820669_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quality
-~ ... ·-~· ...... ~ .·-· . ··~-....., -
Complia nce Inspection Operation Review 0 Structure Evaluation
Reason for Visit: ~tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other
DateofVisit: I 7-27-1$( Arrival Time:! I : ou
FarmName: ,~JiyrJ. r=a,,._
DepartureTime,j 01' :vv I County' Sy-er-RegM>n ' /!!!5!J
Owner Email:
I
OwnerNa me: J~ 4>-yrJ Phone:
Mailing Address:
Physical Address:
Facility Contact: , 5:~--/ \f)' 1/ cJ Title: --~~=-~~~~~~~---
,;,_,-~ 6 ~ :Paul). LoPe --z....
)
Integrator:
Pbooe:
,~m.H.rJ) Onsite Representative:
8:>a.u-: J L D~'P "L. Certified Operator: Certification Number: ,
Back-up Operator: Certification Number:
Location of Fann: Latitude: Longitude:
Di scharges and Stream lmoacts
I . Is any di scharge observed fro m a ny part of the operatio n? DY es ~ D NA O NE
Discharge origin ated at: D Struc tu re 0 Applicati on f ield 0 Othe r:
a. Was the co nveya nce man-made? DYes 0 No DNA ONE
b. Did the di sc ha rge reac h waters ofthe S tate? (If yes , no ti fY D WR ) DYes 0 No D NA O NE
c . What is th e esti mated vo lume th at reac hed waters of the State (gall ons)?
d. Does the disc harge bypas s the wast e ma nagement system? (I f yes, noti fy DWR ) DYes 0 No D NA O NE
2. Is there ev idence of a past discharge from any pan of th e operati on?
3. W ere there any ob se rv ab le advers e impacts or po tential adverse imp acts to t he waters
of th e State other than fr om a di scharge?
Page I of3
DYes
DYes
I2J'No D NA O NE
~0 DNA ONE
214/2015 Co ntinued
!nate of Inspection: z--,,;z 7-/ff
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): !2.
Observed Freeboard (in): 1')---
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes ~DNA
DYes 0No DNA
StructureS Structure 6
0 Yes [3"'N'o 0 NA 0 NE
0 Yes [31'lo 0 NA 0 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
1 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes
DYes
DYes
DYes
[1-"No DNA ONE
~ DNA ONE
~0 DNA ONE
~DNA ONE
ll. Is there evidence of incorrect land application? lfyes, check the appropriate box below. 0 Yes ~DNA 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. D Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropriate box.
DYes DNA
DYes @'No DNA
DYes f2r'No DNA
DYes k:}-No DNA
DYes ~ DNA
DYes ~ DNA
DYes ~ DNA
ONE
ONE
ONE
ONE
ONE
ONE
ONE
0WUP Ochecklists 0 Design D Maps 0 Lease Agreements Do~:
21. Does record keeping need improvement? 1fyes, check ~ppropriate box below. lrJ Yes 0 No 0 NA D NE
0 Waste Application 0 Weekly Freeboard [3'\Vaste Analysis D 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 D Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes ~ 0 NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? Q Yes Wo 0 NA 0 NE
Page 2 of3 21412015 Continued
lFacility Number: !5;b-fQ le'f loate oflnspection: ?--? 7-!jj
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
DYes
DYes
~0
~0
DNA ONE
DNA ONE
D Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
D Non-compliant sludge levels in any lagoon
List 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.
D Application Field D Lagoon/Storage Pond D Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page3 of3
DYes ~ DNA ONE
DYes ~ DNA ONE
DYes ~o DNA ONE
D Yes [d"No DNA D NE
DYes~ DNA ONE
DYes ~o
DYes
DYes
0 Yes
DNA ONE
DNA ONE
DNA ONE
DNA ONE
Phone: 91z;-3D3-DD/
Date: 2-?7-.?otY
21412015
'
Date of Visit: lltz -1/c) zl Arrival Time: I 11 :oo I Departure Time: I k)... •• t) o I Co~~ty : _57' ;i.:?:-Regioo: FJ?:. D
5 4ift: ·-.pyrJ.. ·Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
' 0
Physical Address:
Title: (.9-W n 'r ,.-Phone: Facility Contact: >~ 75yce/
Onsite Representative: :J2 a v ~J. L...o 'f -e "2..
Certified Operator: £}t:e.A../1 J l-qpc= 2.,.
Back-up Operator:
Integrator: _,...?~~~::....:L.~~~";~~:.JI')r::.,_ ____ _
Certification Number: /DOez.K-1'/
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation? 0 Yes ~No DNA ONE
Discharge originated at: 0 Structure 0 Application Field 0 Other:
a. Wa s the conveyance man-made? DYes 0No DNA ONE
b. Did the discharg e reach waters ofthe State? (If yes, n otifY DWR) DYes 0No DNA ONE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) DYes 0No DNA ONE
2. Is there evidence of a past discharge from any part of th e operati on?
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 ~No
0 Yes l)aNo
DNA ONE
DNA ONE
21412015 Continued
I Facility Number: (Date of Inspection: (,-1 0-2<> 1 b.
'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): IL
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 D NA 0 NE
0 Yes 0 No D NA 0 NE
StructureS Structure 6
DYes ~No DNA ONE
DYes ~No DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes ~No DNA ONE
0 Yes ~No 0 NA 0 NE
D Yes l8J No 0 NA 0 NE
DYes ~No DNA ONE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~No 0 NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN> 10% or 10 lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12.CropType(s): 3 ·-c-:Itrn;}q /ov...,.,0l:"rJ
13. Soil Type(s): /Ju.--f-fy J/;} fr::-
/
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?
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 CA WMP readily available? If ye s, check
the appropriate box.
0WUP 0Checklists D Design D Maps 0 Lease Agreements
21. Does record keeping need improvement? lfyes, check the appropriate box below.
DYes .[81..No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes I3JNo DNA ONE
Oother:
DYes ~No DNA ONE
D Waste Appli cation 0 Weekly Freeboard D Waste Analysis D Soil Analysis 0 Waste Transfers D Weather Code
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rainfall Inspections D Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? D Yes ~ No 0 NA D NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes ~o DNA D NE
Page 2 of3 21412015 Continued
• !Facility Number: trJ-=.. -f.s, Co <f l»ate of Inspection: le-I 't-J?I
:f 24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes !29-No DNA 0 NE
DYes aNo DNA ONE 25. Is the facility out of compliance with pennit 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 0 Lagoon/Storage Pond D Other:
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer!lnspector Signature:
Page3of3
DYes [B..No DNA O NE
DYes IJ23-No DNA ONE
DYes ~No DNA ONE
0 Yes ~No DNA ONE
DYes ~No D NA ONE
D Yes ~No DNA ONE
0 Yes DNA ONE
0 Yes DNA ONE
0 Yes DNA ONE
Phone: 9-zP--:? OJ-DIS/
Date: Co -It-~~/?
214/2015
DateofVisit:IZ-/Y-11-I ArrivaiTime:I/O: q5'"1 DepartureTime:l Z/!:15"'lcounty: ~Region: .pj<..'i}
5~ l5u rd {7:1rrv--Farm Name: Owner Email:
Owner Name: Phone:
7
Mailing Address:
Physical Address:
Facility Contact: ~~ p Y /j
I
Onsite Representative: A/I:J~c J)q.V ~ J
Title: &JWtz -r-..,.,-
Lo:j?eZ--Integrator:
Phone:
.5m d(r:-rJ /J
',?1 Certified Operator: ._5 ~ Certification Number: I oo,;;zs--'fl
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
l.ls any discharge observed from any part of the operation? 0Yes ~No DNA ONE
Discharge originated at: 0 Structure 0 Application Field 0 Other:
a. Was the conveyance man-made? D Yes 0 No D NA O NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) D Yes 0No DNA ONE
c . What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) D Yes 0No DNA O NE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of3
DYes
D Yes
&_No DNA O NE
~0 D NA O NE
11412015 Continued
I nate of Inspection: 7-lf'--.?b(L.
t
Waste Collection & Treatment
. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
•
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure4
Identifier:
Spillway?:
Designed Freeboard (in): {2=-
Observed Freeboard (in): /2=-:
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 "g!No DNA ONE
DYes 0No DNA ONE
Structure 5 Structure 6
DYes ~No DNA D NE
DYes ~No DNA ONE
If any of questions U were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes j>d-No
DYes JEL.No
DNA ONE
DNA ONE
DYes ~o DNA ONE
DYes [3,No 0 NA 0 NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. D Yes ~No DNA D NE
D Excessive Ponding D Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN> 10% or 10 1bs. D Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Approved Area
12. Crop Type(s): Jr'r/11 ~ /or../->-/_3--z.:-cl
13. Soil Typo(,): ,/b&~ V. //..-
14. Do the receiving crops differ:n: 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?
Reguired Records & Documents
19. Did the facility fail to have the Certificate ofCoverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
DYes ~0
DYes jg!No
DYes 0-No
DYes @-No
DYes ~No
DYes ~o
DYes ~o
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
OwUP Ochecklists 0 Design 0 Maps 0 Lease Agreements 00ther: _________ _
21. Does record keeping need improvement? Ifyes, check the appropriate box below. DYes ~o DNA D NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Weather Code
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections D Monthly and I" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected. did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page1of3
DYes ~o DNA ONE
DYes {2fNo DNA 0 NE
114/2015 Continued
!Facility Number: [Date of Inspection: 2-/fC";?bl P.
