HomeMy WebLinkAbout820681_INSPECTIONS_20171231l
NORTH CAROLINA
Department of Environmental Quality
-.-.... ~·~···.,7l · ' .... -•• ~ ....... .,.... ...... -..:t . <:..-'"-·;,:~-~-........... -.:· . ~ ............ .
ompliaoce Inspection Operation Review 0 Structure Evaluation
Reason for Visit: ~utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I ~ 6~· 18'1 Arrival Time: 11'~ 'I 5 ,It Departure Time: I !tJ; r5z1l County: g,f1 ( Region: 8_2.;0
Farm Name: l )c?K5 ftki"W, I..{v~ Owner Email:
Uwoer Name' Q "'"'r (;Je;«:S' Phooeo
Mailing Address:
Physical Address:
Facility Contact: ___.:M:....:..e;..;.Je:~_s-;_·r_:5....;;s_· o_--..P _____ Title: Phone:
\ (
Onsite Representative: Integrator: _.:::..5t-=:t:..!..(....l.·f _____ ~---
certification Number: I 0 0 u /., I Certified Operator:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Str-eam Impacts
I. Is any discharge observed from any part of the operation? 0 Yes (£}MO 0 NA 0 NE
Discharge originated at: 0 Structure 0 Application Field 0 Other:
a. Was th e conveyance man-made? DYes 0No (3"NA ONE
b. Did the discharge reach waters of the State? {If yes, notifY DWR) DYes 0No EJNA ONE
c. What is th e estimated vol um e that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system ? (If yes, notify DWR) DYes 0No r:fNA ONE
2. Is there e vidence of a past disc harge from a ny part of the operation?
3. Were there any observable adverse impac ts or potential adverse impacts to the waters
of the State other th an from a di scharge?
Page I of3
DYes
DYes
[:d'No DNA ONE
[LjNo DNA ONE
214/1015 Continued
jFaciijty Number: g"'$ -CJt !({ !Date of Inspection: 6 Ez{/: r ·7
Waste Collection & Treatment
.( Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .3 D
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes~ DNA O NE
0 Yes 0 No t::(NA 0 NE
Structure 5 Structure 6
0 Yes g}1ro 0 NA 0 NE
DYes ~DNA ONE
If any of questions 4-6 were answered yes, and the situation poses ao immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dl)' stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures req uire
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
0 Yes 0 No 0 NA 0 NE
D Yes D No DNA 0 NE
DYes 0No DNA ONE
0 Yes D No 0 NA 0 NE
II. Is there evidence of incorrect land application? If yes, check the appropriate box be low. D Yes 0 No DNA 0 NE
0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN > 10% or 10 lbs. 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): Ctv g J3cJwt.-r/'1 a~~-z..e SG 0
13. Soil Type(s):
' 14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17 . Does the facility lack adequate acreage for land application?
I 8. 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 hav e all components of theCA WMP readily available? If yes, check
the appropriate box.
OwuP O c heckli sts 0 Design 0 Maps 0 Lease Agreements
2 1 . Does record keeping need improvement? If yes, check the appropriate box below.
DYes ~0 DNA ONE
DYes rrNo DNA ONE
Dyes ~ DNA ONE
DYes ffNo DNA ONE
DYes [3"No DNA ONE
0 Yes j3'No D NA ONE
0 Yes EfNo DNA ONE
Oather:
DYes G{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 I " Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to in stall and maintain a rain gauge? 0 Yes c:(No D NA D NE
23 . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes ~No 0 NA 0 NE
Page 1 of 3 2/412015 Continued
~aciiJty Number: ff'f"'-k 8 { loate of Inspection: iJ F ... C:. ( 8"
24. Did the facility fail to cal ibrate waste application equipment as required by the permit? ,-
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
DYes ~ DNA ONE
DYes ~o DNA ONE
0 Failure to complete annual sludge survey 0Failure to deve lop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicati ng non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notifY the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
D Application Field 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?
~t,(tb~.~-f-, v'\ _. cr -I~ -lb
~)'-4~ 1 s C( ~-y ~ t } -s --r7
Reviewer I I nspector Name:
Revi ewer/Inspector Signature :
Page 3 of3
DYes ~o DNA ONE
DYes~ DNA ONE
0 Yes [31'fo 0 NA 0 NE
DYes @No DNA ONE
DYes ~o DNA ONE
DYes (3'No DNA D NE
DYes QrNo DNA ONE
0 Yes [2t'No 0 NA 0 NE
0 Yes [J-No 0 NA 0 NE
Phone : Cf( 0 · Lf3 } 3.5 S 1
Date :~&f-k ( t
Z/411015
Technical Assistance
Reason for Visit: e(Routine 0 0 Other 0 Denied Access
h I DepartureTime:I]{;J: 1otl}l County: 5 4nt
,"Jv....e, ~~~er Email:
Region/Fj7o Date of Visit: I [1 i1Q4I (1 Arrival Time :f7~1D
l.() ~f£f 'f7,.v H." Farm Name:
Owner Name: ·lM Phone:
Mailing Address: --------------------------------------5 0 Physical Address: -----------------------------------------------------------------------~
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at : D Structure 0 Application Field
a. Was the conveyance man-mad e?
D Other:
b. Did the discharge reach waters o f th e State? (If yes, notifY DWR )
c. What is the estimated vo lum e tha t reached waters of the State (gallons)?
Phone:
Integrator: ........:·fz::...~......:!:~---------
Certification Number: {(JTJ J.f/,('
Certification Number:
Longitude:
DYes~ DNA ONE
DYes 0 No B"NA O NE
DYes 0No ~A ONE
d. Does th e discharge bypass the waste management system? (If yes, notify DWR ) DYes QNo aNA 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 o th er than from a dis charge?
Puge I of3
DYes
DYes
~··
~0 DNA ONE
IZ]'No DNA ONE
21412015 Continued
!Facility NJ!mber: n.-I nate oflnspection: ;(7ctr" q:z ~-~
Wll'!ite Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ~
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes ~DNA ONE
DYes 0No ~ ONE
Structure 5 Structure 6
DYes~ DNA ONE
DYes ~o DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
12. Crop Type(s):
13. Soil Type(s):
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?
Page lof3
DYes
DYes
DYes
DYes
DYes
DYes
DYes
~0
~
~0
~0
~No
~0
~0
DNA
DNA
DNA
DNA
DNA
DNA
DNA
ONE
ONE
ONE
ONE
ONE
ONE
ONE
0 Yes 0'No DNA 0 NE
DYes crNo DNA 0 NE
DYes [1No DNA ONE
DYes c(No DNA ONE
Oother:
DYes [2("No
2/4/2015 Continued
IFacili!l: N•tmber: ~2-0lf I nate of Inspection: {9] S ... -t, t/1 •
24. bid the facility fail to calibrate·waste application equipment as required by the permit? 0 Yes li:d-'No DNA ONE
25. Is the facility out of compliance with permit conditions related to sludge? lfyes, check 0 Yes ~0 DNA ONE
the appropriate box(es) below.
0 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date offrrst survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? 0 Yes ~0 D NA ONE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes g1-lo DNA ONE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes ~0 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 [3'No D NA 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 U(No D NA 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. 0 Yes [?'No DNA ONE
0 Application Field 0 Lagoon/Storage Pond D Other:
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP? 0 Yes c:(No D NA ONE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? 0 Yes a--No D NA ONE
34. Does the facility require a follow-up visit by the same agency? 0 Yes [2(No D NA ONE
~lc. h 'f _, 5c.-/ b
sf.Jji-s"-'7 _ t'J..-;;3-11.
Reviewer/Inspector Name: Phone: qJi-3S{r{
Reviewer/Inspector Signature: Date :
Page 3 of3 21412015
..
ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit : ~outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1/o (.Vt /L I Arrival Time:l7! 30}1roepa rture Time: I /f!oo &county: 811--M. Region :
Farm Name' (,()e.d!-_ §"""" J r Owner Email: --------------------------------
Owner Name: -f?.y~ -0~~ ·' Phone:
Mailing Address:
Physical Address: ---------------------------------------------------------------------------------
Title: Phone: FacilityConta<t' ·~~~J --------------------
Onsite Representative : ( ---------------------------------------
Certified Operator: t/
Back-up Operator:
Location of Farm : Latitude:
Discha rges and Stream Impa cts
L Is any disc harge observe d fro m any part of the ope ration?
Di scharge orig inated at: D Structure 0 App licat io n Fie ld D Other:
a. Was the con veyance man-made?
b. Did the di scharge reach waters of the State? (If yes , noti fy DWR)
c. What is the estima ted volume that reached waters of the State (gallons)?
Integrator: __;_J_'M_.'[)"-=---------
Certification Number: 1]1Z..§
Certification Number:
Longitude:
D Yes ~ DNA ONE
D Yes 0 No ~A ONE
D Yes 0 No ~O NE
d . D oes the discharge bypass the waste management system ? (If yes, notify DWR) D Yes 0 No ~O NE
D Yes ~o D NA ONE
D Yes ~D NA O NE
2. Is th ere evidence of a past di sch arge fro m any part of the operation?
3 . Were there any observabl e advers e impa cts or poten tia l adve rse impac t s to th e w at ers
of the State oth er than fro m a discharge?
Page l of3 2/411014 Continued
I Fa~ility Number: f-z...-65( I !Date of Inspection: JDFcB lQ I
Waste Collection & Treatment f
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 Structure4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes~ DNA ONE
DYes 0No ~A ONE
Structure 5 Structure 6
DYes [91Jo DNA ONE
DYes ~o DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or e nv ironmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits , dry stacks, and/or wet stacks)
9 . Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
0 Yes
DYes
~No
GfNo
DNA ONE
DNA ONE
0 Yes [j"'No DNA D NE
0 Yes [2f'No 0 NA 0 NE
II. Is there evidence of incorrect land application ? If yes , check the appropriate box below. 0 Yes [?'No 0 NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN D PAN> 10% or 10 lbs. 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptabl e Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): CC.,'C) ~~=
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 si te need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination ?
Page2of3
DYes
DYes
DYes
DYes
D Yes
0 Yes
DYes
O other:
D Yes
~0 DNA O NE
~ DNA ONE
~ DNA ONE
[2t'No DNA ONE
[LrNo DNA ONE
[2fNo DNA ONE
[3"No DNA ONE
[2fNo
214/1014 Continued
•
I Facility Number: I nate of Inspection: /0 F6 t't
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 ~o DNA ONE
DYes ~ DNA ONE
'
0 Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26 . Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus lo ss assessments (PLAT) certification?
