa-q,4M Pt'''n Co US -!{fl'(AVvil(::_ -a '5'
Yig-cJ a fttrro:!.' ~(p-~
CQrl_ecL ~l'< ad ~~ 4 hrJ-c r I rr IJJ.. I p 11 vvvv/" Htf~J~.e q to-or76-d 11./J
~ f:x}r ~1M shtr'--3-lf-IO
IA0\)00'-lO ( cJIJJ 1---?P-o? _!;(frJf fJ:J ohoe_
Operation Review 0 Structure Evaluation
Reason for Visit: 0 Follow-up 0 R eferral 0 Emergency 0 Other 0 Denied Access
Date of Visit: l!flri.11Jt I Arrival Timed~; SOAtj-I Departure Time: I I I'·~AI1
Farm Name: fQr tmf! RooL ftWJ ( Owner Email:
OwnerName: -~~~r~~--C>~tu~~tZL--------------------Phone:
Mailing Address:
Physical Address: fotO ht~f { lrJ @iJo, AJC -/
Facility Contact: -LJRo.Jojlht+--G.=-f!u..Mu.;f:~ooL...£ ________ Title: 0t-'D-(f"
J County: ~J?s{h ,
Phone:
Region: FRo
Onsite R epresentative: _\.....,.tKt.......,G._.?u.fwlb!""fJ""---------------
Certified Operator: H ichoe/ 0 OrtJeq
Integrator: ..... H...l....-......:..BL----------
Back-up Operator:
Loca tion of Farm: Latitude:
Di sc harges and Stream Impacts
I . Is any discharge observed from a ny part of the operation?
Discharge originated at: 0 Structure 0 Application Field
a. Was the conveyance man-made ?
0 Other:
b. Did th e discharge reac h wa ter s of the State? (If yes, notify DWQ)
c. What is the estimated vo lume that reached waters of the State (ga ll ons)?
Certification Number:
Certification Number: -~__;_~......;::;~;..../'-------
Longitude:
0 Yes 18 No DNA ONE
D Yes 0 No DNA ONE
Q Yes 0 No DNA ONE
d. Does the d ischarge bypass the waste management system? (If yes, notify DWQ) DYes 0 No D NA ONE
2. Is there evidence of a past discharge from any part of th e operat ion?
3. Were there any observable adverse impact s or potentia l adverse impacts to the waters
of the State other than from a di sc harge?
Page I ofJ
0 Yes
D Yes
~No DNA ONE
~No DNA ONE
21411011 Continued
'lhcilit)' Number: ~a -fahY !Date of Inspection: 'lla3lll
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: Ba&,. TOI
Spillway?:
Designed Freeboard (in): l9 17
Observed Freeboard (in): 3~ ~:!.
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
0 Yes ~No 0 NA 0 NE
0 Yes .Ja 0 NA 0 NE
Structure 5 Structure 6
0 Yes 181 No 0 NA 0 NE
DYes fiS}No DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement ?
~ Yes 0 No D NA 0 NE
D Yes fiJ No 0 NA D NE
D Yes ~No DNA 0 NE
D Yes ~ No D NA D NE
11. Is there e videnc e of incorrect la nd applicat ion ? If ye s, che ck the appropriate bo x below. D Yes rn No DNA D NE
0 Ex ces sive Ponding D Hydraul ic Overl oad 0 Fro zen Ground D Heav y Metal s (Cu, Zn , etc .)
D PAN D PAN > 10% or 10 lb s. D Tota l Phosphorus 0 Fa ilure to In corporate Manure/Sludge into Bare Soil
D Outs id e of Acceptable Crop Window D Ev iden ce of Wind Dri ft D Appli cation Outside of Approved Area
t2.cropTyp e(s): Coaml ~rmn:/11 Hav·.S~na/fara,b OverJI¥jj
t/
13. Soil Type(s): futrvvfUe. Is AvO
14. Do the rec eiv in g crops ~itfer from th ose de s ignated in theCA WM P?
15. Does th e rece iving crop and/or land applicati on s it e need improveme nt?
16. Did the fac ility fail to secure and /o r op erate pe r the irrigation design or wettable
acre s dete rminati on?
Page 2 of 3
DYes !2l'No DNA ONE
DYes !BiNo DNA ONE
0 Yes ~No DNA ONE
DYes ~N o DNA ONE
DYes 183No DNA ONE
0 Yes ~No DNA ONE
~Y es 0No DNA ONE
0 0 th er:
~Y e s 0No
21412011 Continued
~,Facility Number: <{ ~ I Date of Inspection: q Ia 3/ l 1
I
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
0 Yes ~No D N A ONE
0 Yes ~No DNA 0 NE
D Failure to complete annual sludge survey 0Failure to develop a POA for sludge levels
D Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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?
lfycs, 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 ~ Other: Mn spra.; f; eiJJ
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
DYes fig No DNA D NE
DYes 0No 15dNA ONE
D Yes ~ No D NA 0 NE
0 Yes (E No D NA D NE
0 Yes [8No DNA D NE
~Yes 0No DNA ONE
D Yes ~ No D NA 0 NE
D Yes ~ No D NA 0 NE
DYes ~No DNA ONE
I. \\1~:\-\\ lh cttn. netv ~ jh 0-l.ie. d. -\-o be.. rvor kerl. o, In n -€«" fvtVte, -n,· f i J ~"' the. .stht e ar fa.. a .rP€
Cracl{ """"dt'r"'or-flvg.rl laJ"t yeot DAd probrJk,~ Is~ vl\d-Q-.jrOv,.lproblen.
l I GotJ_ j 0 b Df-mo"'fhq I ~001 Ovbld~ btnk I Please. chof. rvoat; rv-eeds a, rllr{d"P cf
\aJlXh I I wn I()~ ~k c« ( ()( fl'f/' ()"f-( ~ Otn I h lew d 0 wn ' n Hvrrfco, e lrene. Vo
aeporih+ d..omay -fo dIke. b()l k at-+Ms +·rne . Pleose. p (c~ Uf tra th 0, i(\s:de lxJ.1tJ of.
I ~9oen J.
0, 'The. worle Pta, ~0 .t rD>hl. bvt not 50ne uf-t1Je. bacl(Jr~ !Afctma-l,'or?)'Svch C/f
€mfl'9enc1 clleclt llrl-J, Ttvp r,·jerJ ~ere. addftl._ lo:rt year l wi'+ h IYP..cs crof-shve}t~~l
a cop1 o+he. ne..,_, J:rr~crh'cn J-e1~n ii nPPdfli.
~1. Pleare Vje COif~ w ba/{J!(e W,r Crtf,l~o ~OrA~~~~ &' pro.l eve/f'f-J .sho...td hn~ b~
ued HeeL -+P Cnusf-a l BermvdO-lr·.skod ~ rY.e. bvt-'rvovld not ha~ f!p_(fderJ... ~A-ftlth
~ftiYl'flo.-. PleaJl~. roJt [rOf\}l'fttL ( no..) c~i) f-a J0/1,
I ~lean: WOrlc Uf ~(I) I 0 .s l vdJe.S~~ f.eadinjJ, Slvri_Je Je~IJ or-e not-1)._ rro blf-"1 llf-bnj
OU1i.
