820688_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quality
'-U''"~''''"nce Inspection
0 Routine 0 int 0 Denied Access
Date of Visit: f.liNoi/?qi6Arrival Time:!//: IS
Farm Name: /Zott!#;~ W-rcR.. ).)-;. 2-,
Mailing Address:
Physical Address:
Facility Contact: ;j(2.(fjft< .A1PP!tc
Ons ite Representative:
Departure Time: I // :?f,s-I County: S~(:J Region: fi'2i>
Owner Email:
Pbone:
Title: ~ £'pye_ Phone:
Integrator:
Certified Operator: luwA:{ C,mele;1'<. Certification Number: 92'4? L/:z.r
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
I . Is any d isc harge observed from any part of the opera tion?
Discharge originated at: D Structure 0 Appli cation Fi e ld D Oth er:
DYes ¥No
DYes ~N o
D Yes ~No
a. Was the conveyance ma n-made?
b . Did the d ischarge reach wate rs of the State? (I f yes, not ify DWR)
c. What is th e estimated vo lum e that reached waters o f th e State (ga ll ons)?
d . Does the di sc harge bypass the was te manageme nt syste m? (I f yes, not ify O WR ) D Yes No
2 . Is the re evid e nce o f a past discharge from any pa rt ofthe operation?
3. Were t here any observab le ad verse impacts or potentia l adve rse impacts to th e wa ters
of t he State other t han fi:om a discharge?
P11ge I of3
D Yes No
DYes No
DNA ONE
DNA ONE
DNA O NE
DNA O NE
D NA O NE
DNA O NE
1/412015 Continued
!Facility Number: f22 -tz!)i!j (.}v:: 2,) loateoflnspection: 1!>2/IJV ZOii?
Waste Collection & Treatment
,4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes ~No DNA ONE
DYes ~No DNA ONE
Structure 5 Structure 6
D Yes-IKJ No DNA 0 NE
D Yes ~No D NA 0 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes
DYes
DYes
DYes
~No DNA ONE
lflNo DNA ONE
llJ No DNA ONE
~No DNA ONE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. D Yes [)!No DNA 0 NE
0 Excessive Ponding 0 Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN> 10% or 10 lbs. 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): Pe>41~ /~B2Mvt 04-llv&? se=r;v ueu I~H@) )£#t Bt£4-tJ
M~ r 1 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 faci li ty lack adequate acreage for land application?
18. Is there a lack of properly o perating waste application equipment?
Required Records & Documents
19 . Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the faci lity fai l to have all components ofthe CAWMP readily available? I f yes, check
the appropriate box.
0 Yes lLiNo 0 NA 0 NE
0 Yes [)9 No 0 NA 0 NE
0 Yes lXJ No 0 NA 0 NE
D Yes !29 No 0 NA 0 NE
D Yes ~No DNA ONE
DYes 00 No
0 Yes Iii No
DNA ONE
DNA ONE
DwuP 0chccklists 0 Design D Maps D Lease Agreements Oother: ________ _
21. Docs record keeping need improvement? If yes, check the appropriate box below. D Yes l2J No D NA 0 NE
0 Waste Application D Weekly Freeboard 0 Waste Analysis 0 Soil Analys is 0 Waste Transfers D Weather Code
0 Rainfall Ostocking 0 Crop Yield 0 120 Minute Inspections D Monthly and I" Rainfall In spections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? DYes ~No DNA 0 NE
23. If selected, did the facility fai l to install and maintain rainbreakers on irrigation equipment? D Yes ~No DNA ONE
Page 1 of3 11412015 Continued
!Facility Number: 62. _ -(q @ Uv~ 2--) loate of lospectioo: Is-' )./IJtJ 2<2)fJ
'24 . Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes ~No DNA ONE
DNA ONE
1
'25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes ~N o
the appropriate box(es) below.
0 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance :
26. Did the facility fail provide documentation of an actively certified operator in charge?
27 . Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead a nimals 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)
D Yes ~ No 0 NA 0 NE
0 Yes [)No 0 NA 0 NE
0 Yes !p1' No 0 NA 0 NE
0 Yes ~No 0 NA ONE
0 Yes lfl No D NA D NE
D Yes ~ No D NA 0 NE 31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field 0 Lagoon/Storage Pond 0 Other: ----------------------
32 . Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Reviewernnspector fail to discuss review/inspection with an on-site representative?
34. Docs the facility require a follow-up visit by the same agency?
St--1t1V~e 5v,Q_t/G" 1 8j17-jzc:ni!>
DYes 9'JNo DNA ONE
DYes ~No ONE
DYes
WA-f·-rc 4-'A/.4--L/f f";J -,;gjr7j~z~n~ 11::. f,. Z
I L JX::v-k)
St111., >4*ff'vtE"f -PJ/t ~-"""-'v-..d. n ~ _.?o -r l s 5 ~ -
Reviewer/lnspectorName: /t£!{)f wurrc I ~~
t:}p/&11~£. J,4;VT 2-.9'~1
Zc/1~
Reviewer/Inspector Signature : ~ I ~ r; --+,~------------~---------~--~~---------------
Phone: 7?tJ ~ ?-~-&{-I i> 9
Date : 1 '? V€v 24>1fJ
1/4/1015 PageJ of3
Compliance Inspection Operation Review
Reason for Visit: 0 Routine 0 Com laint ~llow-up 0 Referral 0 Emergency
Date of Visit: I /1 • 7 -ltfl I Arrival Time: I ~ I Departure Time: I ~ I County:
~f\(\S'~ wfw @ .fhv s~p ~)0
Owner Email: Farm Name:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: -----------------------------Phone:
Oosi te Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
I . Is any di scharge observe d from any part of the operati on?
Discharge origin a ted at: D Stru cture D Appli~tion Field
a _ Was th e conveyance man-made?
0 Oth er:
b. Did the di scharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volum e that reached waters of t he State (gallons)?
Certification Number:
Longitude:
0 Yes Of No
D Ye s 0No
D Ye s 0 No
d. Does the discharge bypass th e waste manageme nt system ? (If yes, noti fY DWR) DYes 0No
2. Is there evid ence of a past di scharge fr om any pan of the operation?
3. Were th ere any obs ervable adverse impacts or potential adverse impacts to th e waters
of the State oth er than from a d ischarge?
Page I of3
D Yes ftJ No
0 Yes ~No
Region :
DNA ONE
DNA ONE
D NA O N E
DNA ONE
D NA O N E
D NA ONE
114/20 15 Continued
(Facility N;~mber: n z_. -~ate of Inspection: /f . 7 /1 b
• Waste Collection & Treatment
4 . Jfstorage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural rreeboard?
Structure I Structure 2 Structure 3' Structure 4
Identifier: }
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ___.3~1---
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6 . Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes ~No
DYes D No
DNA ONE
DNA ONE
Structure 5 Structure 6
DYes ~No DNA ONE
DYes ~No DNA ONE
If aoy 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? 0 Yes ltl No D NA D NE
8. Do any ofthe structures lack adequate markers as required by the permit? DYes ~No DNA 0 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
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
D Yes [l' No D NA 0 NE
0 Yes ~ No D NA 0 NE
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. D Yes ll No D NA D NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn, etc.)
0 PAN D PAN > I 0% or I 0 lbs. D Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Approved Area
12. Crop Type(s):
13 . Soil Type(s):
14 . Do the receiving crops diffe r from those designated in the CAWMP?
15. Docs the receiving crop and/or land application site need improvement?
16 . Did the facility fail to secure and/or operate per the irri gation desibrn 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 fac ility fail to hav e the Certificate of Coverage & Permit readily available?
2 0. Does the facility fail to have all components ofthe CAWMP readil y available? If y es, check
the appropriate box .
Owup 0 Checklists D Design 0 Maps 0 Lease Agreements
21 . Does record keepin g need improvement? If yes, check the appropr iate box below.
0 Yes DNo DNA rtj NE
DYes 0No DNA ~NE
DYes 0 No DNA [j;NE
DYes DNo DNA ~NE
DYes 0No DNA (ENE
DYes 0No DNA rnNE
DYes 0No DNA ~NE
00ther:
DYes 0No DNA Ill NE
D Waste Application D Weekly Fre eboard D Waste Anal ysis 0 Soil Analysis D Waste Transfers D W e athe r Code
D Rainfall 0 Stocking 0 C rop Yield D 120 Minute Inspections D Monthly and I" Rainfall Ins pections 0 Sludge Survey
22. Did the f acility fail to install and maintain a rain gauge? 0 Yes 0 No DNA 00 NE
23 . If s elected, did th e facility fail to in s tall and ma intain rainbreakers on irrigation equipment? 0 Yes 0 No D NA ~ N E
Pagel of3 114/1015 Continued
[facility Number: & z -I Date of lospedioo: /I ·~ 2-/ fJ
~
24. pid 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 0No DNA ~NE
0 Yes 0 No 0 NA [)1 NE
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 indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secu re 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 siruations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field D Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance ofthe permit or CAWMP?
33. Did the Reviewer/Inspector fai l to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
t.vJI<eJ ~C»T\
~-~r(., ~+~ ;)q L, of+w J J, .. , @_ 3) ., now
Uork 0('1 11~.5 Cover C7V1 Dtl<e_ £../'!,!;
Reviewer/I nspector Name:
Re viewer/] nspector Signature:
Page3 of3
0 Yes D No 0 NA rn NE
0 Yes 0 No 0 NA D NE
DYes 0 No 0 NA l;i'NE
0 Yes 0 No 0 NA ~ NE
0 Yes ~No 0 NA 0 NE
0 Yes D No D NA ~ NE
0 Yes 0 No 0 NA 00 NE
D Yes ~ No 0 NA 0 NE
DYes fBNo DNA ONE
Phone :
Date:
1/0· ?'i6-?JJ6
/1-2~/~
21412015
Reason for Visit: ~tine 0 Co nt 0 Follow-u 0 Referral 0 OOther
Date of Visit: 1//-/Z-;z I
Farm Name: ?onrz; -c
ArrivaiTirne:l//:·00 I DepartureTime:l J/,"_'3tl !county: ;?'~Region: .flSD
C-avt"E r ~ P / n'L-Owner Email:
Owner Name: A 0 (! r1 ", ~ £ Ca. rf-'C"'r-Phone:
Mailing Address:
Pbysical Address:
Facility Contact: Gr~,.---f21{)c:¥'-c_ Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of th e operation? DYes ~o
Discharge originated at: 0 Structure 0 Application Field 0 Other:
a. Was the conveyance man-made? 0 Yes 0No
b. Did the discharge reach waters of the State? (If yes , notifY DWR) 0 Yes 0No
c. What is the estimated volume that reach ed waters of the State (gallon's)?
d. Does th e discharge bypass the waste management system? (If yes, notify DWR) 0 Yes 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 th a n from a discharge?
