820679_INSPECTIONS_20171231

l
NORTH CAROLINA
Deparbnent of Environmental Quality
Reason for Visit:
Departure Time: I 3 ~ "\:)~ I County:~ Region: £,RD
Farm Name: let-2-: Owner Email:
Phone:
Physical Address:
Facility Contact: Phone: ~Dy .f12ut1.; Title: ----~~~~~~~~~~~~--------
£---Onsite Representative: Integrator: ~,/19;
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any pan of the operation? 0 Yes (2J.No
Discharge originated at: 0 Structure D Application Field 0 Other:
a. Was the conveyance man-made? DYes 0 No
b. Did the discharge reach waters of the State? (If yes, notify DWR) 0 Yes 0 No
c. What is the estimated volume that reached waters of the State (gallons)?
d. Docs the discharge bypass the waste management system? (If yes, notifY DWR) 0 Yes 0 No
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
0 Ye s ~No
DNA ONE
DNA ONE
DNA ONE
DNA O N E
DNA ONE
DNA ONE
l /411015 Continued
.)Facility Number: 8/--(p ZJ
Waste Collection & Treatment
joate of Inspection: q:;_;;?j/-; 7
( 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
'
0 Yes !3No
0 Yes 0 No
DNA D NE
DNA ONE a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: rttd-:.bpJ
Spillway?:
Designed Freeboard (in): ?Gf ~(7
Observed Freeboard (in): J 7 d0
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?
Structure 5 Structure 6
0 Yes g) No 0 NA 0 NE
0 Yes !3-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 DWR
7. Do any ofthe structures need maintenance or improvement? ~Yes £fff!ffo 0 NA 0 NE
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks , and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes J2?1No DNA ONE
DYesS-No DNA ONE
DYes ~No DNA ONE
II. Is there evidence ofincorrcct land application? If yes, check the appropriate box below. 0 Yes [3. No 0 NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Gro und 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN > 10 % or 10 lb s . D Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Approved Area
12. Crop Type(s): :lf-_,mJ.Je /P~V3~~~J
13. Soil Type(s): --1-=-!)------------------------------------
14 . Do the receiving crops differ from those des i!:,'llat ed in theCA WMP?
15. Does the receiving crop and/or land application si te need improvement?
16. Did the faci lity fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land ap pli cation?
18. Is there a lack of properly operating wa ste application equipment?
Required Records & Documents
19. Did the facility fail to ha ve the Cenificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
0WUP Ochec klist s D Design 0 Maps 0 Lease Agreements
21. Does record keepin g need improvement'! If yes. check the appropriate box below.
0 Yes [3.No DNA ONE
~Yes 0No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
[8. Yes 0No DNA ONE
0 Yes ~No DNA ONE
DYes ~No DNA ONE
Oother:
I8J.-Yes cii& 0 NA ONE
D Waste Application 0 Weekly Freeboard ~aste Analysis D Soil Analysis 0 Waste Transfers D Weather Code
D Rainfall 0Stocking 0 Crop Yield 0120 Minute Inspections 0Monthly and 1" Rainfall Inspections Ostudge Survey
22. Did the facility tail to instalJ and maintain a rain gauge?
23. If sel ected, did the facility fai l to in stall and maintain rainbreakers on irri gat ion equipment?
Page2of3
DYes ~o 0NA ONE
DYes ~o QNA O NE
214/2015 Continued
"I Facility Number: I Date of Inspection: ~1': { Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? / DYes ~No
DYes [21..No
DNA ONE
DNA ONE
I
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
0 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field 0 Lagoon/Storage Pond 0 Other:
32. Were any aqditional 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?
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
f3,No
~No
j8._No
j3No
~No
~No
~No
WNo
34. Does the facility require a follow-up visit by the same agency? D Yes j5a_No
DNA
DNA
DNA
DNA
DNA
DNA
DNA
DNA
DNA
Comments (refer to question#): Explain any YES answers and/or any additional recomm~ndations or any otber comments.
Use drawings offacility to better explain situations (use additional pages as necessary).
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date:
9'0-...3a3 -v tsZ
~~17
Page3 of3 2/412015
Reason for Visit:
Date of Visit: l¥fg:-/bl Arrival Time: I J : ot> Departure Time:l q,',J'V I county:~ Region: -~1)
Farm Name:'---,_,),._.1.(2'"'"-.=ll..:..:.I~.:;.;----L-N::uu~r:.:...:.:5~~,_,9c....~'-.t-/.~r6-/?-""-----
~0V 17Pur
Owner Email:
Owner Name:
I
Phone:
Mailing Address:
PhysicaiAddr~s: -----------------------------------------------------------------------------------
Facility Contact: _-.... ~--=:.&!'?'_,r---rM...=.o:u"-'n~L-----Title: Peo17 ~
/ I (I
Phone:
Onsite Representative: ---~~~~==--------------------------Integrator: __ 2'.n-z~1Q,C.~~~...;.~{/.::..._ ____ _
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
l. Is any di sc harge observed from any part of the operation? 0 Yes ~No DNA ONE
Discharge originated at: 0 Structure 0 Application Field 0 Other:
a. Was the conveyance man·made? DYes 0No DNA ONE
b. Did the discharge reach waters ofthe State? (If yes, notify DWR) D Yes 0No DNA ONE
c. What is the estimated volume that reached waters of the State (gallon s)?
d . Does the d ischarge bypass the waste management system? (If yes , notify DWR ) DYes 0 No DNA O NE
2 . Is there evidence of a past discharge from any part of th e 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 o/3
DYes
D Yes
6?J No DNA O NE
g) No DNA ONE
V412014 Continued
.!Facility Number: ,-v---Gz9' I I Date of Inspection: ?f:H-<}i0/4
Waste Collection & Treatment
.• 1 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): I?
Observed Freeboard (in): d? 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?
0 Yes g} No 0 NA 0 NE
0 Yes 0 No 0 NA 0 NE
Structure 5 Structure 6
DYes B N o DNA ONE
DYes (8}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? BYes ~ 0 NA 0 NE
8. Do any of !.he stru~.:tures 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?
D Yes ~Nu DNA O N E
DYes ~No DNA ONE
DYes ~No DNA ONE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~ 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 In corp orate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window D Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): .hmu/a ,/evrr;-g,...}
13. Soil Type(s): 0
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.
0WUP Ochecklists 0 Design 0 Maps 0 Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
DYes t3J No DNA ONE
"g) Yes 0 No DNA ONE
DYes I8J No DNA ONE
D Yes ~No DNA ONE
D Yes ~No DNA ONE
D Yes rRJ No DNA ONE
DYes ~No DNA ONE
O o ther:
""fi?J Yes 0No DNA ONE
p(i Waste Application 0 Weekly Freeboard 0 Waste Analysis ~Soil Analys is D W aste Transfers '0 Weather Code
0 Rainfall 0 Stocking 0 Crop Yield i2SII20 Minute Inspections D Monthly and 1 n Rain fa ll In spections D Sludge Surv ey
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?
Page2of3
D Y e s ~ No
D Yes g] No
D N A O N E
DNA O N E
214/2014 Continued
Wacility Number: - & jDate of Inspection:
❑ Yes
U No
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
'S No ❑ NA ❑ NE
the appropriate box(es) below.
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
® Yes
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA
❑ Non-compliant sludge levels in any lagoon
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
List structure(s) and date of first survey indicating non-compliance:
❑ NA
❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
Z] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
'® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No ❑ NA ❑ NE
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?
❑ Yes
® No ❑ NA ❑ NE
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
[—]Yes
E] No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
U No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
® Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
Cg No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #) ymm
Explain any YES answers and/or any or any other coments.h l
Use drawings of facility to better, explain situations (use additional pages as'necessary).
'5u�,- •va7 fI l3 rz�: jOl r✓i I T j�1�r� B�i�lJ�rd ��'Y� }tea / ^ D U r. ✓s rd i S
d- AJ145
/yt /ia, /tb% �'"ol�z—/firr�5.YD� l c ��OfDnz sF� c
�T
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: D /6
2/412014

..