Reviewer/Ins pector Name:
Reviewer/Inspector Signature:
Page3 of3
Phone: ~IQ-113J-3JoO.{offi'f J
I
Date: Sep-rt~ ao II
21412011
Checicr <h-ie ~for Ot
A L .~ C-WJ) -IXJ lld-* ~-3~0
Farm Name ....;:Cot::..:......:.-.iJn:...L..-e=-..r.j_JZ'---=-"tL _____ Date q ld} / f I
•
Facility No. <6d-{lbt(
Permit ;......./ COG ._/ OIC_ NPDES (Rain breaker PLAT Annual Cert)
Pop. Design Current
Type
Lagoon
Spillway
Design freeboard
Observed freeboard (in)
Sludge Survey Date
Sludge Depth(ft)
Liquid Trt. Zone (ft)
Ratio Sludge to Treatment Volume
Calibration Date 1alrs-IJ1
Design Flow .~()
Actual Flow ~qt?
Design Width :Jqf:_
Actual Width jhf) ,,
Soil Test Date q ~q}u ctr'
pH Fields b~
Lime Needed _,0""---
Lime Applied
Cu-I ____!L Zn-1 C7
Needs P tJo
Cro Yield
-,
#I
FB
Drops
1~111 I(() ,,
<CU. I'
"'1 I
1 2 ~I
~~~Ito fd.li)S/Jf) ~~~~~-
'?xi l.-S l,<;f
If};)?
2 3 4 5
Pull/Field Soil Crop Acres PAN
l ocl
'
1~1
~q(C-. P(CI-} ~ ~ 1 . Q, " "'1P '\..-10;}0161,) -01(/~1
mverify PHONE NUMBERS and affiliations
Date last WUP FRO Da'e lar WUP at farm
FRO or Farm Records HI~/Op f J ) b)
Lagoon# ·
Top Dike 50 50
Stop Pump 4 ~ ~
Start Pump ~ d ~
Conversion-Cu~~O 0= 108 lbfac ; Zn-1 3000= 213 lbfac
\qQ.(
~\~r>d.; 11~~ G,~
~ 5 6 7
~
t!lr.SO
~;.~
6 7 8
~UGE eadbo or incinerator
Mortality Records
'I l'fflt., Jr.~e_
Window Max Rate MaxAmt
0,(.. t.n
App. Hardware
Compliance Inspection Operation Review Structure Evaluation
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Denied Access
Date of Visit : I q la.~d If I Arrival Time: I ot~so
Farm Name: 6-J)nel 'RCVld F41hl (
>
Owner Name: Hvrlh G, 1Prt' (
Mailing Address:
Departure Time: I[' ~oo "'r
Owner Email:
Phone:
. Physical Address: cRm Gt t"me, rM_ J Fa j 1 t!1 hie<
Facility Contact: ]?OD Gt imfC
I County: sa.,~.?l
I
Phone:
Region:
Onsite Representative: __,R~lh~,.--::..;G,"'c~...fN.:..:.i ..a:.·,.iof>c:.... ___________ _ Integrator: ,., vrfly Brol(h
Certified Operator: H !thO£ I OOrd.f'()
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
I. Is any discharge obs erved from any part of the operation?
Di scharge originated at: riSJ Structure 0 Application Field
a . Was the conveyance man-made?
0 Other:
b. Did the disc harge reach waters of the State'! (If yes, notify DWQ)
c. What is the es timated volume that reached waters of the State (gallons)?
Certification Number: _..c;rb=-==~'-'6~1------
Certification Number:
Longitude:
~ II! Yes DNA ONE
(8l Yes 0No DNA ONE
DYes j8No DNA ONE
d. Doe s the discharge bypass the waste management syst em? (If yes, notifY DWQ) DYes 0No DNA ~NE
2. Is there evidence of a past discharge from any part of the opera tion?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of3
DYes
DYes
~No DNA ONE
~No DNA ONE
21412011 Continued
•!Facility Number: $'0-I Date of Inspection: 'f b-3) IJ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: 8oftm tor
Spillway?:
Designed Freeboard (in): lg ~~
Observed Freeboard (in): a a ~j
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 0 NA 0 NE
0 Yes 0 No 0 NA 0 NE
Structure 5 Structure 6
D Yes ~ No 0 NA D NE
0 Yes l2No 0 NA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the 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?
~Yes 0 No 0 NA 0 NE
DYes !Sa"No 0 NA 0 NE
0 Yes ~ No 0 NA 0 NE
DYes ~No 0 NA ONE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~No 0 NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn, etc.)
D PAN 0 PAN> 10% or 10 lbs. D Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window D Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): Coorlal Berm vda.. thJjSmo ''JrQJb ove·seeJ.
13. Soi!Type(s): Avtryvi Ue.. \s AvB
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components ofthe CAWMP readily available? If yes, check
the appropriate box.
Owup ~Checklists 8Design [8-Maps D Lease Agreements
DYes ~No DNA ONE
DYes !}§No DNA ONE
DYes !E'No DNA ONE
QYes (;8J'No DNA ONE
DYes ®No DNA ONE
0 Yes DJNo DNA ONE
~Yes QNo DNA ONE
00ther:
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 NA 0 NE
~Waste Application D Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Weather Code
D Rainfall D Stocking~ Crop Yield D 120 Minute Inspections 0 Monthly and I" Rainfall Inspections 0 Sludge Survey
~Yes QNo
22. Did the facility fail to install and maintain a rain gauge? 0 Yes (Sd'No 0 NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page2of3
D Yes 0 No ~ NA D NE
21412011 Continued
!Date of Inspection: ql~311 1
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
DYes ~No DNA ONE
0 Yes {2fNo 0 NA 0 NE
0 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency si tuations as required by the
permit? (i.e ., discharge , freeboard problems , o ve r-application)
DYes ~No DNA ONE
0 Yes D No ~ NA D NE
DYes ~No DNA ONE
D Ye s (5t'No D NA 0 NE
O Yes ~No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. !StYes 0No
DNA ONE
~
DNA lWNE
0 Applicat;on F;dd 0 Lagoon/Stmage Pond ~Other. filots~ =fi£1Jr
32. Were any additional problems noted which cause non-compliance of the perm~; CA WMP? ~0 Yes rg-No
r)a No
j8No
DNA ONE
DNA ONE
DNA ONE
33. Did the Revi ewer/Inspector fail to discuss review/inspection with an on-site representati ve? u fJI"Yes
34. Does the facility re quire a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature :
Page3 of3
0 Yes
or any other
· .. ·:: •... ·.,..,. :',. "."r'·· -.•. ·.;.~· .
Phone: qlfJ-l/33-33/Joltfflc~
Dato ' s.rt<PdOII
'/411 01 I
Type of Visit ~Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint ~Follow up 0 Referral 0 Emergency 0 Other D Denied Access
Region: f@ rrival TimediJ', ~ At11 Departure Time: II~ l/0 'P 11 County: .9J1Hpsth
Farm Name: 6r~et Roodg 'FamS Owner Email:-------------
Owner Name: -~R.r.Oi.&.+--------~0f:::::.....:.r......!I'J?:....:.e.I'.=. _____ _ Phone:
-\
Mailing Address: -----------------------------------------
Physical Address:-----------------------------------------
Phone No=-----~---Facility Contact: ...~.t~)O:::L;IY!L..L.k:eJ:.~.--_ ____:.RJ>-=-:escb=~---Title: __,H...,.tn""----'-'aT-"~'l-"ft: _____ _
Onsite Representative: --=-~=_,Y\__.__...:::G::......r~r:::.M&.:.:g~---------Integrator: ........ H-4-----B~------------
Certified Operator: H \cha~) OaJ-PI) Operator Certification Number: --------
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: · Latitude: D OD'D" Longitude:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? rl§fYes 0 No DNA D NE
Discharge originated at: ria Structure 0 Application Field 0 Other
a. Was the conveyance man-made?
b. Did the discharge reac h waters of the State? (If yes, notifY DWQ)
c. What is the estimated volume that reached waters of th e State (gallons)?
d. Does discharge bypass the waste management system? (If yes, noti fY DWQ)
2. Is there evidence of a past di scharge from any part of the operation?
3. Were there any adverse impa cts o r potenti a l adverse impacts to the Waters of the State
oth er than from a di sc harge?