Page I of3
0 Yes ~No
0 Yes ~No
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
1/412015 Continued
• [facility Number: ?l,?: -{/;;;p'
Waste Collection & Treatment
loateoflnspection: //=/b-1? I
'• 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 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): .a
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 SNo 0 NA 0 NE
DYes 0No DNA ONE
Structure 5 Structure 6
DYes j&No DNA ONE
0 Yes .B) No 0 NA 0 NE
If any of questions 4-6 were answered yes, and tbe situation poses an immediate public healtb 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
mainten~ce or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
~Yes 0No DNA ONE
D Yes 13-No 0 NA 0 NE
DYes ~No DNA ONE
DYes 13l_N o 0 NA 0 NE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. D Yes _f;g_No D NA D NE
D Excessive Ponding D Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn, etc .)
0 PAN 0 PAN > 10% or 10 lbs. 0 Total Phosphorus 0 Failure to In corporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift D Application Outside of Approved Area
12 .Crop Type(s): ~wr./75&",-.~ j;vl!',;;1-z-r-d / Corrz /tdf~/.zP7'./~_s
;
13 . Soil Type(s): ...-J.:......::::;,...O::::........::It-....!...... ______________________________ _
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 Jack adequate acreage for land application?
18. Is there a lack of properly operating waste app lication equipment ?
Required Records & Documents
19. Did the facility fail to have the Certificate ofCoverage & Pcnnit readily available?
20. Does the facility fail to have all components of theCA WMP readil y available? If yes, check
the appropriate box .
Owup Ochecklists 0Design 0 Maps 0 Lease Agreements
21 . Does record keeping need improvement? If yes, check the appropriate box below.
DYes jgNo DNA ONE
DYes ~N o DNA ONE
0 Yes 5iNo DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes IZJ No DNA ONE
DYes [;8l_No DNA ONE
00ther:
DYes ~0 DNA ONE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis D Soil Analysis 0 Waste Transfers 0 Weather Code
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and I " Rainfall Inspections 0 Sludg e Survey
22. Did the facility fail to install and maintain a rain gauge? DYes ~N o 0 NA 0 NE
23. If se lected , did the facility fail to in s tall and maintain rainbreakers on irri gation eq uipme nt? DYes ~o 0 NA 0 N E
Page 2of3 214/2015 Continued
!Facility Number: ZC-lo rj? I I nate oflnspection: /)-/ b -J zl
' 24. Did the facility fail to calibrate waste application equipment as required by the permit?
I
1 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
DYes ~No DNA ONE
DYes ~No DNA ONE
0 Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Otber Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field 0 Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
33 . Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature :
Page 3 of3
0 Yes BJ No
DYes ~No
DYes ~No
DYes ~No
0 Yes ~No
0 Yes ~No
DYes t&( No
0 Yes ~No
0 Yes (23_No
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
Phone: 9tr.5u3-c)/.s-f
Date: //:-/"---~/ 7
214/2015
-· ~~~~~~~~~==~~~~~~~ ompliance Inspection Operation Review Structure Evaluation 0 Technical Assistance
Reason for Vi sit: ~e 0 Complaint 0 Follow-u 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I I cH"' I Arrival Time : I/¢. J I £1 Depart~re Time: I ..?3' / .e.JJT County: ..?~trZ--Region : P}::J:)
Farm Name: Zorz rzl 'C-~r 2 p_,.~. Owner Email:
Owner Name: /t()YlJ"fi z:: _r. Car+~ Phone:
Mailing Address:
Physica l Addres s:
Facility Contac t: G ,rr.r"'~ ££t?z?;-Title: ~~' Pho ne:
Integrator: ~m~~
Certification Number: C}--9-t,tj~
Onsite Representative:
Certified Operator: .....;...J.-......;;..u=-c_:;q...._· ... ) _ ___...C_..a"'""'"y:_f;.<......;.cv-__________ _
Back-up Ope rator:
Loca tion of Farm: Latitude:
Discharges and Stream Impacts
I. Is a ny di scha rge o bserved fro m any part of the operati o n?
D ischa rge origi nated at: 0 Structure 0 App lic ation Fi e ld
a . Was the conveyance man-made?
0 Oth e r :
b. Did the di scha rge re ach waters o f the State? (If yes, not ifY DWR )
c. What is th e estimated volume that reache d wa ters of th e Sta te (gall ons)?
Certification Number:
Longitude:
0 Yes flNo
0 Yes 0 No
0 Yes 0 No
d . Docs th e d ischarge byp ass the wa ste manageme nt syste m? (I f yes , notifY DWR) DYes 0 No
2. Is there evid ence of a past di sc harge from any part of the ope ration?
3. Were the re any observ abl e adverse impacts or potential ad ve rse imp ac ts to the waters
of the State o th er th an from a di sc harge?
Pa,::e I of3
D Yes ~No
0 Yes 3-No
D NA O NE
D N A O NE
DNA O NE
DNA ONE
DNA O NE
DNA ONE
21412015 Continued
1Facility Number: I nate of Inspection: /7-t.. -a I
Waste Collection & Treatment A
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): / ?-
Observed Freeboard (in): 2-/,
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
0 Yes ~o 0 NA 0 NE
0 Yes 0 No 0 NA 0 NE
Structure 5 Structure 6
DYes gJ_No 0 NA 0 NE
DYes 5No 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 ofthe structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
IO. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
DYes ~o DNA ONE
0 Yes ~No D NA 0 NE
0 Yes (iiNo DNA 0 NE
DYes g.No DNA ONE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. DYes 0-.No 0 NA 0 NE
D Excessive Ponding 0 Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn, etc.)
D PAN 0 PAN> 10% or 10 lbs. D Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window D Evidence of Wind Drift D Application Outside of Approved Area
12.CropType(s) ~; ~ ~0{r /J;cv.-n-J h~q~,/~/tuU-
13. Soli Type(s): _ ===:::... __ _ 1 =:::=-==:==::OJ -=-JJ 0 z4-~ ~J
14. Do the receiving crops differ from those designated in the CAWMP? D Yes s,No 0 NA 0 NE
15. Does the receiving crop and/or land application site need improvement? DYes e}No 0 NA 0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes. check
the appropriate box.
owup Ochecklists 0 Design D Maps 0 Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
DYes ,8_No DNA ONE
DYes l2J.No DNA ONE
DYes ~No DNA ONE
DYes RNo DNA ONE
DYes ~No DNA ONE
Oother:
DYes [H.No DNA ONE
0 Waste Application 0 Weekly Freeboard D Waste Analysis 0 Soil Analysis D Waste Transfers 0 Weather Code
D Rainfall 0Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? D Yes 13J,..No D NA 0 NE
23. If selected. did the facility fail to install and maintain rainbreakcrs on irrigation equipment? DYes ~o 0 NA 0 NE
Page 2 of3 21412015 Continued
·!Facility Number: I nate onnspection: z;: -I? -/.b I
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
DYes ~No DNA ONE
DYes £1-No DNA ONE
0 Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field 0 Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative ?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page3 of3
0 Yes 13-No DNA ONE
DYes BNo DNA ONE
DYes ~o DNA ONE
DYes J'8_No DNA ONE
DYes J29_No DNA ONE
DYes ~No DNA ONE
DYes ~o DNA ONE
DYes ~o DNA ONE
0 Yes IZ}.No D NA ONE
Phone: <Jzp-3ZJJ---O/,F{
Date: p-i,--~
21412015
':\~~~~~~~!!!!-'!
ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ~utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date ofVisit: I!D-:/'1-l_;T Arrival Time:! {/ :o 0 I Departure Time:! ( ',t) D I Countyc::_¥O"t--
FarmName: }?pnr1ft::.. C'e?-r\:l!"'.r ~ F~ OwnerEmail:
Region: F""f?-u
OwnerName: za,nr '-C. ~drc Phone:
Mailing Address:
P~ysical Address: ------------------~------------------------
Title: ~ri~.:....r;-"'<2:..:.../._. --"i5r~-c,._. __ _ Facility Contact: Grz::~,r-ffloov--c...... Phone:
Integrator: -L!1J.!...!....:u-f::;;._ ~~L.~_.._7>..,...6>u.u.L.L4.1u&~----
Cf:cr{,ef2?
Onsite Representative: __ ..5::::.....· =-~===--------------
Certified Operator: l.-.-'1 k (.{ 1 C.L!I ..-+ ~ Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation? DYes ~o DNA ONE
Discharge originated at: 0 Structure D Application Field 0 Other:
a. Was the conveyance man-made? DYes 0No DNA ONE
b. Did the discharge reach waters of the State? (If yes, notify DWR) DYes 0No DNA ONE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) DYes 0No DNA ONE
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of3
DYes
DYes
~No DNA ONE
[E-No DNA ONE
21411014 Continued
!Facility Number: 82-:-&if. I !Date of Inspection: 1 o-:Jlj-Js-
'
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] Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5 . Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees , severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes ~o DNA ONE
D Yes 0 No 0 NA D NE
Structure 5 Structure6
0 Yes 5-No 0 NA 0 NE
D Yes !29-No 0 NA 0 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
8. Do any of the s tructures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
D Yes (2J-No 0 NA 0 NE
0 Yes ~No 0 NA 0 NE
DYes 5No DNA ONE
0 Yes 129-No DNA D NE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes 12J-No 0 NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN > 10% or 10 lbs. 0 Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window D Evidence of Wind Drift 0 Application Outside of Approved Area
12 . Crop Type(s) ~"'-~~'C!£/;_7£,._-!,if ~ oe_ (_ z,..,,.J~ (Jv<' /$-.-,}
13. Soil Type(s):
14. Do the receiving crops differ from tho se 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 app lic ation ?
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 .