Other Issues
28 . Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29 . At the time of the inspection did the facility pose an odor or air quality concern?
If yes , contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge , freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
DYes ~0 DNA ONE
DYes ~ DNA ONE
DYes ~0 DNA ONE
DYes ~ DNA ONE
DYes ~ DNA ONE
DYes ~ DNA ONE
0 Application Field 0 Lagoon/Storage Pond D Other: ---------------------
32. We re any additional problems noted which cause non-compliance of the permit orCA WMP? DYes [3'N'o DNA ONE
33 . Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes ~ DNA ONE
34. Docs the facility require a follow-up visit by the same agency? DYes (d1ilo DNA ONE
Comments (refer to question .#)::Explajn any¥ES an'5Wers and/or any additional recommelidatil).ns;or;_any other commenu;;;,"f~,•l;;l~:t ·~'· ~
• -~ · •• · .;,·:·:"'···i.:',.:r·.:·"'~[~>'--_-_-._.-:·· -·J ·., •·.:,: .. ~ .•-• • •. :· • .. .,: ... ~~~-:~~-. ~··:'~-~ .. .;.t'•;,;~'""r): • · · -~ ~:: -~-···'. :::_·':.'•:.~~:'-·~--:-· · Usedrawm s offacih to -be~r:e:lplam sitjlations'(us~ addational pages as necessary);;."':--' -~ ~:, .···· · . . ''<--?~'::~1i,7:,t_~.,.
-
Reviewer/Inspector Name :
Reviewer/lnspector Signature :
Page3of3
(9-P-J', 7
Phone; t{ .)J-~~ V
Date: /0 F4 {h
21411014
Owner Name: Pbone:
Mailing Address:
Physical Address: ----------------------------------------------------------------------------------
Facility Contact: _ __..·fh-+...;..""L...=.._..U.a..L:Je=..~Jrs~~· ____ Title:---------Phone:
Onsite Representative: { Integrator: .-.:::5i~JY?::::..:.J ________ _
Certified Operator: J{ Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
I. Is any discharge obseJVed from any part of the operation? O Yes ~DNA ONE
Discharge originated at: 0 Structure 0 Application Field 0 Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
DYes 0No eP?A ONE
DYes 0No ~ ONE
c . What is the estimated volume that re ached waters of the State (gallons)?
d . Does the discharge bypass the waste management system? (If yes , notify DWR) O Yes 0No ~A ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any obseJVable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of3
DYes
DYes
QrNo DNA ONE
ffNo DNA ONE
214/1014 Continued
I Facility !Jumber: !Date oflnspection: gt 'JttR{ ('j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes ~DNA ONE
DYes 0No ~A ONE
Structure 5 Structure 6
0 Yes Q-NO 0 NA 0 NE
DYes ~ DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the 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 ~DNA ONE
DYes ~ DNA ONE
DYes ~ DNA ONE
DYes DNA ONE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. D Yes DNA ONE
D Excessive Ponding 0 Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
D PAN D PAN> 10% or 10 lbs. 0 Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): s c., v G.A--z-r rft{ t<e;
13 . Soil Type(s):
14. Do the receiving crops differ from those designated in theCA WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage fur 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 D Design 0 Maps D Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
DYes
DYes
DYes
DYes
DYes
DYes
DYes
00ther:
DYes
No DNA ONE
[Et1fo DNA ONE
~0 DNA ONE
[f}KO DNA ONE
[3-No DNA ONE
1]3'"No DNA ONE
!::}NO DNA ONE
~0 DNA ONE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis D Waste Transfers 0 Weather Code
0 Rainfall 0 Stocking 0 C rop Yield 0 120 Minute Inspections D Monthly and I" Rainfall Inspections 0 Sludge Survey
22. Did the facility f ail to install and maintain a rain gauge?
23. If selec ted, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 2 of3
DYes
0 Yes
DNA ONE
DNA ONE
21412014 Continued
!Fllcility Number: 81;-(; f { I loate oflnspection: /2G "tr (5 I
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes g-No DNA D NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check D Yes ~ D NA D NE
the appropriate box(es) below.
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 offrrst 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 Joss 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 Offi ce of emergency situations as required by the
permit? (i .e ., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
DYes ~o
DYes ~o
D Yes ~No
DYes E:(No
D Yes ~o
D Yes ~o
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
0 Application Field D Lagoon/Storage Pond 0 Other: --------------------------
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
-c;:{ AJ,~_,
sfu17 ~ Sw,-
Reviewer/Inspector Name:
Reviewer/Inspector Signarure:
Page 3 of3
0 Yes [2(No
DYes @No
DYes U3'No
DNA ONE
DNA ONE
DNA ONE
Phone:. tfJ3. 3 8 3f
Date: /J> Mllf , { :5
214flb14
Denied Access
Date of Visit: Region: 1n 1"1l-C((lq1 Arrival Time:l5 1t:OI Departure Time: I @f.>~ I County£'~~
a ya--:i.) L) ~-ztts Owner Email: ---------
. "-J -R-c.fs k vv-j ~ \.. Phone:
Farm Name:
Owner Name:
Mailing Address: --------------------------------------------------------------------------
Physical Address: -----------------------------------------
Facility Contact: ---f4r=+_:4vt.___,___::::.l,..J_....,l!'_r£<~,a...._---Title: --------Phone:
TIVD Onsite Representative: [(
Certified Operator: l(
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure 0 Application Field
a. Was the conveyance man-made?
0 Other:
b. Did the discharge reach waters of the State? (Ifyes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Integrator: ;;;!.. _
Certification Number: J 7 1 L fr
Certification Number:
Longitude:
DYes ~DNA
DYes 0No ~
DYes 0No ~
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes 0No g-r:fA
2. Is there evidence of a past discharge from any part ofthe operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
DYes
DYes
Q-Mc> DNA
~· DNA
ONE
ONE
ONE
ONE
ONE
ONE
Page 1 of3 214/10// Continued
I Date of Inspection: n ?.tit( tr I Facility Number:
Waste Collection & Treatment
4. Is stora~ capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
\
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
DYes 0 No ~ ONE
Structure 5 Structure 6
~~DNA ONE
DYes ~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 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 ~DNA ONE
DYes ~DNA O NE
DYes ~DNA ONE
D Yes DNA ONE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes DNA ONE
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 Ou~ide of Aeoeptable Crop =w [ D Evidence of Wind Drill D Application Outside of Approved A<eo
12 . Crop Type(s): f) -et'-~ fj' G, 0
13. Soil Type(s): -i> tJ~ fJ p ro./' ub,.,
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 a ll components of theCA WMP readily available? If yes, check
the appropriate box.
0 WUP 0Checklists 0 Design 0 Maps 0 Lease Agreements
DYes
DYes
DYes
DYes
DYes
DYes
D Yes
00ther:
~0
~
~0
~0
DNA
DNA
DNA
DNA
DNA
DNA
D NA
ONE
ONE
ONE
ONE
ONE
ONE
ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes c:a--No 0 NA 0 NE
0 Waste Application D 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 l" RainfalllnspectioJ 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes ~yo 0 NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes 0 No 0 NA 0 NE
Page2of3 21411011 Continued
!Facility Number: ~f)-~r11 I Date of Inspection: 4 .z;cr 'l( 7 I
24. bid the facility fail to calibrate waste application equipment as required by the permit? 0 Yes ....
25. Is the facility out of compliance with permit conditions related to sludge? If yes , check 0 Yes
the appropriate box(es) below.
0 Failure to complete annual sludge survey 0Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? DYes
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? DYes
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? DYes
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
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. DYes
0 Application Field D Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP? D Yes
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? . 0 Yes
to~ J-( -(.1
-LD-1--l ~ L3 D-<J-( f' r-~. s
Reviewer/In spector Name :
~ DNA ONE
Q1'Jo DNA ONE
~ DNA ONE
g-No DNA ONE
~0 DNA ONE
~0 DNA ONE
~0 DNA ONE
~ DNA ONE
@No DNA O NE
12f'No D NA O NE
[2(N'~ DNA ONE
Reviewer/Inspector Signature :
Page3 of3
Dat e: ...L.:-t} ~~Jsfl---.%..1 ~-+---' _
11412111
0 Technical Assistance
Reason for Visit: &"Routine 0 Complaint 0 Other 0 Denied Access
( J"-.......,.....-"-o-----,
Date of Visit: ]q/y fl3 ] Arrival Time: L.....-'-L..L..I..I-L-----1 Departure Time:]I',30PH ] County:..Yhpt>t Region:
Farm Name: Neeft.s f?¥AJ 1nc_ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address: ~91.1 Glflb Rrl'>l RfL) hiAl I)
Facility Contact: Ryttl Wff~( Title: ~0'-!tt:..:..'Mr&...IL-_____ _
Onsite Representative: Ry l1t) W.p..e liJ Integrator: Jtd-ef'Y"tt
Phone:
Certified Operator: Ry /JI) W'.ffltt Certification Number: )&...7&...CG ......... .._t _____ _
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: D Structure 0 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)?
Certification Number:
Longitude:
DYes ~No
DYes 0No
DYes 0No
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes 0No
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of3
DYes (BNo
DYes 18] No
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
214/2011 Continued
I Facility Number: I Date of Inspection: q1C:f}! 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure3 Structure4
Identifier:
Spillway?:
Designed Freeboard (in): _JL..q....._ __
Observed Freeboard (in): :r5:
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 fSa No 0 NA 0 NE
DYes 0No DNA ONE
Structure 5 Structure 6
DYes ~No 0NA ONE
DYes !ENo 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 QgNo DNA ONE
DYes ~No DNA ONE
0 Yes ~ No D NA 0 NE
DYes ~No DNA ONE
II. Is there evidence of incorrect land application? lfyes, check the appropriate box below. DYes ~No 0 NA D NE
0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
D PAN D PAN > 10% or 10 lbs. 0 Total Phosphorus 0 Failure to lncorf,orate Manure/Sludge into Bare Soil
D Outside of Acceptable Cropt(c1ndl~}. D Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s) Cbt.&ia/ ~~S111all @tQ!h) {!fo-_" lt'he:rt .~ tl;nk&!IIDI 01 fl® J \S lS'j .) ~ J
13 . Soil Type(s): Yvo....B No f«l!'Wh &'W
J J ) .
