ACES/AU Form R-5 "Aces Afo/Cafo Qcp Annual Inspection/Evaluation Form" - Alabama

What Is ACES/AU Form R-5?

This is a legal form that was released by the Alabama Department of Environmental Management - a government authority operating within Alabama. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 15, 2006;
  • The latest edition provided by the Alabama Department of Environmental Management;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of ACES/AU Form R-5 by clicking the link below or browse more documents and templates provided by the Alabama Department of Environmental Management.

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ACES AFO/CAFO QCP Annual Inspection/Evaluation Form
Submitted To ADEM By The Facility Operator/Owner Or Their Authorized Representative
REGISTRANT/OPERATOR NAME
FACILITY NAME
COUNTY
PRIM RY WASTE TYPE
A
Liquid
Dry
ADDRESS
CITY
PHONE NUMBER
STATE
ZIP CODE
REGISTRATION #
REGISTRATION EXPIRATION DATE
TOWNSHIP, RANGE, SECTION
GPS LATITUDE & LONGITUDE
PRIMARY ANIMAL TYPE
CURRENT # OF ANIMALS
INSPECTION DATE
INSPECTION TIME
EVALUATION COMPLETE DATE
If more than one QCP participates in the evaluation, the responding QCP should initial the response.
Yes
No
NI
N/A
Comprehensive WMSP for facility operations and land application activities including required
1.
component plans prepared, PE/QCP certified, and kept current?
2.
Any significant changes to the operation since the last QCP inspection or NOR submittal?
Construction of any new or updated structures occurred since the last inspection?
3.
Number of animals currently confined consistent with the WMSP?
4.
5.
All owner/operator controlled land application sites addressed in the WMSP?
Records maintained to document proper facility operation and good housekeeping BMPs?
6.
7.
Weekly inspections been performed and documented by the operator?
Animal waste given/sold to CAWVs or others? If yes, indicate the % in the Yes Column.
8.
Temporary waste storage at the facility or in the field meets applicable requirements?
9.
10. Detailed records maintained to document the transfer of animal waste to others?
11. Detailed records maintained to document proper land application?
12. Detailed predicted and actual precipitation records for land application activities?
13. Soil samples taken within the last 3-years for all land application sites?
14. Effective erosion and sediment control BMPs implemented and maintained where needed?
Any evidence of point source or nonpoint source discharges to groundwater or surface waters
15.
from the facility or land application sites?
16. Applicable structures and land application buffers/setbacks implemented and followed?
17. Records maintained documenting animal mortality management to ADAI requirements?
18. Proper operation/management of drystack, composter, freezer, incinerator, etc.?
19. Effective bio-security measures implemented to prevent disease and disease transmission?
20. Nuisance/vector prevention/minimization BMPs implemented to the extent practicable?
21. Odor prevention/minimization BMPs implemented to the extent practicable?
22. SPCC BMPs implemented with no evidence of any fuel/chemical spills or contaminated soils?
23. All contaminated stormwater contained or managed to prevent discharges of pollutants?
24. All liquid/dry structures/conveyances/equipment constructed and operated to NRCS TSGs?
25. Any evidence of irregularities/deficiencies with any dry or liquid waste structure(s)?
Any other deficiencies, irregularities, or potential concerns identified by this evaluation and/or
26.
available information not otherwise addressed by this form?
27. Comments Page attached?
The undersigned QCP has completed this evaluation and to the best of my knowledge, all information herein and attached is true and correct
Printed Name of QCP
Signature of QCP
Designation & Certification #
Date
of QCP
Printed Name of QCP
Signature of QCP
Designation & Certification #
Date
of QCP
The undersigned operator/owner has reviewed this form and to the best of my knowledge, all information herein and attached is true and correct
Printed Name of Owner/Operator
Signature of Owner/Operator
Date
ACES/AU Form R-5 1/15/06
Page 1
ACES AFO/CAFO QCP Annual Inspection/Evaluation Form
Submitted To ADEM By The Facility Operator/Owner Or Their Authorized Representative
REGISTRANT/OPERATOR NAME
FACILITY NAME
COUNTY
PRIM RY WASTE TYPE
A
Liquid
Dry
ADDRESS
CITY
PHONE NUMBER
STATE
ZIP CODE
REGISTRATION #
REGISTRATION EXPIRATION DATE
TOWNSHIP, RANGE, SECTION
GPS LATITUDE & LONGITUDE
PRIMARY ANIMAL TYPE
CURRENT # OF ANIMALS
INSPECTION DATE
INSPECTION TIME
EVALUATION COMPLETE DATE
If more than one QCP participates in the evaluation, the responding QCP should initial the response.