D WUP 0Checklists D Design 0 Maps D Lease Agreements
2 1. Does record keeping need improvement ? If yes, check the appropriate box below.
DYes
DYes
DYes
DYes
DYes
DYes
DYes
00ther:
D Yes
~No DNA ONE
!3No DNA ONE
~No DNA ONE
[3_No DNA ONE
0No DNA ONE
~No DNA ONE
~No DNA ONE
~No DNA ONE
0 Waste Application D Weekly Freeboard D Waste Analysis 0 Soil Analysis 0 Waste Transfers D Weather Code
0 Rainfall 0 Stocking 0 Crop Yield D 120 Minute Inspections 0 Monthly and I" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? D Yes ~o D NA 0 NE
23. If se lected, did the f~ci l ity fai l to install and maintain rainbreakers on irrigation equipment? DYes ~o DNA D NE
Page 2 of3 2/4/2014 Continued
· I Facility Number: ([ate oflnspection: I i>-/9-rSI
24. Did the facility fail to calibrate waste application equipment as required by the permit? .. ,
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
DYes ~No DNA ONE
0 Yes 12J-No D NA D NE
0 Failure to complete annual sludge survey 0Failure to develop a POA for sludge levels
D Non-compliant sludge levels in any lagoon
List structure( s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Otber Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility 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 t;tl-.No
DYes ~No
0 Yes [2?lNo
0 Yes [glNo
0 Yes @.No
DYes ~o
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
D Application Field D Lagoon/Storage Pond 0 Other: ------------------------
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page3 of3
DYes ~No
0 Yes l]lNo
0 Yes [Z}No
DNA ONE
DNA ONE
DNA ONE
Ph~ ;o-;t-1-;:kJ/.s-
Date: 9-to~q:r:J-'3'JvD
2/412014
ompliance Inspection Operation Review 0 Structure Evaluation
· Reason for Visit: 91t(;'utine 0 Complaint 0 Follow-u 0 Referral 0 Emergency 0 Denied Access
Date of Visit:
Farm Name: 'R.odtz(z; '
Arrival Time: I J /f C() I Departure Time: I @ ! ool County: ... {~ Region: av
Cp; J;.c ~ {?J~w--' Owner Email:
Owner Name : Cd'+~ Phone:
Mailing Address:
Physical Address: -----------------------------------------
Facility Contact: ar~ ;?'?{)c)r~ Title: Phone: --~---~~~~~~--------------------
Integrator: !lfv/ ~ l)/ow~"'-
Certification Number: C,9'-& t{/:5:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure 0 Application Field
a. Was the co nveyance man-made?
0 Other:
b. Did the discharge reach waters of the State? (lfyes, notify DWR )
c . What is the estimated volume that reached waters of the State (gallons)?
Certification Number:
Longitude:
DYes ~No
DYes DNo
DYes 0No
d. Does the discharge bypass the waste management system ? (If yes, notify DWR) DYes DNo
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of3
DYes ~No
DYes ~No
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
214/1014 Continued
iFacility Number: g5; -G O<ri""l I Date of Inspection: ji)-{o-llfl
Waste CoUection & Treatment
'L • 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure2 Structure3 Structure4
Identifier:
Spillway?:
Designed Freeboard (in): /9
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 12J.No
DYes 0No
DNA ONE
DNA ONE
Structure 5 Structure 6
0 Yes (S.No D NA D NE
DYes ~No DNA ONE
If any of questions 4-6 were answered yes, and tbe situation poses an immediate public health or environmental tbrea~ notify DWR
7. Do any of the structures need maintenance or improvement?
8 . Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
1 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement? ·
DYes ~No DNA ONE
0 Yes ~No DNA 0 NE
DYes ~No DNA ONE
DYes ~No DNA ONE
I 1. Is there evidence of incorrect land application? If yes, check the appropriate box below . 0 Yes ~No 0 NA 0 NE
0 Excessive Ponding D Hydraulic Overload 0 Froze n Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN> 10% or 10 lbs . 0 Total Phosphorus 0 Failure to Incorporate Manure/S ludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s): a;,.,-tv/~"./-/.~e.-.5/ ~;uy/a. &J.U~4--n/ F<:-~p~
13. Soil Type(s): rJo .A-·
14. Do the receiving crops differ from those designated in the CA WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18 . Is there a lack of properly operating waste application equipment?
Required Records & Documents
19 . Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Docs the facility fail to have all components of the CA WMP readily available? If yes, check
the appropriate box.
owup Ochecklists D Design D Maps 0 Lease Agreements
DYes 0No DNA
DYes 0No DNA
DYes 0No DNA
DYes 0No DNA
DYes 0No DNA
DYes 0 No DNA
DYes 0No DNA
00ther :
ONE
ONE
ONE
ONE
ONE
ONE
ONE
21. Does record keeping need improvement ? If yes, check the appropriate box below. DYes 0No 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 In spections D Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes 0 No D NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipm ent ?
Page 2 of3
0 Yes 0 No 0 NA 0 NE
2/4/1014 Continued
!Facility Number: ~ ?;.yy I IDate oflnspection: /klO-Ii' I
, 24. Did the facility fail to calibrate waste application equipment as required by the permit? D Yes ~ No D NA D NE
r"
25. Is the facility out of compliance with permit conditions related to sludge? Ifyes, check DYes ~No DNA D NE
the appropriate box( es) below.
D Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
D Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
D Application Field 0 Lagoon/Storage Pond 0 Other:
DYes
DYes
DYes
DYes
DYes
DYes
------------------------
[)a No
.1&] No
[&.No
5iNo
j4No
[E'No
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP? 0Yes~No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes ~No
34. Does the facility require a follow-up visit by the same agency? DYes ®No
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page3 of3
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
11412014
I, •
ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ~tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: II_ o;;tf:tj Arrival Time:l //: D 0 Departure Time:l I I :3 c I County: s~~ Region: a:u
Farm Name: R pn ,.,. r Cact;,.r ~;z-Fiz_;ty\../ Owner Email:
Owner Name: g 0 n n; c._ Ca-r ~;--Phone:
Mailing Address:
PhysicaiAddress: --------------------------------------------------------------------------------------
Facility Contact: &t ~..,.. r /ll'b{);-c:. Title: lt~c. 5~.
;
Phone:
Onsite Representative: Integrator: ------------------
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
I. Is any discharge observed from any part ofthe operation? DYes j3.No
Discharge originated at: 0 Structure 0 Application Field 0 Other:
a. Was the conveyance man-made? DYes 0No
b. Did the discharge reach waters of the State? (If yes, notifY DWQ) DYes 0No
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notifY 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 0-No
DYes ~No
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
214!1011 Continued
[Facility Number: l Date of Inspection: / P~ -1 3 l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): l9-
Observed Freeboard (in): 3D
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 16J.No 0 NA 0 NE
0 Yes 0 No 0 NA 0 NE
Structure 5 Structure 6
0 Yes (g No 0 NA 0 NE
DYes ~No D NA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures Jack 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?
0 Yes ~ No 0 NA 0 NE
0 Yes ~ No 0 NA 0 NE
0 Yes [g.No 0 NA 0 NE
DYes @.No DNA ONE
II. Is there evidence of incorrect land application? Ifyes, check the appropriate box below. DYes [29.-No 0 NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN > 10% or 10 lbs. 0 Total Phosphorus 0 Fai lure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Approved Area
12 .CropType(s): CotrL-WJ..~af-,f~~ &,~ ~vc;.j~ Cc..5~
13. Soil Type(s): ----L-tJ.....:.......Jt~Q::......k.u._ ____________________________ _
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 detennination?
Page2of3
DYes ~No
DYes [2g_ No
DYes [BNo
DYes ~N o
D Yes ~No
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA O NE
DNA ONE
21411011 Continued
.
lr::F:-ac~m~·ty_N __ u_m_b-er_:_?';~~ ..... --_ "T"(;_W,...,....,,._, -.I I Date or Inspection:
I, 24. Did the facility fail to calibrate waste application equipment as requ ired by the permit?
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
the appropriate box(es) below.
DYes ~No DNA ONE
0 Yes 12J.No 0 NA 0 NE
0 Failure to complete annual sludge survey 0Failure to develop a POA for sludge levels
0 Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to 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)
0 Yes ~No 0 NA 0 NE
D Yes ~ No 0 NA D NE
0 Yes j29.No DNA 0 NE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE 31. Do subsurface tile drains exist at the facility? lfyes, check the appropriate box below.
0 Application Field 0 Lagoon/Storage Pond 0 Other: -----------------------
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name :
R ev iewer/In spector Signature:
Page3of3
0 Yes 1}4 No
0 Yes l3l No
DYes ~o
DNA ONE
DNA ONE
DNA ONE
Phone: ?;~il--f'....o--3~
Da te : /0-.¢;3 -13
2141201 1
ompliance Inspection 0 Operation Review 0 Structure Evaluation
Reason for Visit: ~tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency
Date of Visit: [ 12-fl-/2+ Arrival Time:l I 0 i 0 0 I Departure Time :I /A 0 ol County: r >~tt'-Region: $ 0
Farm Name: ROn,; t' Ce .,fi-r ~,2-Fa,.-,...,._ Owner Email:
Owner Name: Phone:
Mailing Address:
PhysicaiAddress: --------------------------------------------------------------------------------------
Facility Contact: --IG-~...r..r....::l!'";;...~.:;_;_r-_...r..m...r.....:......:D:....:tl:;..;V<:::...___;:=---Title: I ,_J_ ¥ ?:'""C • Phone:
Onsite Representative: Integrator: --------------------------
Certified Operator: J< Onr1 .-c. Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation? DYes ~No
Discharge originated at: D Structure 0 Application Field D Other:
a. Was the conveyance man-made? DYes 0No
b. Did the discharge reach waters of the State? (If yes, notify DWQ) DYes 0No
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify 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 1 of3
DYes QSI No
DYes ~No
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
2/4/1011 Continued
lFacility Number: !Date of Inspection: /?--13-12--
Waste CoUection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 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 mana~ement or closure plan?