•
DateofVisit: kP'-?-ArJ Arrival Time:l/ ,'pv DepartureTime:l,.?~oc..> I County: j'~,....._ Region: F){V
Owner Email: --------------------------------
Owner Name: Phone:
r ' Mailing Address:
PhysicaiAddr~s: -----------------------------------------------------------------------------------
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure 0 Application Field 0 Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
Phone:
Integrator: Mv~{p/1 w----
Certiftcation Number:
Certification Number:
Longitude:
DYes 2.No DNA ONE
DYes DNo DNA ONE
DYes DNo 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?
Pagel of3
DYes
DYes
~No DNA ONE
~No DNA ONE
1/4!1014 Continued
!Facility Number: I Date of Inspection: 2:-/S#6P'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): ;cr 17
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?
0 Yes 181-No 0 NA 0 NE
DYes 0No DNA ONE
Structure 5 Structure 6
DYes ~No DNA ONE
0 Yes ~ No D NA D NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threa4 notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as r equired by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9 . Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
1 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
0 Yes g) No D NA D NE
DYes ~No DNA ONE
j2g. Yes 0 No D NA 0 NE
DYes BNo DNA ONE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes ~No DNA D NE
0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground D 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 D Evidence of Wind Drift D Appli cation Outside of Approved Area
12. C ro p Type(s): :J2rt.. .. ~ / ove-r.j~/
13. Soil Type(s): -~T~~...J'----------------------------------
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 o r wettable
acres determination?
17 . Does the facility lack adequate acreage for land app lication?
18. Is there a lack of properly operating waste application equipment?
Reguired Records & Documents .
19. Did the facility fai l to h ave the Certificate of Coverage & Permit readily available?
20. Does the fa ci li ty fail to have all components of theCA WMP readily available? If yes, check
the appropriate box .
0WUP 0 Checklists D Design 0 Maps 0 Lease Agreements
21. Does record keeping n eed improvement? If yes, check the appropriate box below.
DYes {3No DNA ONE
~Ye s ~ DNA ONE
DYes ~N o DNA ONE
0Yt!S ~No DNA ONE
DYes gJ No DNA ONE
D Yes ~No D NA ONE
0 Yes ~No DNA ONE
DOther:
DYes ~No DNA ONE
D Waste Application 0 Weekly Freeboard 0 Waste Analysis D Soil Analysis D Waste Transfers 0 Weather Code
D Rainfall 0 Stocking D Crop Yield D 120 Minute In spections 0 Monthly and l" Ra infall Inspections 0 Sludge Survey
22 . Did the fac ility fail to insta ll and maintain a rain gauge? 0 Y es ~No 0 NA 0 NE
23 . If selected, did th e faci li ty fail to insta ll and maintain rainbreakers on irrigation equipment? 0 Ye s l25 No 0 NA 0 NE
Page2of3 214/2014 Continued
•!Facility Number: !Date oflnspection: ,g-C)-...;::z.:,ljt
24. Did the facility fail to calibrate waste application equipment as required by the permit?.
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
DYes ~No DNA ONE
D Yes {g.No 0 NA 0 NE
0 Failure to complete annual sludge survey DFailure 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., di scharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
DYes ~No DNA ONE
DYes (&No DNA ONE
0 Yes fSNo DNA 0 NE
DYes [BlNo DNA 0 NE
D Yes [8No 0 NA 0 NE
DYes ~No DNA ONE
0 Application Field 0 Lagoon/Storage Pond 0 Other: __________ _
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
;Jll'h-.; &12_~ Jrd ~ ~ -r . ;;4J IS'
51"'~ w~ rl':' nrovY') pz.o ~'•' ~r
'j-, /fovJt'! I t-VoAr.JJ-l!P'-?/ ;#'\... L-f:T ~#c---.
)Jo'-(f,
D Yes t81 No D NA 0 NE
0 Ye s E;l No 0 NA 0 NE
DYes ~o DNA ONE
, I 1 I ) ~-.J., f-l"""' 7/)_:.l~rj ~;-fL f}t?rr. ;' IS ,_vcr ~.:1-tu ~~ W r-.,vK. / t-<3""' vr 1> ~5
Rev iewer/Inspector Name:
Reviewer/Inspector Signature :
Page3 of3
Ph on e: 9;/0-433-3 3 00
Date: ;? -~-p2t!) / £:'
214/2014
Operation Review 0 Structure Evaluation
Reason for Visit: 0 FoUow-up 0 Referral 0 Emergency 0 Otber
Region: fM
Owner Email:
Pbone:
Physical Address: _?b!..:_ :.Lr---~...:Yo2J~~ ,_...:::La~1-'-'€.,"'"=-~)....L..fu""~-r~r-t:~-"""IJ~J-------------------­
__,.......,r-_._.<-=.:.:r--------Title: -~-="~ .... -e .... r'--------Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream lmoacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure 0 Application Field
a . Was the conveyance man-made?
0 Other:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Pbone:
Integrator: ..:H-1-'---lB-..-----------
Certification Number: -=Q~0:::..4-=--:l.(w)r.__ ____ _
Certification Number:
Longitude:
0 Yes -~No DNA ONE
DYes 0No DNA ONE
DYes 0No DNA ONE
d . Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes 0No DNA ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of3
DYes
O Yes
~No DNA ONE
~0 DNA ONE
114/2011 Continued
..
loate oflnspection: lalil l3
Waste Collection & Treatment
4_ Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: ~
Spillway?:
Designed Freeboard (in): }q,) )q,_s-
Observed Freeboard (in): ~5' (;}3
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
0 Yes ~No
0 Yes 0No
DNA ONE
DNA ONE
Structure 5 Structure6
' J
·,
DYes ~No 0NAl ONE
DYes ~No DNA-ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes
DYes
DYes
DYes
~No DNA ONE
i3'No DNA ONE
~No DNA ONE
t:i'No DNA ONE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes £SrNo D 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 0 Application Outside of Approved Area
12. Crop Type(s): Co01ia I 'f>Pr'Muda t\av j S;nq /'l .gtaih tMtflffi.
13. SoilType(s): 'Ibm a hatvk '3 I
14. Do the receiving crops differ from those designated in theCA WMP?
15-Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropriate box.
0WUP 0Checklists 0Design D Maps 0 Lease Agreements
21. Does record keeping need improvement? Ifyes, check the appropriate box below.
DYes L?No · DNA ONE
DYes 0No DNA ~NE
DYes ~No DNA ONE
ov~~No DNA ONE
0Y£ No DNA JiNE
DYes GiNo DNA ONE
DYes ]Sa No DNA. ONE
Qother:
DYes 1S'f No DNA ONE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Weather Code
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? D Yes l8f No 0 NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 2 of3
DYes 0No ~NA ONE
21412011 Continued
I Facility Number: <Sq.., I Date of Inspection: Q \2"113
i4. 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 0No
DYes 0No
DNA 621 NE
DNA -~NE
0 Failure to complete annual sludge survey 0Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? DYes ~No DNA ONE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? DYes 0No J>tNA ONE
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?
DYes ~No DNA ONE
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
DYes lSaNo DNA ONE
30. Did the facility fail to notifY the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
DYes ~No DNA ONE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. DYes I& No DNA ONE
0 Application Field 0 Lagoon/Storage Pond 0 Other: ----------------------
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes j8No DNA ONE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? 0 Yes CSNo DNA ONE
34. Does the facility require a follow-up visit by the same agency? 0 Yes ia'No DNA ONE
Comments (refer to question#): Explairfany::YES answers and/or any additional ~co~~~~d:!!tions or ,any;.Qther.·c:~in
~ •, ···-' '· ;· " ,",· ---. ·_ .. ·: ,,· ...... ,_---. __ . __ ,>. -' ---~·_.-·-~-·_-·:.-~ .. ""'~:-:~ ~;.}_$~~ .. :;:--··_.. _. _-_ ·'. ·.··---~----=:• ---~-~-·:
USe ·drawings of facility to better,~xpl:iin''sifuations (use additional pages as necessacy);;t/~j.£,;i~1tt£:;, . •. · ·: +'~Ji!;;;~~>•·,<!,t'!]
Reviewer/Inspector N arne:
Reviewer/Inspector Signature:
Phone: qll~433-33DO loffi~
Date: fg__ ~ 0)0 13
Page 3 of3 11411011
Date )a} 5//3 _ ~acility No. <6(J-(p7'f Farm Name ~'j. ~ vry
Permit -®t:...6'oc ~ c_ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
L-1 FB Drops
h 1,..1 f"J.. hl/.r;;\
rn~ I.-..