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?
23 . If se lected, did the facility fai l to install and maintain rainbreakers on irrigation equipment?
Page2 o/3
DYes •-~6 NO ~Yes ~J~o DNA ONE
DNA ONE
DYes ~No DNA ONE
0 Yes [B) No 0 NA 0 NE
D Yes IS!J No D NA 0 NE
DYes
DYes
00ther:
DYes
!Sa No
l)g No
~No
DNA ONE
DNA ONE
DYes 0No ~NA ONE
21412011 Continued
IFafi~!I Number: fb~ -6zKI !Date oflnspection: qly J 13
'" 24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes IS(I No DNA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check DYes ~No DNA
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 to provide documentation of an actively certified operator in charge? DYes ~No DNA
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? DYes DNo [5i"NA
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes [81 No DNA
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? DYes (ENo DNA
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 r)a No DNA
permit? (i .e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. DYes DNo DNA
D Application Field D Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance ofthe permit or CAWMP? DYes ~No DNA
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes I8J No DNA
34. Does the facility require a follow-up visit by the same agency? DYes ~No D NA
l5· Pl-e~e lrme {!i.etJJ +ntrl--f) "fled rt' This SfYYfJ ar 0, NO() (Noffre i'f 'fkf;c/·t;?{y ),
Goa:J rearrlr.
FDfl~p for h~h ~~~b,a--tiln vv~
do¥1\ a~w{)(elJ,
, Nov +o b_;. fss~J.
(~ob cf? gf Vio la"hr Or?)
ONE
ONE
ONE
ONE
ONE
ONE
ONE
~NE
ONE
ONE
ONE
Re viewer/Inspector Nam e:
R evi ewer/Inspector Si gnature:
Phone: q, fr433-3300 {offi(V
Date : Ser + '!J a 013
Page 3of3 114/1011
f=acility No. ~ct I Farm Name W-t>e~ F?P7
Permit / COC I ./ OIC / NPDES(Rainbreaker PLAT Annual Cert Daily Pipe)
FB Dro~s
I I I I I I I I I I I
Lagoon Name, S for spillway 1 2 3
Design Freeboard J Last Recorded (in)
Observed freeboard :JS
Sludge Survey Date iqlltlt~
Sludge Depth (ft) .. .j,j
Liquid Trt. Zone (ft) 3t'"
Ratio Sludge to Treatment Volume if> 0.45 0-'-11
Date out of compliance/ POA?
I rtr
Calibration Date 1GJfltlh 2 3 4
Ring Size (in) I, \
Design Flow (gpm) :>~.,
Actual Flow :;1~}..
Design Diam. (ft) 34')'
Actual Diam. .3Yo
Soil Test Date Jl ~ fr'h Crop Yield
pH Fields AI' _
Lime Needed o-L~ >J,O l~O
Wettable Acres __ _
LimeAppli~
Cu-I Zn-1 7
Needs S (S-1<25) ~_not-_ ~
Needs P iHLJ IIIIIM{.-~lH'!PK
WUP v
Weekly Freeboard __
1 in Inspections __ _ _
120 min Insp.
Weather Codes
Waste Date -:) lb.ln 3/"Jn. lOII'llh
-60 Day ./ llhlf:3
+ 60 Day l~ lqfll.
N (lb/1 000 Gal) ~ct 'l.m I. i:.lb
pH 1 ()
lOaf' Ia. l\4rlt).-llhfl'3
Pull/Field Soil Crop Acres PAN
1-1-~ MBo.lloB DfSb I:Jorlbn
4-J 6fbb Oa0 ,
llr
~ .. 1 .l-J.. ~~ ~lhn
J-t1.w -~-{ b:e ';)')d/W)
<6-~-"t-<-t )Jt)_& IChn 'I~
~ lc)S
IC9v ~7
'vJ\ flo
·'?-I \~ IDI.~ 'J:MJ/110 _,
"' ...
Verify PHONE NUMBERS and affiliations
Date last WUP FRO ~Iliff() FRO o~ecords
Date last WUP at farm~~ Lagoon# l
App. Hardware Top Dike f34.0
Stop Pump l~q,q ..,
Start Pump 131ro --:l.s · Fn~l.JtdOt ;)' Rtt
Conversion-Cu-I 3000= 1 08 lb/ac; Zn-1 3000= 213 lb/ac
~~~""' =-~-~ u sivp= '1 q, (Y j, ~.f+belOI-"~
&~ur-1~~£. ltl
4
5
5 6
6 7
Transfer Sheets
RAIN GAUGE
7
8
Dead box or incinerator __ _
Mortality Records
Check Lists
Storm Water
Window Max Rate MaxAmt
HI~-~Hav Qj I
' • I ll VJ)
Htr-J"''
SRP-1\?/
A2 'Y-~ I)
sJ t~-At-
~ ~
mpliance Inspection
Reason for Visit: ~tine 0
Operation Review
0 Referral 0 l(m,Pro•Pnc•v OOther
~I Date of Visit: ¥fJZ.Arrival Time: I/,'¢(»' I Departure Time: I ,2i f'yJL,county:~ Region: r=?z,o
Farm Name: ~q ~ /uc..., Owner Email:
Owoe< Name: .t?y&-' '~I Pbone'
Mailing Address:
Physical Address: -------------------------------------------
FndliiyContad' ~ ~S Title: jZ;I'N>
Onsite Representative: ~~ u.le.ei.s
Certified Operator: ~ tc.J,:::e.Js
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: D Structure D Application Field
a. Was the conveyance man-made?
0 Other:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Phone:
Integrator: ----!/.:....M-=.::~=--~___;_=..:......::EI=....J=if-:...~.--___ _
Certification Number:
Certification Number:
Longitude:
DYes ~DNA ONE
DYes 0No [B1<A ONE
DYes 0No ~ ONE
d. Does the discharge bypass the waste management system? (If yes, notifY DWQ) DYes 0 No [!f1'iA
~DNA
ONE
2. Is there evidence of a past discharge from any part ofthe operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of3
0 Yes
0 Yes
ONE
0-' DNA ONE
11411011 Continued
I Facility Number: [5;). -'? 8J I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'!
a. If yes, is waste level into the structural freeboard?
Identifier:
StruJl.J Structure 2 Structure 3 Structure 4
Spillway?:
Designed Freeboard (in): 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
0 Yes
Structure 5
DYes
0 Yes
~DNA ONE
DNo ~ONE
Structure 6
~DNA
~DNA
If any of questions 4-6 were answered yes, and tbe situation poses an immediate public health or environmenta~eat, notify DWQ
7. Do any of the structures need maintenance or improvement? D Yes [g1fo DNA D NE
8. Do any ofthe structures lack adequate markers as required by the permit? DYes ~ DNA D NE
(not applicable to roofed pits. dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required butTers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes~ DNA ONE
DYes ~ DNA ONE
I LIs there evidence of incorrect land application? lfyes, check the appropriate box below. DYes ~ DNA ONE
D Excessive Ponding D Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn, etc.)
D PAN 0 PAN> 10% or lO lbs. D Total Phosphorus D Failure to In corporate Manure/Sludge into Bare Soil
0 Outs;de of Acceptable Crop Willdow 0 Evidebc of Wind Drifi D Application Outside of Approved Area
12.CropTypc(s )o ~~~&-~-&&tJ
13 . Soil Type(s): l:;i.h__-&Lf -~ ~-~ 1 4..J:;. b-
1 .........,/ 14. Do the receiving crops differ from those designated in the CAWMP? 0 Yes i.k:rNO DNA ONE
15. Does th e receiving crop and/or land application site need improvem ent?
16 . Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
DYes ~ DNA ONE
0 Yes g1fo 0 NA D NE
17. Does the facility lack adequa te acreage for land application?
18 . Is th ere a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
Owur O c heckli sts D Design D Maps 0 Lease At,'Teements
2 1. Docs record keepi ng need improvement? If yes, check the appropriate box below.
DYes
DYes
DYes
DYes
Oother:
DYes
~ DNA ONE
~ DNA ONE
~ DNA ONE
~0 DNA ONE
~ DNA ONE
D Waste Applicati on D Weekly Freeboard 0 Waste Analysis D Soil Analysis D Waste Transfers D Weather Code
0 Rainfall 0 S tocking 0 Crop Yield D 120 Minute Inspections D Monthly and I" Rainfall Inspections _.P S ludge Survey
22. Did the facility fail to install and maintain a rain gauge? D Yes [B"'N""o 0 NA D NE
23. If sele cted, did th e facility fail to in sta ll and maintainrainbreakers on irrigation equipment? DYes 0 No ~A 0 NE
Page2of3 214!201 I Continued
IParmly 'N~mbero KZ -aJ I !Date oflns2e<tion' 4-o/Jz
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes ~DNA ONE
DYes ~ DNA ONE 25 . I s tbe 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 Jo ss 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 pos e an odor or air quality concern?
I f yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
DYes
DYes
DYes
DYes
DYes
DYes 31. Do s ubsurface tile drains ex ist at the facility? I f yes, check the appropriate box below.
0 Application Field 0 Lagoon/Storage Pond D Other: ---------------------
32 . Were any additional problems noted which cause non-compliance of the permit or CAWMP? DYes
33 . Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes
34. Doe s the facility require a follow-up visit by the same agency? 0 Yes
~0 DNA
0No ~
~ DNA
[Ll.Xo" DNA
~ DNA
~0 DNA
~0 DNA
~0 DNA
~0 DNA
Comments ( r'~-fer··to·~que~t!~.n : #): Explain any~-~_SA~~sw~~{~~IJI.~r :alY.Jadditional recommerida~~~s:t_~!;J_~~~l~t!~ft~o.~~:~
Use drawings'of facility ·to better explain situati~ns (us¢.a~(!!tiij~a(p~(g~ as necessary). _ . .';;-:,:.:,;}_&:-:~~~?~~;;~£'-
Reviewer/Inspector Name:
Page 3 of3
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Date of Visit' vo;WI/ I Arrival Time,J2,~ Departure Time'~ ~ounty'¥n· Region'
Farm Name: u ere b !Zlnn s he I Owner Email:
I
Owner Name: ~l?A) lt.kek Phone:
Mailing Address:
PhysicalAddress: --------------------------------------------------------------------------------------
Facility Contact: '"7?t4v ~S
Onsite Representative: ~· J IA.Jc:e/:.;s
Certified Operator: !<you Wee /..;s
Title:
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation'!