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 rela ted to sludge? If yes, check
the appropriate box(es) below.
0 Yes ~No
0 Yes fi4No
DNA ONE
DNA ONE
0 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date offust survey indicating non-compliance:
26 . Did the faci lity 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
imd 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
p ermit? (i.e ., discharge, freeboard problems, over-application)
31 . Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field 0 Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non -compliance of the permit or CAWMP?
33. Did the Reviewer/I nspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/In spector Name:
Reviewer/Inspector Signature :
Page3 of3
0 Yes IS No 0 NA 0 NE
DYes ~No DNA ONE
0 Yes S. No D NA 0 NE
0 Yes l5a,No 0 NA 0 NE
0 Yes 12JNo 0 NA 0 NE
0 Yes ~No 0 NA 0 NE
0 Yes l3 No 0 NA 0 NE
0 Yes 181 No 0 NA 0 NE
0 Yes 12i,No 0 NA 0 NE
Phone: r;t?-"tf]J-33oo
Date : ·2 -JY-.?lJ 11. •
114/2015
\
ompliance Inspection
Reason for Visit: Q.)..ROUtine 0 Complaint 0 Denied Access
DateofVisit: IlL"" I ArrivaiTime:l .ft.'3u DepartureTime:l a ':..>:.0 I Conn~~ Region: r=t=.v
/,-'{-IS --;r-
Farm Name: 4'.cJf= E. wrA fZz.,-,.._ Owner Email:
~ I --------------------------------
Owner Name: 1t::;.4 f {) 'f cJ Phone:
Mailing Address:
Physical Address: -----------------------------------------------------------
Facility Contact: ://a/, 5 ~ v cJ
I
Title: )J(~~r Phone: p-
Onsite Representative: ~
---9.~~-----------------
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
1. ls any discharge observed from any part of the operation?
Discharge originated at: 0 Structure 0 Application Field
a. Was the conveyance man-made?
D Other:
b. Did the discharge reach waters of the State? (Ifyes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
Integrator: --------------------------
Certification Number: ~/?
Certification Number: /'i?"9iJ&rZ
Longitude:
DYes ~o 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
!29-No DNA ONE
(B_No DNA ONE
214/1014Connnued
. !Facility Number: lnate of Inspection: fe-4-1Jj
Waste CoUection & Treatment
\ 4. Is storage capacity (structural plus storm storage plus heavy rainfall) Jess than adequate? . 0 Yes ll:J-No 0 NA 0 NE
DYes 0No DNA ONE a. If yes, is waste level into the structural freeboard?
Structure I Structure2 Structure 3 Structure4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / J:. /r!!f 3t{
Observed Freeboard (in): ..L./.L<d---'----!Ot.{
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion , seepage, etc.)
DYes ~No DNA ONE
6 . Are there structures on-site which are not properly addressed and/or mana ged through a DYes ~No DNA ONE
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 structures lack adequate markt:rs as required by the permit?
(not applicable to roofed pits , dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes ~No 0 NA o ·NE
D Yes ~No 0 NA D NE
0 Yes (}?I No DNA 0 NE
DYes ~o DNA ONE
II. Is there evidence of incorrect land application? If yes, check the appropri a te box below . 0 Yes 0 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/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): 1dm~ /&IY'z"'r:-:frrJ
13 . Soil Type(s): ,IJ-u;l-qv!/)z;..-
14 . Do the receiving crops differ from those designated in the CA WMP?
15 . Does the rece iving 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 Jack of properly operating waste application equipment?
Reguired Records & Documents
19 . Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to ha ve all components ofthe CAWMP readily available? If yes, check
the appropriate box.
0 WUP 0 Checklists D Design 0 Maps 0 Lease Agreements
21. Docs record keeping need improvement? If yes, check the appropriate box below.
DYes ~No DNA ONE
0 Yes {2iNo DNA ONE
0 Yes Gd:_No DNA ONE
DYes NNo DNA ONE
DYes ~0 DNA ONE
DYes ~0 DNA ONE
DYes ~No DNA ONE
0 0ther:
DYes g.__ No 0 NA ONE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysi s D Soil Ana lys is 0 Waste Transfers 0 Weather Code
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rainfall In spections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes ~No 0 NA 0 NE
23. I f selec t ed, did the faci lity fail to in s tall and maintain rainbreakers on irrigation equipment? 0 Yes .12}-No 0 NA 0 NE
Page 1 of3 214/lOll Continued
·,
~ !Facility Number: loate oflnspection: Z "j aFt?&
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 QNA ONE
0 Yes [9--No 0 NA 0 NE
0 Failure to complete annual sludge survey 0Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to s ecure a phosphorus loss assessments (PLAT) certification?
Otber 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 po se 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)
0 Yes j5iNo 0 NA 0 NE
DYes ~No DNA ONE
DYes ~No DNA ONE
QYes BNo DNA ONE
DYes ~o DNA QNE
DYes ~o 0!"1A ONE 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field D Lagoon/Storage Pond 0 Other: ------------------------
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33 . Did the Reviewer/Inspector fail to discuss review/inspection with an on-s ite representative?
34. Does the facility require a follow-up visit by the same agency?
DYes ~o
DYes ~No
QYes tzg_No
DNA ONE
DNA ONE
DNA ONE
Coriu:ilents:(re"fer-'to;question #):Explain any YES,answers and/or any additional recommendation~<oJ:"aiiyotber~·coniment~~:~5W;'}Pit''·'­
lJse-drawings offacilitY to better explain situation~·:(tlse additional_p_ages as necessary), . · --"~\ ·-. · ' .. •·, : : • · <: .·2/~;:ti:';~•: ,
;Jef~"'.: rr">=bc.,,J. J."'")!~ ~ n--st-3~ ~/'..-L.s N•-r-u,;-t.-~
5 f_" 1r .?' «r '}'---~ J,_J "'y .e'fyt, ~ l'fV "'-n ~ ,v. ,.,1_,.-,
4/IJ -:-+-5 Ti 1 ( t{/01' J<z-) ~ ~ 1o w-1J-r ~ ~~~ ·
Reviewer/Inspector Name:
R evi e wer/In spector Signature:
Page3of3
Phone: 9/b-p3-3 500
Date : &,-t{--;?o (~
21412011
0 Denied Access
Date of Visit: 1~7-.3-:Jf Arrival Timed <j-;1Yl> Departure Time:I/D:3t> I County:..$~ Region: F"""J?t:J
Farm Name: S:jf= J5ynJ.. &;VV"'-' Owner Email:
Owner Name: 5 c..ttf1= (!; y rtA Phone: ,
Mailing Address:
.....Eoo~=-=--"b~r....~.c....;;.~..:..;.._· ___ Title: tPwn ~,_.,
Onsite Representative: 75vd
7
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure D Application Field
a. Was the conveyance man-made?
0 Other:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Phone:
Integ••'•" ffi#"fc#'l.•
Certification Number: ~9()8'9
Certification Number:
Longitude:
DYes ~o DNA ONE
DYes DNo DNA ONE
DYes DNo DNA ONE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes DNo DNA ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
......... ..;: ., .
Page I of3
DYes
DYes
Q?J. No DNA ONE
~No DNA ONE
114/lOll Continued
• !Facility Number: 1f2= -~ollt I I nate of Inspection : 7-J-Jbfl11
·t 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 Structure2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Aie there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc .)
6 . Aie there structures on-site which are not properly address ed and/or managed through a
waste management or closure plan?
0 Yes ~No 0 NA 0 NE
0 Yes D No DNA D NE
StructureS Structure6
0 Yes ~No D NA 0 NE
D Yes [Z.No D NA D NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7 . Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate marke rs as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9 . Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0 . Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
0 Yes ~No DNA 0 NE
0 Yes 6a No D NA D NE
DYes ~No DNA QNE
0 Yes g! No 0 NA 0 NE
II. Is there evidence of incorrect land application? lf y es, check the appropriate box below. 0 Yes g.N'o DNA 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 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): 'f~('nwJ,_ J()v~_s--,.,~ J~/#1\-Jwj.,:f /.s~~-r~.
13 . Soil Type(s): ,4u}, Yvj Jlr ~~~,~LU~~----------------------------------------------------------------
14. Do the receiving crops differ from those designated in the CAWMP? 0 Yes 00 No 0 NA 0 NE
15. Does the receiving crop and/or land application s ite need improvement?
I 6 . Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
I 7 . Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
I 9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all compone nts of theCA WMP readily available? If yes, check
the appropriate box.
0WUP 0 checklists 0 Design 0 Maps 0 Lease A&>reements
21. Does record keeping need improvement? If yes , check the appropriate box below.
0 Yes E.No
O Yes ~No
DYes g]No
O Yes ~No
O Yes ~No
DYes ~No
00the r:
O Yes !:8-No
DNA
DNA
DNA
DNA
DNA
DNA
ONE
ONE
ONE
ONE
ONE
ONE
DNA ONE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers D Weather Code
D Rainfall 0Stocking 0 Crop Y ield 0 120 Minute Inspections 0 Monthly and I " Rainfall Inspections 0 Sludge Survey
22 . Did the facility fail to install and maintain a rain gauge? 0 Yes ~No DNA 0 NE
23 . If selected, did the facility fa il to install and maintain rainbrcakers on irrigation equipment? 0 Yes )21 No DNA 0 NE
Pagel of3 21412011 Continued
a !Facility Number: [Date of Inspection: 'C-5-Lt{
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 gNo
0 Yes ~No
DNA ONE
DNA ONE
0 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date offtrst 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 tbe facility? If yes , check the appropriate box below.