.... 1.-;.;...rn_
v •"../
Lagoon Name, S for spillway 1
Design Freeboard I Last Recorded (in)
Observed freeboard 0,
Sludge Survey Date l
Sludoe Depth (ft)
LiQuid Trt. Zone (ft)
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
Calibration Date 1 2 3
Ring Size (in)
Design Flow (gpm)
Actual Flow
Desiqn Diam. (ft}
Actual Diam.
Crop Yield
L~~
I..,. '"-fl I~JSl~
:tl;>':llD? qJr'tTn
ro IIPII\
2 3
.;::)"7.
./
4 5
4
s~ Q>OJ3
5 6 7
6 7 8
Soil Test Date TObe-n.ofk?;{_
pH Fields
Lime Needed
Wettable Acres \....:"""
WUP --
<Q[,b;wo_ Jf~~~ts ~il~fk Dead or incinerator __ _ cxog..__ Mortality Records
Ch eck Lists
Storm Water
Lime Applied
Cu-I Zn-1
Needs S (S-1 <25} __
Needs P
Waste Date ~lwlr\
-60 Day
+ 60 Day
N (lb/1 000 Gal) rl£.1£1 ,SX"
pH /
Pull/Field Soil
1-{o Th
i-rn
Weekly Freeboard c..---
1 in Inspections ~
120 min Insp. 7
Weather Codes ~
lfn~l/~ IJJNII~
'
r.n i/f ltD __,
Crop Acres PAN
( )J lk;., q. [(l'a-.--e ~~0 XT'
.c:d ~
..
Ve r ify PHON E NUMBER S ~nd affili ati ons
Date last WUP FRO 5 /1'-/{0/ FRO or Farm Records
Date fast WUP at farm Lagoon# .::#:-1 ~1{)[]1:;
ApR-Hardware Top Dike 10;)
S t>\1~~ Stop Pump q ~J
Start Pump fOO,;), H--;1').=-\q, r-
Conve rsi on -Cu-I 300 0= 10 81 b/ac ; Zn -1 3000 = 2 13 lb/ac
Window Max Rate
IHtt~.Yif-
~~~/
~ il
'\'\,&f\0: :l.t~-;::'()(2.._
~~}~
-it~ ~f5'l.tf) \~
(~5"'
qq,8
ID~j
H--r~Jll-)
~-
MaxAmt
11 \'-L()
Date of Visit: 112--lt.f~IJ+-Arrival Time:! I : oo I Departure Time:Loj ¢;z::;...;'''--"'o--'D~..JI County:.~ ~rr--
Farm Name:;....__,_,fuo""'-.w:Vo..!"\.J..,~~-).)=v~r:....:.5~t:-..:..r~'?"---~--!./---=rJ--=-,?--~ __ _
Region:
Owner Email:
I v I
f(o /" Owner Name: Phone:
Mailing Address:
PhysicaiAddress: --------------------------------------------------------------------------------------
Facility Contact: he:z V12un '7__.. --r r 7
Onsite Representative: __ ..::;S.::;._~_....:;;:::=-------------------------
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure D Application Field
a. Was the conveyance man-made?
D Other:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Phone:
Integrator:
Certification Number: ~2-D:.......!:::::........=.~ ..... o/~Z ____ _
Certification Number:
Longitude:
DYes ~No DNA ONE
DYes 0No DNA ONE
DYes 0No DNA ONE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes 0No DNA ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of3
DYes
DYes
~No DNA ONE
I2J No DNA ONE
214120Jl Continued
JFacility Number: f2": I Date of Inspection: 12 -Uf-12-
Waste CoUection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 19 19
Observed Freeboard (in):
5. Are there any immediate threats to the integrity ofany.ofthe structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
0 Yes i2S-No 0 NA 0 NE
QYes QNo DNA QNE
StructureS Structure6
QYes ~No DNA QNE
QYes ~No DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10 . Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes g) No 0 NA D NE
DYes ~No DNA ONE
DYes ~No DNA ONE
0 Yes [BJ No 0 NA D NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. D Yes [g). No 0 NA D 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 D Failure to Inc orporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): :J'-cmuda / ~v-r/J 'C"--J
13. Soil Type(s): _ _.~l~..::.o _________________________________ _
14. Do the receivi ng crops differ from those designated in the CA WMP?
15. Does the receiving c rop 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?
Page 2 of3
DYes
DYes
DYes
DYes
DYes
DYes
DYes
00ther:
DYes
181. No DNA ONE
IRJ No DNA ONE
IB'J No DNA ONE
I&J No DNA ONE
IE] No DNA ONE
~No DNA ONE
gj No DNA ONE
~No
1/412011 Continued
.!Facility Number: !nate of Inspection: lJ.-11-/.:z...__
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 !:8] No 0 NA 0 NE
fi(]Yes 0No DNA ONE
0 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
_glNon-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: ;;z -1'1-11
26. Did the facility fail to provide documentation of an actively certified operator in charge? DYes ~No DNA ONE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes ~No DNA ONE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes g) No DNA ONE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? DYes ~No DNA ONE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the DYes ~No DNA ONE
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below . DYes l!f-No DNA ONE
0 Application Field D Lagoon/Storage Pond 0 Other: ------------------------
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
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?
~+-c-: -pv-T .5o;l .;7lr r-cJ~ ;..____ yovr~vx
/Jrh::~'"3'r"Y) w~ II b~ ?~'""~ II-/,s--1..2-
'--?"'-51Hv7 cJ-c.J~~~ a---){J TY-+-~c k_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page3of3
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~0 DNA ONE
Phone: o/!O-t/33-.33rf0
Date: /2 -I L1 -;?? I:?-
21412011
mpliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: @-KOiitine 0 Complaint 0 FoUow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date ofVisit: I/0-H//J Arrival Time:j pti/s-1 Departure Time:l3.'i/5: J County: o/...,.__ Region: f5KlJ
Farm Name: You 11~ /J g,; Jel' r /d-,;L ~~~~-~,~'-~~~~~,~--~~&--------------Owner Email:
Roy lleun ..z... Owner Name: Phone: r r ,
Mailing Address:
Physical Address: ------------------------------------------------------------------------------------
Facility Contact:
Onsite Representative:
Certified Operator: r ,
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
l. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure 0 Application Field 0 Other:
a. Was the conveyance man -made?
b. Did the discharge reach waters of the State? (If yes, noti fy DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Phone:
Integrator: ,<Jt~
Certification Number: dTJI/'1 7
Certification Number:
Longitude:
DYes ~No DNA ONE
0 Yes 0No DNA ONE
0 Yes DNo DNA ONE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes DNo DNA ONE
2. Is there evidence o f 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 tha n from a disc harge?
Page I of3
DYes 18-No
DYes L3No
DNA ONE
DNA ONE
21412011 Continued
·!Facility Number: p -z;;z'7' I I Date of Inspection: / 'j)y~-?'1
' Waste Collection & Treatment
I 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a . If yes, is waste level into the structural freeboard ?
Structure l Structure 2 Structure 3 Structure4
Identifier:
Spillway?:
Designed Freeboard (in): /?'
Observed Freeboard (in): l<j:
5. Arc there any immediate threats to the integrity of any of the structures observed?
(i.e ., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes [lg No 0 NA ONE
DYes 0No DNA ONE
Structure 5 Structure6
0 Yes C8 No 0 NA 0 NE
0 Yes 8-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 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?
jgJ Yes 0 No D NA 0 NE
0 Yes ~ No 0 NA D NE
DYes ~No DNA ONE
DYes ~No DNA ONE
II . Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes l8J No D NA 0 NE
D Excessive Ponding 0 Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu , Zn, etc.)
D PAN 0 PAN > 10% or 10 lbs. 0 Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Approved Area
12. Crop Type(s): Pt:S~ou.Jo /'OU't7.(''$7:',-,/
13. Soil Type(s):
14 . Do the receiving crops differ from those designated in theCA WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
Pagelof3
DYes
DYes
DYes
DYes
DYes
DYes
DYes
00ther:
~Yes
~N o
6ZJ No
~No
~No
[2VJo
jgNo
~No
0No
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
214/2011 Continued
·I Facility Number: 8;;7: -6 7 2 !Date oflnspection: /tJ·-''1-'~11 I
._· 24. Did the facility fail to calibrate waste application equipment as required by the permit?