Page I of 3
.RYes 0No DNA ONE
gJYes 0No DNA ONE
I
fSl-Y es 0No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
12128104 Continued
. . I Facility Number:~~-h&Y I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: -------
Spillway?:
DYes ~No DNA ONE
DYes 0No DNA ONE
Structure 5 Structure6
Designed Freeboard (in): -~'J...:oq~---_....~\_9.~....... _____________________ ------
Observed Freeboard (in): __ Y.....:.....;-~;;;,__ ___ Lt_.:..,J.L' ----------------------------
5. Are there any immediate threats to the integrity of any of the structures observed? DYes EitNo 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 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. 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 12fNo DNA ONE
DYes ~o DNA ONE
DYes ~No DNA ONE
DYes 0No DNA j3'NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. DYes D No DNA fi:l 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. Crop type(s) -------------------------------------------------------------------------
13. Soil type(s)
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?D Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Pagel of 3
DYes
DYes
~No DNA ONE
0No DNA lS}'NE
0No DNA ~NE
0No DNA RNE
DNo DNA ~NE
_"'\ Continued
rvC /f
# I Facility Number: q) g,-~~~ Date oflnspection ~IID7llf 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 appropirate box. 0 WUP 0 Checklists D Design 0 Maps 0 Other
DYes DNo DNA ~NE
D Yes D No 0 NA E;;l-NE
21. Does record keeping need improvement? If yes, check the appropriate box below. DYes D No DNA ~ NE
0 Waste Application 0 Weekly Freeboard D Waste Analysis 0 Soil Analysis D Waste Transfers 0 Annual Certification
0 Rainfall 0 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 orCA WMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notifY the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site represe ntative?
33. Does facility require a follow-up visit by same agency?
Additio"n~Jl§6.#11Deots·•and/or ·orawings:·"
Page 3 of 3
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
12128104
~No DNA ONE
0No iSlNA ONE
0No DNA ~NE
DNo DNA (SiNE
~No DNA ONE
DNo ~A 'liNE
~0 DNA ONE
~0 DNA ONE
i8No DNA ONE
18No DNA ONE
~No DNA ONE
~No DNA ONE
~~" ~ .. :"':' ;.>"'--"•-. -~·l """"""""'· '
-~,..., .··:---:..:;:!~~~' -....-,..:;-"" ~.
J IVS PECTf OM
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: l10hi)/(Q I ArrivalTimcdlf~(S'/41 I DepartureTime: lJ;jQ PHI County:---!~:.....:_-Region: FRO
Farm Name: Gc Vnfr RcarL fOrttf Owner Email: -------------
Owner Name: -....;..R=O\.._._ _______ ...::&.~r/Jn:;.;...,.::f!.J=-------Phone:
Mailing Address: -----------------------------------____ _
Physical Address:----------------------------------------
Facility Contact: J"OI?'lf.J Roesch Title: Hfh~ Co-~1\tJ: Phone No: 919 dd.}--1 q J..O
Onsite Representative: .... )D........,I ... m£......., ... 1_..z.f0p""""......,S'c._·h"+----------Integrator: ......:..t-1..:..--':B=--------------
Certified Operator: ...:..M...~..~.~ootch""""'ae~f~---_ ___.D~O«J'""""-~£, .... a....._ ___ _ Operator Certification Number: ..... ~ ......... '-=~-'~~~----
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D" Longitude:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ffYes DNo DNA ONE
Discharge originated at: ~Structure D Application Field D Other
a. Was the conveyance man-made?
b. Did the discharge reach waters ofthe State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. 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 1 of 3
1)5. Yes 0No DNA ONE
DYes fS{No DNA ONE
~Yes 0No DNA ONE
~Yes 0No DNA ONE
DYes 'fia"No DNA ONE
11118104 Continued
I Fac~ity Number:<6a.., -V;t,'j Date of Inspection hOh~hO l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a .. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
DYes &fNo DNA ONE
DYes 0No DNA ONE
Structure 5 Structure 6
Identifier:--------------------------------------
Spillway?:
DesignedFreeboard(in):---=\~qL-------.!...'q..J_ ___________________________ _
Observed Freeboard (in): .....~.o~~----_ _.).L..~J--------------------------------
5. Are there any immediate threats to the integrity of any of the structures observed ? DYes 18No DNA ONE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed DYes 0No 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
1 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
t8'1Yes 0No DNA ONE
DYes 1,5a No DNA ONE
0 Yes ISI'"No 0 NA 0 NE
DYes gNo DNA ONE
II. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes ~No DNA 0 NE
0 Excessive Ponding 0 Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn, etc.)
0 PAN D PAN> IO% or 10 lbs 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Area
12. croptype(s) WCbJgl Beorwdtt Hay; Smallgralh OverJfflL
13. Soil type(s) _A~v::....:B~.L.:}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 a cre determination ?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of3
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~NoD NA D NE
DYes ~No DNA O N E
DYes f;j(No DNA ONE
12128104
Rev I ~~0, Nov~-' a'll> I 0
. I Fatottity Number:~~ -~'fl Date oflnspection I llJh~lf 0 I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropriate box. D WUP D Checklists D Design D Maps D Other
~Yes 0No DNA ONE
~Yes 0No DNA ONE
21. Does record keeping need improvement? lfyes, check the appropriate box below. ~Yes D No DNA 0 NE
i}a Waste Application D Weekly Freeboard D Waste Analysis D Soil Analysis D Waste Transfers D Annual Certification
D Rainfall D Stocking IE Crop Yield D 120 Minute Inspections D Monthly and I" Rain Inspections D Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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 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 i':8"No DNA
DYes 0No fR'NA
DYes ~No DNA
DYes ~No DNA
DYes l'8J No DNA
DYes DNo 18'NA
DYes ~No DNA
DYes ~No DNA
DYes J!l No DNA
DYes llJNo DNA
DYes ~No DNA
QYes 0No DNA
}Cl.;},Srnall c:Us~e. (5(o~ St¥f) fron. ctrtlf' cf-pjhD'1e ~ fit J¥~dr ne~r7 cYtlln
()tyl GtJ!hft! S rvaMf a !JJ fll""'lfit by ~m Y\1~. W OJ f.e._ tt'Ps not-rRacA ~~ Svrf'o re_
yvcdfu 01 dp.ychaltt~. Mr, fWJ~salcl i+ hpJ bflfh !J o,c_, en~ O/J10"Pl tr~o,
Crack httr l?ff-1 YYfY ~ft) O; ;11 pol+.
PfeP-Je+rf"7 bdtl£ bvJhei frtm bockrik &f-ltyan /, Good IJ,trk th fttJ'f -fdmm!J
;;rf>-"L I '1jlJin I q. .:>. S rnal/Jvi!J nttr I~ 1 hiP J' fi 1/'fti l<,. GOld c~ a, I ~a:Jn ;:;>.
ltl4-d{), 'Pito,e have ca:r; Pfl?J'Iff.~ a,J_ WPJ-ie Pta, avuf/a b/e i?r J}?J~-1-Jbn.