0 Yes S No DNA O NE
0 Yes ~N o DNA ONE
DYes i:5No DNA ONE
DYes fii_No DNA ONE
DYes ~0 DNA ONE
0 Yes l2S No DNA ONE
0 Application Field D Lagoon/Storage Pond D Other: ------------------------
32. Were any additional problems noted whi ch cau s e non-compliance of the permit orCA WMP? DYes (8No DNA ONE
33 . Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes ~No DNA ONE
34. Does the facility require a follow-up visit by the same agency? DYes (8.No DNA ONE
Comments (refer to question #):·Explain any YES answers and/or any additional recommendations or any otber ~com~~ntS!~·j~li';"~}~"''<
· :. V· . ·• "'" . .P. ·~~:\: -~~ ~: ·;'~!<a •• :~.·t '
Use drawiogsoffacility to better explain situations (use additional pages as necessary). : ~,·,::?~;;f;.~;::',~~~"~"i-7:fi.E ~·:f!'', ·'-
Re viewer/Inspector Name:
Re viewer/Ins pe ctor S ignature:
Page3 of3
Phone: 7;?e -~ 53ZlD
Date : ?-:5-,?VIf
21411011
Operation Review 0 Structure Evaluation 0 Technical Assistance
0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: lSI R h 3 I Arrival Time: I yj: '40 J01t1
Farm Name: Scoft l'J vrrl_ ftul?l
Departure Time: Ill; 30Atjl County: S't~tt~f'h
Owner Email:
Region: F X?..()
I
Owner Name: Sco'ff-B~ Phone:
Mailing Address:
Physical Address: ...LI\1...31,LJ..._...L.!II~,li;;,.,...~~:::.L~.:...._-+;....:A...!;J~~I-rrLJ/"'-{~fe_=--------------------­
Facility Contact: ....:R~u...._..,;r;.:::..,.:=--~'....lr-P..-----Title: HOIIQy
Onsite Representative:
Certified Operator: --'~=.!L...=D¥~-------------­
Back-up Operator: R~afd D B~
Location of Farm: Latitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: D Structure 0 Application Field
a. Was the conveyance man-made?
D Other:
b. Did the discharge reach waters of the State? (lfyes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Phone:
Integrator: __:f+;,_:__.BL.L.. _________ _
Certification Number: _C5~...::Q..:0'6..:....:7~---­
Certification Number: _q~~~O=-Z~9'~----
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 DWQ) 0 Yes 0No DNA ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of3
0 Yes
0 Yes
~No .DNA ONE
]2g' No DNA ONE
214/lOIJ Continued
rFacmo/ Number: $<h I nate of Inspection: SJih~
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: SfoJet Sfr&e~
Spillway?:
l~~SJ-Designed Freeboard (in): I d..
Observed Freeboard (in): I d. ~/;).. ~0 11 heltw rerJ llh~
5. Are there any inunediate 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
D Yes D No 0 NA D NE
Structure 5 Structure 6
D Yes ~ No 0 NA 0 NE
0 Yes l)a'"N o DNA D NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public hea lth or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Aoplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
~Ye s DNo
D Y e s Gf No
DYes ~N o
0 Yes ~No
DNA ONE
DNA ONE
DNA ONE
D NA ONE
ll. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes lSC No DNA 0 NE
D Excessive Ponding D Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, e tc .)
D PAN 0 PAN> 10% or 10 lbs. 0 Total Phosphorus D Failure to Inco rporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Applic ation O utside of A ppro ved Area
12. Crop Type(s): Cowia\ 'OetiYfr.do.. .Jl.a(:/Smqllgra{h &lii'Jeeri
13. Soil Type(s): ..J.Allh'-l..::~Cu~t...p.VuiL.Lfuff~-----------------------------
14. Do the recetving crops differ from those designated in theCA WMP? D Y es !)!No DNA 0 NE
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page2of3
0 Y es [)d No D NA
D Y es ~No DNA
ONE
ONE
0 Yes figNo
D Ye s ~o
DYes 12f-No
DYes [RNo
00ther :
~Ye s 0No
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DYes 0 No ~N A ONE
214/2011 Continued
(Facility Number: $'a., I nate oflnspection: sis 113
24. Did the facility fail to calibrate waste application equipment as required by the pennit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box( es) below.
DYes !Sa No DNA 0 NE
0 Yes ('5lNo DNA 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 to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
DYes
DYes
DYes
DYes
DYes
IS§ Yes
~Application Field 0 Lagoon/Storage Pond 0 Other:_Lbl---=.....;...,£_3,..__ _____ _
32. Were any additional problems noted which cause non-compliance of the pennit orCA WMP? 0 Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? 0 Yes
34. Does the facility require a follow-up visit by the same agency? 0 Yes
~No DNA
DNo f5dNA
[}lNo DNA
~No DNA
r5rNo DNA
DNo DNA
fia No DNA
~No DNA
8JNo DNA
Comments (refer to question #): ~Iplain any YES answers and/or any additional reco01mendations or any other,c~mm.en, · .
Use drawings offacility to betten!IplaJn.sitnations (use additional pages as necessary)~, :::::'.'.'i"_ :::.;~;~,~:'
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
7, PleAle... r€ftlsue.. \Orjf.s~ cgo.k "er ~;de. eotn('rt*I~OOl7 1 Gyj_ h~ hovJe..., H~ no+-
v-t-y c) DJe. ~t-C 0~ d. be ct p/1) h (f"' f II 'fl,e_ -Mtil"t'' -'-4j«T\ htJ.fa h•Uf.. V fry !jool CIJvtr ~
ls. p ~e. c1 0 nut v1e. s ~fe sfra1her!J... '" '2ble 1 behf'nti._ LdJf»l a ~M-fi Ia roJJ" ffl II ;9
beir, A II Bft\t't" -flre(J J" have!]ool LJJvft'.
~ f l'we> sfra! evtn'i! fl\ Od.D~Jt. YY~e 11crl-tCJ.'~d. "Itt.. rvor'le. s~fl-e. . 11Jt'J ~~ CIJ
' a. "'dtiJ'ce of Def;ci~cy, Also -tiJe_ <!Jdob6-Sf~l €"81+cShoJd ho~ ~ c "yr'i;. +o -fl! e.. ~~ Cfi1 f' , 1h 1 s .50ne.fr«~ b /6o rYIIf n ukfL 01 I ,J-ye/J" !J Itt f fPdr"t¥1. t'Vt)1
MN val""€1 VVfre.. ncf. IJJf'd ur. (JIOO-~OG-Pt-Dn3]
~tef(t or 11 eie! a bBve..J ~€ll mtt'lrl.fhR'I._.(brhf a,J._ joel recorth .
\ .,YJftiWlll'Ofea~ r1Df-D1 ta/l.tfTCDffJ.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of3
Phone: 'tro-lf»-.JJtd of6ee)
Dote ~-~~ ~ ;;)0 ).3
'4/lOil
Lagoon Name, s fcir'spillw~w . 1 2· 3
Design Freeboard I Last Recorded (in)
Liquid Trt. Zone (ft) ·' .:~ l iii; ·; :; ~;'::. ·:.' · . },{n
Ratio Slud~e to Treatment!Volume if> 0.45
Date out of crimpliarice/ POA? ·· .
Calibratibn Date' :'. >' 1iA llri: 2 · 3 4
Ring Size (in) ·
Design Flow (gpm) :~:A ~Ol) "'k'
-Actual Flow : · ; 3' : r • ·, :: '::l~ j~l \
Design Diam~ (ft) . : t1 ~!(Lr ,., ::-: tOo 1 I
Actual Diam. · l.;l:r': · )b_.Jtt
Soil Test Date __ ·. _l S~~1~f&
pH Fields ; ' · :·; ',~/1)..~ ·
LimeNeeded; ••.. ,·,.Me~~~
Lime Applied i
Cu-I 'Zn-1 __ ..
Crop Yield
Wettable Acres ./
WUP 7 -..,.---
Weekly Freeboard._~_
1 in Inspections , · v
~==~~ ~ (S-1~25) : : ; :. i !•: ~! ';
120 min Insp. __ _
Weather Codes
Waste Date . l~j...J :hiJ<I/1"' ~~nr~ Jl, '
-60 Day '!'i~ .. v
+ 60 Day ! .. qnqJt'l
N (lb/1000 Gal) t .. ~ l.~)
pH ' ~-~:h.: ! ~·)... '
OJ ~g lj()/(9; 'Jill!~~ rl:t "(I ffL&ie' ~Jfp
PulflF=ield I ! S6il Crop w Acres PAN l : . '
1-7 iAu '! ! : ! : !'; l)m6t lx{J')e /),.}-50
i :!. ! v;..p):~1l~ CJ7~ .. 'J_l ' ;-. "ff: rlJ 'I
r oti&~l-1 I :_.:· ;1: i . •' . r~r,;~,·~ ~~~5"'
r~(h t-7 i .: rntnw~ ~LJ>~ lOB ; '' '' ~~O\r1 : &;,.~~ 100.,
II ' ~ /.I
i ::
! ~
' !• :
1 I ~ i . : t .. ~ : ~ I ; ' i •i
I ! l ~ ~: i . ·: i
~ I ~ i :
,-j , . ·I '
r ~ · ~ ; ; : j :
Verify PHONE NUMBE~S :and flffiliations 0
Date last WUP FRO · ~lfb/{1 FRO or Farm Records I .