~ 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
DYes ~No DNA ONE
DYes ~No DNA ONE
0 Failure to complete annual sludge survey
~Non-compliant sludge levels in any lagoon
D Failure to develop a POA for sludge levels
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
DYes ~No DNA ONE
DYes ~No 0 NA 0 NE
DYes Da No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE 31. Do subsurface tile drains exist at the facility? Ifyes, 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? DYes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes
34. Does the facility require a follow-up visit by the same agency? DYes
~/<-c-Pf>; J f7/r_j
~k'l::: tl.bp--~ro..fj~ f> ~ 0 ef 7.s k-ro~-c._ or .A--F-1-r-r p~~·
lcar-J.. ft7-~ I'X. ,,.._ ·r"Jjr-h--e--rr.;.J~~~~cr::vf~ lP--!T rr [).
j3.No DNA
~No DNA
[S.No DNA
XJo-1-~-c~Jht~~ .fbtt-hrJ~r~ r/-J~~cd~ 7() /<.~.
!Uef-e-~tj;~ ~~Due Ft>r Lr..-1,?-~o---.
ONE
ONE
ONE
R eviewer/Inspector Name:
Reviewer/Insp ector Signature :
Page3of3
Phone: 9/ c-1/.J:r-;J;!oo
Date : ~ -?=1{---;:ft:?l/
21412011
Type of Visit e-fompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit erRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: IQ-1 ~-f.ol Arrival Time: I 9/ ~ D Departure Time: l/0 : 0 21 I County: Region: 0D
Farm Name: r , OwnerEmail: __________________________ __
Owner Name: ___ __,];-J.,=..ln...,...v _____ -~,-r/';_.l)"..;;;.~__:_-r--------
1 /
Phone:
Mailing Address: ----------------------------------------------------------------------
Physical Address: ----------------------------------------------------------------------
Facility Contact: Rt:!p /~ Title: _..~~~n:.L.!o,.-..;..,...-_____ _ PboneNo: ______________ ___
Onsite Representative: _ .... , ... 5':......:::.~=:..-=----------------------­
Certified Operator: Fro:nc.:J J?
Integrator: ~;:::
Operator Certification Number:~ t'V ) 7
Back-up Operator: ---------------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D" Longitude:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? DYes j)(l,No DNA 0 NE
Discharge originated at: D Structure 0 Application Field D Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (lfyes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
DYes 0No DNA ONE
DYes 0No DNA ONE
DYes 0No DNA ONE
DYes ®.No DNA ONE
DYes ElNo DNA ONE
12128104 Continued
I Facility Number: t.J..--~ 7? I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
D Yes 0No DNA ONE
DYes DNo DNA ONE
Structure 5 Structure 6
Id entifier: ______________________________________ _
Spillway?:
Designed Freeboard (in): __ _CJ:_~r--__ ____,/7'-.....:; _______________ ------------
ObservedFreeboard(in):_.e;.eL....::::;._ ____ ..t:::d;..:~;;;..._--------------------------
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
DYes ~No DNA ONE
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
0 Yes jid No 0 NA 0 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental tbreat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits , dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10 . Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes B!No DNA ONE
D Yes 6?J No 0 NA 0 NE
0 Yes 8l.No 0 NA D NE
DYes ~No DNA ONE
11 . Is there evidence of incorrect application? If yes, check the appropriate box below. DYes ~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 I 0 lbs 0 Total Phos phorus 0 Failure to In corporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evide n ce of Wind Drift 0 Application Outside of Area
12 . C rop type(s) JJ,_~ /otr<;.z...-J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA WMP? DYes ~0 DNA
15. Does the receiving crop and/or land application site need improvement? DYes ~No DNA
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?O Yes !BI.No DNA
17. Does the facility lack adequate acreage for land application? DYes !}?No DNA
18. Is there a lack of properly operating waste application equipment? DYes _B. No DNA
f1 I. c~/ .. -:1-r 'i. 7< II
IJ~r-; C>ln .. .r.5.,_.e/ /,.:1.5 b~n ~/
ONE
ONE
ONE
ONE
ONE
Reviewer/Inspector Name L~--2...a~:::.J~~~=::;;z::.:...;~:;:__;,·'···.:~.:,::_'·..:.._ ___ _...~ Phone: ~:ru-3".3oa
Reviewer/Inspector Signature: Date: ;.,:z-//.) 2o/O
Pagel of 3 12/28104 Continued
J Facility Number: §"";2 -&.71l Date of Inspection I IJI-Jo-to I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to ha ve all components of theCA WMP readil y ava ilable? If yes, check
the appropirate box. 0 WUP 0 Checklists 0 Design 0 Maps 0 Other
DYes )g No D NA O NE
DYes ~No DNA O NE
21. Does record keeping need improvement? If yes , check the appropriate box below. ~ Yes 0 No D NA 0 NE
~Waste Application 0 Weekly Freeboard 0 Waste Analysis D Soil Analysis 0 Waste Transfers 0 Annual Certification
0 Rainfall 0 Stocking D Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspe ctions D Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the fa c ility fail to calibrate waste application e quipment as required by the permit?
25. Did the facility fail to conduct a s lud ge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fa il to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
29 .. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose a n 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/in spectio n with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Page 3 of 3
DYes ~No
DYes ~No
DYes ~No
D Yes ~No
D Yes ~No
D Yes fia No
DYes ~No
D Yes ~No
D Yes [Qt. No
D Yes ll?l..No
DYes ~No
D Yes Gl,No
12128104
DNA
D NA
D NA
D NA
DNA
DNA
DNA
DNA
DNA
DNA
DNA
DNA
ONE
ONE
ONE
ONE
O N E
O NE
ONE
ONE
ONE
ONE
ONE
ONE
...
1-
1-.....
Type of Visit 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ~tine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
Date of Visit: llJ--..30-ot Arrival Time: I J () : '0 'D I Departure Time: I//! oc/ I County:~~ Region: CK 0
Farm Name: :/nwn ~ Nu,. 5?f'r'Y I ~ .?= Owner Email: --------------.,_. r 7
Owner Name: M. o:y Yo u (I ~ Phone: ' ; /
Mailing Address: ------------------------------------____ _
Physical Address:-----------------------------------------
Facility Contact: $7 W 7Vt9 W;o?,?= Title: -----------Phone No:---------
Onsite Representative: _.;:,.S=!...:!ec...---d'=1=5--------------Integrator: muyf
Certified Operator: r; and!? ":j_-f.....,Do<..lv=-:.7~-·~------Operator Certification Number~ J.f L{ 7
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D" Longitude:
Di scharges & Stream Impacts
I. Is any di sc h arge obse rved from an y part of th e opera ti o n? D Yes (&No DNA ONE
Di scharge ori ginate d a t 0 S tru ctu re 0 Appli cati on Fie ld 0 Othe r
a. Was th e con veya nc e ma n-m ade?
b . Did the di sc harge reach wat ers of th e S tate? {If yes, notifY DWQ )
c. What is the es timated vo lume that reached waters o f the Sta te (gallons)?
d . Doe s di scharge bypass the waste ma nag ement syst em? (If yes, noti fy DW Q)
2. Is there evi dence of a past di s ch arge trom any part of the operation?
3. Were there any adverse im pacts or potenti a l adverse impacts to th e Waters of the S ta te
other tha n from a d isc harge?
DYes 0No DNA ONE
DYes 0No DNA ONE
DYes 0No DNA ONE
DYes ~No DNA ONE
DYes ~N o DNA ONE
11118104 Continued
'J
[Facility Number: 8/9--/,?'J I Date of Inspection 112~ lO:Of-
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn stomge plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
DYes 18-No DNA 0 NE
DYes IZ!No DNA ONE
Structure 5 Structure 6
Identifier:-----------------------------------------
Spillway?: -----------------------------------------
Designed Freeboard (in): --~1_9='----___ _.l:... • ...e.9-:..._ _____________ ------------
Observed Freeboard (in): _ _.,.1:......£..9 ______ .~:.1 ..... ?-'-----------------------------
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/Iarge trees, severe erosion, seepage, etc.)