~(. Ple~e !ttrra..t?&r 1 Rfl~ fbr eacf, crof ~PPJI>) OYi ~II ~~ cor red-P-411 t11tl tlcl'el,
PAw~YO fu-rye. Ct1J_ ;;l7S ttr c~oda./. Plehep()J+ Crof y/eldl.
~4, \v ;It net>t ca I i bra+t~ lJ P7J tJf J-€()r,
~~ w ,'ll nffl sf vrlye S Ll~ Or ~&n,-h'rn b/ lht! 1!1-y{JtJr,
03. Ff; II D w llf n ePr!ftl +a chtt it {)) Cl' t1 cit_ -A';< ,
Page 3 of3 12128/04
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
• Fac'itity No. fu-k I{!{ Farm Name bt \}y,fJ @.rud Date f {){I~//()
Permit __ COC ___ _ OIC_ NPDES (Rain breaker PLAT Annual Cert }
IM I I I
Pop. Design Current
Type
Lagoon 1 2 3 4 5 6 7
Spillway _:tnn-l4 gd... Jf,of l'l
Design freeboard II
Observed freeboard (in) ~J ~h
Sludqe Survey Date ....:::....; irilllflR
Sludge Depth {ft) {(),!<) I "~ Liquid Trt. Zone (ft} ll:),qQ i3 lo.'
Ratio Sludge to Treatment Volume
5r 1 ~iav..P
Calibration Date 1l-l~IN 2 3 4
Design Flow ~ll'l
Actual Flow ~
Design Width j.;r
Actual Width 'Jhn
Pull/Field Soil Crop Acres PAN
j A,~ ~-1---~ Lq ;){}
I~ I _)_)
~ LJ
!t.J \,)f :..Y 1~.'1
SYl"l ,t'lnt, -6me_
lq;)\oAel
"\
(h., 5"'" i" bcJ ra~11
Verify PHONE NUMBERS and affiliations 'f
9D
Date last WUP F RO \-\\ir) Date last WUP at farm
FRO or Farm Records ~ B"""'-. ~-,. ~09
Lagoon # ~ 1 v'VI'} ~
Top Dike )l\ J ff~ss
Stop Pump tq W'l.
Start Pump '-IJ '.J
Conversion-Cu-I 3000= 108 lb/ac; Zn-1 3000= 213 lb/ac
I
5 6 7 8
RAIN GAUGE
Dead box or incinerator __ _
Mortality Re cords
Wffdt~r~
1 P.. rt d.. 's n {J(?(/ "-~ (
Window Max Rate Max Amt
Htt"-St>t ·f OLh i , I
,)i,o.-A1r
~ '
App. Hardware
tJ~to be-~~~ t~vf v f IS~
/iD~e. h6~ cvf-I q-h,
Ha,berlJ-1-ttto·{ ~ o 11
Type of Visit ~Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q"Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
Date of Visit: IHI~DJlkf I ArrivaiTime:IJ; ll2/tf
Farm Name: GtfM£1 Root!... fOterS
I Departure Time: 'f);~DPfj I County: SamfJ(n Region: F,eo
Owner Email: -------------
Owner Name: ---~..Hw-.L...;;.;...::::frt...J._ _________ ..,6='1-'t_m_eJ=--------Phone:
Mailing Address: ------------------------------------,-,Tilf:tl;d.-rr_*d""d-1 ~--111J
Physical Address:-------------------------------------7./:----
Facility Contact: JOm.Ps ~oesc6 Title: Hb<!ytt= Pbone No: Cfl'f 1jf-~tl {t}
Onsite Representative: -::x.J~ FJefcJ, / Rlh GrfiJ1ti Integrator: Hvti~1-~0l'f} tt
Certified Operator: Hfdvt£\ --''Q;...:::'/Y"""J"-*1"'-+------Operator Certification Number: M d.~ap}
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D" Longitude: D OD'D"
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge origin ated at: 0 Structure D Application Field 0 Other
a. Was the conveyance man-made?
b. Did the discharg e reach waters of the State? (If ye s, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3 . Were there any adv e rse impacts or potential adverse impacts to the Waters of the State
othe r than from a di sch arge?
DYes ()INo 0 NA ONE
DYes DNo DNA ONE
DYes 0No DNA ONE
I
DYes 0No DNA ONE
DYes l5iNo DNA ONE
DYes (2{No DNA ONE
12128104 Continued
...,. '•
j'F_a_ci-lit_y_N_u_m_b-er-:~-d---.....,{(;,....(p_'f.....,l
Date of Inspection IJU20£09 I
Waste CoUection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
0 Yes 5a'No 0 NA 0 NE
0 Yes 0No DNA 0 NE
Structure 5 Structure 6
Identifier:-------------------------------------
Spillway?:
Designed Freeboard (in): _.:..,./ ~....:,__ ___ --"l:....q'-----------------------------
Observed Freeboard (in): ___.,;;,..~&.u...._ ___ _..,~~0'-----------------------------
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
DYes ~No DNA ONE
6. Arc there structures on-site which are not properly addressed and/or managed DYes N-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
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
&Yes DNo DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
II. Is there evidence of incorrect application? If yes, check the appropriate box below. DYes ~No DNA 0 NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
D PAN D PAN> 10% or 10 lbs 0 Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outs ide of Area
12. Crop type(s) Coo£1-o l Y3ttm..da Hay'. SmO Gtoln o_s
77
13. Soil type(s) bit.Y"II/e B ls
14. Do the receiving crops differ from those designated in the CAWMP?
15. Docs the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
rc:oilllmtelits !(refer' 'th:question #): Explain any
·Use drawiligs offadlity·to better explain
Reviewer/Inspector Name
Reviewer/Inspector Signature:
.:.:i~l:if'~f;:i.il'7il~ any recommendations
u.:>•;.~ .. ·~~~uuu ... pages as necessary): '
DYes ~No DNA ONE
DYes !Sa No DNA ONE
DYes D No 0 NA lSI NE
DYes l:2i No DNA ONE
DYes l){No DNA ONE
Continued
I Facility Number:'b d-. Wt.( I Date of Inspection II danIa? I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropriate box. D WUP D Checklists D Design D Maps D Other
18Yes 0No DNA ONE
~es 0No DNA ONE
21. Does record keeping need improvement? Ifyes, check the appropriate box below. 5l'Yes D No 0 NA D NE
Df'waste Application D Weekly Freeboard D Waste Analysis D Soil Analysis D Waste Transfers D Annual Certification
0 Rainfall 0 Stocking D Crop Yieid 0 120 Minute Inspections D Monthly and 1" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? DYes lSI-No DNA ONE
-23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes DNo ~NA ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes !)a No DNA ONE
25. Did the facility fail to conduct a sludge survey as required by the permit? DYes ~No DNA ONE
26. Did the facility fail to have an actively certified operator in charge? DYes fgNo DNA ONE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? DYes 0No ~NA ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes i:fNo DNA ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes
and report the mortality rates that were higher than normal?