DYes ~No DNA ONE
0 Yes 0 No 0 NA 0 NE
Structure 5 Structure 6
DYes ~No DNA ONE
D Yes [;81 No 0 NA 0 NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequate markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part ofthe waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
0 Yes ~No
0 Yes l8J. No
DYes ~No
DNA ONE
DNA ONE
DNA ONE
0 Yes I8J No 0 NA 0 NE
II . Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes [gl No 0 NA 0 NE
0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN> 10% or 10 lbs . 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window D 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 the CAWMP?
I 5. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 1 of3
DYes ~No DNA ONE
DYes j3No DNA ONE
DYes g) No DNA ONE
DYes Ud_No DNA ONE
D Yes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DOther:
DYes ~No
D Yes ~N o DNA ONE
2/4/1011 Continued
."!Facility Number: ~ -Crri' I I nate oflnspection: / :?:-1 3-I ;J-I
• 24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the facility out of compliance with pennit conditions related to sludge? Ifyes, check
the appropriate box(es) below.
DYes (g.No DNA 0 NE
DYes !$-No DNA D NE
D Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
D Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over-application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below .
DYes IL9 No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes 0,_No DNA ONE
DYes 1Z:1 No DNA ONE
D Application Field D Lagoon/Storage Pond D Other: ------------------------
32. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page3 of3
DYes ~No DNA ONE
DYes j8No DNA ONE
DYes (2g.No DNA ONE
or any
Phone: /!t'~I/Jy.--:5300
Date: //---13-;JfJI;;;.--
11411011
·•[~!!f!l!~~!'!~~l!l!~~--~~
ompliance Inspection Operation Review 0 Structure Evaluation
Reason for Visit: ~utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Denied Access
DateofVisit: ljf--i:i/ I ArrivaiTime:IJc,'J o I DepartureTime:l;z t; 00 I county:£~~ Region:t=I:o
Farm Name: f?._onn;-r (,1.,-frY ? Fafl'fl":= Owner Email: -----------------
Owner Name: J<J:n ni r"' F C a,.;frr Phone:
Mailing Address:
Physical Address: -------------------------------------------
Facility Contact: G 1'-r'" ,-r /J1ocr-r:_ Phone: Title: _...__U_L:".=d;....;;...._~~!il"'pe. ...... ~..._.....;;."--
Integrator: ...~~kZ~..::c..l:::..~"~'/.~'[~.t:.P::..:'~"'":....~:...UJ_~_· -----IT Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 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:
Certification Number:
Longitude:
0 Yes G8kNo
0 Yes 0No
0 Yes 0No
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) 0 Yes 0No
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 ~No
0 Yes ~No
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
DNA ONE
214/2011 Continued
!Facility Number: !nate of Inspection: //-8' /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 I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in): 3.3
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
waste management or closure plan?
DYes ~No DNA ONE
D Yes D No 0 NA D NE
StructureS Structure 6
D Yes ~No DNA 0 NE
DYes ~No DNA ONE
If any of questions 4-6 were answered yes, and tbe situation poses an immediate public bealtb or environmental threa4 notify DWQ
7. Do any of the structures need maintenance or improvement?
8. Do any of the structures lack adequale markers as required by the permit?
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Docs any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance or improvement?
D Yes l:la No 0 NA 0 NE
DYes ~No DNA ONE
D Yes ~ No D NA 0 NE
DYes ~No DNA ONE
II. Is there evidence of incorrect land application? If yes, check the appropriate box below. D Yes 5{] No 0 NA D NE
0 Excessive Ponding 0 Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN> 10% or 10 lbs. D Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window D Evidence of Wind Drift D Application Outside of Approved Area
12. crop Type(s): ilrr~ //Jvc--rr//rrx~ t::-
13. Soil Type(s): ;Jo.4-
14. Do the receiving crops differ from those designated in theCA WMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropriate box.
OwuP Ochecklists 0 Design D Maps D Lease Agreements
DYes ~No DNA ONE
DYes ~No DNA ONE
DYes fiQ No DNA ONE
DYes ~No DNA ONE
DYes IZJ No QNA ONE
0 Yes [RI No DNA ONE
DYes [iJNo QNA ONE
Oother:
21. Does record keeping need improvement? Ifyes, check the appropriate box below. 0 NA 0 NE DYes JXI No
0 Waste Application D Weekly Freeboard 0 Waste Analysis D Soil Analysis 0 Waste Transfers 0 Weather Code
0 Rainfall D Stocking D Crop Yield 0 I 20 Minute Inspections D Monthly and I" Rainfall Inspections D Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes ~ No 0 NA 0 NE
23.1fselected, did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes lXI No 0 NA D NE
Page2of3 214/2011 Continued
- Facility Number: pate of Ins ectioo: f
J
24. Did the facility fail to calibrate waste application equipment as required by the permit?
'
❑ Yes
®No ❑ NA [_]NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ 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?
❑ Yes
® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
&No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
e No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[K No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAV;W?
❑ Yes
Z No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[3 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
O No ❑ NA ❑ NE
(Comments refer touestion ES answers and/or any additional recommendations or any other comme`rifs. I
Use 'draww¢s(of facility to better explain situ t oLnkuse additional oases as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9%0"-</X`-3r3a"
Date: /% ?%O /J
2/412011

..
•\
Type of Visit ~pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit e6uline 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: lbZ--1 J{-1~ I ArrivaiTime:l cor!)"';::) I Departure Time: I /.,;?~ 'D () I County: 2ayn r--Region: rJ!:.-0
Farm Name: R V" l"l ; t= CO ,y~(' .p::-d-& I'Y'V'-Owner Email: -------------
Owner Name: J< 0 ~ n i Z::. {!_,::~. ,-1-;;; Phone:
Mailing Address:
Physical Address:------------------------------------____ _
Facility Contact: _B<.....L.""f2...:Y1~n.!....L.(..!:z;_:::::...__....;C?=;;.:Y':...fu.L..:..Y..::v-~-Title: t/!wtz,..,...-Phone No: ---------
Onsite Representative: a:,jl' er= #"' rl1. Dt>·I'"C-Integrator: 121 11'/"f
Certified Operator: 8 'Dn rl ,J:::_ Co~,--Operator Certification Number: _JL......9c........;0::.........7~1 __ _
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D" Longitude:
Discharges & Stream Impacts
I. Is any discharge observed from any part ofthe operation? DYes ~o DNA ONE
Discharge originated at: D Structure D Application Field D Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
DYes 0No DNA ONE
DYes 0No DNA ONE
DYes 0No DNA ONE
DYes ~0 DNA ONE
DYes ~0 DNA ONE
11118104 Continued
I Facility Num~r: Q= /, f(~ Date of lns~ction I JC ~I "1 -,p
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
a. If yes , is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
DYes ~No DNA ONE
DYes 0No DNA ONE
Structure 5 Structure 6
Identifier:---------------------------------------
Spillway?:
Designed Freeboard (in): __ ._/_9......_ _______________________________ _
ObservedFrecboard(in): __ 3"'-3~---------------------------------
5. Are there any immediate threats to the integrity of any of the structures observed? D Yes [;&No D NA 0 NE
(i e/ large trees , severe ero sion, seepage, etc .)
6 . Are there structures on-site which are not properly addressed and/or managed 0 Yes 00 No DNA 0 NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structure s need maintenance or improvement?
8. Do any ofthe stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10 . Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes I,RNo DNA ONE
DYes ~No DNA ONE
0 Yes f&_No 0 NA 0 NE
0 Yes ti&No DNA ONE
11 . Is there evidence of incorrect application? lf yes, check the appropriate box below. DYes JS..No 0 NA D NE
D Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn , etc .)
D PAN 0 PAN > 10% or 10 lbs 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
14 . Do th e receiving crops differ from those de signated in theCA WMP? DYes ~0 DNA ONE
15. Does the rece iving crop and/or land application site need improvement? DYes ~No DNA ONE
16. Did the facility fail to sec ure and/or operate per the irrigation design or wettable acre determination? DYes r& No 0 NA D NE
17 . Does the facility lack ade quate acreage for land application?
18 . Is there a lack of properly operating waste applic ation equipme nt ?
}Jo ~! Fa--''11..
~ fJK . 3 -rs--/Z>~
Reviewer/Inspector Name
Re\iewer/lnspector Sig nature:
Pa ge 2 of 3
DYes IR.No DNA ONE
DYes ~No DNA ONE
Phone: 9;/ ~-L:(:rs-3'Jo-o
Date: /;?-/ 'o/'-;;Lb'D
12128104 Continued
I Facility Number: 0 ~ffi Date of Inspection I/R-7#-Iol
.,
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
the appropriate box. 0 WUP D Checklists 0 Design 0 Maps 0 Other
DYes ~No ONA ONE
DYes ~No DNA ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes .129. No D NA 0 NE
D Waste Application D Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers 0 Annual Certification
0 Rainfall 0 Stocking D Crop Yield 0 120 Minute Inspections 0 Monthly and I" Rain Inspections 0 Weather Code
22. Did the facility fai l to install and maintain a rain gauge? DYes J8lNo DNA ONE
23 . If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes !;».No DNA ONE
24 . Did the facility fa il to calibrate waste application equipment as required by the permit? DYes ~No DNA ONE
25 . Did the facility fail to conduct a sludge survey as required by the permit? DYes (R_No DNA O NE
26. Did the facility fail to have an actively certified operator in charge? DYes QlNo DNA ONE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? DYes l)a.No DNA ONE
Other Issues
28 . Were any additional problems noted which cause !Ion-compliance of the permit orCA WMP? DYes jgNo DNA ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes
and report the mortality rates that were higher than normal?