Yes
No
NI
N/A
Comprehensive WMSP for facility operations and land application activities including required
1.
component plans prepared, PE/QCP certified, and kept current?
2.
Any significant changes to the operation since the last QCP inspection or NOR submittal?
Construction of any new or updated structures occurred since the last inspection?
3.
Number of animals currently confined consistent with the WMSP?
4.
5.
All owner/operator controlled land application sites addressed in the WMSP?
Records maintained to document proper facility operation and good housekeeping BMPs?
6.
7.
Weekly inspections been performed and documented by the operator?
Animal waste given/sold to CAWVs or others? If yes, indicate the % in the Yes Column.
8.
Temporary waste storage at the facility or in the field meets applicable requirements?
9.
10. Detailed records maintained to document the transfer of animal waste to others?
11. Detailed records maintained to document proper land application?
12. Detailed predicted and actual precipitation records for land application activities?
13. Soil samples taken within the last 3-years for all land application sites?
14. Effective erosion and sediment control BMPs implemented and maintained where needed?
Any evidence of point source or nonpoint source discharges to groundwater or surface waters
15.
from the facility or land application sites?
16. Applicable structures and land application buffers/setbacks implemented and followed?
17. Records maintained documenting animal mortality management to ADAI requirements?
18. Proper operation/management of drystack, composter, freezer, incinerator, etc.?
19. Effective bio-security measures implemented to prevent disease and disease transmission?
20. Nuisance/vector prevention/minimization BMPs implemented to the extent practicable?
21. Odor prevention/minimization BMPs implemented to the extent practicable?
22. SPCC BMPs implemented with no evidence of any fuel/chemical spills or contaminated soils?
23. All contaminated stormwater contained or managed to prevent discharges of pollutants?
24. All liquid/dry structures/conveyances/equipment constructed and operated to NRCS TSGs?
25. Any evidence of irregularities/deficiencies with any dry or liquid waste structure(s)?
Any other deficiencies, irregularities, or potential concerns identified by this evaluation and/or
26.
available information not otherwise addressed by this form?
27. Comments Page attached?
The undersigned QCP has completed this evaluation and to the best of my knowledge, all information herein and attached is true and correct
Printed Name of QCP
Signature of QCP
Designation & Certification #
Date
of QCP
Printed Name of QCP
Signature of QCP
Designation & Certification #
Date
of QCP
The undersigned operator/owner has reviewed this form and to the best of my knowledge, all information herein and attached is true and correct
Printed Name of Owner/Operator
Signature of Owner/Operator
Date
ACES/AU Form R-5 1/15/06
Page 1
Comments Page
AFO/CAFO QCP Annual Inspection/Evaluation Form
REGISTRANT/OPERATOR NAME
FACILITY NAME
REGISTRATION #
DATE
Attach additional information as necessary. Detach and discard this page prior to submittal of form if not needed.
Provide explanations, observations, comments, and proposed schedule of actions to correct any identified deficiencies or
areas needing improvement (NI). The operator/owner should submit this report when completed and follow-up with
ADEM within 20 days regarding items that have been addressed and the status of any items needing further attention.
LIST NAMES OF OTHER PARTICIPANTS:
ACES/AU Form R-5 1/15/06
Page 2
Completion Considerations
AFO/CAFO QCP Annual Inspection/Evaluation Form
Detach and discard form Completion Considerations page(s) prior to submittal of form.
While submission of a detailed report prepared by a QCP based upon a comprehensive evaluation of the facility,
operations, records, land application, etc. is required by ADEM Admin. Code Ch. 335-6-7, use of this ACES form is
voluntary. Submission of this completed form will address ADEM’s regulatory requirements for submission of an annual
inspection by a QCP. However, the operator/owner is free to submit a comprehensive, detailed report prepared by a
QCP using a different format with equivalent content which addresses applicable ADEM regulatory requirements.