Date last WUf' at farrn[3\5-~. lagoon #
App. Hardware .. : ' · Top Dike
! ' : Stop Pump
: : ~ : Start Pump
i j : ! : i!
Conversion-Cu-I 3ooo:=: o8' ibiac; i:n-1 3000= 213 lb/ac
i ' ' i:: "·: ~ l , ' I , , .. : i l :· ! .
:. ' I .
/
. : ::' ... ~ :· .
I I I I , I
4
5
5 ·s
•"
6 7
Transfer Sheets
RAIN GAUGE
7·
·.·:· ,, .·
"· ·'
·. :
8
Dead box or incinerator __ _
Mortality Records
Check Lists
Storm Water
Window ·Max Rate Max:Amt
ls'~n-AAr (),, {,0
1-b--~eFf-
Har-S~P
~ 1)-iJ~.&'~h"fl'
~-)@pi;· v ......... " v
'I ' ./
Reason for Visit:
Date of Visit: I bi(;)(Qh). I Arrival Time:l$:5oAtf
Farm Name: .. )arff f.ytd fa,,.,
Owner Name: s·caH GvtcL
I
Mailing Address:
Physical Address: I U)~ne_ )'1-re:f0 Pd
Departure Time:UQ :10 Afq I County:,YJ,pr:;-.
Owner Email:
Phone:
Facility Contact: ___;::n:..JOa::....v.>..:t.r---"'~+-t=-=rL ________ Title: Mo.'Y/ j er Phone:
Region: f" £0
Onsite Representative: . ....31)~Qoc..::..v.L/rL----~.:~"...:f-Jrd__'-4L::-...-----------­
Certified Operator: ScoiJ '6 dd_
Integrator: ------------:--:;:;-rr.----(JVJ}
~~~~,,~~-----------------------
Back-up Operator: --=frl..._c.~_,_·i L.,f __ ..,Bfr->-lt..;..-L_. -------------
Location of Farm: Latitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: liJ Structure D Application Field
a. Was the conveyance man-made?
0 Other:
b. Did the discharge reach waters of the State ? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Certification Number:
Certification Number:
Longitude:
~Yes 0No
~Yes 0No
DYes IE:fNo
d. Does the discharge bypas s the waste management system? (If yes, notify DWQ) DYes 0No
2. Is there ev idence of a past discharge from any part ofthe 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 '5SJ No
DYes ~No
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
21412011 Continued
I Facility N'umber: 1) i}.._ I nate of Inspection: fP{~h{ld..
\Vaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes , is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes ~o DNA ONE
DYes 0No DNA ONE
Structure 5 Structure 6
DYes ~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?
X. 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 fiaNo
0 Yes ~No
0 Yes ~No
DNA ONE
DNA ONE
DNA ONE
DYes ~No DNA ONE
{\Nj)
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. iJII'es ~No D NA 0 NE
0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN> 10% or 10 lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
l ~Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12. tLp Type(s): CiJo,ia I &:rl';lcda , small gro~ o~8'JPfd I opirn i7Y frln-~hflll-'*/::?r!v
13. Soil Type(s): Av}yvi/fe_ } . 1
14. Do the receiving crops differ from those designated in theCA WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? lfyes, check
the appropriate box.
Owup 0Checklists 0 Design 0 Maps D Lease Agreements
O Yes ~No
DYes ~No
DYes ~No
DYes IRJ No
DYes ~No
0 Yes l8l No
DYes ~No
00ther:
DNA
DNA
DNA
DNA
DNA
DNA
DNA
ONE
ONE
ONE
ONE
l~fioes record keeping need improvement? If yes, check the appropriate box below. 0 Yes 0 No D NA 0 NE
~ ~astc Application 0 Weekly Freeboard [8f Waste Analysis D Soil Analysis 0 Waste Transfers D Weather Code
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rainfall Inspections D Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes (8:-No DNA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes 0 No ~NA 0 NE
Page 2 of3 2/412011 Continued
I nate of lnspection: I; l Qla / f J.<
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with pennit conditions related to sludge? If yes, check
the appropriate box(es) below.
0 Yes fSa"No 0 NA 0 NE
0 Yes 5fNo 0 NA ONE
0 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than nonnal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
pennit? (i.e., discharge, freeboard problems, over-application)
0 Yes [}lNo 0 NA 0 NE
0 Yes 0 No lia""NA 0 NE
0 Yes 181"No 0 NA 0 NE
0 Yes {3No 0 NA 0 NE
0 Yes ~No 0 NA 0 NE
0 Yes 0 No 0 NA 0 NE 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[8" Application Field 0 lagoon/Storage Pond 0 Other: ---------------------
32. Were any additional problems noted which cause non-compliance of the pennit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name: ""V'O-ft1J SCftVEI eR.
Reviewer/Inspector Signature:
Puge3 of3
0 Yes jgNo 0 NA ONE
DYes ~No 0 NA 0 NE
DYes rg[No 0 NA 0 NE
Phone: q /{}-<{TI-330fi O'f{k)
Date: \101€ s) ~;:X) I d.._
2/412011
Facility No. ~d-06C{ _Fa~ Name ... ~rrfr~v,rc.-:Z...
Permit J COG / OIC2 NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
I FB Drol I I I I I I I I I I I
Lagoon Name, S for spillway 1 2 3
Design Freeboard I Last Recorded (in)
Observed freeboard lJ. .:sz ..
Sludge Surve_y Date vl.jfltJIQ..-T
Sludge Depth (ft)
Liquid Trt. Zone (ft)
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
Calibration Date 1~{/Qe. 2lfl1/l b 3 4
Ring Size (in) .5l ~rdi*-ta
Design Flow (Qpm)_ ) , I ~ri.
Actual Flow jltl fd-
Design Diam. (ft) JS'5 ;:; m
Actual Diam. ill) ~
Soil Test Date aJtl(l
pH Fields
L.fl::{M
Crop Yield / ~
Wettable Acres __ _
Lime Needed
Lime Applied ~~ /f.,(vl
WUP , /
Weekly Freeboa~rd'--C?......,.....
Cu -I .L_ Zn-1 __::::::__ 1 in lnspec~ions ../
Needs s (S-1<25) ~o-~-120 min Insp. __ _
Needs P Weather Copes
Waste Date ls/;u.l,, .~1~11 ';1//J../1/
-60 Day 12.1 C){) lr~
+ 60 Day 10\;)51{1
N (lb/1 000 Gal) IJ.~ I~ ()rffp ~1\,l
pH ~';h ~~~~I 1 /,1'5 I I
/ ~
Pull/Field Soil Crop Acres PAN
i Pv CBHtt ~.;) ~nr
~ ' I t./.b
) a4
lf V1
') l.i
l:i L~
l \l /. LJ
1-·1 56-(JtOl€._ I'?D
il.'f-0~ v-.Ddro,e blS.J1
~I -0 ~1\r-""' if}Y/1 q,
""" ~-1\ 9~ Veri "PHONE NUMBE S and ~ffiliations
Date last WUP FRO :J"b(f /
Date last WUP at farm ·
lOO
App. Hardware
AyO~
FRO or Farm Records
Lagoon#
Top Dike /O'f
Stop Pump
Start Pump
4
5
Window
1'1tr'Yf
f
[)~·1t'
HV ,~f
'!hiT~1e
Af'-SPfrr
5 6
6 7
Transfer Sheets
RAIN GAUGE
7
8
Dead box or incinerator __ _
Mortality Records
Check Lists
Storm Water
Max Rate MaxAmt
Q,f; ~D
I
l
j
!
i
1
i
;
I
j
! ~.I/
lj ,
s d~Sfe.P'C, Ql
Compliance Inspection Operation Review 0 Structure Evaluation
Reason for Visit: ®Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Denied Access
Date of Visit: I Cf& J I I
I
I Arrival Time: I 1,};5-o pij I Departure Time: b; IS' .p rr I County: s,,, 0.,
Farm Name: Scoil-eyJ-farm
Owner Name: Scoff-'Byrtl
Mailing Address:
Physical Address: II3J t-\(All?f 5-hefc:b J?J.., j Avt'ltlkllf-e_.
~ ~I I
Owner Email:
Phone:
i::'nr~ Region: r .c~
Facility Contact: .IX! vI t Byab. Title: fhP>fy~ HollOj tc Phone:
Onsite Representative: Da..-f£ BJL Integrator: -..!..H....:......-..... B~----------
Certified Operator: Scol\-'B~,.J_, Certification Number:
Back-up Operator: ~cnald_fi:rvi'S SyrL Certification Number:
Location of Farm: Latitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Di sc harge originated at: D Structure D Application field D Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes. no tify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d . Do es the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part ofthe operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I ofJ
Longitude:
DYes 181 No
DYes 0No
O Yes 0No
DYes 0No
DYes ~No
DYes 5'J No
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
21412011 Continued
·I Facility Number: ~?-. I nate of Inspection: 'Tf3s f 1 I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: S-1-ojel S~RJ
Spillway?:
Designed Freeboard (in): ld.. 5;)..._
Observed Freeboard (in): ~~ 7J
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 Ye s ~No 0 NA O N E
0 Yes 0 No 0 NA 0 NE
Structure 5 Structure 6
0 Yes tg"No 0 NA 0 NE
0 Ye s ~ No 0 NA 0 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any ofthe structures lack adequate markers as required by the permit?