Discharge originated at: D 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)?
Phone:
Integrator: _.....!.7~~:.......=:~4F=i'J-!::...Cu!ev::5o:::..::=f-:.L __ _
Certification Number: J12dLt
Certification Number:
Longitude:
DYes ~ DNA ONE
DYes 0No ~ONE
DYes 0No (g.£ ONE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) DYes 0No ~ ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of3
DYes
0 Yes
~DNA ONE
No DNA ONE
21412011 Continued
I Facili?' Number: -C?J'J I I Date of Inspection:
.Waste CoUection & Treatment
4 . Is storage capacity (structural plus storm storage plus heavy rainfall) Jess than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: #I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e ., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes
DYes
Structure 5
~0
~0
DNA ONE
DNA ONE
Structure 6
DYes~ DNA ONE
DYes~ DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public bealth or environmental tbreat, notify DWQ
7. Do any of the structures need maintenance or improvement? D Yes ~ 0 NA D 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
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
II. Is there evidence of incorrect land application? If yes, check the appropriate box below.
DYes~ DNA ONE
DYes~ DNA ONE
DYes~ DNA ONE
DYes ~NA ONE
0 Excessive Ponding 0 Hydraulic O ve rload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN D PAN > 10% or 10 lbs. 0 Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): &
13 . Soil Type(s):
14. Do the receiving crops differ from those designated in theCA WMP'!
15 . Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18 . Is there a lack of properly operating waste application equipment?
Required Records & Documents
19 . Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
the appropriate box.
0WUP Ochecklists 0 Des ign 0 Maps 0 Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
DNA ONE
(91\fo" D NA ONE
DYes ~ DNA ONE
DYes ~DNA ONE
DYes ~DNA ONE
DYes ~0 DNA ONE
DYes ~0 DNA ONE
Oother:
DYes ~0 DNA ONE
0 Waste Application D Weekly Freeboard D Waste Analysi s 0 Soil Analysis 0 Waste Transfers 0 Weather Code
0 Rainfall 0 Stocking D Crop Yield D 120 Minute Inspections D Monthly and 1" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes ~ 0 NA D NE
23. If selected, did the facility fail to install and ma intain rainbreakcrs on irrigation equipment? 0 Yes 0 No ~A D NE
Page2of3 2/4/201 I Continued
IFadU!)' N•m""" ;!f) -&1J I loo~e of Inspection' ¢/lz I
.24. "Did the facility fail to calibrate waste application equipment as required by the penntt? D Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
DYes
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 provide documentation of an actively certified operator in charge? DYes
27 . Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? DYes
Other Issues
28 . Did the facility fail to properly dispose of dead animals with 24 hours and/or document DYes
and report mortality rates that were higher than normal?
29. At the t ime of the inspection did the facility pose an odor or air quality concern? D Yes
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 0 Yes
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. DYes
0 Application Field 0 Lagoon/Storage Pond D Other: ------------------------
32. Were any additional problems noted which cause non-compliance of the penn it orCA WMP? DYes
33. Did the Reviewer/Inspector fail to discuss review/inspection with a n on-site representative? DYes
34. Does the facility require a follow-up visit by the same agency? DYes
~DNA
~0 DNA
~ D NA
DNo DNA
~DNA
~ DNA
~ DNA
~DNA
~0 DNA
~DNA ~DNA
ONE
ONE
ONE
~
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Reviewer/Inspector Name : Phone : t::Jtu -®-{~?/j
Date 1')/¥/261/
'141201 1
Reviewerllnspector Si
Page 3 of3
Type of Visit e Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit e Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I !]'zJ. /fo J Arrival Timed {)fJ:}()a;IVJ Departure Time: I Jo! fPa,.._l County: 5~~ • Region:
J
Farm Name: Lt}.gg_k~ ~h.-\$ 1 ;:t,.. c., OwnerEmail: ----------------
Owner Name: ~g...._ ~Afte._g 5 Phone:
Mailing Address: -----------------------------------------
Physical Address:------------------------------------------
Facility Contact: ~ LJ~S Title:-----------Phone No:---------
\(
Integrator: ~
Operator Certification Number: /7Cfrl-6
Onsite Representative: ------------------
Certified Operator:--------------------
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 !pNo DNA ONE
Discharge originated at: D Structure 0 Application Field D Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gal lons)?
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 0No $NA ONE
DYes DNo jA ONE
DYes 0No '?NA ONE
DYes ~0 DNA ONE
DYes eyNo DNA ONE
12128104 Continued
!Facility Number: 82.. -68J Date of Inspection I 4'ZJ/ro I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 2 Structure 3 Structure 4
DYes ~No DNA ONE
DYes 0No ~NA ONE
Structure 5 sbcture 6 Stru,ture I
Identifier: __ ___:~----------------------------------
Spillway?:
Designed Freeboard (in): -------::-----------------------------------
~~
Observed Freeboard (in): --...::~=~oo::--------------------------------------
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 DYes ~No DNA ONE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any ofthe structures need maintenance or improvement?
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Apolication
10. Arc there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
D Yes "§lNo D NA D NE
DYes ~o DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
ll. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes 'l1No 0 NA 0 NE
D Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN> lO% or 10 lbs 0 Total Phosphorus
D Outside of 0 Application Outside of Area
12. Crop type(s) --W!:::!.!J~~~!....(!:bt-.,_:.-L~~4--olllu..J~lW:.E!...U~~~Z1,....:'--------------
l3. 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 acre determination ?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
-to·question #): Explain any YES
· facility;.to',better explaio situations. (use
Reviewer/Jnspector Name
Reviewer/Inspector Signature:
Pagel of3
DYes lpNo DNA ONE
DYes ~No DNA ONE
DYes ~No 0 N~ 0 NE
DYes 'fj1No DNA ONE
Continued
I Facility Number: 8Pt:6f/l
Required Records & Documents
Date of Inspection I t;_jub J
{
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components oftbe CAWMP readily available? lfyes, check
the appropriate box. 0 WUP 0 Checklists 0 Design 0 Maps 0 Other
DYes ~No DNA ONE
DYes r{JNo DNA ONE
21. Does record keeping need improvement? lfyes, check the appropriate box below. 0 Yes lfJ No DNA D NE
D Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis D Waste Transfers 0 Annual Certification
0 Rainfall D Stocking 0 Crop Yield 0 I 20 Minute Inspections 0 Monthly and I" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rain breakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or docwnent
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does fac ility require a follow-up visit by same agency ?
AdditlonafCommeilts and./or Draltings:
Page 3 of3
DYes
DYes
DYes
DYes
DYes
~No
~No
~No
l')lNo
~No
DNA ONE
DNA ONE
D NA ONE
DNA ONE
DNA ONE
DYes ~No DNA ONE
DYes 129No DNA ONE
DYes EfiNo DNA ONE
D Yes g) No DNA ONE
DYes ts:JNo DNA ONE
D Yes bNo DNA ONE
D Yes (t1g No DNA O NE
.. -:·:~~'"':
-~.-:·~.:' . ... -~~~t?l:~~~~~
• -
12/28104
,
' . . ~ ...
• Division of Water Quality
0 Division of Soil and Water Conservation
D Other Agency
Facility Number : ..,.82 .. 06.....,8._.1 ____ Facility Status: ...,A..,.ctwivuoe ____ _ Permit: 8WS820681 0 Denied Access
Inspection Type: Compliance Inspection Inactive or Closed Date: --------
Reason for Visit: .~..F ... o.ll.llloouw~-;;.~~U:~~P~-------------County: ~s~allm~p~s~olln ___ _ Region: Fayetteyjlle
Date of Visit: 03/11/2009 Entry Time: 03·15 PM Exit Time: 03"45 PM Incident#: --------
Fann Name: Weeks Farm Inc Owner Email: weeksfarms@jotrstar.
Owner: Ryan p Weeks Phone: 910-820-1121
Mailing Address: ...L1.w;63"-L,;RW~uwffi.u.n.wR~d..__ ______________ _ Dunn NC 28334
Physical Address : 2915 Green Path Rd Dunn NC 28334
Facility Status: 0 Compliant 0 Not Compliant Integrator: -------------------
Location of Fann: Latitude: 35"13'22" Longitude: 78"36'59"
SE of Dunn in NE Sampson Co. Located 2 miles South of intersection SR 1002 and SR 1005 o r 2.0 miles North of Larry's General
Store, on west side of SR 1005 (fayetteville or Green Path Rd). Address 2915, UNMARKED entrance road . Pass pond, tum left.-
Question Areas:
Iii Discharges & Stream Impacts Iii Other Issues
Certified Operator: Ryan 0 Weeks
Secondary OIC(s):
On-5ite Representative(s}: Name
24 hour contact name
On-site representative
On-site representative
Ryan Weeks
Ryan Weeks
Ryan Weeks
Primary Inspector: Joan Schneier
~~/ Inspector Signature: ~ __
Secondary lnspector(s}:
Inspection Summary:
Followup for spill-BIMS incident 200900143.
Operator Certification Number: 17926
rrtJe Phone
Phone:
Phone:
Phone:
Phone:qiO ~33-3300 X 2a35
Date: Ji•lot -JHhfttl '-If 17/0 'f
New 4 inch diameter PVC overflow pipes were installed leading from each pig house plenum to the lagoon and these were in the
process of being t ied in . These will be flushed periodically as a test.
The weekly flush procedure for the houses has been chan ged and is now documented whenever done.
The timers were replaced a few weeks back and documented on another inspection .
I have seen the new timers. the new procedural clipboard , the disturbed soil from each house where the overflow pipes were buried,
some of the new pipe ends near the houses, and all of the new pipe ends at the lagoon.l'm satisfied that the measures ta ken will
prevent this type spill from happening again at this facility, assuming the flushing and checking routines a re followed.
Page: 1
Pennlt: AWS820681 Owner -Facility: Ryan D Weeks Facility Number : 820681
Inspection Date: 03/1112009 Inspection Type: CompHance Inspection Reason for VISit : FoUow-up
Waste Structures
Type Identifier Closed Date Start Date Designed Freeboard Observed Freeboard
~a goon 19.001
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation ?