ACRONYMS
ACES-Alabama Cooperative Extension System ADAI-Alabama Department of Agriculture & Industries ADEM-Alabama
Department of Environmental Management AFO-Animal Feeding Operation BMP-Best Management Practices CAFO-
Concentrated Animal Feeding Operation CAWV-ADAI Certified Animal Waste Vendor NI-Needs Improvement NOR-
Notice of Registration NRCS-Natural Resources Conservation Service PE-Professional engineer registered in the State of
Alabama QCP-Qualified credentialed professional consistent with ADEM Admin. Code Ch. 335-6-7 TSGs- Technical
standards & guidelines WMSP-Waste Management System Plan
ITEMS THAT ADEM STAFF EVALUATES/CONSIDERS DURING INSPECTIONS & ENFORCEMENT
WMSP COMPONENTS
Potentially applicable WMSP component plans: ● Record keeping ● TSH- Manure/wastewater treatment, storage, &
handling ● EDRP- Emergency and natural disaster plan ● Animal mortality management ● Bio-security and disease
transmission prevention ● NMP-Nutrient management for all fields, including NRCS P-Index as applicable ● Composter,
freezer, incinerator operation ● SPCC-Spill prevention control & countermeasures for stored fuels and chemicals ● Feed
management ● Potable water management ● Irrigation system ● CBMPP-construction best management practices for land
disturbance activities ● Equipment maintenance? ● Other applicable component plans? ● NMP include phosphorous?
RECORD KEEPING
● Have detailed records been maintained to document that facility operation and any land application is consistent with
WMSP, and meets/exceeds NRCS TSGs and ADEM requirements? ● Is waste land applied on land owned or leased by the
owner or operator? ● Is animal waste given/sold/contracted to CAWVs or others? If CAWV, check ACES website to ensure
certification was valid when waste was transferred. ● Have detailed records been maintained to document the transfer of
animal waste to CAWVs and others for all waste not accounted for in the operator’s land application records? ● Have detailed
land application records been maintained, including NWS weather Forecast or Farmers Map, documenting compliance with
requirements for rates, timing, location, buffers, etc.? ● Have representative soil samples been taken within the last 3-years for
all land application fields/sites and the NMP updated as needed to reflect the results? ● Records maintained to document
proper construction/management of animal mortality equipment/structures/wastes?
FACILITY OPERATION & MANAGEMENT
● Detailed, complete records? ● Operator fully implemented/maintained effective BMPs that meet/exceed NRCS TSGs &
ADEM requirements? ● Vegetation established/managed on all slopes and erodeable areas at the facility and land application
fields? ● Are applicable production building, waste storage/treatment structure, well, surface water, occupied dwelling, and
other buffers implemented or waivers from affected landowners documented? ● BMPs to minimize odor generation to the
extent practicable been implemented for all waste storage/treatment/transport, production buildings, and other aspects of the
facility? ● Any evidence of spillage/leachate from drystack/composter? ● Carcasses fully covered? ● Incinerator operation? ●
Have BMPs to minimize fly production, rodents, and other nuisances or potential disease vectors to the extent practicable been
implemented/maintained for all waste storage/treatment/transport, buildings, and other aspects of the facility? ● All
contaminated stormwater diverted to a treatment/storage structure or managed to prevent discharges of pollutants? ● Onsite
wells being maintained to prevent contamination from facility operations and contaminated stormwater runoff?
NUTRIENT MANAGEMENT & LAND APPLICATION
● Detailed, complete records? ● QCP should briefly evaluate selected fields representative of land application practices. It is
not necessary to inspect all fields where wastes/wastewater has been applied. ● Vegetation or cover crop consistent with
WMSP and amount of waste/wastewater being applied? ● Temporary waste storage located to prevent runoff? ● All piles
covered? ● Are the crops/grasses grown on all land application sites consistent with WMSP and NRCS TSGs? ● Are buffers
and filter strips implemented/maintained at all land application sites? ● All wastes/wastewater permanently/temporarily stored,
transported, and managed according to NRCS TSGs? ● Tons per acre applied noted? ● Spreader calibration records? ● Any
evidence of spreading of incompletely composted mortality?
LIQUID WASTE MANAGEMENT
● Detailed, complete records? ● Have all liquid waste storage/treatment/conveyance structures been evaluated within the last
5-years by an Alabama registered PE? PE certification is required to be submitted by the Operator of all defined/designated
liquid waste CAFO operations. ● Liquid level markers/gauges located in structures? ● Liquid level records maintained? ●
Storm retention volume maintained to prevent discharges? ● Any visible irregularities or deficiencies with any storage,
treatment, conveyance structures (design freeboard, burrowing, trees, overgrown vegetation, eroded areas, wet spots, “green”
vegetation spots, embankment settling/slumping/erosion, etc.)? ● Any evidence of leakage of confinement structures/buildings
or storage/treatment structures? ● Any evidence of groundwater or surface water discharge, or other potential/noted problems,
irregularities, or deficiencies, considering structure siting, operation, and/or maintenance? ● Woody or unmanaged vegetation
on embankment prevents full access to entire structure? ● Liquid structure fenced with warning signs?
ACES/AU Form R-5 1/15/06
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