Qf"No DNA ONE
30. At the time of the inspection did the facility pose an odor or air quality concern? DYes tiaNo DNA ONE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by DYes tiaNo DNA ONE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes SNo DNA ONE
33. Does facility require a follow-up visit by same agency? DYes N"No DNA ONE
12128/04
.. F~cljity No~~(t,y Farm Name Gtf111-1 /<(X)J fu,y Date _____ _
Permit / COC --OIC ./ NPDES (Rainbreaker PLAT Annual 'cert}
Pop. Design Current
Type
FB
Drop~
/J fr110d
~~~UII't' I I 1-I t1•'"
·~ Tof
Lagoon . 1 ! 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard (in) !
Sludge Survey Date I
Sludge Depth (ft) r~Urfot
Liquid Trt. Zone (ft
Ratio Sludge to Treatment Volume
Calibration Date 10iallt8' 2 3 4 5 6 7 B
Design Flow 300
Actual Flow ~~
Design Width J.,r
Actual Width . 3po
Soil Test Date ~
pH Fields " 1
Lime Needed {). ~
LimeAppl,
Cu-I __ Zn-1 =:::__
Needs P l)
Cro Yield
RAIN GAUGE (_...../
Dead box or incinerator __ _
Mortality Records
Wettable Acres , .
WUP t.JFb'1f~il\ ~c-e_
Weekly Freeboard~--
1 in Inspections -.,.-
120 min Insp. ;::::;;::>"'
Weather Codes ;:::;::>
Transfer Sheets·
Pull/Field Soil · Crop Acres PAN Window Max Rate MaxAmt
1-lf ~.B Ct ~-lh ."L,q, 7" CJI) ~or-5ef Q.(p /.0
.56-~ 5o ,<;:.1-A ?i
v u
Verify PHONE NUMBER,S and affiliations
Date last WUP FRO 1IJIIC/ Date last WUP at farm App. Hardware _ -r L.
Qec 3l;}Jib; \1\& L 1. \~av~~
FRO or Farm Records ~ llJ'l '-llJ J
Lagoon# -sqo ~or>ib(eJ~ sBCOtltr ~ ~~:p ~~~p ~t2 ~3.:3 wrrfo.-oat -StcoA/1-' ~'
StartPump '-1~4> 4~·)/V7 t)1~ ~~.e. lO-IS~hf»t ~
Conversion-Cu-I 3000= 1 08 lb/ac; Zn-1 3000= 213 lb/ac l.... nt;-S f lc, .,~J,e /t,17 ) f O)l~\t\t. ~o (i " 1/J (\~ _l .bP ~~
S-=-1£-q'-f fo'ir~\tl< roukf~tvf~~~ -"w~~Q"-~ ~~ 1-~~ ~~~/ f''..,e{
.·,
. -. . . .
. ' -./
. ~
tlhl' 110) \b\0
_1qc $e ') ~ 1 <1'\~\ o -\\i
J5l~ )f't bth
--::>~ 4J~b!'Ji ~W\JjV~
~1~
-rtf~CJ 1qi"J Vfl ~ oq h o-\ L-e,
J -=* ~ ~ \() u
jf ~tlll 'e-.:/tfrJfJ6JJ 'e
l4wttJvcJ
Ia It~ fOG
• . ~ I Facility Number I ~ ?-. H ~.~.~11 Q Division of Water Quality
0 Di visio n of Soil and Water Conservation
0 Other Agency
Type of Visit 0<:ompllance 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
Dat e of Visit : IIi: J~ Arrival Time : I~.:OCt.-!.:111,,):...:0~J¥l....,,,...._.l Departure Time : PI; I) !rf1 I County: StJttfS<!b ~egion : FflO
Farm Name: 6t fhtf\ Rozd. Fi;tmJ Owner Email: _----::.\-----::---::; ______ _
Owner Name: --->.::tt~~.x...l._L _______ -'~'~-..u.~.:.~ ...... ~~J.'l__,;J""_r;...._ ____ _ Phone:
Mailing Address: ----------------------------------------
Ph ysica l Address:----------------------------------------
Facility Contact: i~ Roesch Title: firm fi()f.~ Phone No: q1q 13"l-~fl.f3
Onsite Representative: ~ .... ._.lh'l""":..a.4_.__ .... ~ ....... ..,Mo.:...,,___________ Integrator: H Wf7l3ro .... h
Certified Operator: t·flre t»t/tn Operator Certification Number: A~ :JEJ6/
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD 'D " Longitude: D OD 'D "
Design C urrent Design Current Design Current
Sw in e Capacity Population Wet Poultry Cap acity Population Cattle Capacity Population r r:::ID::::--L-ay_e_r __ """T""" ___ r--__ ___,
D Non-Layer
ID Wean to Finish
jg'wean to Feeder gg-36 5J/(b
D Dairy Cow I
D Dairy Calf i
~ F ceder to Finish
Farrow to Wean '
D Farrow to Feeder
0 Farrow to Finish
0 Gi lt s
0Boars
;
-~ -· ·-·-. ---
D Dairy He ifc1 '
0 DryCow '
D Non-Dairy I
D Beef Stockel
;
D BeefFeeder
D Beef Brood Cow ' -.
Dry Poultry
D Layers
D Non-Layers
D Pullets :
0 T urkcys I
Otber D T urkey Poults
D Other [D Other Number of Structures: I~ .J 1
Discharges & Stream Impacts
I . Is any discharge observed from any part of th e operation? D Y cs 6.d No D NA D NE
Discharge origin ated at: D Stru cture D Application Fie ld D Other
a. Wa s the conveyance man-made? DYes 0No DNA ONE
b . Did the discha rge reach waters of the State? (If yes, notifY DWQ) D Yes 0 No DNA O NE
c. What is the est imated vo lume th a t reached waters of the State (gall ons)?
d . Does discharge bypass th e waste manageme nt system? (If yes , notify DWQ) D Yes 0 No DNA O NE
2. Is the re e vidence of a past di scharge from any part of the operation? D Yes Clf No DNA ONE
DYes jgNo D NA O NE
• '
3. Were there any advers e impacts or potenti al adverse impa cts to th e Waters of the State
other than from a discharge?
12128/04 Continued ~
Date oflnspection ha hbltlt 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?
DYes ~o DNA ONE
DYes DNo DNA ONE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _TiL:O~fr-3-____ &~~1-L.:-'-L--------------------------
Spillway?: --Jo.J~I..,~~-----2L"'"'----------------------------
Designed Freeboard (in): _....;:~=-::..:':.....L..-"f-lqL.-___ --.~lw'l~.-______________ ------------
Observed Freeboard (in):------------------------------------
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
DYes ISaN o DNA ONE
DYes ~No DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0 . Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
l)tYes 0No DNA ONE
DYes ~o DNA ONE
DYes DNo DNA ~NE
,.
DYes QkNo DNA ONE
11. Is there evidence of incorrect application? Ifyes, check the appropriate box below. DYes D No ISCNA 0 NE
0 Excessive Ponding 0 Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn, etc.)
0 PAN D PAN > 10% or 10 lbs 0 Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Area
12 . Crop type(s) Coarfa lllfl=m.,b... -Hal ' S G> (H
:J
13. Soil type(s) !..Au~uB!............IL...s~----------------------------
14 . Do the receiving crops differ from those designated in the CA WMP? 0 Yes
15 . Does the receiving crop and/or land application site need improvement? D Yes
16 . Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?D Yes
17 . Does the facility lack adequate acreage for land application?
18 . Is there a lack of properly operating waste application equipment?