Discharge originated at:
Structure
Application F ield
Other
a . Was conveyance man-made?
b . Did discharge reach Waters of the State? (if yes , notify DWQ)
c . Estimated volume reaching surface waters?
d . Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past disch arge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts t o Waters of the State other than from a
discharge?
Other Issues
28. Were any additional problems noted which cause non-compliance of the Permi t or CAINMP?
29. Did the fa ci lity fa il to property dispose of dead animals within 24 hours and/or document and report those
mortality rates that exceed normal rates?
3 0 . At the time of the inspection did the facility pose an air quality concern? If yes, contact a regional Air
Quality representative immediately.
31 . Did the fa ci lity fail to n otify regional DWQ of emergency sit uations as required by Permit?
32. Did Reviewer/Inspector fail to discuss review/inspecti on with on-site representative?
33. Does facility require a follow-up visit by same agency?
Yes No NA NE
D•DD
0
0
0
DODO
DODO
DODO
• DOD
0 • DO
Yes No NA NE
0 • DO
0 • DO
0 • DO
D • DO
0 • DO
D • DO
Page: 2
Mr. Ryan Weeks.
163 Ruffin Rd
Dunn NC 28334
Weeks Farm Inc
82-0681
. Sampson County
AWS820681
Dear Mr. Weeks:
Be\'Crl y Eav es Perdue
G overnor
Dee Freeman
Secretary
North Carolin a Department o f Environm e nt and Natural Resources
Date: April 17, 2009
Coleen Sull ins, Direc tor
Division of Water Quality
This is a copy of the inspection form from my last visit on March 11, 2009. Please keep it with your other
inspections. It is just a short version of our usual inspection in a different format. Unfortunately, I forgot extra blank
forms· that day. Your report arrived at our office on March 10. Thank you. By the way , that was a good sketch map
you sent with the earlier report. I closed out the incident (200900143) on our BIMS computer system.
I hope your businesses are running about as well as could be expected right now.
Sincerely,
~hn~
Environmental Specialist.
Cc: AP F iles, FRO
North Caro lin a DWQ/Aq ui fcr Pro tecti on Section 225 Green St./ S uite 7 14 Fayctte nllc. NC ~8301 Phone (910) 433 -3300
FAX (9 10) 486-0 707 Internet h2o.em state nc.us Cus tomer Service 1-8 77-623-67 48
An Equ al Opportunity/Affirmati ve Action Employer -50% Recyc led/10% Post Consu mer Paper
N~~C arolina
,Naturally
a /11/0q-UVJ
.ti(Facili;;,Number I~~ . II '9-Division of Water Quality H _k~r .. 0 Division of Soil and Water Conservation ,: ··:'''• 0 Other Agency ...... ~~-:;." . .>
Type of Visit Qrcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine Ocomplaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
DateofVisit: ba/l,r/8 I Arriva1Tirnedof;ooA}11 DepartureTime: IJ/;J~Jfil County: StWJ:jUh Region: Fgo
Farm Name: Yv.eeks ~ 1;. k= Owner Email: -------------
Owner Name: _....;.;glo.J-1-"'~q...._------_..!.W:....-f-l...~ll::..:.r.lr_~r _____ _ Phone:
Mailing Address: 1 la3 ~"tf.'n ld. ___ ____:o:Quo~r..:..,Q,__ _____ Q>S3..3)'
Physical Address:----------------------------------------
Facility Contact: ...,R'"i)""4lh~-~.:........;;~=ek""~'-------Title: ---------Phone No: __ 13=--:JO~-.._11_;;,...._1 .:.o{ (:r)-
Onsite Representative: ------------------
Certified Operator: _R~~M'b~-----_.W'-1.,.;-f.lo,.;!.f.~~..§.--------
Integrator:----------------
Operator Certification Number: ,_J7~9 ........ ::.>I:.j!OS.._ ___ _
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD 'D " Longitude: D OD'D"
Des ign Current Design Current
Capacity Population Capacity Population Swine Cattle Wet Poultry -. '· ...
D Wean to Feeder
iEii_Fcede r to Finish ~i "10 1~ lfO
0 Dairy Cow ' I 0 Dairy Calf i
D Dairy Heife1
JD Wean to Finish I I ID L ayer I I 0 Non-Layer
:~
. ... ··~· •, !!·
Number of Structures: [:\:}. ::.~( ·. . ...
D FarroW:'to Wean
• D Farrow to Feeder
0 Farrow to Fin ish
D Gilts
DBoars --.
D Dl)' Cow I
D Non -Dairy I
D Beef Stocker i
D Beef Feeder i
D Beef Brood Cow I
----------.. .., -. --
Dry Poultry ·
Other
0 Layers
D No n-Layers
D Pullets
0 Turkeys
0 Turkey Poults
0 Other
··---·-·
ID Other J
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation? D Yes ~o DNA ONE
Di sc harge originated at: 0 Structure D Application Field D Other
a. Wa s the conveyance man-made? DYes 0No DNA ONE
b. Did the di scharge reach waters of the State? (If yes, notify DWQ) D Yes 0 No DNA ONE
c. Wha t is the est ima ted volume that reached wa ters of th e State (gallons)?
d_ Doc s di sc harge bypas s th e waste management system? (If yes, not ify DWQ)
2. Is there evidence of a past di scharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impac ts t o th e Waters of the State
other than from a di sc harge ?
DYes 0No
'\a"Yes 0 No
'
DYes ~0
12128104
DNA O NE
D NA ONE
DNA ONE
Continued
I Facility Number;(b';)._ -b~ { I Date of Inspection le» Itt kJCt I
Waste Collection & Treatment
4. Is storage capacity (structura l plus storm storage plus heavy rainfall) less than adequate?
a . If yes, is waste level into the s tru ctural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
D Yes r;iNo D NA ONE
DYes 0 No D NA ONE
StructureS Structure 6
Identifier:-----------------------------------------
Spillway?:
Designed Freeboard (in): __ ) .... 'f-L-----------------------------------
Observed Freeboard (in): __ ":>...._lf-4----------------------------------------
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
DYes ~0 D NA ONE
6. Are there structures on-site wh ic h are not properly addressed and/or managed D Yes 15J:No D NA O 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 ad equate 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 th an the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required bu ffe rs, setbacks, or compliance alternatives that need
maintenance/improvement?
D Yes [)(No DNA ONE
D Yes '1SJNo D NA O NE
DYes ~No D NA O NE
D Yes ~o DNA O NE
II. l s there evidence ofineorrectapplication? If yes, check the app ropri ate box below. 0 Yes 1)1-No 0 NA 0 NE
0 Excessive Ponding D Hydraul ic Overload 0 Frozen Ground D Heavy Meta ls (Cu, Zn , etc.)
D PAN 0 PAN > 10% or 10 lb s 0 Total Phos phorus D Failure to Incorporate Manure/S ludge into Bare Soi l
D Outside of Acceptab le C rop Window 0 Evidence of Wind Drift 0 A pplication Outsid e of Area
12. Crop type(s) CoorlfJ Bttm,d4 ( Hal q_ ftxkr}.y 5 b OJ
13. Soil type(s ) Bt hfz<t vilmftn I f;a~a., ' ~crfoPc :tbh·~ j hl~tlb ;; J J
14. Do the receiving crops differ from those designated in the CAWMP'!
15. Does the receiving c rop and/or land appl ication site need improvement?
DYes IS!aN o DNA ONE
'fig Yes 0 NE 0 No D NA
16. Did the fac ility fail to secure and/or operate p er the irrigation design or wettable acre determ inat ion?O Yes
17. Does the facility lack adequate acreage for land application?
18 . Is there a lack of properly ope rat ing waste application equipment?
DYes
DYes
l)lNo
~0
~No
Comments (refer to question#): Explain any YES answers and/or any r ecommendations or. any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
DNA
DNA
DNA
ONE
ONE
O NE
.....
I-
..__
'P
Reviewer/Inspector Name \fQAv Scftri~I?R.._
..
Phone: q fO lfJl.-.1300 X .3a.l)
Reviewer/In spector Signature: --~ ~4. lt.t'l.. {:',_b II ~'1 ..
Date:
v 11118104 Continued
I Facility N·~mber:~ ~ -~ / I
1-
Date of Inspection lm Ill 1lif I
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropirate box. D WUP D Checklists D Design D Maps D Other
DYes ~No DNA ONE
DYes ~o DNA ONE
21. Does record keeping need improvement? lfyes, check the appropriate box below. DYes 1:)1-No DNA 0 NE
D Waste Application D Weekly Freeboard D Waste Analysis D Soil Analysis 0 Waste Transfers D Annual Certification
0 Rainfall D Stocking 0 Crop Yield D 120 Minute Inspections D Monthly and I" Rain Inspections D Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional oflicc of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representati ve?
33. Does facility require a follow-up visit by same agency?
.·
b".l'fe~clOSt>iJ ()lvJ~J,•J ~ ~tm a,d_ rrme_ ~ recomm~-/10,.,
DYes I}J-No DNA
DYes 0No ~NA
DYes ~No D NA
DYes ~No DNA
DYes Of No DNA
DYes 0No lJtNA
DYes ~No DNA
DYes '6'a No DNA
DYes ~0 DNA
DYes IR'No DNA
DYes !&No DNA
DYes ~0 DNA
~. sr; It t'eftrkd...~ ~a,v7 q logpl l'l 01 t3 I HS, PP.J~r~ iJ dry,~ "'(I ~ re,~s-J.e[
Q. Jlitte nr~e. f"l"'f'~ ()vi-of ~e_ J~r nD/'f I ll)e o1\tr 3 Pr-e OJ<,
O~ller i.s 0\Q~~ procerlllfa{ cha~ +o Jl\lft'.?Ue.. rreve,-h"e mol~tie?PNe 41
h~ ho~ ~L Olfe-lVIJ preve,+ ~re sfnls,
Page3 of 3 12128104
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Type of Visit S'Compllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for V isit 0 Routine 0 Complaint 'a Follow up 0 Referral 0 Emergency ®:Other 0 Den ied Access
DateofVislt: ll~crl~q I ArrivaiTime:lp;yl)pnj DepartureTime: li:yoP/1) County: ~(),{flh Region: f,t{)
FarmName: Ry:? ~elg Owner Email:--------------
Owner Name: _.~~'f,...~q....-------_.._\v_~-=e~~..,..s ______ _ Phone:
Mailing Address: ----------------------------------------
Physical Address:----------------------------------------
Facility Contact: Rl flo wee~s Title: {),'lP/"
Oosite Represe ntative: _,R'""1_,...:;'h;..,~·---"wL.I...P.ll:8""":k_""f _________ _ Integrator:----------------
Certified Operator:--------------------Operator Certification Number: -------
Back-up Operator: -----~--------------Back-up Certification N umbe r:
Location of Farm: Latitude: D OD'D" Lo ngitud e:
Di sc harges & Stream Impac ts
I . Is an y di sc harge observed fro m any part of the operation? DYes ~No DNA ONE
Discharge originated at: 0 Structure 0 Appli cation Field 0 Other
a. Was the conveyance man-m ade?
b. Did th e 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 th e waste mana gement system? (If yes, noti fy DWQ)
2. Is there evidence of a past di sc harge from any part of the operation?
3. Were there any adverse impa cts or potenti a l adverse impacts to the Waters of the State
other than from a discharge?