D?JNo DNA ONE
30. At the time of the inspection did the facility pose an odor or air quality concern? D Yes SNo DNA ONE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by DYes ~No DNA ONE
General Permit? (ie/ discharge , freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss re view/in spection with an on-site representative? D Yes 1:8J.No DNA ONE
33. Does facility require a follow-up visit by same agency? D Yes C&No DNA ONE
Page] of3 12/28104
8JM.5 /2-1(, -2tJOCj
Type of Visit e-f(;mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit a-J(outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
Date of Visit: IIZ-IS-ot1 I Arrival Time: It ,'Z{) jJJII.t I Departure Time: II.Q"O "es I County: ~-er·~
'
Region: FM
~ ,
Farm Name: iZ.oAJt-./lc... C6-dLv tlo, "-Owner Email:-------------
Owner Name: __ R......:Aoo~fi:........:.N,;_;_t'....;c.-;__C.___::::C<..t~rl-:::....:....-=.ev...:....._ ------------Phone:
Mailing Address: -----------------------------------------
Physical Address:-----------------------------------------
Facility Contact: ........,.G::.....L.rt.........,;;~:.Lc_.d..;::___:o::;..:<l:...!V:....<---=;...._---Title: ---4,z...;;·tU..=~~·;__::s.;r:-/...;;tL::.:o..a.C-· __ PhoneNo: ________ _
Onsite Representative: ------------------Integrator: __ .:....M-=---g_,..._"....:c,-~---=...._,.J _______ _
Certified Operator: f<oJ.IAI i ~ <::A H-c..v
I ·-----------
Operator Certification Number: --=...I-'9!:.-::0......;.7_1 __ _
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D" Longitude: D OD'D"
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: D Structure D Application Field D Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part ofthe operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters ofthe State
other than from a discharge?
0 Yes B1'fo DNA D NE
DYes 0No l:fN"A ONE
DYes 0No 13"1'fA ONE
I
DYes 0No (31:fA ONE
DYes 131'10 DNA ONE
DYes ~DNA ONE
11/28104 Continued
~
Date of Inspection l;.t-IS"-D91
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
DYes EfNo DNA ONE
E(Yes [3ifo DNA ONE
Structure 5 Structure 6
Identifier: --"k:J::.=o:~";........;/ __ ----------------------------------
Spillway?: ---------------------------------------
Designed Freeboard (in): __ l_q ____ -----------------------------------
Observed Freeboard (in): _......:....1..::1...:.r.JC.L ___ -----------------------------------
5. Are there any immediate threats to the integrity of any of the structures observed? DYes B'No DNA ONE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed DYes [31qO 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? 0 Yes ~ 0 NA 0 NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes [31% DNA ONE
0 Yes B'1'Jo 0 NA 0 NE
DYes ~ DNA ONE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. 0 Yes ~ 0 NA 0 NE
0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN> 10% or 10 lbs 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Area
12. Crop type(s) &YA4 cl ~ rrk,z f~r~c-J I ..5~tl 6-;"' (o. S.) F~~c. ...... c....~...J/::'r..t-uL...I-&c-4
13. Soil type(s) A
14. Do the receiving crops differ from those designated in theCA WMP? DYes
15. Does the receiving crop and/or land application site need improvement? DYes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination!O Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
f4L..J . # ~.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
DYes
DYes
12128104
No DNA ONE
G:t'No DNA ONE
·~ DNA ONE
[3'}/o DNA ONE
~ DNA ONE
Continued
. . .
I Facility Number: 82 -~881 Date of Inspection 112-15-o 'f I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropirate box. 0 WUP 0 Checklists 0 Design 0 Maps D Other
DYes ~DNA ONE
DYes.~ DNA ONE
21. Does record keeping need improvement? lfyes, check the appropriate box below. DYes §1qO"" 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 D Crop Yield 0 120 Minute Inspections 0 Monthly and l" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to 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 (PLAn certification?
Other Issues
28. Were any additional problems noted which cause non-compliance ofthe permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
Genera] 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:
I
DYes ~DNA" ONE
DYes ~DNA ONE
DYes ~DNA ONE
DYes
DYes
~DNA ONE
~
DYes~
DNA ONE
DNA ONE
DYes
DYes
DYes
DYes
DYes
DYes
12118/04
~DNA ONE
~0 DNA ONE
~DNA ONE
~
~
~
DNA ONE
DNA ONE
DNA ONE
... -
I-...
Type of Visit ~mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Gntoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit : ltz-ls-~o B I Arrival Time: I/,' 10 ~,..... , De parture Time: I //7o4 ,.._ I County: s::b~StJ;<o/ • Region: r-Lo
Farm Name: _l2..:......;.o.:;..IV;..;;...:..N_..:....i L=-___;;:C::;:a::::.;.'r{::.......l.:...<c:.~:V;,.__ ________ _ Owner Email: --------------
Owner Name: --=~:.....;.:;D:..:.:t.I:.:N~I'..::L::::......_C.;;.~_~_....;...._ -----------Phone:
Mailing Address: -----------------------------------------
Physical Address:-----------------------------------____ _
Facility Contact: __ G-_ru..r_..:....__~____::...:...~~____;:~---Title: T uJ.... SfGC..-· Phon e No:---------
Onsite R epresentative: Gr.(..<..-V'" Mo t>.r <-Integrator:----------------
Certified Operator:--------------------Operator Certification Number: -------
Back-up Operator: --------------------Back-up Certification Number:
Loc ation of Farm: Latitude: D OD'D" Longitude:
Disc harges & Str eam Impacts
I . Is any discha rge observed fro m any part of the operation?
Discharge originated at: 0 Structure 0 Appl ication Field 0 Other
a . Was the conveyance man-made?
b. Did the disc harge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (ga ll ons)?
d. Does discharge byp,ass the waste management system? (If yes . notify DWQ)
2. Is there evidence of a past disc harge from any pan of the operation?
3. We re there any adverse impacts or potential adve rse impacts to the Waters of th e State
other than from a discharge?
Page 1 of3
D Yes ~ DNA ON E
D Yes 0No ffNA ONE
D Yes 0 No BNA O NE
I
D Yes 0No ~ ONE
D Yes [31(o DNA ONE
DYes ~D NA O NE
12/28104 Continued
[Fac~ity Number: 8Z -" 8 8 I Date oflnspection liZ-IS-"'S l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate ?
a. If yes , is waste level into the structural freeboard?
Structure 2 Structure 3 Structure 4
DYes ~o DNA ONE
DYes ~ DNA ONE
Structure 5 Structure 6 Structure I
~cilz.. Identifier:__,_~;...:!...;;;..._ ____ --------------------------------
Spillway?: N 0
lq ,,
Desib'lled Freeboard (i n):---------------------------------------
ob 2 / ,,
served Freeboard (in): _ __;;::;...~::....... ___ ----------------------------------
5. Are there any immediate threats to the integrity of any of the structures observed? DYes l3'1'io DNA ONE
(ie/large trees, severe erosion, seepage , etc.)
6. Are there struc tures on-site which are not properly addressed and/or managed DYes ~ 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 struct ure s need main tenance or improvem ent? D Yes B"No 0 NA D NE
8. Do any of the stuctures Jack adequate markers as required by the permit?
(Not applicab le to roofed pits, dry stacks and/or wet stacks) DYes ~DNA ONE
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
DYes ~DNA ONE
Waste Application
10. Are there any required buffers, setbacks, or compliance a lternatives that need
maintenance/improvement?
DYes rJNo 0 NA 0 NE
ll. Is there evidence of incorrect application? If yes , check the appropriate box below. 0 Yes ~ DNA 0 NE
0 Excessive Ponding 0 Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
0 PAN D PAN > 10% or 10 lbs 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window D Evidence of Wind Drifl 0 Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the rec e iving crops differ from thos e desib'llated in th eCA WMP? DYes l9-No DNA
15. Does the receiving crop and/or land application site need improvement? DYes ~ DNA
16. Did the faci li ty fail to secure and/or operate per the irrigation design or wettable acre determination?O Yes []'No DNA
17 . Does the facility lack adequate acreage for land application? DYes ~ DNA
18 . Is there a lack of properly operating waste application equi pment? DYes ~ DNA
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings offacility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Ric .. ~ ~Js . Phone: 't'IO . ¥3.3.3330
Reviewer /Inspector Signature: tl~:J.. R~ Date: i2-l)-UXJ8
ONE
ONE
ONE
ONE
ONE
• -
~ •
12128104 Contznued
..
I Facility Number: 1Z _,8 8 I Date oflnspection l1z -l.t"-o S I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Pennit readily available?