DYes [2iNo DNA ONE
6. Are there structures on~site which are not properly addressed and/or managed DYes (giNo DNA ONE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes ~No DNA ONE
DYes (gNo DNA D NE
r;a.Yes 0No DNA ONE
DYes ~No DNA ONE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. DYes ~No DNA D NE
0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN> 10% or 10 lbs 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Area
12. Crop type(s) ~,..-c~ /o Vr/ 'Lz-J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA WMP? DYes 13No DNA ONE
15. Does the receiving crop and/or land application site need improvement? DYes 131No DNA ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination ? DYes ~ NoD NA 0 NE
17. Does the facility lack adequate acreage for land application? DYes ~No DNA ONE
18. Is there a lack of properly operating waste application equipment? DYes liQ No DNA ONE
11/28/04 Continued
I Facility Number: 8fJ--t, ?91 Date of Inspection la;?o~'f-
Required Records & Documents
19. Did the fa c ility 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. D WUP 0 Checklists 0 Design 0 Maps D Other
DYes 12!1No DNA ONE
0 Ye s 18-No 0 NA D NE
21. Does record keeping need improvement? If yes, check the appropriate box below. D Yes mNo D NA D NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis D Soil Analysis 0 Waste Transfers 0 Annual Certification
D Rainfall 0 Stocking 0 Crop Yield D 120 Minute Inspections 0 Monthly and I" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge ? DYes 1:3No DNA ONE
23. If selected , did the facility fail to install and maintain rain breakers on irrigation equipment? DYes ~No DNA ONE
24 . Did the facility fail to calibrate waste application equipment as required by the permit? DYes &No DNA ONE
25. Did the fac ility fail to conduct a sludge survey as required by the pennit? DYes ~No DNA ONE
26. Did the facility fail to have an actively certified operator in charge? DYes l!l.No DNA ONE
27 . Did the facility fail to secure a phosphorus loss asse ssment (PLAT) certification? DYes ~0 DNA ONE
Other Issues
28 . Were any additional problems noted which cause non-compliance of the permit or CAWMP? DYes Ia:No DNA ONE
29 . Did the facility fail to properly dispose of de ad anima ls within 24 hours and/or document
and report the mortality rates that were higher than normal?
DYes !SilNo DNA ONE
30. At the time of the inspection did the facility pose an odor or air quality concern ? DYes ~0 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 requi red by DYes
General Permit? (ie/ discharge, freeboard problem s, over application)
~No DNA ONE
32. Did Revi ew e r/Inspector fail to discuss review/inspec tion with an on-site representative? DYes ~No DNA ONE
33 . Does fa cili ty require a follow-up visit by same agency? DYes ~No . DNA ONE
iriW'
12128/04
Type of Visit ~m~ce Inspection 0 Operation Review 0 Structure Evaluation
Reason for Visit b1Gutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
DateofVIsit: l,t;2#-0ffArrivaiTime:l ?'/JIJ I Departure Time: 1/c?/.:JO I County:~ RegiontJeO
Farm Name: )t"tltt ur Nu; fe7 Owner Email: -------------
Owner Name: &o '7' Yo~~~ Phone: r r 7
Mailing Address: ----------------------------------------
Physical Address:----------------------------------------
Facility Contact: __,;.~---=7~.~~-l-o~u....:........,~.,.¥"-------Title: ----------Phone No: ---------
Integrator: /¥~ Onsite Representative: _.,.£;....:~:_...;;.._;;...._ ____________ _
Certified Operator: r ,-4-vt e ;.>
I
Operator Certification Number: ,:::ZZ #( 4?
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D" Longitude:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? DYes ~No DNA ONE
Di sc harge origi nated at: D Structure D Application Field D Other
a. Was th e conveya nce man-made?
b. Did the discharge reach wat ers of the State? (If yes, notifY DWQ )
c. What is the estimated volume that reached waters ofthe State (gallons)?
d. Does discharge bypass th e waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to th e Waters of the State
other than from a di sc harge?
Page I of 3
DYes DNo DNA ONE
DYes 0No DNA ONE
DYes 0No DNA ONE
D Yes ~No DNA ONE
D Yes [ENo DNA ONE
12128/04 Continued
, [Facility Number: 8');-b711 Date of Inspection ~
~Collection & Treatment
4. Is storage capacity (structural p lus stonn storage plus heavy rainfall) less than adequate?
a. lfyes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
DYes !SaNo DNA ONE
DYes 0No DNA ONE
Structure 5 Structure 6
Identifier:-----------------------------------------
Spillway?:
Designed Freeboard (in): _ __,j/~~,c---_ ..... U""-----------------------------
Observed Freeboard (in): _,..c£~P~&,..__ __ ....~.I--'-? _______________ ------------
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
DYes lijNo DNA ONE
6. Are there structures on-site which are not properly addressed and/or managed 0 Yes jgl.No DNA ONE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structu res need maintenance or improvement?
8. Do any of the stuctures lack adequate markers as required by the pennit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
1 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
0 Yes !Ja'No DNA ONE
D Yes ~No DNA ONE
DYes ~No DNA ONE
DYes t8No DNA ONE
I l. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes ~No DNA 0 NE
0 Excessive Ponding 0 Hydraulic Overload 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 Area
12. Crop type(s) /3e;';nu.Je. /o v~r:s~/
13. Soil type(s)
14 . Do the receiving crops differ from those designated in theCA WMP? DYes GJ'No DNA
15. Does the receiving crop and/or land application site need improvement? DYes .81 No DNA
16. Did the facility fai l to secure and/or operate per the irrigation design or wettable acre detennination?O Yes rENo DNA
17. Does the facility Jack adequate acreage for land application? DYes ~No DNA
18 . Is there a lack of properly operating waste application equipment? DYes t8J No DNA
tfl! c~j/-Jih/irm lr--~ yovrLf<R ;L r=D~m.>.
;J~~ O~Hr-so@~) A~ ~~n..pLJ4 tf-m...-. yog7 k/111 pP~7;Jo . .:L
4-J·;fp, a/h&'~ ~;l:'L/ t:l7~~
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
ONE
ONE
ONE
ONE
ONE
Pagel of 3 12128104 Continued
~ I FacilityNumber: P-b7}f Date of Inspection I 4?-/f:D~
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Pennit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. D WUP D Checklists 0 Design D Maps 0 Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
DYes KI.No 0 NA D NE
DYes IENo DNA ONE
lZ]Yes 0No DNA ONE
00 Waste Application 0 Weekly Freeboard D Waste Analysis D Soil Analysis 0 Waste Transfers D Annual Certification
0 Rainfall D Stocking D Crop Yield D 120 Minute Inspections D Monthly and I" Rain Inspections D Weather Code
22. Did the facility fail to install and maintain a rain gauge? DYes ~No DNA ONE
23. If selected, did the facility fail to install and maintain rainbniakers on irrigation equipment? DYes ~(]No DNA ONE
24. Did the facility fail to calibrate waste application equipment as required by the pennit? DYes ~No DNA ONE
25. Did the facility fail to conduct a sludge survey as required by the permit? DYes ~No DNA ONE
26. Did the facility fail to have an actively certified operator in charge? DYes 15aNo DNA ONE
27. Did the facility fail to secure a phosph_orus loss assessment (PLAT) certification? DYes ~No DNA ONE
Other Issues
28. Weie any additional problems noted which cause non-compliance of the permit orCA WMP? DYes K}No DNA ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes
and report the mortality rates that were higher than nonnal?
!;8l.No DNA ONE
30. At the time of the inspection did the facility pose an odor or air quality concern? DYes DQNo 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 I:KI.No DNA ONE
General Penn it? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes (S(t No DNA ONE
33. Does facility require a follow-up visit by same agency? O Yes !>lNo DNA 0 NE
~~diiig,~~~J~2:ri.l!i!~~f.¥,~~I(df~n~.Dr:awiogs:j.,;:~1;r..~G~~"· "'; · ., .. · .i; ... c; . ·; ··· '·· .• ~~~~~E'·:~}i_ .. _
Page3 of 3 12128104
.....