Puge 1 of 3
D Yes DNo D NA O NE
D Yes 0 No DNA O NE
D Yes 0 No DNA O NE
!Sa Yes D No DNA ONE
D Yes ~No DNA ONE
12128/04 Co ntinued
I Facility Numb;;.":£6. -u,z f
I
Date of Inspection I ,td'11or I
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
DYes ~No DNA ONE
DYes DNo DNA ONE
Structure 5 Structure 6
Identifier: _____________________________________ _
Spillway?:
Designed Freeboard (in): _.L} q-'----------------------------------------
Observed Freeboard (in): -~::::ko.3L------------------------------------
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 DYes !&No DNA ONE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes lSJ'No DNA ONE
DYes !&No DNA ONE
DYes !RNo DNA ONE
DYes ~No DNA ONE
II. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes 0 No 0 NA 1}1-NE
0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground 0 Heavy Metal s (Cu, Zn, etc.)
0 PAN 0 PAN> 10% or 10 lbs D Total Phosphorus 0 Fai lure to Incorporate Manure/S ludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Area
12. Crop type(s) --------------------------------------
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA WMP? DYes
15. Does the receiving crop and/or land application site need improvement? DYes •
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?O Yes
17. Does the facility lack adequate acreage for land application?
18 . Is there a lack of properly operating waste application equipment?
Reviewer/Inspector Name
Reviewer/Inspector S ignature :
Page 2 of 3
DYes
DYes
0No DNA RNE
0No DNA ~NE
0No DNA ~E
0No DNA ~NE
0No DNA JS;:rNE
I Facility Num'ber: <0{} -ftG{ I Date of I ospection I !l.19lO ? I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropirate box. D WUP D Checklists 0 Design D Maps 0 Other
D Yes 0 No D NA Ikl NE
DYes 0No DNA ~
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes D No 0 NA E"NE
D Waste Application D Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers D Annual Certification
0 Rainfall 0 Stocking D Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rain Inspections 0 Weather Code .
22. Did the faci lity fail to install and maintain a rain gauge? DYes 0No DNA GJNE
23. If selected, did the facility fail to install and maintain rain breakers on irrigation equipment? D Yes 0No ~NA ONE
24. Did the facility fail to c alibrate waste application equipment as required by the permit? DYes 0No DNA ~E
25. Did the facility fail to conduct a sludge s urvey as requi red by the permit? DYes DNo DNA l3rNE
26. Did the facility fail to have an actively certified operator in charge? DYes 0No DNA ~E
27. Did the facility fail to sec ure a phosphorus loss assessment (PLAT) certification? DYes DNo ilJ-NA ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes ~No DNA ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes 6(No DNA ONE
and report the mortality rates that were higher than normal?
30. At the time of the inspectio n did the fa cility pose an odor or air quality concern? DYes ~0 DNA ONE
If yes, contact a regional Air Quality repres entative immediately
3 I . Did the facility fail to noti fy the regional office of emergency situations as required by DYes lY'No DNA ONE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/i nspection with an on-site representative? DYes ~0 DNA ONE
33 . Does facility require a follow-up visit by same agenc y? ~es DNo DNA ONE
Page 3 of 3 11/18/04
-... A_c__
' -.. Division of Water Quality \) \ ,, \...::> Q) ~Facility Number 1.:1?-.-H (Q~l._ .II 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit llJ Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit *Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ll fc;A ( ()& I Arriva1Timed9 C£:h; I Departure Time: I
Farm Name: \.A:)f.f.k.,~ Farm l n c....,
Region: f=-~
Owner Email: -------------
OwnerName: ~ \We~ Phone:
Mailing Address: ----------------------------------------
Physical Address:------------------------------------------
Facility Contact:~ ~ Title: C)\.}JCRL Phone No:---------
Onshc Rcpmentative: ~ \,.Ue,d..>,{ ln<eg•ato" \ rd.» f'1 ros:k.,y,:t--
Certified Operator: ~ w~e.......W Operator Certification Number: \ 1<0{ ~
Back·up Operator: --------------------Back-up Certification Number:
Location of Farm: r-1 oD'D" Latitude: L.....J Longitude: D OD'D"
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle · Capacity Population
ID Wean to Finish I I
D Wean to Feeder
ODairyCow I
D Dairy Ca lf
10 Layer
0 Non-Layer
~e eder to Fi ni s h 139-.LIO ::2~ 0 Dairy Heife1
D Farrow to W can
D Farrow to Feeder
D Farrow to Finish
D Gilts
DBoars . . ..
0 Dry Cow
0 Non-Da iry
0 Beef Stocker
0 Beef Feeder i
0 Beef Brood Cow I
·--..
Dry Poultry
Other
D Layers
0 Non-Layers
0 Pullets I
0 Turkeys
0 Turkey Poults
0 Other
.. -·-·-
ID Other Number of Structures: rn.
Discharges & Stream lmpacts
1. Is any discharge observed from any part of the operati on? DYes ~N o DNA O NE
Discharge originated at: 0 Structure D Application Field D Other
a. Was the conveyance man-made? DYes 0No ~NA ONE
b. Did the discharge reach waters of the State? (If yes, notifY DWQ) DYes 0No BNA ONE
c. Wh at is the estimated vo lum e that reached waters of the State (gallon s)? L-::::..
d. Does discharge bypass the wa ste management system? (If yes , noti fY DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other th an from a di sc harge?
DYes 0 No
DYes "8lJNo
DYes Pi No
12128104
~A ONE
DNA ONE
DNA ONE
Continued
.I .
Date of Inspection • l FacilitY Number~J-.-(@l ]
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?
DYes l&.._No 0 NA D NE
DYes 'JSNo DNA ONE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:---"'-'-------------------------------------
Spillway?:
Designed Freeboard (in): fC)
Observed Freeboard (in): lf6
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees , severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
DYes ~No DNA ONE
DYes )(No DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
DYes ~o DNA ONE
DYes )&_No DNA ONE
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
DYes ){No DNA ONE
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes
II. Is there evidence of incorrect application ? If yes, check the appropriate box below. 0 Ye s
D Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
~No
~No
DNA ONE
DNA ONE
D PAN 0 PAN> 10% or 10 lbs D Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Area
13. Soil typc(s)
14. Do the receiving crops differ from those designated in theCA WMP? DYes ~No
15 . Does the receiving crop and/or land application site need improvement? DYes ~o
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?D Yes .)j.No
17. Docs the fac ility lack adequate acreage for land application? 0 Yes ~o
I 8. Is there a lack of properly operating waste application equipment? D Yes ~ No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any otber comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
Re,·iewer/lnspector Signature:
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
I ·' . ~
j Fpcility Number:~ -ft£i
Required Records & Documents
Date of lnspocrion ~
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
the appropirate box. D WUP 0 Checklists 0 Design 0 Maps 0 Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
D Waste Application D Weekly Freeboard D Waste Analysis 0 Soil Analysis D Waste Transfers D Annual Certification
D Rainfall 0 Stocking D Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rain Inspections D Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the pennit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CA 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 ofthe inspection did the facility pose an odor or air quality concern?
lfyes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
DYes }9No DNA ONE
DYes 0No ~A ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes 0No ~NA ONE
DYes ~No DNA ONE
DYes )ONo DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA D NE
....
1-
-...
12128/04
Type of Visit f'. Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit '&Routine 0 Complaint 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L;if ;l..J /a11 Arrival Time:.._._....__ _ _,___.
Farm Name: ~ l=CLrm. l V\.G OwoerNam"~ {l~-N~Wc:.&kd
Region: ~
Owner Email: --------------
Phone:
Mailing Address: -----------------------------------------
Physical Address: ----::-':""""r------,....---------------------------------
Fadlity Conta<to >"" ~ ~ kN mleo at>:l:!:!f Jt: Phone Noo "l('j 'j;l_e) (12. ( ( ~
Ous;te Reprcsentativeo ~~ \. ),.~ lotegrato" L nclo fR £d"~ CertifiedOperato~ -~ OpmtorCertifi<atlonNomhe" /{Gfd1
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D"
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at D Structure D Application Field 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)?
Longitude:
DYes Qa)No DNA D NE
DYes 0No ,f9NA ONE
DYes 0No _Q,NA ONE
-I
d. Docs discharge bypass the waste management system? (If yes, notify DWQ) DYes 0No~A ONE
D Yes;fuNo DNA ONE
DYes ~No DNA ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of3 12128104 Continued
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 Structure4
DYes ~No DNA ONE
DYes 0No ~NA ONE
Structure 5 Structure 6
Identifier: __ .J.( ____ -----------------------------------
Spillway?:
Designed Freeboard (in): ___ JL...L9_J ___ ---------------------------------
Observed Freeboard (in): __ ;!!:J,a:.....:.. ___ -----------------------------------
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
DYes B-No DNA ONE
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
0Yes~o DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat. notify DWQ
7. Do any of the structures need maintenance or improvement?
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 ~o DNA ONE
DYes ~No DNA ONE
DYes l!JNo DNA ONE
DYes DNA ONE
II. Is there evidence of incorrect application? If yes, check the appropriate box below. D Yes
_1ijNo
~No DNA ONE
D Excessive Ponding D Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu , Zn, etc.)