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
the appropirate box. 0 WUP 0 Checklists 0 Design 0 Maps 0 Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
DYes ~o DNA ONE
DYes ~o DNA ONE
DYes ~o DNA ONE
0 Waste Application 0 Weekly Freeboard D Waste Analysis 0 Soil Analysis D Waste Transfers D Annual Certification
0 Rainfall D Stocking 0 Crop Yield D 120 Minute Inspections 0 Monthly and I" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? DYes ~ DNA ONE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? DYes [3ifu DNA ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes ~ DNA ONE
25. Did the facility fail to conduct a sludge survey as required by the permit? DYes ~ DNA ONE
26. Did the facility fail to have an actively certified operator in charge? DYes B"No DNA ONE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? DYes ~ DNA ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? DYes ~ DNA ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes Gl1fo DNA ONE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? DYes ~DNA ONE
If yes, contact a regional Air Quality representative immediately
~ 31. Did the facility fail to notify the regional office of emergency situations as required by DYes DNA ONE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative? DYes B"No DNA ONE
33. Does facility require a follow-up visit by same agency? DYes ~ DNA ONE
~f ..., ...--~ ~ .. ~
-.'-11~·~~'~ ,;;·;.,· ·,:,.,.~
Page3 of 3 12128104
Dl/o~/zoo8
I Facility Number [ 8'2 1.1
G15i'vision of Water Quality H tog_g 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ®"Compliance Inspection 0 Operation Review 0 Structure Evaluation ()Technical Assistance
Reason for Visit e1ioutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other D Denied Access
DateofVisit: l/Z-IJ-01 ArrivaiTimedll:-zo .1\~~A. DepartureTime: ln :S".rA,.... I County: -s~e~o rJ Region : t:'/i:..D
Farm Name: Owner Email: -------------
Owner Name: _R_c._N_N_I_'-_Ca;..;;..._..-l_c.-r ___ -----------Phone:
Mailing Address: ----------------------------------------
Physical Address:----------------------------------------
Facility Contact: ~ONNf<-Cod-v.r-Title: _..;:O~v..l:;...;;....;t..J...;;....(..y-~-----PhoneNo: __________ __
Onsite Representative: "&o·~ t.1 i >-Ca. r+ (.N"'""""
Certified Operator: 12g#JNI<... Cc.r-k-v-__________ __
Back-up Operator: ---------------------
Integrator: Mv.ve~ -"Bn.I.JN
Operator Certification Number: l'l 0 7 I
Back-up Certification Number:
Location of Farm: Latitude: D Oo·ou Longitude: D OD 'D "
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
pL~~ I I . t ID Wean to Fini sh I I
D Non-Layer 0 Wean to Feeder
~ Feeder to Finish Z5So
D Farrow to Wean
0 Farrow to Feeder
D Farrow to Finish
D Gilts
D Boars
.... -·
O DairyCow ' 0 Dairy Calf I
D Dairy Heife1 i
I
ODrvCow I
0 Non-Dairy
0 Bee f Stocker : 0 Beef Feeder
0 Beef Brood Cow . ··--·-·
Dry Poultry
0 Layers
0 Non-Layers
0 Pullets
0Turkeys
Other 0 Turkey Poults
0 Other ID Other
·'
Number of Structures: ITJ
··----·--~:)
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation ? D Yes l:B No DNA ONE
Discharge originated at : 0 Structure D Application Field D Other
a. Was the conveyance man-made? DYes C2l No DNA ONE
b . Did the discharge reach waters of the State? (If yes, notify DWQ) D Yes [A No DNA O NE
c. What is th e estimated volum e that reached waters of the State (gallons)?
d. Does di scharge bypass th e waste management system? (If yes, notify DWQ)
2. Is there evidence of a past di sc harge 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 di scharge ?
D Yes 1}1 No
DYes [jNo
DYes ~No
12/28104
D NA O NE
D NA ONE
D NA ONE
Continued
[Facility Number: i2 -(, 811 Dateoflnspection I!Z-IJ-o71
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
DYes lENo DNA ONE
DYes ~No DNA ONE
Structure 5 Structure 6
Identifier:---------------------------------------
Spillway?:
l ~I(
Designed Freeboard (in): --L-_.:!~-------------------------------------
'? t"; If
Observed Freeboard (in): __ ,...2_""-~-------------------------------------
5. Aie there any immediate threats to the integrity of any of the structures observed? DYes
(ie/ large trees, severe erosion , seepage, etc .)
(gNo DNA ONE
6. Aie there structures on-site which are not properly addressed and/or managed DYes !jNo DNA ONE
through a waste man agement or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental tbreat, notify DWQ
7. Do any ofthc structures need maintenance or improvement?
8. Do any of the stuctures la ck adequate markers as required by the permit?
(Not applicable to roofed pit s, 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 . Aie there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
DYes [jNo 0 NA ONE
DYes 00No DNA ONE
DYes (2gNo DNA ONE
DYes li]No DNA ONE
1 I . Is there evidence of incorrect application? Jfyes, check the appropriate box below. 0 Yes ~No 0 NA 0 NE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground 0 Heavy Metal s (Cu, Zn, etc.)
0 PAN 0 PAN > 10% or I 0 lb s 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evi dence of Wind Drift 0 Application Outside of Area
12 . Crop typc(s) 'g (..r IN\_I:Ld "'-{Pt~Sh.t.~) J s. c;. (611C¥S<ul), F--sc.u ~{~)I CCr"{. wiu~ ~;b-ot¥..5
13. Soil type(s) --....L.:.~D::...:A~------------------------------
14 . Do the receiving crops differ from those desi&'flated in the CA WMP? DYes ~No DNA ONE
15. Does the receiving crop and/or land application site need improvement? DYes ~No DNA ONE
16. Did the facility fail to sec ure and/or operate per the irrigation desi&rn or wettable acre determination?O Yes ll:i No DNA ONE
17 . Does the facility lack ade quate acreage for land application? DYes ~No DNA ONE
18. Is there a lack of properly ope rating waste application equipment? DYes EiiJNo DNA ONE
Comments (refer to question #): Explain any YES answers and/or any· recommendations or any otber comments.
Use drawings offacility to better explain situations. (use additional pages as necessary): ..
f-.
"---...
Reviewer/Inspector Name "eic..~~ . K<-"' <:...\. ..S Pbone: qJo. 'lh·33tJO
Reviewer/Inspector Signature: R -~ R~ Date: IZ-13-Zt!JO 7
12118104 . Continued
I Facility Number: <g7_ -&,~1
Required Records & Documents
Date of Inspection I /Z4J-o7 I
19. Did the fa cility fail to have Certificate of Coverage & Pennit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropirate box . 0 WUP 0 Checklists D Des ign 0 Maps D Other
DYes !lfNo DNA ONE
DYes [!No DNA ONE
21. Does record keeping need improvement? If yes, check the appropriate box below. DYes C?No 0 NA D NE
D Waste Application 0 Weekly Freeboard D Was te Analysis D Soil Analysis 0 Waste Transfers 0 Annual Certification
D 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? DYes [!!No DNA ONE
23 . If selected, did the facility fail to install and maintain rain breakers on irrigation equipment? DYes ijlNo DNA ONE
24. Did the facility fail to calibrate waste application equipment as required by the pennit? DYes ~No DNA ONE
25 . Did the facility fail to conduct a sludge survey as required by the pennit? DYes ~No DNA ONE
26. Did the facility fail to have an actively certified operator in charge? DYes ~No DNA ONE
27. Did the fa c ility fail to secure a phosphorus loss as sessment (PLAT) certification? DYes ~No DNA ONE
Other Issues
28 . Were any additional problems noted which cause non·compliance of the pennit orCA WMP? DYes U1No DNA ONE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document DYes ~No DNA ONE
and report the mortality rates that were higher than normal?
30. A t the time of the inspection did the facility pos e an odor or air quality con cern ? DYes ~No DNA ONE
If ye s, contact a regional Air Q uality representative immediately
31. Did the facility fail to notify the regional office o f emerge ncy s ituations as required by DYes f¥JNo DNA ONE
Gene ral Permit ? (i c/ di scharge, freeboard problems , over applic ation)
32 . Did Reviewer/Inspector fa il to discuss review/ins pection with an on·site representative? DYes ~No DNA ONE
33. D oes fa cility require a follow-up vi sit by same agency? DYes It] No DNA ONE
Additional Comments and/or Drawings:·
....
1--
1--...,.
.1212 8104
Type of VIsit Cl Compliance Inspection 0 Operation Review 0 Structure Evaluation
Reason for VIsit fir Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other
Date of Visit: I I -q I ijo(J Arrival Timed I z. OJ I Departure Time: I I County~ rnps 611
Farm Name: J<onnU ew+cr 4 2 Owner Email:------------
Owner Name: c~c~~~e¥~-------------Phone:
Mailing Address: ----------------------------------------
Physical Address:.-~--,---.,..--------------------------------____ _
Facility Contact;l<b()&o CD...r ~ Title: 0 W nif Phone No:~----~--
Onsite Representative: E oan; e Ca { Jer Integrator: __ -L_m_:_..:...__-......:..6""""' _____ · _· ·_· --
Certified Operator: ~0 n n,;,; (Jl cJ<er Operator Certification Number: ...:,:....-.'l~....:~oD~7...._· .... I_' ...;___
Back-up Operator: --------------------Back-up Certification Number:
Location of Farm: Latitude: D OD'D"
Discharges & Stream Impacts
I. Is any disc harge observed from any part of the operation?
Discharge originated at: 0 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 (gallons)?
Longitude:
0 Yes )lll No 0 NA 0 NE
DYes 0No ~A ONE
DYes 0 No elNA ONE
.....-:-:= I
d . Does discharge bypass the waste management system? (If yes, n otify DWQ) D Yes 0No ~NA ONE
DYes -No DNA ONE
DYes J8No 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 1 of3 11128104 Continued
I Facility Num.ber: tJ:-~
Waste CoUection & Treatment ----
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
DYes aJNo DNA ONE
DYes 0No ~NA ONE
Structure 5 Structure 6
Identifier:------------------------------------
Spillway?: . ' Designed Freeboard (in): --~...-L-----------.,...------------;::---------------
. [) H _ (J I · 'd. {"; Observed Freeboard (in): _ _ ~ ffio...o htte!.. £l'h 111 u on.....Y
5. Are there any immediate threats to the integrity of any ofthe structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
DYes ~o DNA ONE
DYes fJtNo DNA ONE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any ofthe structures need maintenance or improvement? DYes flNo DNA 0 NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures requ ire
maintenance or improvement?
Waste Application
I 0. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
II. Is there evidence of incorrect application? If yes, check the appropriate box b elow.
DYes ~o DNA ONE
DYes ~o DNA ONE
DYes ~No DNA ONE
DYes ~o DNA ONE
0 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn , etc .)
D PAN D PAN> 10% or 10 lbs D Total Phosphorus D Failure to Incorporat e Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window 0 Evide nce of Wind Drift 0 Application Outside of Area
12. Croptype(s) '&.trn~n -PI ~br Pis Fe~c.v.g, p CJ:x" wW ~~ns l-JoA~ ' 13 . Soil type(s)
14. Do th e receiving crops differ from thos e designated in the CAWMP? 0 Yes~ No DNA 0 N E
15 . Does the rec eiving crop and/or land appli cation site ne ed improvement? 0 Yes~ No DNA 0 NE
16. Did the facility fail to secure and/or operate per the irriga tion design or wettable acre determination ? 0 Yes ~ No D N~ 0 NE
17. Does the fac ility lack adequ ate acreage for land appli cation? DNA 0 NE
18 . Is there a lack of properly operatin g wast e applic ation equipment? D NA 0 NE
.. '.·: -~--··.-:<~----:.:-·:r·~~---·{'¥'(!:' .. :-:
· ... ···. · (referto q·~~.tio"tJ:if)::: Explain any YES answers use dr~Wings of faCility ':t~~ ~ert~r, explain situations. <use .a. ddim•n~tl i p"ltki~sTiis ··-",:·.. ' .. · ... -.. ·-<-:::~·:.~~-~~-:-· ...