(not applicable to rooted 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?
~Ye s 0 No 0 NA 0 NE
DYes ~No DNA 0 NF.
D Yes ~No DNA ONE
DYes ~No D NA ONE
11. Is there evidence of incorrect land application? If yes, check the appropriate box bel ow . 0 Yes ~No DNA 0 NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 He avy 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 App licat ion Outside of Approved Area
12. Crop Type(s): CoodY! t>tz.l!lvt/q fM;j5malljf41h f}vqJr>fli
13. Soil Typc(s): =-Avt.!!:....L4ryl.ll:v:.uflu.!le.~'".....J.5:.._ _________________________ _
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 wenable
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 available? lf ye s , c hec k
the appropriate box.
0 Yes 5(1 No DNA ONE
0 Ye s f&1 No DNA ONE
0 Yes rgNo DNA ONE
DYe s ®No DNA ONE
0 Ye s IS No DNA ONE
0 Yes ~No DNA O NE
DYes 1)3 No DNA O NE
Owur Ochecklists D Design 0 Maps 0 Lease Agreements QOther: _________ _
21. Does record keeping need improvement? If yes. check the appropriate box below. 0 Yes ~N o
0 Waste Application D Weekly Freeboard 0 Waste Analysis 0 Soil Analys is 0 Waste Transf ers
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and I " Rainfall Inspection s
D NA O NE
0 Weather Code
0 Sl udge Survey
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 equipm ent?
Page 2 of3
0 Yes ®N o DNA ONE
0 Yes 0 N o '@ NA 0 N E
214/2011 Continued
·jFacilli)! Number: $n. -ut6 (\M~ lnatc oflnspection: ~/1/ II
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
the appropriate box(es) below.
~No DNA ONE
D 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.
~ Application Field 0 Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page3 of3
DYes ~No DNA ONE
DYes 0No ~NA ONE
DYes §9 No DNA ONE
0 Yes ~No DNA ONE
DYes ~No DNA ONE
!Sa' Yes DNo DNA ONE
DYes f8No DNA ONE
DYes j8No DNA ONE
DYes (8No DNA ONE
Phone: q{(l--l/3313Jj/rJh'rrj
Date Sef~ @Q /)
'14120/1
. .:..,
Date Cf/~ rca Facility No. ~';)-6~ Farm Name Scoit-}31/rd.._
/ I
Permit , / CO~ OIC_ NPDES (Rain breaker PlAT Annual Cert )
Pop. Design Current
Type
.>
Lagoon 1 2 3
Spillway
Design freeboard
Observed freeboard (in) _b })._
Sludge Survey Date
Sludge Depth (ft)
Liquid Trt. Zone (ft)
Ratio Sludge to Treatment Volume
· 5lL1J.,e~~A~ lni\ I do I~ 5S fA> I ~I hJ'"IJr
Calibration Date 1qh}t[)_ 2 3 ... 4
Design Flow 3lr I ____ ":: _ ~-~ -·-~ ~-----
Actual Flow .Jil
Design Width Jr:f6'
Actual Width E1'<7
Soil Test Date jg IY/{t 1/a 1/tD
pH Fields ·
Lime Needed f,5 Ft o-
Lime Applied ~O'f
cu-I ~z~--
Needs P
C ro Yield
'100
'A..-y)"
Pull/Field Soil Crop
I lr~BJ.h !::C. Av
~ /
J
~
)
6
l"J
n-nts resN''4fifd... ;:xa
Wettable Acres ...._/
WUP /
Weekly Freeboard ~
1 in Inspections ....,/"'
120 min Insp. \...-"""'"
Weather Codes
Transfer Sheets
Acres PAN
5S' ~b1rY/J D
\v
Verify P~di<IE NUMBERS and affiliation s
Date last WUP FRO 315io ~ Date [ast WUP at farm
-·(;l-, \~)
FRO or Farm R ecords
Lagoon#
Top Dike l\5,)
StopPump ~
Start Pump 1. o
Conve r sion -Cu-I 3000 = 108 lb/ac; Zn -1 3 000= 2 13 lb/ac
4
5
-·---·
I I I I
5 6 7
6 7
~AUGE
~x or incinerator
Mortality Records
B
Window Max Rate MaxAmt
~~ v I
App . H a rdware
Ree \ "'"''\s t-J ss ~vi\u 4-
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit OXkoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Region: EJe 0 Date of Visit: I i ct-1\ \0 J ArriniTime:l;: 00 PH I Departure Time: lb I i5 1'111 County:Sanpstl1
Farm Name: Scoft Byrd. ~/ /I'J Owner Email: ------------
Owner Name: sCOt[ "f3ya:L Phone:
Mailing Address: -----------------------------------------
Physical Address: ...:..S"""'""'t..~.,;c').:..:i!;Li.~·-\3z::...;~~r;.....:t1-~--------------------------___ _
Facility Contact: -----------~Title: --.~oO,:;..,:..;W_,_I'Iu.r.._r______ Phone No: j 9r Z 55";2.
Onsite Representative: Scot\:·Q.... R01ald Grr~ Integrator: ---'-M ...... -___..\3'-------------
Certified Operator: ~ ----=(3~~1/':....J_=----------Operator Certification Number: 989tJNZ
Back-up Operator: ~Q'!a 'L r?yrJ. Back-up Certification Number: q8C(08<(
Location ofFarm: Latitude: D OD'D" Longitude:
Discharges & Stream Impacts
I. Is any disch arge observed from any part of the operation? 0 Yes ~No
Di s charge originated at : 0 Structure 0 Application Fi eld 0 Other
a . Was the co nveyance man-made? DYes 0No
b. Did the discharge reach waters of the State? (If yes, notil)t DWQ) DYes 0No
c . What is the estimated volume that reached waters of the State (gallons )?
d. Docs discharge bypas s the waste management system? (If yes, notify DWQ) DYes 0No
2. Is there evidence of a past di scharge from any part of the operation?
3. Were th ere any adverse impacts or potentia l adverse impac ts to the Waters of the State
other than from a di sc harge?
P age I of3
DYes ~No
DYes ~N o
12128104
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
Co ntinued
~acilitY Number:~ -fR091 Date of Inspection !ICH It 0
Waste CoUection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: .5fog..e ( ~l.
0 Yes KINo DNA 0 NE
DYes 0No DNA 0 NE
Structure 5 Structure 6
Spillway?: -----------------------------------------
Designed Freeboard (in): _ _._\"d....._ ____ --~5~;)..:!..-_ __ -------------------------
Observed Freeboard (in): __ lL.:d..~. ::.....__ ___ ----l~~Ltl....---------------------------
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
0 Yes 1i'J No DNA ONE
6. Arc there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
0 Yes "l;iJ No 0 NA D NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Docs any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes !BNo DNA ONE
II. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes l;g No 0 NA 0 NE
D Excessive Ponding 0 Hydraulic Overload 0 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 0 E vidence of Wind Drift 0 Application Outside of Area
12. Crop type(s) Cot}Jia l ~111~a. ~; Sma11 Grab O:i!Jff'J_ J Cmtn ~l()h,l
13. Soil type(s) pw!ry1d lle..... \s
14 . Do the receiving crops differ from those designated in the CAWMP? DYes ~No DNA ONE
15. Does the receiving crop and/or land application site need improvement? DYes ~No DNA ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination '! DYes -~NoD NA 0 NE
17 . Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reviewer/Inspector Name
Reviewer/Inspector S ignature:
Page 2 of3
DYes ~No DNA ONE
DYes ~No DNA ONE
Phone:,~~~~--~~~-­
Date:
12128104 Continued
(Facili~ Number:~~ -@?I
Required Records & Documents
Date of Inspection ll CH\ f 0 I
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components ofthe CAWMP readily available? lfyes, check
the appropriate box . D WUP D Checklists 0 Design D Maps D Other
21 . Does record keeping need improvement? If yes, check the appropriate box below.
DYes l)lNo DNA D NE
DYes ts(No 0 NA 0 NE
DYes iZJNo 0 NA D NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Annual Certification
0 Rainfall D Stocking D Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did th e faci lit y fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facil ity fail to calibrate waste application equipment as required by the permit?
25. Did the facilit y 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 sec ure a phosphoru s loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-complian ce 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 / di scharge, freeboard problems, over application)
32. Did Reviewer/I nspector fail to di scuss review/inspection with an on-site representative?
33 . Does facility require a follow-up visit by same agency?