D PAN D PAN> I 0% or I 0 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 Appl ication Outside of Area
12. Crop type(s) ]:, nnvdse · c;t Q..Q o( S:,
13. Soil type(s) ~ l\
14. Do the receiving crops
15. Does the receiving crop and/or land application site need improvement?
16 . Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
17. Does th e facility lack adequate acreage for land application?
18 . Is there a lack of properly operating waste application equipment?
Reviewer/Inspector Name
Reviewer/) nspector Signature:
Pagel of3
DYes ~No DNA ONE
DYes lj]No DNA ONE
DYes )ia} No 0 N~ 0 NE
DYes JdJmo DNA ONE
DYes ,tjNo DNA ONE
( . . .•
Date of Inspection $P 1 Facilify Number: A): :WI
Required Records & Documents
19 . Did the facility fail to have Certificate ofCoverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. 0 WUP 0 C hecklists 0 Design 0 Maps D Other
0Yes ~o
DYes ~o
DNA ONE
DNA ONE
21 . Does record keeping need improvement? I f yes, check the appropriate box below. D Yes ~No 0 NA 0 NE
0 Waste Application 0 Weekly Freeb oard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Annual Certification
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 Weather Code
22. Did the facility fai l to install and maintain a rain gauge?
23 . If selected, did the facility fail to install and maintain ra inbreakers o n irrigation equipment?
24. Did the facilit y fail to calibrate waste application equipment as required by the permit?
25 . Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the fa cility fail to secure a phosphoru s loss assessment (PL AT) certification?
Other Issues
28. Were any additional problems noted which caus e non-compliance of the permit orCA WMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or d ocument
and report the mortality rates that were higher than normal?
30. At the time of th e inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality repre sentative immed ia te ly
31 . Did the faci li ty fai l to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection w ith an on-site representative?
33 . Does facility requi re a follow-up visit by same agency?
Additional Comments and/or Drawings:' : ·· .. ' ~'· ·
Page3 of3
DY es~ DNA O NE
0 Yes l3:,No DNA ONE
D Yes ~0 D NA O NE
D Yes ~No DNA ONE
DYes ~0 DNA ONE
D Yes ~0 DNA ONE
D Yes ~0 D NA O NE
D Yes !i8No DNA ONE
D Yes ~No DNA ONE
D Yes ~No DNA ONE
D Yes ~No DNA O NE
D Yes ~No DNA ONE
. ·.·:·:~"\)~;.:;~~~~;~:~
1 1118/04
.. -
1--....
'· Facility No. '6J-La_~ Timeln ____ TimeOut____ Date d/~1
Fann Name ~\r)=~=-:.--=----:-....!.\...:..\1\...=...:o.C..---------Integrator --,/t-'-b.-"cY,......,l""f~'t-'------
Owner D~ l ~ Site Rep _________ "'--_
Operator _________________ No.--------
Back-up No
coc_ ~ Circle: General or·~-0:~
Design Current Design
Wean -Feed Farrow-Feed
Wean -Finish c--.. Farrow -Finish
ctFeed -Finish ) <, b\..{)(1 Gilts I Boars
Farrow =wean Others
. FREEBOARD: Design __ } ~--
Sludge Survey V
7
Observed -------
Calibration/GPM _-t' __ !.-/--=::.:2::::;;;....;~=...;:=--
Crop Yield Waste Transfers -~----
Rain Gauge ..___-----Rain Breaker __ _
Soil Test / r:> 1.._ V PLAT ~ ---=----
Weekly Freeboard __ _.t-----;..... Daily Rainfall __ -__
Wettable Acres-----
1-in Inspections~
Spray/Freeboard Drop -----------------------
Weather Codes __ _ 120 min Inspections __ _
Waste Analysis:
Date Nitrogen (N) Date Nitrogen (N)
\ .-,
(.-, "2". ' l
9 ) !-<;"
Current
Pull/Field Soil Crop Pan Window
·<'"' ll ~ n \ ' l lA1. f) ~_, I .17. ~ '-l/t -1/~0
l 0 () 9} I -.J.j c)..~
~''~(]' I I
-\ 117 c
\-()1\{Zof'OY'-.... t I '-'-'
(JO
to.\. I ~ I,, /)U
1\J\J'\...... IV 1'-J I v \XV
eR-n; ... ;.,;.., .. of Water Quality
0 -Division -of.Soil and :water Conservation _
0 Otber Agency · {''>'-' ..
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date or Visit: I f)-K'-o9 Arrinl Time: I Cj ~ 00 l,_peparture Time: I I ;2..' 30 I County: .24/f'2~t:J1\., Region:~0
Farm Name: lLI 'f!!? -e K S -Fa1 rn...-:::r: 1'\ c. Owner Email: -------------
Owner Name: 1< ~1(1 rJ-DeW ex. V d ~ W ree/s.s Phone:
I f
Mailing Address: -----------------------------------------
Physical Address:-----------------------------------------
Facility Contact: --'-A-'17Y.....,.,~...:..,.,__~---"M~_..~'-"'z:......,..k...;;;;,;~J...._ __ Titlc: -----------Phone No: ---------
Integrator: --~-"'...:/.,:...~;.cP-'=..;;..;J.,v'-;:;...;;.~---------Onsite Representative: ---~'-"'~-L-''-""'='--------------
Certified Operator: ---.-... 5":"~""~==:---------------Operator Certification Number: -------
Back-up Operator: --------------------Back-up Certification Number:
Location ofFarm: Latitude: D OD 'D " Longitude: D OD 'D "
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry C~pacity Population Cattle Capacity Population
ID Wean to Finish I I 10 Layer I I I 0 Wean to Feeder
IS'aFeeder to Finish 15/?'t/0 35""tXJ
0 Farrow to Wean
0 Farrow to Feeder
0 Farrow to Finish
0Gilts
0 Boars -.... .. -....
0 Dairy Cow I
I 0 Dairy Calf i
D Dairy HeifeJ
I 0 Dry Cow
0Non-Dairy I
D Beef Stocker I
! 0 Beef Feeder
0 Beef Brood Cow i
... -~----. --··---._;
0 Non-Layer
Dry Poultry
0 Layers
0 Non-Layers
D Pullets
0 Turkeys
Other 0 Turkey Poults
D Other
... --· _,, .. _. -J Number of Structures: . [I];
Discharges & Stream Impacts
I . Is any discharge observed from any part of the ope rat ion ? p{Yes 0No DNA ONE
Discharge originated at: 0 Structure 0 Application Field !)a Other
a. Was the con_veyance man-made? DYes ~No DNA ONE
b. Did the discharge reach waters of the State? (lfyes, notify DWQ) 12Sl.Yes 0No DNA ONE
c . What is the estimated volume that reached waters of the State (ga llon s)? AI .£ ,u-ri ~-n,., ~
d. Doe s di scharge bypass the waste management system? (If yes , not ify DWQ)
2 . Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potenti a l adve rse impacts to the Waters of the State
other than from a di scharge?
IX, Yes 0No
DYes ~No
DYes 0No
12128104
DNA ONE
DNA ONE
DNA SNE
Continued
I Facility-Number:<@ -Z, ~} I Date oflnspection IJ? 'eor...
Waste Collection & Treatment
4. Is s torage 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 jgNo DNA ONE
DYes lLf.No DNA D NE
Structure 5 Structure 6
Identifier: ----"'L------------------------------------
Spillway?: Yc s ,
Designed Freeboard (in): __ ·..~;/_T".L-___ -----------------------------------
Observed Freeboard (in): _....,...::;t~3"----------------------------------
(',.""
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 DYes cgNo DNA ONE
through a waste management or closure plan?
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
I 0. Are there any required buffers, setbacks, or comp liance alternatives that need
maintenance/improvement?
DYes D('JNo DNA ONE
DYes ~No DNA ONE
DYes (2JNo DNA ONE
DYes ~No DNA ONE
11 . Is there evidence of incorrect application? If yes, check the appropriate box below. D Yes '&1 No 0 NA D NE
D Excessive Ponding 0 Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu , Zn, etc .)
0 PAN D PAN > 10% or 10 lbs 0 Tota l Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window D Ev id enc e of Wind Drift 0 Application Outside of Area
14 . Do the receiving crops differ from those des ignated in theCA WMP?
15 . Does the rece iving crop and/or land application site need improvement?
DYes
DYes
I 6. Did the facility fail to secure and/or operate per the irrigation desi~:,'ll or wettable acre determination! D Yes
17 . Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste app li cation equipment ?
DYes
DYes
11128104
[E.No DNA
~No DNA
~No DNA
Ci-No DNA
~No DNA
ONE
ONE
ONE
ONE
ONE
I Facility Number:@: -/e%'"11 Date of Inspection !Jl-E:=O]l,
..
Required Records & Documents
19 . Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropirate box . 0 WUP 0 Checklists 0 Design 0 Maps D Other
DYes lJaNo DNA D NE
DYes ~No DNA ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. ~Yes D No DNA D NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Annual Certification
0 Rainfall D Stocking ~Crop Yield 0 120 Minute Inspectio ns 0 Monthl y and I" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? DYes jENo DNA
23 . If selected, did the facility fail to install and maintain rain breakers on irrigation equipment? DYes ~No DNA
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes I2Sj No DNA
25. Did the facility fail to conduct a sludge s urvey as required by the permit? DYes j{J No DNA
26. Did the facility fail to have an actively certified operator in charge? DYes j(JNo DNA
27. Did the facility fail to secure a phospho rus loss assessment (PLAT) certification? DYes 18-No DNA
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit orCA WMP? DYes ~No DNA
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes R;!No DNA
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? DYes ~No DNA
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 DaNo DNA
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/i nspection with an on-site representative? DYes 3 No DNA
33 . Does facility require a follow-up visit by sam e agency? 8J. Yes 0No DNA
@. kee-r y1rl) DF /17 ;Fcv'-1·
@ w;/1 Ctnnc .l..ak. a-n) mo'>-at;:;/"' ..,/'<!: C./,.......,_ U:f'
AT 7i ; s ~ .. 'Yl e' i I tooK s 'L; ke-a hf;)u_J,~ (9Ue"r.PLc<PL::'d ,. r"..:fo
('){ J)/"d~ n q./~ L;· n..~ <riAl-Le-) f'b ~ Nl::'Lel arloR tlr-~,_ r,f/ "-<:..