Reviewer/Inspector Name
Reviewer/In spector Signature :
Page 1 of3
I Ficility ~'timber: 'tt-G~ I~ Date of Inspection I rqJ ?[
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If yes, check
the appropriate box . 0 0 · 0 · O 0 WUP Checkhsts Design Maps Other
DYes j1t.No DNA ONE
0Yes~o DNA ONE
21 . Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes ~No DNA D NE
D Waste Applicat ion 0 Weekly Freeboard 0 Waste Analysi s 0 Soil Analysis 0 Waste Transfers 0 Annual Certification
0 Rainfall D Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and I " Rain Inspections D Weather Code
22 . Did the facility fail to install and maintain a rain gauge?
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 phosphoru s 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 high er 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 immediate ly
31 . Did the facility fa il to notify the regional office of emergency s ituations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32 . Did Reviewer/Inspec to r fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Pagel ofJ
DYes Q!No DNA ONE
D Yes ~0 D NA ONE
D Yes )!.No DNA O NE
DYes il)No DNA ONE
0Yes~o DNA ONE
0 Yes ISt·No DNA ONE
DYes flt.No DNA 0 NE
DYes 's-No DNA ONE
DYes eNo DNA ONE
DYes ~No DNA O NE
DYes ~No DNA ONE
D Yes 8No DNA ONE
12128104
FacilitY Ne~ -lt g ~· Time In/a • .. QJ Time Out____ Date ___._l......;U=t...Ll =L=---
Fann Name 'R, C a.J \!f ~ 2.... Integrator _ __.mr-r-.!....-.1)~------
0wner ---=-__,.----::-------------Site Rep-----------
Operator __ JS~ ... ( __ Sll!"--'-f.__,_,u"'-"----------No. --------
Back-up < No .-------~
coc \07" Circle: General or
Design Current Design Current
Wean-Feed Farrow-Feed
Wean-Finish Farrow-Finish
Feed-Finish blSK:) Gilts I Boars
Farrow-Wean Others
.---/3') .
Pull/Field Soil Cro~. Pan Window
.. -,1 /" I
~0 t\ !lt.vmv\ d_l) G, a.~!., cJ~3.1'S -::J/f-1/::xJ . ~~r so ~I I -'f/30
F ~~<..u. ~ (::v CL "t:.,(_ 13/~~ ~I I -7 l ~I
C':,. r
/"" (' 6f n G rct-4 ..-.. I d.'(, :rs " l./ \':> ...-·~·G.-~ ~~ v _Oft I f_ S:-\\ t tun. n <.. Ito~ t7
\ I VI ' ~ \ ' \ ~t
t.u~o.J
. -·~~~~~~~~~==============~======~==~~~~
• Division of-WaJer Quality
0 Division · and Water Conservation
0 Other · · --· ·
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 D Denied Access
Dateof\'isit: '" -~-e:6' I Arrival Time: I ;z:q~ I DcpartureTime: ._1 ___ __,1 County: _S~s .. .., Region: FRo
Farm Name: &tJa /c: Cq,f~r # ~ ft?,., Owner Email: --------------
Owner Name: ,f t!'httJ,:e. Cr.Yd.~ -----------Phone:
Mailing Address: .3 t( G-I
Physical Address:-----------------------------------------
Facility Contact: _,f.~"~":e.":.L.L/~e _ ___;C=t:V>~Ii~c..!.r~ ____ Title: -----------Phone No: f!:J/0-19C-:JD..:Z./
Integ rator: ,+t,.,to.h..y____/S_c() ,_.!!:!~-----­
Operator Certification Number: I eu>2/
On site Representative: __11~,.,. ,~e ___ Ca_r tee_ ______ _
Certified Operator: /(DIJIH'_t. ___ -----------
Back-up Operator: --------------------Rack-up Certification Number:
Location of Farm: Latitude: D OD'D" Longitude: D OD'D"
Design Current Design Current Design Current
Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
[D Wean to Finish
0 Wean to Feeder
0 Dairy Cow
0 Da iry Calf J I
10 Laver I I
1!3-feeder to Finish 1.;2 ~ao .:U~h 0 Da iry Heife1 I
0 Farrow to Wean
0 Farrow to Feeder
0 Farrow to Finish
0Gilts
0 Boars
-· --
0DryCow ' ' 0 Non-Dairy i
0 Be ef Stocker :
0 BeefFeeder
0 Beef Brood Cow -= ·-··-·--·---------~ ,. .. -
Dry Poultry
0 Lavers
0 Non-Layers
D Pullets
0 Turkeys
Other
ID Other Number of Structures: UJ : 0 Turkey Poults
0 Other --. ----
Discbarges & Stream Impacts
I. Is any discharge observed from any part of the operation? DYes ~ D NA ONE
Discharge originated at: D Structure 0 Application Field 0 Oth e r
a. Was the conveyance man-made? DYes 0No DNA ONE
b. Did the discharge reach waters of the State? (If yes, notify DWQ ) DYes 0 No DNA ONE
c. What is the estimated volume that reached waters of the Stat e (g all ons)?
d. Does discharge bypass the waste 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 than from a discharge?
D Yes 0No
DYes ~0
D Yes ~0
12128104
D NA ONE
DNA ONE
D NA ONE
Continued
jFacility Number: 8A. ~881 Date of Inspection I t/-"·/J) 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?
DYes ~o DNA ONE
DYes DNo DNA ONE
Structure I
Identifier:----'-'--------------------------------------
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?: l}o
Desi1:,'lled Freeboard (in): _.....;;1_9.~....-"_'-:-----------_______ ---------------------
Observed Freeboard (in): --'~:::....;,c.l'--_,,_._· _ -------------------------------
5 . Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
DYes B'N'o DNA ONE
6. Are there structures on-site which are not properly addressed and/or managed DYes G?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 t he structures need maintenance or improvement?
8. Do any of the stuctures lack adequate markers as required by the pennit?
(Not applicable to roofed pits , dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
~es 0No DNA ONE
DYes g1.i'o DNA 0 NE
DYes G31'io DNA 0 NE
DYes ~o DNA ONE
II . Is there evidence of incorrect application? If yes, check the appropriate box below. DYes ~o DNA 0 NE
0 Excessive Ponding D Hydraulic Overload 0 Frozen Ground D Heavy Metals (Cu, Zn, etc.)
0 PAN 0 PAN> 10% or 10 lbs D Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window D Ev idence of Wind Drift D Application Outside of Area
11/'l,lt~~/1 In I,~. 1, '1 :;) ¥., ~o
12. Crop type(s) &sc"c ""~~/'Itt~ Sm&!l 6-,-a,'~
13. Soil type(s) 1./.,,.fo/1{ 0-a/dsl,,.o
14. Do the receiving crops differ from those designated in theCA WMP? DYes
15. Does the receiving crop and/or land application site need improvement? DYes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination! D Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
, s Dote.
Reviewer/Inspector Name
Reviewer/Inspector Signature: _,,.,_, __
DYes
DYes
~0 DNA
~0 DNA
0No DNA
0No DNA
GI'No DNA
ONE
ONE
g.m:
ffNE
ONE
11118/04 Continued
• 4 • • ..
I Facility Number: (l.:l -&,gg I Date oflnspection I" w'·o~l
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Pennit readily available?
20. Does the facility fail to have all components of theCA WMP readily available? If ye s, check
the appropirate box. D ~ 0 C~s 0 ~n 0~ 0 o~
DYes ~o DNA ONE
DYes ~o DNA O NE
21. Does record keeping need improvement? Ifyes, check the appropriate box below . ) DYes 91ifo DNA 0 N E
'1·1-? ~ :>.f /.:>·?-, -~
0 W:astc Applieati6rt-D Weekly f'leeboatd D Waste Anal,sis D S9il itnal,sis D Wwtc 'fransfer5 0 AaaHal Ceilificatiort
D-ttamiitU 0 Stoeltisg 0~ 0 126 Miuute ht5pectinn<> D Memdtly aud I" ltaln Inspections D Weathet Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit orCA WMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notifY the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representati ve?
33. Does facility require a follow-up visit by same agency?
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
DYes
12128/04
ffi1(o DNA ONE
[YNo DNA ONE
GJ..Ho DNA ONE
~0 DNA ONE
l:Q1<fo D NA ONE
0No DNA 81<tE
~0 DNA ONE
~ DNA ONE
~0 DNA ONE
[;~-No DNA ONE
~0 DNA ONE
0No D NA ONE
8 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
1 Reascln for Visit e Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other 0 Denied Access
Facility Number r i l H ", e I Date o!Vwt: I q -{ 'O'( lrrme: I Jt!}•, fl) I
1 _ lo Not Operatioual 0 Below Threshold I
~rmitted ~rtified D Conditionally Certified C Registered · Date Last Operated or Above Threshold: ---·
Farm Name: _/j.RJ.J.tJ.i.L.._..£..fLd:t.r: _ _t~ :l. ----County: .J~!rf/l.S-n r!SO
Owner Name: ~ tJtJI) ,,, C.~t,.l(, ·Phone No: q /0 -S"3 ;J' -'..2 'I 1
Mailing Address: ---3 Lf vi A~p.· .. t, _C4,,.(..~ lf.d..... &r1..1.l/.J I 4/L :; g .., 'f ..... Y __ _
FacilityContact: (l,,a,·L ~ltr Title: . PhoneNo: q10 · 910· 20:Jj
Onsite Representative: ----~-"-'-1'1!1~.:...' 1~t.-.,__-(:,z.41~..,.r'-'twt~o..~r:... _____ _ Integrator: t1 Wi"' 4T &CPWf?