Page 3 of3
DYes ~No DNA ONE
DYes 0No ~NA ONE
DYes ~No DNA ONE
DYes Iii~' gNA ONE
DYes ~No DNA ONE
DYes 0No fia:NA ONE
DYes !Sl"No 0 NA D NE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes (:&No DNA ONE
DYes ~No DNA ONE
DYes "tilNo DNA ONE
12128104
C6"d-ft~q I ~Facility No .~ l~ Farm Name _S<l)--="""'-~'-'----J'3......,Y'-CC!.___;__; __ Date _____ _ ~ I
Permit COC OIC_ NPDES (Rainbreaker PLAT Annual Cert )
Pop. Design Current
T_ype
Lagoon
Spillway
Design freeboard
Observed freeboard in)
Sludge Survey DateEffi~l'r\ VI\\ :::1 o I")
Sluc!ge Depth (ft)
Liquid Trt. Zone (ft)
Ratio Sludge to Treatment Volume
Glhlto
Calibration Date 1~
Design Flow ]it. i
Actual Flow ·?I t I
Design Width \~
Actual Width i '1 ")
Soil Test Date I \d \ I ( 0 r~\,(~·1 6
pH Fields
Lime Needed x·-1-?f~..-/lj
Lime Applied _v"":---
Cu-1
Needs P
Cro Yield
2
~~
~:)..
~Th
':;tj')
Pull/Field Soil Crop
\ A.i.l\llfi '"" l~<fl-lk.
cl I '1
)
'i ..,
b
1 -
AI\ SG
I Cal\
1 2
3 4
Wettable Acres--'/~_
WUP ,·/
Weekly Freeboard ,/
1 in Inspections · -
120 min Insp. __ _
Weather Codes
Transfer Sheets
Acres PAN
3,1:1;. JWs-
q.,~
~0
~ 'i'l
,, !{'/
LlN
_L ~'t.
50
3
I I I I
4 5 6 7
5 6 7 8
RAIN GAUGE
Dead box or incinerator __ _
Mortality Records
Window Max Rate Max Amt
~& -i1P {J.C; .J-r(J ; :f5
v
1Sffl-Hu, .. I
514( D. •' ) . -. .., " .
Verify PHONE NUMBERS and affiliations .'J.f ·. 'Jc {{~ -\u ft, \ "J.h ~ ~-t~ I€JOr
Date last WUP FRO :JI(}olof:' Date last WUP at farm App. Hardware
FRO or Farm Records
Lagoon#
Top Dike
Stop Pump
Start Pump
Conversion-Cu -I 300 0= 108 lb/a c; Zn -1 30 00= 213 lb/a c
•'
Type of Visit 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit "':le Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 other 0 Denied Access
Date of Visit: tf.J}(J'f J Arrival Time: I 05."1s-P'11 Departure Time: )7,'00 Ptf I County: SornfJ01 Region:F~
Farm Name: ..SCIJft (3yn( Ftv'b Owner Email: -----------/
Owner Name: .S Catf: f3v~ Phone: I
Mailing Address: sso stra ..... PM School YJJ. ....... N ...... e.o..:..:rrirn...:..;;......:.....:::;~;..:..ooiM:!,_=..r._~----Q&3bf
Physical Address:------------------------=:-----------------------
Title: _{)=---~~ll'-lo<ft:~-----Facility Contact: 5coft Bvtd.... PhoneNo: ___________ _
Onsitc Representative: Dtt"ls ;scoft -».,d..
, I /J
Certified Operator: Scuft --=";..,ll,_:.ff1..--~=--------
Integrator: ~H'-'--'-!K-ef;_;_;~r-Y_-..::;J3r:----"-O_h_']L..-_____ _
Operator Certification Number: _Cfg~_'f!...:{A=--=...:7~--
Back-up Operator: ~«i_ Back-up Certification Number: qsqO~'f
Location of Farm: Latitude: D OD'D" Longitude: D OD'D"'
Discharges & Stream Impacts
L Is any discharge observed from any part of the operation?
Discharge originated at: D Structure D Application Field D Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
DYes ~No DNA ONE
DYes DNo DNA ONE
DYes DNo DNA ONE
DYes DNo DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
12128104 Continued
D»te of Inspection IJl£JDql
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Stn1cture I
I de ntifi~r: 5-l-e?tt
S pillway?:
Stn1cture 2 Structure 3
5~eJ..
Structur..: -t
D Yes ¥No DNA ONE
DYes 0No DNA ONE
Structur..: 5 S tructure 6
Des igned Freeboard (in): ---11"'-d..c._ ______ _.SA.,t..iii::;:o.... ______________ ------------
Observed Free board tin): --.~~l.t~~.l~o......... ____ .~...~IO~O'----------------------------
5. Are there any immediate threats to the integrity of any of the structures observed?
(iellarge 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 ~No DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate pubUc 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)
'EfYes 0No DNA ONE
0 Yes t'){No DNA 0 NE
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
0 Yes fj4'No DNA ONE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes MNo DNA ONE
II. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes LlrNo DNA 0 NE
0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN > 10% or 10 lbs D Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of W~ Drift D Application Outside of Area
12Crop lype(s) Oh-/a I !Mnt=t!IL #o,0 S G ~ Q¥ n-gr01b
13. Soil type(s) ..LA..l!:v::.~B"-..... lS'~-------------------------
14 . Do the receiving crops differ from those designated in the CAWMP?
15 . Does the receiving crop and/or land application site need improvement?
DYes
D Yes
16._ Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination'i 0 Yes
. 17 . Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
D Yes
D Yes
l;)GNo
~No
ti§No
~No
~0
Comments (refer to question#): Explain any YES answen and/or any recommendations or any other comments.
Use drawi.op of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
Reviewer/Inspector Signature:
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
I Facility Number:~~ -fa/8 I
l{cquirffi Records & Documents
Date of Inspection liJj)SJoq I
19. Did the facility fail to have Certificate of Coverage & Permit readily avai !able?
20. Does the facility fail to have all components of theCA W:MP readily available? If yes, check
the appropirate box. 0 WUP 0 Checklists 0 Design 0 Maps 0 Other
DYes 0No DNA ONE
DYes ~No DNA ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ~No 0 NA 0 NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Annual Certification
0 Rainfall D Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain lnspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? DYes ~No DNA· ONE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes 0No ~NA ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes ~)it No DNA ONE
25. Did the facility fail to conduct a sludge survey as required by the permit? DYes "[)1No DNA ONE
26 . Did the facility fail to have an actively certified operator in charge? DYes t8No DNA ONE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? DYes 0No ~NA ONE
Otlwr Issues
28. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes ~No DNA ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes IE No DNA ONE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? D Yes ~No DNA ONE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notifY the regional office of emergency situations as required by DYes ~No DNA ONE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes ~No DNA ONE
33. Does facility require a follow-up visit by same agency? DYes ~No DNA ONE
Additional Comments aocllor Drawings:
• -
-....
12118104
• Fadlity No .~kf Farm Name SaJfrBvrd
I
Date 1lblO~
Permit COC ---OIC_ NPDES (Rainbreaker
Pop. Type Design Current I FB Droes
I I I
Lagoon
Spillway
Design freeboard
Observed freeboard (in)
Sludge Survey Date s\~'tlO'f
Sludge Depth 1ft) & %
Liquid Trt. Zone (ft)
~o\~rer-
Calibration Date 1flhn
Design Flow "'·' Actual Flow ~I· I
Design Width ~
Actual Width 14}..
Soil Test Date ~;r-f(<8
pH Fields
Lime Needed '('()
~~eAp~d z~
Needs P-3?i[
Waste Analysis Date ~115"1()((
-60 Day
+ 60 Day ··
Qp,J
2
~~~
lit').
~00
~
1 2
~IOV
J.'1
q._Y
3 4
/ Crop Yield
Wettable Acres \/
WUP --=/:...._,..-... -
Weekly Freeboard 7
Rainfall >1" v-
1 in Inspections __
t,.o.tt I~
3
'
N Amt (lb/1000 Gal 1. U -~.'S Y,o
pH '·'i "1./~."1 1.C
/ J
Pull/Field Soil Crop RYE PAN
r
' ~~Orl ~~~ ff'flli . Ml'(~~ "W'd/1 ~~
Venfy PHONE NUMB and affiliations
Date last WUP FRO I Of Date last WUP at farm
~ ") .J.-_ -1F--=<
r Farm Records~.:#-I':! -A-i:> f{~~~
ag n # ~O -~--/ ';;J
Top Dike ~ Lb-. -r y 4 '
Stop Pump ~ . ct '31 , '> .
Start Pump ld-3t{,(p:J -Y,3?:'1aJ ~
1,/f\-h~
4
5
Window
I ''
PLAT Annual Cert )
5 6
6 7
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
7
8
Dead box or incinerator __ _
Max Rate
\.V
MaK .Afftt
--~11 .4M7 ..rll' ,, .,,
V ~ I
Type of Visit 8 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit '9 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
Date or Visit: IZ ltd Oi I Arrival Timedld: ~ Pt"fl Departure Time: lr. Jot' t( I County: ~fJ 0,
S ft h r:-r-: NJIM ov5
Region: F@
Farm Name: CtJ D.,cJ_ ltJfh] Owner Email: ___ .------------
1
Owner Name: Senft ..-:;;;e'-iY'-'-"' ..... rL'-='--------
.1
Phone:
Mailing Address: ruo S±rm... PM -SLhOIJ I Q.d_.