Cry~!:!' k ~ l¢'1 i-/,3 7T m ~ t).l-c_ Aav ~ rw'fc-tl/J(:/a:/.;j TIV!" J:n??'/" ~
(/, -e 6"/;;k w,:f.-r if<"""/ . C. L.,.., u I' ; ~ Tf., !> r 6 t-ub"'~ J r}; 5
Trvn.r-II,· 3 o ..A-.1?"\-. d~ PWI'tl!"'r u.h.'5 ;;tvrrRL) b1 h ;~ u.Jvrf.c.,....r-
~ ~ tl~ f,iJ" 1/ y/tzl-h~,ft'~ yj'tt! t:ly 6~-Fi>r·
12128104
ONE
ONE
ONE
ONE
\
ONE
ONE
ONE
ONE
ONE
ONE
ONE
ONE
Type of Visit e Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit e Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other D Denied Access
IDateo!Visit: 112 ·/0-0'tiTune: I 8 ~ 30 Facility Number I B¢ H "8/ ~..._ _________________ _, lo Not Operational 0 Below Threshold
li:JPermitted ~rtified [J Conditioaally Certified C Registered Date· Last Operated or Above Threshold:
Farm Name: w,~f<j __ Ftu-o r;<J(., ----County: -~;..;.~~'-!f2~.s~a,n'-----
l--1~..,,
E./? a
Owner Name: tf.vta<' a,r/ .tJ~wi!J.v~e I:J,tt:ei....J,.. __ _ ,r Phone No: _ C:Z10-Set;;-3 <i.JO
MailiDg Address: lv3 f?w_F/',·n l(ae,.L tJ(!n.fl J NG,.. __ 2_g33't_
t:.•ll .......
Facility Contact: _ lfy4n ... Wtp~~J Title:··----------· Phone No: _11..1-g.:3o -II ::1/
Onsite Representative: ---=-~-l,ip:ld---..:;.M~ee:r;..A;._;r._s:~..-_______ _ Integrator: Lrh;tt<#?ek,-/:. ___ _
Certi.fied Operator: ---·--'~'-+l'u;c.:e.un--
1'
Operator Certification Number: _____ _
Location of Farm:
~ne 0 Poultry D Cattle D Horse Latitude '--___,1•'-1 ---~~ ''---....11" LoDgitude ,___,1• ..... 1 _ _,l' '-' _....,~l"
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: 0 Lagoon 0 Spray Field 0 Other
a If discharge is observed, was the conveyance man-made"?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the openttion?
3. Were there any adverse impactS or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4 . Is storage capacity (freeboard plus storm storage) less than adequate? 0 Spillway
Structure 1
Identifier: __ _}_ __
Freeboard (inches): ;:J s-'' __ ......._ __ _
12112103
Structure 2 Structure 3 Structure 4 Structure 5
DYes ~~
DYes ~-
DYes 131fo
DYes @?a
DYes Q-No
DYes [31ifo
DYes g.t(o
StrUcture 6
Date of Inspection I J2 · Jo ·rtfl
5. Are there any immediate threats to the integrity of any of the structures observed? (ieJ trees, severe erosion,
seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a waste management or
closme 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 sttuctUres need maintenancefunprovement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
DYes [31(o
DYes [31(o
~ DNo
~~~es ~
DYes [i].Ko
10. Are there any buffers that need mainten.ancefunprovement? 0 Yes G;J.No
11 . Is there evidence of o ver application? H yes, check the appropriate box below. D Yes (3.Nt5
0 Excessive Ponding 0 PAN 0 Hydraulic Overload 0 Frozen Ground 0 Copper and/or Zinc
1 -t-t? r,:J,l -IJ7 . .-!i ,~-II:J .~ uo
12. Croptype .tJ~,.ItarJe fqs/we. . 5!'?«b t;..c •• ;, t'•,f...ce •
13 . Do the receiving crops differ with those designated in the Certified Animal Waste Manageme nt Plan (CAWMP)?
14 . a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c} This facility is pended for a wettable acre detemrination?
IS . Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge all or below
liquid level of lagoon or storage pond with no agitation?
18. Aie 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.
'1. ~,... w,.ft, "'·· Cit. htv f>/116 ~f" e ro~:, c.r~~-' J. •'s /a4j-~ ,
(.,.A. l. ... it-H-e. ,.,,..,)
H~
DYes
DYes
DYes
DYes
DYes
DYes
DYe s
DYes
D Yes
DYes
~PS
s,l',ftt., ,.,; f. I. f~ c ~., f rae-I"~ #160vf rl'~ta l;-""~ s .'J.,s . A-Is~ J,.,s ··,
1'/&~,s ~-~ /*'-/-"' f"~,r~ <rt?u.,J rlt~ l~t'"""' -1-o k ~"'fO 0~ c. tJ C¥J
II., e;/;/l,j • fl,~au do l4,nt: ;{,.,J A S ·.Suo 'l ~s 1<~oSJ ,''/"•
Reviewer/Inspector Signature: Date: 1 .:z -to -or
12112/03
~
ONo
ONo
ONo
~0
~
ONo
~·.
[i'No
~
., Facility N'IIDI.ber: 9 ~ -(,81 Dau of laspection l1 :J • 10 ·O'f I
Required Records & Documents
21. Fail to have Certificate of Coverage & 6eaemi Permit er othet Peuait readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/~bec~~~tc.)
23 . Does record keeping need improvement? If yes, check the appropriate box below.
0 Wasce Apfllicatioa 0-Frceeeard 0 ¥hate .\eelysis D Soil Samplmg
It ·?.:; /,r, 9 · 13 _, 2.1 !?·tq-J .z .7 ._.,,., _.., 1,'1
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25 . Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss reviewfmspection with on-site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified A WMP?
NPDES Permitted Facilities
30. Is the facility coven<! under a NPDES Permit? (If no. skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on iJrigation ~uipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge smvey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
D &uciciag F9HR gC"rop Yield Form ~a '-fall O~ea Mter 1" Reitt
0 -129 Minute !Bspeetions 0 Annual Certifieatiou Fmm
12112103
Mes
,,,..6
~
DYes @.Nif"'
DYes l9No
DYes 13-tfo
DYes [3-Nb
DYes 8M6
DYes [3-No
DYes li:J1Qo
DYes ·13-M5
~ 0No
DYes (3-No
DYes ~
DYes ~
DYes 9-i(o
EPteS ONo
~ .
Division of Soil and Water Conservation D Other Agency
Division of Water Quality
Facility Number I ['L H c# 8" I
Time of lnsp£:ction
[]Registered Certified 0 Applied for Permit []Permitted IC Not Operational I Date Last Operated: ......................... .
Farm Name: .... LAJ .. ~.e..ks ....... £~f.'..~.1 ... kg_,__,,................................ County: ..... ?.9.::.~R~9. .. ~ ................................... ..
Owne. Name: .. .l'j.f!,& ..... t../}f:.~g·r"·<;.. ..... h.!_t;.g/:5......... !'hone No: .......... i'l.Z ... : ... J.~ .. 3.Q ........................ .
Facility Contact: .... i.7 .. 9.:: .. !:::-:: ...... &.J./!;:ff.: .... $ .......... Title: .. D. .. ~ ... r':-.. g .. c.......................... Phone No: ... ~.~-~ .................. .
Mailing Address: ..... t.i:..\..\.-) .... .8.~ .. .J..{g............................................................ ..1).~ .. ~ .. ~--I ..... N .. ~ ...................... :............ Z.4..3 .. 3.tJ-
Onsite Rcprescntath·e:........................................................................................................... Integrator: ..................................................................................... .
Certified Operator~ .. ~-~-~ ...................... -~-~$................................. Operator Certification Number~ ........................................ .
Location of Farm:
General
.~---4--.-::-.,...,.,.F_,_ID Subsurface Drains Present liD Lagoon Area
;jjo No Liquid Waste Management System
1. 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 D Other
a. If discharge is observed, wa" the conveyance man-made?
b. If disch:uge is observed, did it reach Surface Water? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
·d. Does discharge bypass a lagoon system? (If yes , notify DWQ)
3. Is there evidence of past 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
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge'!
7/25/97
DYes
DYes
9r~o
~0
DYes DNo
DYes 0No
DYes D_No
DYes
DYes
DYes
DYes KNo
DYes J\[No
Continued on back
I Facility Number:~z_ -~ ~~ I
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La~:oons.Holdin~: Ponds, Flush Pits, etc.}
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
DYes ~No
DYes #No
Structure 6
••••o•uoooooooo•ooUhUOOOOOOU*" uooooooooouooouooouo.,uooooooo •oooooooo .. uu .... HOOOOOOOOOUoUo oooooooooooooooOUO,.OOOO'O"'OOOOO OOoonuu .. ouuoooon•<U•oouou. uoooonooOOoooouoooonoooouoouo
Freeboard (ft): ............ 7 .... ~---··········· ................................................................................................................................ -............................................... ..
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 immediate public health or em·ironmental threat, notify DWQ) ·
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
DYes ~No
DYes p(No
DYes S(No
DYes ~No
14. Is there physical evidence of over application? 0 Yes *o ::. :::::::::~:~~~~~~2~~~::::.:::;=:;,:;;~;; -~;~-~~=-
17. Does the facility have a lack of adequate acreage for land application? 0 Yes 9(_No
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment ?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified A WMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
~ ~·~: ~i~la~i~ns~o~ _de~~iencies. ~~re~ no~ed during _this: visi~ ·. y~~ :~ill_ ~e.i~e-no. f~t~er: : ~
·~·correspondence aboutthis'visit.· · .. : · · · · · · · · · · · · · ·
Th \s is-o.. "'e l0 ~c.~ (; ~ a~ ~e I
ljl'!9u. ~ 5 0--~ ueje~+; Je... ceue r
[xcep+101'La_l sr~~~ ~~~tci.s
G~cJ I Dd<~vtS ~r W\. I
Reviewer/Inspector Name
Reviewer/Inspector Sig nature:
DYes RNo
DYes Pi(No
OYes~o
DYes ~o
DYes }?(No
DYes~o
DYes ~o
DYes ONo