Certified Operator: 81111 II / t . ___ (.:.:::(:l:l...r,_f ,),.t~r ___ _ Operator Certification Number: / 'I 0'1/
Location of Farm:
~ne D Poultry D cattle D Horse Latitude .__ _ _,I• I._____,~ L-.1 _-Jl" Longitude
Discharges & Stream Impacts
1 . Is any discharge observed from any part of the operation?
Discharge originated at: D Lagoon 0 Spray Field 0 Other
a If discharge i s 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 estimaled 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 operation?
3 . Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge ?
Waste Collection & Treatment
DYes
DYes
DYes
DYes
DYes
DYes
DNo
0No
ONo
0No
ONo
ONo
4 . Is storage capacity (freeboard plus storm storage) less than adequate? 0 Spillway DYes 0No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: __ __,l,__ __ ------·------· ---· ------------------
Freeboard(inches): _ _....J__...j_,_, ... ["_'• ________________________________ _
12112/03 Continued
• [Faduty Number: 8 ~ -(, g g I Date of Inspection J 7h /•d, J
5. Are there any. immediate threats to the integrity of any of the structures observed? (iel ttees, 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?
(H any of questions 4-6 was answered yes, and the situation poses au
immediate public health or environmental threat, notify DWQ)
7. Do any of the sttuctures need maintenance/improvement?
8. Does any part of the waste JDaila,CJCment system other than waste structures require maintenancel"rmprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancx-funprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
D Excessive Ponding 0 PAN D Hydraulic Overload D Frozen Ground 0 Copper and/or Zinc
~a 1'rt t-(o
12. Croptype >met! trllt'a ~k<c""/, (jlrm.,4 ~SCutc, J ) I
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA WMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pendcd for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipmept?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift dming land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure. and/or public piOperty)
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 immettiately.
Rmewer/ID5pector Name
Reviewer/Inspector Sigoature:
12112103
DYes ~
DYes ~
DYes l3"N"o
DYes GfNo
DYes G:JNo
DYes ~
DYes BNo
DYes B-NO
DYes [3NO
DYes gNo
DYes BNo
DYes 0No
DYes (3-No
DYes 0No
DYes eN6
DYes aN'o
DYes 13-No
I Facility Number: B :2. -(,·~I Date of Inspec:tion
Reauired Records & Doc:mnent.o;
21 . F~ to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel ~ ~.AesigRJ IB&p5,-etc.)
23 . Does record keeping need improvement? If yes, check the appropriate box below.
0 Weste }'..pplieatioe 0 :fTeebeaRt-D ~ 0 SeiJ Sa=plmg
/. • L( -') ;; I ' 3 • s--) :J • '7
24 . Is /8cility not m compliance wtth 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 covered under a NPDES Permit? (If no, skip questions 31-35)
31 . If selected, did the facility fail to install and maintain rainbreakers on iiTigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge SlD"Vey?
34. Did the facility fail to calibrate waste application equipment?
35 . Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
0 SceekiBg-Fcrm 0 &op'Yle1d"Porm D-R:amfaB 0 Inspection After 1" Rain
0 120 Minute Inspections
e .... .,. .. " .. !
"'•sit et..ct:tl·h,.,c'/.•,.., • /11r. L..,/~,..
I r,. II ·· 4;?
12112103
DYes gNo
DYes £31lfu
DYes BNo
DYes 9-No
DYes rg£
DYes ~
DYes BNo
DYes
/ lit,_,
DYes 13'No
~DNo
DYes ~ DYes
DYes ~
DYes ~
DYes ON~
.....
i -~ .... -·.,; ~-....
·site Requires Immediate Attention: _rJ_o_
Facility No. ____ _
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: --7--z.. I , 1995
Time: 1o : ¥2
Farm Name/Owner: __ ----.--=-L~t(~!:::dl...-'SL___~C.e~tt.+l...!~¥~:::......__---~-------.-­
Mailing Address:____.3tL¥~fD~/L-....!.14!.:.1#'!Jp:~.~~~rd~=-= _ ___;c..=..:l~"'~g...:o!>Jc.c.------~:i::!lo..!J!iLC.___---~=J.Iu:&uCL::.;:"'~~~Il.11~_ ...... N~C.."=-___,z.=RLL'I ...... 'i'-tf.L--__
Councy:_~~~~~--~-------------------------------------~---------­
Integrator: _ ___.._-+-~-..L..DL.I::.f-~-........,....-----Phone: __ _L,.!_'/O=-'----<~-i"~"3~1..=--__L~_.7u2..r,q..f----­
On Site Representative: __ £....L!!~I..l..-~s:q..--;--.---;---.
Physical Address/Location : _ ___;Lftj~,____...;)._---!.::::..:o...~~ti...S...-----D..L..-~~--Iiolu.......----!~--L..III.I.I....L.--M--""""-.....____...LL.<!Io....__
fA-IL
Type of Operation: Swine ...,/ Poultry ___ Cattle ----------------
Design Capacity: _-z.=......o.z::'--'~ .... o ____ Number of Animals on Site: ___ -z-=-=:i"'i_' ________ _
DEM Certification Number: ACE DEM Certification Number: ACNEW ______ _
Latitude:.l..t__ o ~' "') ~ " Longitude:_11_ o t "l... '<l.L"
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24. hour storm
(approximately 1 Foot + 7 inches)/Yes or No Actual Freeboard: .if-Ft. ~Inches
Was any seepage observed from th~~(s)'? Yes or@Was any erosion o~? Yes o~
Is adequate land available for spray? ~r No I~ the cover crop adequate'? ~r No
Crop(s) being utilized: J · oA t
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellii:?
100 Feet from Wells? e or o
Is the animal waste stockpiled within 100 Feet of USGS Blue-Line Stream'! es or ·
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes o@
Is animal waste discharged into water~ state by man-made ditch, flushing system, or other
similar man-made devices? Yes o~ If Yes, Please Explain.
Does the facility maintain adequate waste management r~volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)'? ~r No
event
Additional Comments: _____________________________ _
Inspector Name Signature
ce: Facility Assessment Unit Use Attachments if Needed.
»1 .... ~rotuea ... -.pl.-.4 faa u ~ Di'l't•iOD o~ Ba'Ytz~t.allllmaG'-t. at.
u. adU ... Qa ...... _..,.... ... ., ·~ ~oy;J-. , .. , .
iO:fl/i
.1-rk"\) ,
lf __
Naaa ot farm 1 Pleaa• priftt) z·::-::'~~if!r..il..I::I.Jr.f.'::..:.J#t'-=5:::,_-'-{.;1..,.~.g~~a.L.<"-c~if.__ ___________ _
Wra .. : 9;.;;;,J:s ·~: £j'ifi Phone Noc_; S:!Y~ &est9 ----
~--------------------------------~-~~ Count~:--~~~~A~~~~~b~~~-------------­Fum loc£tion: Latitud• and Longitude:.Z"~3~ I::Z8~t..!r (required). Also.
please attach a copy of a county road .map with location identified ..
Type of operation (swine. layer, dairy, etc.) ==--~=----...:S~yt.~i:l:leJuE._ ________ _
Design capacity . (number of animals):---~~--~~~7~~~0~--------~--~-----------­
Average size of operation· (12 month population avg.) =--------~'~&~?~S~~~--~--
Avera;-e acreage needed for land application of waste (acres) t z..t.o Actllo.S
····························-····························--·-········--····-·· Technical Sp•ciali•t. ~i~icat~OD
. .
As a technical specialist designated by the North Carolina Soil and Water
Conservation Commission pursuant to lSA NCAC 6F .0005, I certify that the new or
expanded animal waste management system as installed for the farm named above
ha.s an ani.mal waste management: plan that meets the design. construction,
operation and maintenance standards and specifications of the Division of ·-
Environmental Management and the USDA-Soil ConserJation Service and/or the North
Carolina Soil and Water Conservation Commission pursuant to lSA NCAC 2H.0217 and
lSA NCAC 6F .0001-.0005. The following elements and their corresponding minimum
c:riteria-ha..ve heen_verified by me or other designated technical specialists and
are included in the plan as applicable: minimum separations (buffers); liners or
equivalent for lagoons or waste stora.qa ponds; WL',ste storage ca.5)&City; adequate
quantity and amount of land for wasta utilization (or use of third party); access
or ownership of ·proper waate application equipment: schedule for timing of
applications ; application rates; loading rates; and the control of the discharge .·. ·
of pollutants from •Stoo:watar runoff events lass savttre than· che 25-yaar • .l4-hour ... · ....
storm.
Jtame o~ 'recbzlical. AA,Jk r;,P.{
Affiliation =--------~~~--~~~~~~--~--~--------------------~~~~~~~--­
Address (Age.~cy) =--~~~~~~-L--on~~~~~~~
·······················-··--····················· owner /Hanage.r Ag%-o t
I (we) understand the operation and maintenance procedures established in the
approved animal waste management plan for the farm named above and will ilnplement
these procedures. ·I (we) know that any addirional expansion to the exis~ing
design capacity of the waste treatme~t and storage syscem or construction of n...,,
facilities will require a new certification to be submitted to the Division of
Environmental Management before the new animals are stocked . I (we) also
unders~a.nd that there must be no discharge of animal waste from this syatam to
surface waters of the state either throuch a man-made conveya.nc~ or through
runoff from a storm event less severe than the 25-year. 24-~our storm . The
approved plan will be filed at th farm and at the office of the local Soil and
Water Conse District.
Date: __ ~,~-~7~-~~~Y-------
lll'ama o~ Kanaqer, if different from owner (Please print)=------------------
Signature: Dates __________________ __
~: A ~,anqe in land ownership requires notification or a new cartifieation
(if the approved plan is changed). to be submitted to the Division o .!
Environmental Management within 60 days of a title transfer.
DEH USE ONLY :A~*·----------------
• <
' ... .. ..
0 c.
0
1
I
;·
il
I