Physical Address:-----------------------------------------
Phone No: _________ _ Facility Contact: ---1R&lrf'lll"''(l::lli'llt(:rl---------Title: -----------
Onsite Representative: -~-..=l~~l.L..------=By=+~rL~::...._------Integrator: --~.t'W~--------------
Certified Operator: .:=~:..::(J)=-ft.u...... _____ ......:::;;B-ttt""'"rJ..~__,=---------Operator Certification Number: AM49890!'7
A 'r.!t'tqgq o 8i '
Back-up Operator: ....~R_._n,.wau.:/L=-----__ B+,."-'ryL,=------
1
Back-up Certification Number:
Location of Farm: Latitude: D OD'D" Longitude: D OD'D"
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? DYes ~No DNA ONE
Discharge originated at: D Structure D Application Field D Other
a. Was the conveyance man-made? DYes 0No DNA ONE
b. Did the discharge reach waters ofthe State? (If yes, notify DWQ) DYes 0No DNA ONE
c. What is the estimated volume that reached waters of the State (gallons)? I
d. Does discharge bypass the waste management system? (If yes, noti fy DWQ) DYe s 0No DNA ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
DYes 18'No
DYes 'f8:No
12128104
DNA ONE
DNA ONE
Continued
@cility Number:~ -{ft(Qq I Date oflnspection lcgHrl09 I
~ CoUection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier: ...;~_!'~".:..=4N~--Selbtr/fky
Spillway?: / /
Structure 4
DYes l)lNo DNA D NE
DYes 0No DNA ONE
Structure 5 Structure 6
•'
Designed Freeboard (in): _..,:.\),,iOo.... ____ ....::~~~;...~........._ _______ ------------------
Observed Freeboard (in):_\.~..~+-----=1-t( ~~~ -'E-Ct:xredfll OVS
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
DYes ~No DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ~Yes 0 No DNA 0 NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/o r wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0 . Are there any required buffers, setbacks , or compliance alternatives that need
maintenance/improvement?
DYes ~No DNA ONE
DYes £8No DNA ONE
DYes r8rNo DNA ONE
I I . Is there evidence of incorrect app li cation? If yes, check the appropriate box be low. D 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 D Total Phosphorus D Failure to Incorpo rate Manure/Sludge into Bare So il
D Outside of Acceptable Crop Window D Evidence of Wind Drift D Application Outside of Area
12. Croptype(s) ConJfa\ \3frM~dt! Hay; SG or
13. Soil type(s) ~1..!;.1~~~\u\~--------------------------------
14. Do the receiving crops differ from those design ated in the CA WMP? DYes
l5. Does the receiving crop and/or land app lication site need improvement? DYes
l6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?O Yes
17 . Does the facility lack adequate acreage fur land application?
18. Is there a lack of properly operating waste application equipment?
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
DYes
DYes
g"No DNA ONE
!RNo DNA ONE
lllNo DNA ONE
~No DNA ONE
j(JNo DNA ONE
!'Facility Number:td. -4h'fl Date oflnspection ISIIIJtJlf 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 appropirate box. 0 WUP D Checklists 0 Design 0 Maps D Other -
DYes ~No DNA ONE
DYes 18fNo DNA ONE
21. Does record keeping need improvement? lfyes, check the appropriate box below. DYes ~No DNA 0 NE
0 Waste Application D Weekly Freeboard D Waste Analysis D Soil Analysis D Waste Transfers 0 Annual Certification
0 Rainfall 0 Stocking D Crop Yield 0 120 Minute Inspections D Monthly and t" 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 equipment?
24. Did the facility fail to calibrate waste application equipment as required by the penn it?
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 Joss 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 nonnal?
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 ~No DNA ONE
DYes 0No !SiN A ONE
DYes ~No DNA ONE
DYes 181No DNA ONE
DYes [a No DNA ONE
DYes 0No IBN A ONE
DYes 13'No DNA ONE
DYes 18No DNA ONE
DYes IE' No DNA ONE
DYes 18fNo DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
7 k"eer r.,otlt,~ on I~ covrr -e>r boil, ~OtnJ. Pfe0l:. aJJ...s~ +ofsoJJJ q_
11 ht-(ntJ r c.h +o S"'fflen~~-r gftJrJe ( VI)YJ9-JI
I J srra i!ie!l U a bit sp.n:J cDJfeJ._, IVevfie/J:: is~; II 1~ {,. 'ntu_r{l!fL
s t welJ..s \'Y 8-e. s pra,eL l 11\"fitlL ... fu\l' ret tr lilrw II DR:: ""'1 ~ ~ .. r::~S'J rr~ .
Jl, J.lu II liT mode a cror ~ e+' PbJe.. ke-ef cror yieiL ret&dr lvhfl'l Hdtt-J m4kt>.
Spta.leJ a_ 1H\1e~ ~IJ 5 .,mmir -\-p htfp grtJJJ.
c;>t~ PleiJJe dP ~' CJ-t JlvJ,~ .svrve! :1'01\-Mihh ~OO't) before new ,,mif apfh'ctfb·o •.
OlllJ ol o ~ 1.!1-)aj 'bon.
N ott tt o+ ~ -Ptv",. cor.,:
ISr veeLstrtlf·~ JO\·e o,fiet! ~reef,
Page3 of 3 12/28104
'Facility No. ~-hbC( Farm Name ________ Date ~fttfOR
Permit COC ./ OIC_ NPDES {Rain breaker PLAT Annual Cert)
Current I FB Drops
I I I
Freeboard / 1 2
Design
BIMS
Observed (in} 14"
SludQe Survey Date Perm Liquid (ft)
SludQe Depth (ft)
Calibration Date 1fd11nt
DesiQn Flow ~)
Actual Flow ll'J
Spray Flow
Design Width -~00
Actual Width cnl
Soil Test Date Ylt51~
pH Fields ..r
Lime Needed ./ •
Cu ./ Zn_7_.,..__
NeedsP--~
Waste Analysis Date
-60 Day
+ 60 Day
N Amt {lb/1 000 Gal)
pH
Pull/Field
.....
~· ~.r. .-•5" ..::t"'tt'P-~-:;
':flJ. 0 4).'.-,
~l,s
Yf,fi)
Lii)QJ._
hl~ltJi
11.0
7.'f
Soil
2 t,hla 3 4
-~.\
I~. I
'~ ,...,.,..
Crop Yield lJ/A
Wettable Acres 7
WUP/ -'""7""'-
Rain Gauge 2..
Weekly Freeboard V
Rainfall >1" -:::;;r-
-·-:J14U.
l'f."t
1/.fl
Crop
l?Rn1..-JtJ f[t-,
Sr'"">
0. f, tlv"
tft-toiaf
/
3 4
5
Pan
~.5'
:.,v
5 6
6 7
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
Window
Ha--Sto,+
SPP-M v /
7
8
Type of Visit e.. Compliance Inspection 0 Operation Revi ew 0 Structure Evaluation
Reason for Visit {)jRoutine 0 Complaint 0 Follow up 0 Referral
Date of Visit: ~ Arrival T im e: I ~ ~ I Dep arture Time: ....__........,"'--'_-'
Farm Name' ~!,_ 'l=(M"ffiS, Owner E ma;l,
Owner Name' ~~ ~d Pbon e ' ---------------
Mailing Address: -----------------------------------------
P hysical Address:""""'----,~-~---=---------.....,~----------------------
Facitily C ontact' S 0\\) %d. T;tle ' 0 \.:0J'QJ( Pbone No' -~~------
O o s;te R e present ative' _&o-1\. ~d_. lntegrato" ro \&( ~ ~ e;;;;.;
CertUied Opera ton ~-\\, ~ Operat or Certification Numben q:&q Q~J
Ba ck-up Operator: --------------------Back -up Certification Numbe r :
Lo cation of Farm: Latitude: D OD 'D " Longitude: D o o ·o~"
Di scharges & Strea m Imp acts
1. Is a ny di scharge obse rved from any part of the operation?
Discharge originated at: 0 Structure 0 Application Field 0 Other
a . Wa s the conveyance man-made?
b . Did the disch arge rea ch wate rs of the State? (If yes , notify DWQ)
c . What is the esti mated volume that reached wate rs of th e State (gall o n s)?
d. Does d ischarge bypass the waste management system? (If yes, noti fy DWQ)
2. Is the re evid ence of a past di sc harge from an y part of th e operation ?
3 . Were there any adverse impacts or pote nti a l adverse im pacts to the Waters of the State
othe r th an from a discharge?
Page 1 of 3
I
D Yes ~No D NA O NE
D Yes 0 No ~A O NE
D Yes 0 No ~A O NE
~ ....-I
D Yes 0 No ~A O NE
D Yes ~No D NA O NE
D Ye s _n No D NA O NE
12118104 Con tinued
I Fatility Number:~ -<o~S Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: -z_
Spillway?:
Designed Freeboard (in): ..--.. ~lp
Observed Freeboard (in):
.__) 1~0
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
DYes ~No DNA ONE
DYes 'YNo DNA ONE
Structure 5 Structure 6
DYes ~No DNA ONE
DYes _jSa)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? DYes 9aNo DNA ONE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
DYes ~No DNA ONE
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement? DYes ~No DNA ONE
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes ~No DNA ONE
II . Is there evidence of incorrect application? If yes, check the appropriate box below. DYes ~No DNA ONE
0 Excessive Ponding 0 Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn , etc.)
0 PAN D PAN> 10% or 10 lbs 0 Total Phospho rus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Ev idence of Wind Drift 0 Application Outside of Area
12. Crop type(s) 0\ d \e:l
1
0Qk_5
13. Soil type(s) Av.. 1 1A-lo.....
14. Do the receiving crops differ from those d esignated in theCA WMP? DYes
15. Does the receiving crop and/or land application site need improvement? DYes
16. Did th e 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? DYes
~0 DNA ONE
~No DNA ONE
~No 0 N~ D NE
~0 DNA ONE
18. I s there a lack o f properly operating waste application equipment? DYes._..)No DNA ONE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Us_e drawings offacility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name 1
R eviewerflnspector Signature:
Page2of3
------·-----l Pbooe.