1--
q 0 Division of Water Quality '
Facility Number �y �/ 0 Division of Soil and Water Conservation T-07
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine. 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:Arrival Time: f7�QC� Departure Time: ,�QD County: Region:
Farm Name:B u��Pry rf�- Owner Email:
Owner Name: / 1/ o e4
Mailing Address:
Physical Address:
Facility Contact: 'e/iL�0' X)94 tt 2 Title:
Onsite Representative: .S�
Certified Operator: .2 -
Back -up Operator:
Location of Farm:
Swine
Latitude:
n°
Phone No: �j /
Integrator: _42&z 7k1 `
Operator Certification Number:y�%
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Laver
® Wean to Feeder Q 0 I ILJNon-Layei
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
L Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Longitude:
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: EXI
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?
❑ Yes R No [INA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
EINE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
KNo
[--INA
❑NE
❑ Yes
[R No
❑ NA
EINE
12/28/04 Continued

i .
!Facility Number: @-Z, ?Z Date of Inspection I J.:l-/87
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
DYes ~No DNA ONE
DYes 0No DNA ONE
Structure 5 Structure 6
Identifier:-----------------------------------------
Spillway?:
Designed Freeboard (in): __ dz:;.;;....:O..:..-__ -~dg'--.:;_--------------------------
Observed Freeboard (in): -~d""--'~=---_MArflt:;......:O:;....._ ______________ ------------
5 . Are there any immediate threats to the integrity of any of the structures observed? DYes ~No DNA ONE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed DYes ~No DNA ONE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the stuctures lack adequate markers as required by the pennit?
(Not applicable to roofed pits , dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10 . Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
SYes DNo DNA ONE
DYes ~N o DNA ONE
DYes KINo DNA ONE
DYes ~No DNA ONE
11 . Is there evidence of incorrect application? If yes, check the appropriate box below. DYes 8 No 0 NA 0 NE
0 Excessive Ponding. 0 Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN > 10% or 10 lbs 0 Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Area
12 . Crop type(s) ,&.em~ I Du.,..~ s~~l
13 . Soil type(s)
14 . Do the receiving crops differ from those designated in the CA WMP? DYes 00No DNA
15 . Does the receiving crop and/or land application site need improvement? DYes ~No DNA
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?O Yes !XNo DNA
17 . Does the facility lack adequate acreage for land application? DYes iS. No DNA
18 . Is there a lack of properly operating waste application equipment'! DYes [2g.No DNA
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other commen~.
Use drawings of facility to better explain situations. (use additional pages as necessary):
(j)r~mdi%ey
( 1JJ k <"cf' T eJc-c: 5'0) Ls+ f5 r-c9-W ~
ONE
ONE
ONE
ONE
ONE
• ~
-...
Reviewer/Inspector Name ~~ .. ~L~ ... Phone: t:)r/P--~33-3X:O
Reviewer/Inspector Signature: ~~ AT hl-/ g-.?D::> z -7~~ Date:
, 11128/04 Contmued
I Facility Number: n-b 7f7 Date of Inspection l.tH rr
Required Records & Documents
19 . Did the facility fail to have Certificate of Coverage & Pennit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropirate box. D WUP D Checklists 0 Des ign D Maps D Other
DYes ,i!No DNA ONE
DYes ~No DNA ONE
21 . Doe s record keeping need improvement? If yes, check the appropriate box below. 0 Yes D No DNA D NE
D Waste Application D Weekly Freeboard D Waste Analysis ~Soil Analysis D Waste Transfers D Annual Certification
D Rainfall 0 Stocking D Crop Yield D 120 Minute Inspections D Monthly and 1" Rain Inspections D Weather Code
22 . Did the facility fail to install and maintain a rain gauge? DYes ~No DNA ONE
23. If selected, did the facility fail to install and maintain rain breakers on irrigation equipment? DYes .15(1 No DNA ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes ~No DNA ONE
25 . Did the facility fail to conduct a sludge survey as required by the penn it? DYes ~No DNA ONE
26. Did the faci lity fail to have an actively certified operator in charge? DYes ®No DNA ONE
27. Did the facility fail to secure a phosphorus lo ss assessment (PLAT) certification? DYes .MNo DNA ONE
Other Issues
28 . Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes JZ]No DNA ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes B!No DNA ONE
and report the mortality rates that were higher than nonnal?
30. At the time of the inspection did the facility pose an odor or air quality c oncern? DYes ~No DNA ONE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional offi ce of emergency situations as required by D Yes !&No DNA ONE
General Pennit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes jQNo DNA ONE
33. Does facility require a follow-up visit by same agency? D Yes JilNo DNA ONE
Additional Comments and/or Drawings:
.... -
1-....
12128104
0 Division of Water Quality v-<·· I Facility,N~mber I f'~_H_~~~. Jl
J/-J"3-1Jb 0 Division of Soil and Water Conservation . sf/5-''· .. 0 Other Agency . _,._ ; .
Type of Visit ~mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (}ROl;tine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
Date of Visit: I // -/.3'-t.?4i Arrival Time :I r.' IF Departure Time: 19:.' /6 I County~ Region: F~IJ
Farm Name: Y~~h~ ,A/ur-._5~r-~ r ~ 1 Owner Email:-----------------
Owner Name: _.~.-/S...!...,!,o7~~--------Y&unA-~ ~~~~~,7~-----------
Mailing Address: ---------------------
Phone: 9/trd8'6-Zb¥7 ~~
9'1 [)-,iltrf -f/"J.?~ Gr:-1(
Physical Address:---------------------------------------------
Facility Contact: 1?7 7Ytl 7"' Title: -----------PhoneNo: _______________ _
Onsite Representative: _,_5.=-·~----.::=--------------
Certified Operator:---"'~~--;;;;.... _______ -----------
lntegrator:~/?t~'P.~t::~~~~.;.. ~----------­
Operator Certification Number: ~£'2
Back-up Operator: ---------------------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D" Longitude:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? DYes .R]No DNA ONE
Discharge originated at: 0 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?
Page 1 of3
DYes DNo DNA ONE
DYes 0No DNA ONE
DYes DNo DNA ONE
DYes ~No DNA ONE
DYes BJ.No DNA ONE
12128104 Continued
[Facility Number: !(?= b771 Date of Inspection
··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 1 Structure 2 Structure 3 Structure 4
0 Yes !SiNo 0 NA 0 NE
DYes ~No DNA ONE
Structure 5 Structure 6
Identifier:---------------------------------------
Spillway?: -----------------------------------------
Designed Freeboard (in): _...,d;~~;...._ ___ ---J2o::;.;.o2=~---------------------------
Observed Freeboard (in): _.....;:3~_..3::....._ ____ ..:.,;1.---..~tfL--______________ -----------
5. Are there any immediate threats to the integrity of any of the structures observed? DYes ~No DNA ONE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
DYes ~No DNA ONE
If any of questions 4-6 were answered yes, and tbe situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
1 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes [8No DNA ONE
DYes 6Z!No DNA ONE
DYes lElNo DNA ONE
DYes ~No DNA ONE
11. Is there evidence of incorrect application? Ifyes, check the appropriate box below. DYes tZJ No DNA 0 NE
D Excessive Ponding 0 Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
D PAN D PAN> 10% or lO lbs D Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window D Evidence of Wind Drift 0 Application Outside of Area
12. Crop type(s) ZaadrG(.. fl-y / t9n",..5r-d
13. Soil type(s) _ ___.!.....,!;0~-----------------------------------:--
14. Do the receiving crops differ from those designated in the CA WMP? DYes .1KJ 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 N~ 0 NE
17. Does the facility lack adequate acreage for land application? DYes ~No DNA ONE
18. Is there a lack of properly operating waste application equipment? DYes ~0 DNA ONE
Comments,(refer to question#): Explain
Use draWings of facility to better explain .,;., .. at>nno<i 'J ultl~:zt~~uJluunai
Page 2 of3 12128104 Continued
'\ •
I Facility Number: !{?--{e 2 f
Required Records & Documents
Date of Inspection 1/E/J=Joh
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropriate box. 0 WUP D Checklists 0 Design D Maps D Ot her
DYes ~No DNA ONE
DYes jglNo DNA ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ~No 0 NA D NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers D Annual Certification
0 Rainfall D Stocking D Crop Yield 0 120 Minute Inspections D Monthly and 1" Rain Inspections D Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an active ly certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of th e 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/ dis charge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Additional· Com:miiits aodfor Drawings:
Page 3 of3
DYes KINo DNA ONE
DYes l3'No DNA ONE
gJ Yes DNo DNA ONE
DYes ~No DNA ONE
DYes MNo DNA ONE
DYes giNo DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes J&lNo DNA ONE
DYes glNo DNA ONE
JZ/28104
... -
1-....