DYes
DYes
~No
0No
~0
!)~No
~0
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings offacility to better explain situations. (use additional pages as necessary): ·
DNA
DNA
DNA
DNA
DNA
If ~ Coo~'te.. ~.HO,jllCti>tfolftr-~o;b Ot) (jJCCCY~ ;, ~17"{)-y
et"Oeld(lh~ ~i.-aft llctril'Qo? i.s Feb I 0. Tert iJ MKc.h r~. wetreJf /o(~ .CI'e.. rl41-ey~
~ kflltn.S\Iilft .. ( ~ik 1J-fiOt!nt~toJef DIC cfr1f-HurhbN. ·
(E'JfJ~, no'ftJ (of-0., ~fti~LDfi]
Reviewer/Inspector Name
Reviewer/Inspector Signature:
ONE
15lNE
ONE
ONE
ONE
12128104 Continued
j Facility Number: <5;). ~wy I Date of Inspection Ji I~ flblQ I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
the appropirate box. D WUP 0 Checklists D Design D Maps D Other
~Yes DNo DNA ONE
AlVes ~No DNA ONE
JV)
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes D No D NA ISJ-NE
D Waste Application D Weekly Freeboard 0 Waste Analysis D Soil Analysis D Waste Transfers 0 Annual Certification
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections D Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the pennit orCA WMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
12128104
~0 DNA ONE
0No ~A ONE
0No DNA ~
0No DNA DtNE
lSiNo DNA ONE
0No i)lNA ONE
~0 D_NA ONE
!»No DNA ONE
~No DNA ONE
r8J No DNA ONE
Da-No DNA ONE
I3"No DNA ONE
. . .
Fa cility No . <b.>~' j Farm Name Date ---------------------------
Per m it __ COC __ _ OIC_ NPDES {Rainbreak er PLAT Annua l Cert }
POP . Type Desicm Current
LaQoon
Spillway
Design freeboard
Observed freeboard {in
Sludge Survey Date
SludQe Deoth {ft} & %
Liquid Trt. Zone (ft)
1 2
Soil Test Date ___ _
pH Fields
Lime Needed Ul k"""'1
Lime Applied
C u ___ Zn ____!b)kr\OII'Y7
Needs P
Waste Analysi s Date
-60 Day
+ 60 Dav
N Amt {lb/1000 Gal}
pH
Pull/Field Soil Crop
1\-Y l<r.t.k .5' r..~ -1 'Col
A.lt3 IDR.Jab
I
·~--
FB Drops
v,IJIY' u,...
'U1 2 3 4
)q IQ
;t~ s-:t
3 4 5
Crop Yi eld n/a._.
Wettable Acres ____ _
WUP
Weekly Freeboard J'!L ~
Rainfall >1" ~D\-Sr7~"'-
I
RYE PAN Window
:~/T .5eLf:&r
-~n HJ!-~e)lf-
v
I
5 6
6 7
1 in Inspections .
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Max Rate
().{o
fl.·"
Ver ify PHON E NUMBERS and affiliations J) 07 Date last WUP FRO 4t ( Date Ia* W~ at farm A p p. Hardware
FRO or Farm Re cord s /1'11'\fl~ yr:O ~....-
Lagoon# I "tO)<: ¥fo IS)
T op Dike S"O·G 500
Stop Pump ~.,.oo=~~ ~l3C ~~4 ~
~tart Pump 41 ,)"f ~~ 0 l!} ~ ~~.} 4£'1~.,~~ ~'
ee&_~clta!c.neJc.. ~vf -tlof4-lt'lH k, 'J
I
7
8
Max Amt
I"
1\1'-1 ,,
I ~acility Number l~ ~ H -''lJ. II -R Division of Water Quality
0 Division of Soil and Water Conservation
0 Otber Agency
·-.'
Type of Visit ~Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit i'[Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
~1'11-tJif\'
DateofVisit: ll:)h) JOJ I ArrivaiTimedl~~'fS"Pf11 DepartureTime: f"''-~.'11 County: Sa., lUh Region: rPO
Farm Name: ROn GriMtJ H(IJ7 Owner Email: -------------
Owner Name: ~Oa Grfme.r . VOaJ es Roesc.b
Mailing Address: $ '-13 D Sv:lh, Jb~ oJ 7 ;
Physical Address:---------------------------------f'Wt~7':"1--=::::::aon-ri"l~.,......
Facility Contact: ~Om¢ Roesch Title: Co-own'ft Phone No:ClR ~q,;{ftc;
Oosite Representative: J'o.,eJ Roesch q.. Qp, Gr brt.J Integrator: .....:....;H:...;.~oo~~rfF-=h~1~1J~rO::..:..;_it'<...:.n _____ _
Certified Operator: HI choef Oorr.J.ea ----------Operator Certification Number: ~3~ ~ I ' .
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD 'D " Longitude: D OD'D"
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population 10 Layer
0 Non-Layer
Dry Poultry
0 Laye rs
0 No n-Layers
0 Pull ets
D Turkeys
Other . 0 Turkey Poults
0 Other ID Other --.
Discharges & Stream Impacts
I. Is an y discharge observed from any part of the operation ?
Discharge origi nated at: 0 Structure 0 Application Field 0 Other
a. Was the conveyance ma n-made ?
b . Did the di sc harge rea ch wa ters of the State? (If y es, noti fy DWQ)
-
Design Current
Cattle Capacity Population
0 Da irv Cow I 0 DairvCalf I
0 Dairy Heife1 I I
0 DrvCow
D Non-Dairy . _i
D Beef Stocker I
D Beeffeeder i
D Beef Brood Co\\ I -·-. ·----------····-
Nu~ber of Structures: I ~J
u-vJ
lives
<c~ t(tlll-ittSftt~·tj ,
EJ No DNA O ·NE
DYes 0No DNA ONE
DYes 0No DNA ONE
c. Wh at is the estimated volum e that reached waters of th e State (gallons)?
d . Do es discharge bypa ss the waste management system? (If yes, noti fy DWQ)
2. fs there evidence of a past di sc harge from any pan of the opera tion ?
3. Were there any adverse impacts or potential adverse impacts to the Wat ers of th e State
other th a n from a disc harge?
D Yes 0 No
riJ Yes 0No
DYes lSlNo
12118104
'•.
DNA O NE
DNA ONE
DNA ONE
Continued
Date of Inspection ll~lflJD7 I
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. lf yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: Vff' r lotvfl:
Spillway?:
DYes 'b(tNo 0 NA 0 NE
DYes 0No DNA ONE
Structure 5 Structure 6
Designed Freeboard (in): dO CJI~ b_,a"""-'o::;..._ _______________ ------------
ObservedFreeboard(in): ;a+ _...,515~---------------------------
5. Arc there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, e tc .)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
DYes D(JNo DNA ONE
DYes ~No DNA ONE
If a ny of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? g'" Yes 0 No 0 NA 0 NE
8. Do any of the stuctures lack adequate markers as required by the pennit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Docs any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternative s that need
maintenance/i mprovcment?
DYes ~No DNA ONE
DYes liJNo DNA ONE
DYes 0No DNA ~NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. DYes D No DNA m NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN D PAN> 10 % or 10 lbs 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside owceptable Crop Window 0 ~f e of Wind Drift D Application Outside of Area
:: ~~:,p:~;> h ~&yJww ~m;JA1Wy-~
14 . Do the receiving crops differ from those designated in the CA WMP? DYes 0No DNA l)il NE
15 . Does the receiving crop and/or land app li cation site need improvement? 0 Yes D No 0 NA ~ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre dctennination?D Yes }E No 0 NA II NE
17. Does the facility lack adeq uate acreage for land application?
18 . Is there a Jack of properly operati ng waste application e quipment'?