Date:
I Facil~ty Numbe~ £W I
Required Records & Documents
Date orlnspeclion ~
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 readil y available? lfyes, check
the appropriate box. 0 WUP 0 Checklists D Design 0 Maps 0 Other
0 Yes .Kl.J.Jo DNA 0 NE
DYes ~No DNA ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes tJ. No 0 NA 0 NE
0 Waste Application 0 Weekl y Freeboard 0 Waste Anal ysis 0 Soil Analysis 0 Waste Transfers D Annual Certification
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rain Inspections D Weather Code
22. Did the facility fail to install and maintain a rain gauge? 0 Yes ~o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes 0 No
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes OtNo
25 . Did the facility fa il to conduct a sludge survey as required by the permit? 0 Yes ...llJ No
26. Did the facility fail to have an actively certified operator in charge? 0 Yes ~ No
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
DYes DNo
DNA ONE
PlNA O NE
DNA ONE
DNA ONE
DNA ONE
~NA ONE
28. Were any addi tional problems noted which cause non-compliance of the permit orCA WMP? DYes ~No DNA ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the in spection 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, fre e board problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site repres entative?
33. Does facility require a follow-up visit by same agenc y?
Additional CommentS and/or Drawings:
Page3 of3
DYes ~0 DNA ONE
DYes ~No DNA ONE
D Yes ~N o DNA ONE
DYes P'1No DNA ONE
DYes ~No DNA ONE
...
1-
-...
12128104
Time In~""'"'·~--Time Out____ Date _1.....:~-4~._(~~-tJ-L] __
Farm Nam~r-~rr::te.~~.L-..!._~~~~------Integrator _ __.·(§\~-\-,~~--.&..;;:.._____ _____ _
Owner -~~~~--r'!~~~-=----------Site RR;
Operator No. j 19 ~J
Back-up ------------------No.---------
COC Circle: General or NPDES
~ ~ Design Cur(ent,. Design Current
( WP::~n J=p_ari..) I?IDD 10 l't-'\ Farrow Feed
Wean -Finish Farrow -Finish
Feed-Finish Gilts I Boars
Farrow-Wean Others
Design _____ _ ObseNed --------
~ __ ___,!,____--=~--
Waste Transfers ____ _
Rain BreaKer ___ _ .....
Wettable Acres ___ _ PLAT ___ ---..... __ _
Weekly Freeboard .. ~ Daily Rainfall ___ _ 1-in Inspections ____ _
Spray/Freeboard Drop -------------------------
Weather Codes 120 min Inspections ___ _
Waste Analysis:
Date Nitrogen (N) Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Rea son for Visit 8 Routine 0 Complai nt 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Dat e of V isit: liz-27 -() b I Arrival Time: I 0 Z ~ 2 0 I
''""' Farm Name: Scoff= Byrd F-o,..v~v~
Departure Time : I 02 ~50 I C oun ty: sa-~ 5.z6L L...;:;..~-=-.::;)1..-=""' I
Region: F/lfJ
Owne r Email: -------------
Owne rName: Scot~ s..,rJ Phone:
Mailing Address: ~So S+.-o..w Po~ Rat Sdas/ R.d ___.AI'--'-""",~=..o..,;"""'N .............. Go:.Lt:o............_v~L-.....,7.,...-:-IJ=-c..~ '2. ~3~ k
Physical Address:----------------------------------------
Facili ty Contact: --------------Title:-----------Phone No: ___________ _
Ons ite Representative: ------------------Integrato r :----------------
Certified Operator:---------------------Operato r Cer tification Number: -------
Back·up Operator: --------------------Ba ck-up Certification Number :
Loca tion of Farm: Latitude: D OD 'D " Longitude :
Di sch a rges & Stream Impac ts
1. Is an y di scharge observed from any part of the operation? D Yes ~No D NA O NE
Di scharge ori gi nated at: 0 Structure D App lication Fie ld D Other
a. Was the co nv eyance man-ma de?
b. Did the disc harge reach wa ters of the State? (If yes, noti fy DWQ)
c. Wha t is the estimated volume th at reached wate rs of the State (gallons)?
d . Does d ischarge bypass th e waste manageme nt system? (If yes, notify DWQ)
2. Is there evidence of a past disc harge from any part ofthe operati on?
3. We re there any adverse impacts or potentia l adverse impacts to the Waters of t he State
other than from a disc harge?
Page I of3
·u
t mn "if ·rftttr r"' r·-·-.
D Yes ~No D NA O NE
DYes l1J No D NA O NE
D Yes ~No D NA O NE
D Yes fi No D NA O NE
D Yes [jj No D NA O NE
12128/04 Con tinued
I Facility Number: ~2.-4,4. 'f I Date oflnspection ltz·Z7 -~(p I
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifie r : "(pq -I <z tqq -z...
Spillway?:
DYes nl No D NA ONE
DYes ~N o D NA ONE
Structure 5 Structure 6
Designed Freeboard (i n):------------------------------------
Obs erved Freeboard (in): __ ....;g::;....;;..l ____ q.!..-5~--------------------------
s. Are there any immediate threats to the integrity of any of the structures observed ? DYes
(ie/ large trees , severe erosion, se epage, etc .)
EfJNo D NA O NE
6. Are there struct ures on·site which are not properly addressed and/or managed D Yes ~N o D NA ONE
through a waste management or closure p lan?
If any of questions 4-6 were answered yes, and the situ ation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improv ement?
8 . Do any of the stuctures lack adequate markers as required by th e permit?
(Not applicable to roofed pits , dry stacks and/or wet stacks)
9. Does any part of the waste management system o th e r than the waste structure s requi re
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or com pl ian ce alternatives that need
maintenance/improvement?
DYes ~No DNA O NE
DYes ~No D NA ONE
D Yes ~No DNA O NE
D Yes [tJNo D NA O NE
II. Is there evidence of in co rrect application? If y es, chec k the appropriate box below . 0 Yes ~N o D NA 0 NE
0 Excessive Pending 0 Hy draul ic Overload 0 Frozen Ground 0 Heavy Metals (Cu , Zn, etc.)
0 PAN 0 PAN > 10% or 10 lbs 0 Total Phospho ru s 0 Fail ure to Incorporat e Manure/S ludge into Bare Soil
0 O utside of A cceptab le Crop Window 0 Evidence of Wind Drift 0 Application Outside of Area
12. Crop type(s) ------------------------------------
13 . Soil type(s)
14 . Do the receiving crops differ fro m th ose designated in th eCA WMP? D Yes ~No DNA O NE
15. Does the receiving crop and/or land application site need improvement? DYes !)!' No 0 NA 0 NE
\
DYes f;J No 0 NA 0 NE 16. Did the faci lity fai l to sec ure and/or opera te per the irrigation design or wettable acre determination ?
17. Does the facility lack adequate acreage for land appl ication? DYes ~No DNA O NE
18 . Is there a lack of properly operat ing waste applica tion equipment? D Yes ~No DNA O NE
·.toiciu'estion #): Explaiil any YES answers
fac:il_icy~1to b etter explain situations. (use att'lll.lho,na.l,plllge:s
R eview er/Inspector Name
Re\iewer/lnspector Signature: Date:
Page 2 of3 12128104 Continued
I Facility Number: ~2. _,"<OJ I Date of Inspection ltz ·2 7-b~
Required Records & Documents
19 . Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
the appropriate box . 0 WUP 0 Checklists 0 Design 0 Maps D Other
DYes El}No DNA ONE
DYes [5fNo DNA O NE
21. Does record keeping need improvement? If yes, check the appropriate box below. D Yes [)fNo DNA 0 NE
0 Waste Appli cation D Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Annual Certification
0 Rainfall 0 Stocking D Crop Yield 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 5JNo DNA O NE
23. If selected, did the facility fai l to install and maintain rain breakers on irrigation equipment? DYes cyNo DNA O NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? D Yes (JNo D NA 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 ~No DNA O NE
27. Did the facility fail to secure a phosphorus lo ss assessment (PLAT) certification? DYes [»No DNA ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes QfNo DNA ONE
29 . Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes [j7No DNA ONE
and report the mortality rates that were higher than normal?
30. At the time of the in s pection did the facility pose an odor or air quality concern? DYes
If yes, contact a reg ional Air Quality representative immediately
QI'No DNA ONE
31. Did the fac ility fai l to notify the regional office of emergency situations as required by DYes [,lPNo DNA ONE
General Permit? (ie/ di scharge, freeboard problems, over application)
32 . Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? DYes ~No DNA ONE
33 . Does facility require a follow-up visit by s am e agency? DYes ~No DNA ONE
Additional Comments and/or Drawings:. ·r:~~~z: .... -
-......
Page3 of3 12128/04