Type of Visit e Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
Date of Visit: 15 -to.. 0£ I Arrival Time:IJ;/~p,.., I Departure Time: L'------J' County: Region: F/? 0
Farm Name: Owner Email: --------------
Owner Name: -----'-~....:::z::::=----'-/(+'~""7.:y----__ Y! ..... n"'-u""'-L.n._.9"'J-------Phone: '110-,;?. f?C -"'l (, Lf /f
M ailing Address: _?"'"'o~Lf~-___,Tc"""'OI~,pP""'"-'-___..C""'r'-'e._,e..._.k'-"---'t?'-"-'d..;;......;;.. ____ _ Tec,c 4 v-IV C.... .:;J flY~:> Y
I
Physical Address: ----------------------------------,....--------,.. .-.=--:::-=-:---,--lf;o -:Jflr-~.r~ 9'
Facility Contact: __ f<~o~~£/'~--J~ut'J.t..Lo!U...z.n~~~----Title: -----------Phone No:' 'h" :2 *' T S 9 £ 3:
Onsite Representative: lfrr Yo ""'j Integrator: ~ IJ7vr;~ g,\;;'1, Fe;,..,.,$
Certified Operator: /(tJ/ ---=--r.::;;AI:;..:;"'.u.~f-------Operator Certification Number: .;lo 111(7
Back-up Operator: --------------------Back-up Certification Number:
Location ofFarm: Latitude: D OD'D" Longitude: D OD'D"
Swine
ID Wean to Finish
5;KV ean to F eedcr
D Feeder to Finish
D Farrow to Wean
D Farrow to Feeder
D Farrow to Finish
D Gilts
0Boars
-· ...
Other
ID Other
Design
Capacity
~;;1.00
L
Discharges & Stream Impacts
Current
Population
.1atJh
Wet Poultry
Dry Poultry
0 Layers
D Non-Layers
D Pullets
D Turkeys
D Turkey Poults
D Other
I. Is any discharge observed from any part of the operation?
Design Current
C~pacity Population
-
Discharge originated at: D Structure 0 Application Field 0 Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
D Dairy Cow i
D Dairy Calf !
D Dairy Heifc1
DDrvCow
0Non-Dairy
D Beef Stocke•
0 Beef Feeder !
0 Beef Brood Cow .. ··~~ --. .. ..
Number of Structures: j_.2j
DYes GJ1<1o 0 NA 0 NE
DYes 0No DNA ONE
DYes 0No DNA ONE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes. notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
DYes 0No
DYes 12J"No
DYes ~0
12/28104
DNA ONE
DNA ONE
DNA ONE
Continued
I Facility Number: &'.;}-&'ICf I Date oflnspection I £-lo-o)" l
Waste Collection & Treatment
4 . Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: --~.;; (fljJ;l 1:
Spillway'!: tl.D. aD.
Designed Freeboard (in): 461•'1;. s-..... • aBJq., r. ''•· •
Observed Freeboard (in): ~'rf!~ ~-~::7 .t<
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
DYes ~ DNA ONE
DYes 0No DNA ONE
Structure 5 Structure 6
DYes Q1'1'o DNA ONE
6. Are there structures on-site which are not properly addressed and/or managed 0 Yes ~o 0 NA 0 NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
' 8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9 . Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes [J1qo DNA 0 NE
DYes ~o DNA D.NE
DYes ~ DNA ONE
DYes ~o DNA ONE
II. Is there evidence of incorrect application? Jfyes, check the appropriate box below. DYes ~o DNA 0 NE
D Excessive Pending 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn , etc.)
0 PAN 0 PAN > 10% or 10 lbs 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Area
-; t, r ~{)
12. Crop type(s) f!>ec«wdq, .5,p.{( Ci=m/0
13 . Soil type(s)
14. Do the receiving crops differ from those designated in theCA WMP? D Yes I:J1\Io DNA
15 . Does the receiving crop and/or land application site need improvement? D Yes 0No DNA
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination!O Yes 0No DNA
ONE
~
~E
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly ~operating waste application equipment?
DYes 0No DNA [;1-NE
0 Yes G3"No DNA 0 NE
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
12128104 Continued
• •
I Facility Number: 8;;;1. -b7'tl Date oflns pection I S"-tO ·o'L
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? D Yes (g-rq() 0 NA 0 NE
20. Docs the facility fail to h ave all components of theCA WMP readily ava ilable? If yes, check
th e appropirate box. D ~ 0 Ch~ 0 D~ 0 ~ 0 ~ DYes ~ DNA ONE
21. Does record keeping need improvement? I f yes, check the appropriate box b~low. ..., ; L1 . DYes ~/ Jo 0 NA 0 NE J_? ~-18-:> ~· ),S f{-;1(}--;) "'·II"Tit:J .gy /D-1~-:> • ~/. 3 f;)~ -), 0 Wsltc Apphcatton D Wee~ly Freeboard 0 Waste Analyiii 0 Soil Analysis 0 Waste Iransil:is 0 ARRtutl CeF4it1cstion · 'f
0 Rllinfull EJ Stoddtlg" 0 c~~ Yield D ~_Minute lnspee~iQ~ 0 Monthly and 1" R~tili Inspections 0 We!tthcr Code-
22 . Did the facility fail to install and maintain a rain gauge? DYes ~ DNA ONE
23. If selected, did the facility fa il to install and maintain rainbreake rs on irrigation equipment? DYes 0 No DNA ~
24. Did the facility fail to calibrate waste application equipment as required b y the permit? DYes 0No DNA ~
25. Did the facility fail to conduct a s ludge survey as required by the perm it? DYes ~ DNA ONE
26. Did the facility fail to have an actively certified operator in charge? DYes [i}No DNA ONE
27. Did the facility fail to secur e a phosphorus loss assessment (PLAT) certification? DYes 0 No DNA ~E
Otber Issues
28. W er e any additional pro bl ems noted which cause non-compliance of the permit orCA WMP? DYes (g-JqO DNA ONE
29 . Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes Q-No DNA ONE
and r e port the mortality rates that were higher than normal?
30. At the time of the in s pection did the facility pose an odor or ai r quality con cern? DYes ~DNA ONE
If yes, contact a regional Air Quali ty representative immediately
3 1. Did the fa cili ty fail to no ti fy th e regiona l office of emerg ency s ituations as required b y DYes ~ DNA ONE
General Permit? (ie / discharge, freeboard proble m s, over appli catio n)
~DNA 32. Did Rev iewerllnsp ector tail to di scu ss r eview/inspection with a n o n-site representative? DYes ONE
33. Does facility require a follow-up visit by same agency ? DYes ~DNA ONE ........
12128104
..
8 Compliance Inspection 0 Operation Review
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other 0 Denied Access
Facility Number ._1 :~o~:&>~___,H bZ% IDate ofVisit: l8 ·tt·or hime: lc:o2 :.,s:
-------------------....... lo Not Operational 0 Below Threshold
&Permitted Deii1ified C Conditioually Certified C Registered Date Last Operated or Above Threshold: --·--·--·
Farm Name: ..... _.Y.a.l/.r:u; .. -... IJI..Y..tk'l.y······./. .. (l.ad_.;)._ .. _ ....... -.. ·······-·-··········-County: --~-B~A---·--·----.. £./Z.D._.
Ow~er Name: ___ fl.t2;y--······-·--·.Y.au.n.,_ __ ...... ----··--·-----·-·----·--····-····· Phone No: _'i/.e.:.i!.!!.£.:... .... '1~~-7---··--·-·---·-·-·-·
Mailing Address: --~-q_'J. _______ J]Jjtkr.J .. _.L.r..t!dL._.tJ~------'J:eg.c f;,.,M..._2.8...f.U.______________ ··--·---·
Facility Contact: .. ...ia)"·-···--h.v~ ................... --·--····-·-Title: ··--··--···-··-·-····-· ... ········-····-·· .. ··-···· Phone No: ft/P_-..:?ff.£:.£'.7 f 2 .-...