DYes 18No DNA ONE
DYes 0No DNA liNE
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): '
Reviewer/Inspector Name
Re\'iewer/lnspector Signature: Date:
lZ/28/04 Continued
..
I Facility Number: 8 d., -6~YI Date oflnspection It (;;dtaJOlOD/
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. D WUP 0 Checklists 0 Design 0 Maps 0 Other
DYes 5lNo DNA ONE
DYes (XNo DNA ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. ~Yes 0 No DNA 0 NE
D Waste Application D Weekly Freeboard D Waste Analysis D Soil Analysis 0 Waste Transfers D Annual rertification
D Rainfall D Stocking D Crop Yield D 120 Minute Inspections ~Monthly and I" Rain Inspections 0 Weatller 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 situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
~Yes 0No DNA ONE
DYes 0No ~A fdNE
~Yes DNo DNA ONE
DYes 0No fjlNA ONE
DYes ~No DNA ONE
DYes 0No ~NA WNE
DYes Ill" No DNA ONE
DYes ti(:1 No DNA ONE
DYes KINo DNA ONE
DYes ~No DNA ONE
DYes l&fNo DNA ONE
DYes RfNo DNA ONE
~~I! {'tQ, ithlt liP n&r lo~ver h~V.>f. Tl.ln~ ~>-a.r cal(r.tL ~Jslldf-~M.~ /e11~ ... -
7. ~ tifr ~!)}-Ple..re.. remove.. 5flli-tl'l'e fr0n1 ~ iJ~ "'J It'"' ,,e '(q-h
lm;J~ ~I( VW3~ . t~ r;r-~ ~s;de_ ~~ ~o.se. ~"ill t it..fd f-&e/ comeJ~ below o~'lfftl (lc.rr~ lit-of~ s/o.-'{je ~~~t~l<.)
l..owtr '~.., FHI eroliOn rills io Sw C!Xtlfr Ovl.eJhtbliJh co~er fn--thal-~t"t'a.. , seetf~ t».drtt,lcA!:J, .Pielle. cvt br0h7h/es ond~'a, 1t'Or1 D-trlde_bank
dl, ~~cwh{:atfc ofu.,~ ~...-l:fle "'~"'6\i-fi~N) ~oo7, klewwtble.f1elcL
Pl.!JS stodoeJ... Sl'f <!OU7 , Not-~ r'follilt! &-se.,.,~ ~ ll". LY,001I h4"1' ~ ~~ llttl" f. . lte ~ ~1m~ ,., ~ 'ltu-'14/W. et.-!Jr :)(x~ •
h-it 'leeLSoil Atla~su a.;.! IY11.ik ~su b e ff 1f./ll"4iio-,,
,anv;l( ned sl1f_ ~lit 1', dOot I 0¥&-1~~ fllli'i /J b ufty-11 f(tr I~
~.
hoil/ netJ... :k~ f"-«"Fulfwtfa, ~ !f'l' tJffll 'tn
NteL. -to~ tl far'IJ ~a~. 1--.....
12118104
Mr. Ron Grimes
8430 Suttontown Road
Faison NC 28341
Dec 17,2007
Dear Mr. Grimes.
Michael F. Easle y, Governor
Will iam G . Ross Jr .• Secretary
Nonh Carolina Department of Environment and Nat ural Reso urces
Coleen Sullins . Director
Divi sion of Water Quality
I appreciate all the hard work and money that has gone in to putting your farm back in production . S ince you
have not been operational for several years , some of your paperwork is outdated . These particular items have to be
changed in Raleigh , so please mail your forms there. It would also be a good idea to send me a copy in Fayetteville
at the address below.
1-Please fill in the Operator-In-Charge Form. I was told that this is Michael Darden, License# 28261 but I
cannot make this change. Mr. Darden is a legitimate OIC, but as of now not officially listed for your farm.
Please note that the OIC is responsible for registering annually with our certification commission plus
obtaining 6 hours of approved continuing education credits every 3 years . Also note that this form is mailed ·
to a slightly different address (1618 Mail Service Center, Raleigh) than the item below.
2-We also need a change of integrator form. Our current listing is "independent". I was told that Murphy-
Brown is now your integrator, and again I cannot make this change. This is mailed to 1636 Mail Service
Center, Raleigh .
I added Mr. Roesch as co-owner, as per my conversation with him . However, the official paperwork is still
going to your address as owner. Please let me know if either of theses statements needs to be changed.
Enclosed is an IRR2 form for recording spray events. Th is is also available on the web at as an Excel
spreadsheet at http://h2o.enr.state.nc .us/aps/afou/afou_home.htm und e r "Reporting Forms". I do not remember
whether you had these or not.
I am enclosing a typed co py of my corrected inspection. I made one major mistake in checking item 1 "yes"
instead of "no" and there are some other slight changes. I am informed that Murphy-Brown is pretty strict about
checking that inspection "yes" items are corrected, so that will be one less thing you have to explain to them .
Also, in talking about work on your upper lagoon, I mixed up the east and west sides, although you probably
understand what I meant.
I did not explain the rain gauge situation well during the inspection. One should be installed in the near
future. even though you are not pumping . Preferably it should be somewhere convenient to read and in the
open not very close to roof, tree, power line or any other kind of over hangs, nor subject to splash . It needs to
be read and recorded after each 1-inc h rain event and no less than on ce monthly. Most people read and keep
the rain and lagoon levels together on one form, often on a calendar with multiple months per page . The lagoon
level must be read weekly.
I failed to inquire if you had sludge cleaned out of your lagoons while they were down. If so, you should
keep that paperwork with your other farm records , have sludge surveys done in 2008, and then appeal for "N'ifrth carolin a
.Naturall!f
No rth Carolin a DWQ/Aquifer Protection Sectio n 225 Green St./ S uite 714 Fayetteville . NC 28301 Phone (91 0) 433-3300
FAX (910) 4!!6-07 0 7 Internet: h2o .enr.state .nc.us Customer Serv ice 1-877-623-6748
An Equal Opportunity/Affirmative Action Employer -50% Recycled/10% Post Consumer Paper
..
couple year exemption from surveys. Even if the lagoons were not cleaned out, you can appeal for an
exemption if sludge levels are low and liquid levels high.
You will probably find that there is currently a bit more paperwork and requirements are somewhat stricter
than they were a few years ago. That is just part of doing business in today's environmentally conscious
society. Since you have not been in operation for a while, it would also be a good idea for you to review your
permit.
Please do not hesitate to call me at (91 0) 433-3333 if you have any questions.
Sincerely,
Joan Schneier
Attached :
OIC form
Change of Integrator form
IRR2
Revised inspection
Cc: Mr. James Roesch (no attachments)
fRo fll~
Type of Visit 8 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 8 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
DateofVisit: ~~·Zi'-P~I ArrivaiTimedz:o' h .... l DepartureTime: 12~ lsJ.S AJ County: $0eragAL Region: Eb r r ,
Farm Name: /2.o N C.O!Me S' F'4 v M. Owner Email: --------------
Owner Name: ___ ---~:R:::.~.o~l'l:=...... _____ -'""G""'n~· ~ryt.ag...,G""".S.""-------Phone:
Mailing Address: -----------------------------------------
Physical Address:-----------------------------------------
Facility Contact: N.s Bar~-Eko +--Title: Sls -kv-Phone No{ 'flo) 59'1/-BoY
Onsite Representative: -------------------Integrator:----------------
Certified Operator:--------------------Operator Certification Number: --------
Back·up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D" Longitude:
Discharges & Stream Impacts
l_ Is any discharge observed from any part of the operation? 0 Yes ~No DNA ONE
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)?
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 impact s to the Waters of the State
other than from a di s charge?
Pagel of3
DYes ~No DNA ONE
DYes 0No ~NA ONE
I
DYes 0No ~NA ONE
DYes [1}No DNA ONE
DYes ~N o DNA ONE
12128/04 Continued
I Facility Number: ~z-~btl Date oflnspection ~-Zf-0 4-
Waste CoUection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. lfyes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure4
DYes ~No DNA ONE
DYes [21No DNA ONE
Structure 5 Structure 6
Identifier: 70p UJDD""-&&,.. 'f'm.I·------------------------
Spillway?:
Designed Freeboard (in):---------------------------------------
""'~o"' ~ ~o 'I Observed Freeboard (in):_-_,.!!!_"'-""'-------'~:........::'---------------------------
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/large trees, severe erosion, seepage, etc.)
DYes [»No DNA ONE
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
DYes QtNo _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 pennit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
0 Yes O"No 0 NA D NE
DYes ~o DNA ONE
DYes (]?No DNA ONE
DYes O}No DNA ONE
II. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes ISI'No 0 NA 0 NE
D Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
D PAN D PAN> 10% or 10 lbs D Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Area
12. Crop type(s) ---L~"""'==----------------------------------
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA WMP? DYes (8No DNA ONE
15. Does the receiving crop and/or land application site need improvement? DYes [»No DNA ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? DYes ~NoD NA 0 NE
17.
18.
Does the facility lack adequate acreage for land application?
Is there a lack of properly operating waste application equipment?
to question #): Explain any.yE·s;~*sw~rs.jiid/or any re<:onlm,encJatiolll~.
ra,lfiD!is'lof facility to better explain situations~:(us~ llddi_tional pages as nel~essa•:y):')'.;:.f
Reviewer/Inspector Name 1
~~~~~~~~~~~------------------~·
Reviewer/Inspector Signature:
Page 2 of3
DYes ~No DNA ONE
DYes ~No DNA ONE
Date:
12128104 Continued
I Facility Number: <?z -k?iJ Date of Inspection 1~-Zf-t>,kl
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 D Checklists 0 Design D Maps D Other
DYes rlJNo DNA ONE
0 Yes ltJNo 0 NA 0 NE
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes Q!'No DNA D NE
0 Waste Application D Weekly Freeboard 0 Waste Analysis D Soil Analysis 0 Waste Transfers 0 Annual Certification
0 Rainfall D Stocking 0 Crop Yield D 120 Minute Inspections D Monthly and I " Rain Inspections 0 Weather Code
22 . Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rain breakers on irrigation equi pm ent?
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 whi ch cause non-compliance of the permit o r CA WMP?
29. Did the facility fail to properly di spose 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 th e fac ility pose an odor or air quality conc ern ?
If yes, contact a regiona l Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site represen ta tive ?
33. Does facility require a follow-up visit by same agency?
Ad.dltioitaf ·Comnieiit~:~n dJor Drawings:
Page3 o/3
DYes ra'No DNA ONE
DYes OJINo D NA ONE
DYes [HNo DNA ONE
DYes [)No DNA ONE
DYes Of No D NA ONE
DYes ~No DNA ONE
DYes OJ!No DNA ONE
DYes ~No DNA ONE
DYes QfNo DNA ONE
DYes ~No DNA O N E
DYes (2PNo D NA ONE
DYes l;i(fNo DNA ONE
·~·~;~S.:~~~~,J;~.:~~;~~
..... ,..._
-...
12118104
e Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit e Routine 0 Complaint 0 Follow up 0 Emergency NotifJCB.tion 0 Other D Denied Nx;ess
'-___________________ _.I Date of Visit: '-~;:;:==!Ti:.:un=e:~l==::;::;::~~--~""'1 Facility Number I B2_ H ft.tt · · lo Not Operational 0 Below Threshold
I&J1»ermitted C Certified C ConditionaDy Certified C Registered Date· Last Operated or Above Threshold:
Farm Name: __/fp.Ll. 6r,'m q FarM County: $a~ r£ 0
Owner Name: __ _£.1!.l!._ ~_u,<.S ·Phone No: Cf I 0 -,£9'1 -fl3 3
Mailing Address: __ ~ '1 J.Q_ _ _.?vtfflt':L!.IJ.I6I.n. __ l(f2oJ _E~ ~.., NL. :2 8,1. ':t/ -·---__ _
Facility Contact: Title: ·-------------------PboneNo: --------------------
Onsite Representative: -------------·----~wr. JCae'~na?~t: _______ __
Certified Operator: ________ ----OpendOrC~amooNumber. ______________ _
I...ocation of Farm:
Discharges & Stream Jmpacts
1. Is any discharge observed from any part of the operation?
D ischarge originated at: D Lagoon 0 Spray Field 0 Other
a. If discharge is observed. was th e conveyance man-made?
b . If discharge is observed, did it reach Water of the State? (If yes, no tify DWQ)
c . If discharge is observed, what is the estimated flow in gal/min?
d . Does discharg e bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there an y 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
Structw-e I Suucture 2 Structure 3 Structure 4 Structure 5
Identifier: ------· -----
DYes [i}N"o
DYes 0No
DYes DNo
DYes DNo
DYes DNo
DYes DNo
DYes DNo
Structure 6
Free board (in ches): --------------------------------------
12112103 Contimud
Date oflnspectioo JJ,? · k o7 I
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6 . Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7 . Do any of the structures need maintenancef1mprovement?
8. Does any part of the waste management system other than waste strUctures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenanceflDlprovement?
11 . Is there evidence of over application? If yes, check the appropriate box below.
0 Excessive Ponding 0 PAN 0 Hydraulic Overload 0 Frozen Ground D Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA WMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring veg etation, 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.
Fa'""
Renewerllnspector Name
Reviewerllnspector Signature:
12112/03
Date: /.
DYes ONo
DYes DNo
DYes ONo
DYes ONo
DYes ONo
DYes DNo
DYes DNo
DYes ONo
DYes DNo
DYes DNo
DYes 0No
DYes 0No
DYes 0No
DYes ONo
DYes ONo
DYes 0No
DYes ONo
Dau of luspec:tion I J.2 ·t -<J '1
Required Records & Document.-;
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available ?
(ie/ WUP, checklists, design, maps, etc.)
23 . Does record keeping need improvement? If yes, check lhe appropriate box below.
D Waste Application 0 Freeboard 0 Waste Analysis 0 Soil Sampling
24 . Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25 . Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
27. Did R.eviewerllnspector 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 aNPDES Permit? (If no, skip questions 31-35)
31 . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
0 Stocking Fcnm 0 Crop Yield Form 0 Rainfall 0 Inspection After 1" Rain
0 120 Minute Inspections 0 Annual Certification Fonn
12112/03
DYes 0No
DYes DNo
DYes 0No
DYes 0No
DYes 0No
DYes 0No
DYes 0No
DYes 0No
DYes ONo
DYes ONo
DYes 0No
DYes 0No
DYes ONo
DYes DNo
DYes DNo_