Onsite Representative: .. _.if.~f-.1~--·--·--------·-·--·--·---··--Integrator: ~~)' lfa;.: .• •~------------rr~ .. u·s
Certified Operator: ·--':&1 ·----k~----lB"!L:J----·---·--·-·-·-Operator Certification Number: .,;J 6~~-::z _____ _
Location of Farm:
[~.Swine 0 Poultry D Cattle 0 Horse Latitude L..-_ _.1• ~....I _ ___.!l' L-1 _ ___.l " Longitude L..--___.1• L-1 _ ..... I· L-1 -~'"
n
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Lagoon 0 Spray F ield 0 Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it r each Water of the State? (If yes, notify DWQ)
c. If discharge is obs erved, what is the estim ated flow in gal/min?
d. Does di scharge bypass a lagoon system ? (If y es, notify DWQ)
2 . Is there evidence of past discharge from any part of the operation?
3 . Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4 . Is storage capacity (freeboard plus storm storage) less than adequate? 0 Spillway
Structure I Su-ucrure 2 Structure 3 Structure 4 Structure 5
)
DYes ~
DYes ~·
DYes ~
--:-
DYes ~
~
DYes gNo
DYes l31fu
DYes eNo
Structure 6
Identifier: ·········-·-'····-············ •••••••••••••••··---·----·-•-•-·•-•-.••••u•-•••••••u•• -••••.,.._••••••••••••••-••••-•-•••••-·---•-••·-·--••• _ .. .,._.,_.,_•-•-••----·-
Freeboard (i nches): JLf ,., Jlfl'r
12112103 -----Continued
jFacility Number: B) -b'71 Date oflnspection I $-11-o'i
5 . Are there any immediate threats tO the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6 . Are there structures on-site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste strucrures require maintenance/improvement?
9 . Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancerunprovement?
11 . Is there evidence of over application? If yes, check the appropriate box below.
0 Excessive Ponding 0 PAN 0 Hydraulic Overload 0 Frozen Ground 0 Copper and/or Zinc
12 . Crop type /krezvc/i ) Sttu:dl C.ou'n Owrsee./ -all lky
13 . Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA WMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15 . Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor lssues
17 . Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18 . Are there any dead animals not disposed of properly within 24 hours ?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
12112103
Date:
DYes 8flo
DYes ~
DYes ~-
DYes g.No
DYes [3-NO
DYes ~
DYes [J-No
DYes ~
DYes 8-No
DYes (9'ffo
DYes [3-N_O
DYes [3-NO
DYes @-No
DYes ONo
DYes [jJ_bk,
DYes GtHc>
DYes 13*0
ContUuud
I Facility Number: s~ -t7'j' I Date of Inspection
Required Records & Document"
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
0 Wasl:e AP)'Iicatio"' 0 Freebe&Fd 0 Waste Analysis 0Soi:t Sampling
C,-;)j -> f, ~ /, ~ .::>. ;JO -::> .J. :J, .:J.2, Lf-/1. -;> )/ ~. V
24. Is facility not in ~mpliance with any applicable setback criteria in effect at the bm'e of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified A WMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rain breakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
0 Stocking Form D Crop Yield Form 0 Rainfall 0 Inspection After I " Rain
D 120 Minute Inspections 0 Annual Certification Form
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
C No violations or deficiencies were noted during this visit. You will receive no further correspondence abont this visit.
12112103
8-No
f1No
bl-No
@-NO .
Q.No
~
(3-No
QNo
13--No
(3-No
0No
ONo
ONo
0No
0No
Date of Inspection l/6-f'-f"? I I I Facility Number I ~ H :b-~ !I Time of Inspection I 15!-YJ J24 br. (bb:mm) ~,,
Total Time (in fraction of hours
0 Registered
Farm Status: D Certified
0 Applied for Permit (ex:l.25 for l hr IS min)) Spent on Review I "2....-I
0 Pennitted or Inspection (includes travel and processing)
0 Not Operational Date Last Operated: -----.. ~-----····---~--~·-····-··~-·~·-····-~··-·-·--·----····-····-······
Farm Name: ___ , ___ f.k:.~.~ .. A(.H-~ . ..1~.~---··· .. -· .. ·-··· .. -...... County:-.. ~~~---... -.... -............. _.
Land Owner Name: .. _/?.f!.7. .. -y;,~~fl-----.... -...... _ .............. -.. _ Phone No:(z!C!l.. .. ;?..J!.J:J...~ ... ~.Z ......... .
Facility Cooctact: ............ .tfq. ... P.A.::~·-·-·-··-" Title: _., ........... _ .. _______ Phone No: .. _ .... ___ ,_. ·-·----
Mailing Address:--.. J<?.,~ .. ~N... .... ~ .. .&.~ ...... '.2&.'t ~-4 ~ .. .-J.:: f...Y~f-.... -... -.....
Onsife Representative: -··-~------.. ·,-··--· ... -.... -.... -.... -Integrator:~~--~ .. ----·
Certified Operator: .... .£~~ .. Y:~ .... --... -.... -.. ~--... -.. Operator Certification Number:-~ O.~.Z ... _.
LocationofFarm: ~ '2-/ _sp . ~ ~~ ~ k~ AJ ~
·----•--oooo-oooooo£7""-""' 2~ooooo oomo,..ooomooooonoo oo\oomooo,..m•oo,..OO't:..ooooooo,_mn-oom,..noo -;OO~m-;?J.oo~-•nom.,.,.,.,,_.,,.,,_.,,.,.,,.,.,,_,.,._.,.,_ 0
_.,b._~------~ .. -... ...!L?:::!~---~....L:~ ........ ~.:=~-~-..... --.. --.... -.... -.... -... ---0
Latitude Longitude!'-_ __,l•fL.. _ ___,I•J '-_ ___,J "
General
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at : 0 Lagoon D Spray field 0 Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3 . Is there evidence of pas t discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4 /3 0/97
maintenance/i mprovement?
0 Yes j)fNo
0 Yes 1'8tNo
DYes JSJNo
DYes Ji[No
0 Yes _)ifNo
DYes ~No
DYes ~No
DYes ~No
Continued on back
!Facility Number: ~-;,;t
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structur<'S (La~:oons,Holding Ponds, Flush Pits, ctc.J
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
10. Is seepage observed from any of the structures?
11. Is erosion. or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement'!
(If any of questions 9-12 was answered yes, and the situation poses
an inunediate public health or environmental threat, notify DWQ)
Structure 5
DYes j&No
DYes lXNo
Structure 6
DYes lla:No
DYes .3,No
DYes ~-No
13. Do any ofthe structures lack adequate minimum or maximum liquid level markers ? DYes $No
Waste Application
14. Is there physical evidence of over application? 0 Yes )4-No
(If in excess of WMP. or runoff entering waters of the State. notify DWQ)
15. Crop type --~~---~~d~.ft2&!.1:t.;;_ __ : ......................... ·······································································:·························: ................... .
16. Do the receiving crops differ with those. designated in the Animal Waste Management Plan (A WMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/lnspector fail to discuss review/inspection with on-site representative?
22. Does record keeping need _improvement?
For Certified or Penuitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readil y available?
24. Were any additional problems noted which cause noncompliance of the Cenified A WMP '!
25. Were any additional problems noted which cause noncompliance of the Permit?
0 ~ ~~ vi~l_ations_ or deficiencies were· noted during this. visit. You will receive· ito fu.rth.er .
>>correspondence about this visit-. . . ' ..
DYes ~No
DYes IE No
18Yes 0No
_®Yes 0No
DYes I8J No
DYes ~No
DYes lji:..No
DYes ~No
DYes XJNo
DYes ti{No
I?-'1k; C.t>~ ,6~ f'~sJ ~//7 /~f ,v~ /4C.P~~,-J _,...j
5/ltJ;.,J' ~ ~ ~~ ..6-J~. .
1'?. -,u ,~·,4.; £rv~ ,_;-ik;,: /;_d,/e/ ,/ ~-L ,//~-?.£J;;., .
• -~:~·-:,"·''·'~•'ro;.··' •<''·'·'~'
Reviewer/Inspector Name ~-:-;,_;;_~~6J.31!!:tli=.:.:.t;~tfa~~~~;t_;L_.::-'.:.:__.::.-.J:::.;::~:_::~::L......:l~b~~~&:.:~~2.z..J
Reviewer/Inspector Signature: Date: /0-'f -97