090032_INSPECTIONS_20171231

4
Type of Visit: D-Compliane spection V Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: outine CO Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
...
Date of Visit: Arrival Time: Departure Time: / f'DD I County: u "s Region:
Farm Name: Owner Email:
Owner Name: .L / Phone:
Mailing Address:
Physical Address:
Facility Contact: }�% /v(1j`]" r�� Title: ®(Q n Y'/~ Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Garrent;
Design Curre
Design Current
Swine Capacity '„ Pop.
Wet'.Ponitry Capacity Pop.
Cattle
Capacity Pop.
Wean to Finish
Layer
iry Cow
i
Non -Layer
Dairy Calf
Wean to Feeder
Feeder to Finish"I'�I
Dai Heifer
Farrow to Wean
D . P.oul Ca ac" 1'p
Dry Cow
Farrow to Feeder
Non-Dai
Farrow to Finish
Layers
Beef Stocker
i!
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
$'z
Turkey Poults
Other
I 10ther
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
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)
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?
❑ Yes [&No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
J�LNo
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

[Facility Number: - Date of inspection:
7- /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
R5-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
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 DWR
7. Do any of the structures need maintenance or improvement?
E] Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ 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
❑ Yes
IZ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E[No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)= �x�/7�a_ �tJv✓. S'Crr� --- -- -
13_ Soil Type(s): �0 Z) VA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes f2j-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes LH-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[jj_No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[::]Yes
[Z-No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
a No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA [] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes C2�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EA -No ❑ NA ❑ NE
Page 2 of 3 21417015 Continued

Facility Number: jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes f.No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
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 SNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [A No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ 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?
❑ NA ❑ NE
❑NA []NE
❑ NA D NE
❑ NA ❑ NE
❑ Yes 10-No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes [-No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refe'r� to gaeshon #), Esp�lain anyl answers and/or any addrtaonak: ommeudatious or'any other�coinments.
r
vtt
1Used1raWiB2Soft8Ci1i16'to:betteir eipfain situations (use additional pages as necessary*):
(2) CCt-,nLe-r
Reviewer/Inspector Name:
Phone. a
Reviewer/Inspector Signature: Date: pP
Page 3 of 3 21412015

W
r
Type of Visit: O'Compl' ce Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 4 Arrival Time: ; j'o Departure Time: Q r z County: Region! / `o
Farm Name:/l''Ilgl Owner Email:
Owner Name: 4L I-r n, j J E -11,15 Phone:
Mailing Address:
Physical Address:
Facility Contact: ��n y i©� i Title: Phone:
Onsite Representative: �' �� Integrator:
Certified Operator: ! Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
_ Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Daig Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
qqM
Dairy Heifer
=
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,oultr, y::"Ca acit
P,n
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
=>_
Discharges and Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
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)
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?
❑ Yes D�j No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
J�j No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection: —3 —
Waste Collection & Treatment
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
U�J-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3;;)- -
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
[S-No
❑ NA
❑ NE
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 DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
RNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
�2_No
❑ NA
❑ 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
❑ Yes
2-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
t 1. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ,fid No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of /�_Jvuj
ind Drift ❑ Application Outside of Approved Area
12, Crop Types) �nd`�rW'—��r✓� ,� 1�
13. Soil Type(s): 41,4-
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes D4-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Jallo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes gNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Q_No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F12 No
❑ NA
❑ NE
Require_ d Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
G] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
(a No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Cade
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Wo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: 41 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
d
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EA 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 [j4 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes 0 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes "71 No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
c9-vC1'5rn_/ 21�5 /va
77
Phone: —Q�
Date: J 3
21412015

N 0V -,2-vfL -7 C--D17-5-
M
i ype OI V [sit: U l.ompllance inspection lJ Vr
Reason for Visit: IE)r outine 0 Complaint 0
!w lV :ltruclure Evaluation V iecunicat Assistance
0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � Arrival Time: Departure Time: a County:
Farm Name: yj�/,,, �p rt ,S ��•'�+1 Owner Email:
Owner Name:""^""" 7A"J NL1lt'.5� Phone:
Mailing Address:
Physical Address:
Facility Contact: 14,llr. Mp rr�s Title: O-Ul►i Phone:
Onsite Representative: 1-11'a --.cl Integrator: It i ,5
Certified Operator: J'.j__ Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Region:
Design Current
Design Current
Design Current
Swine
Capacity Pop.
Wet Poultry Capacity Pop. Cate
Capacity Pap.
Wean to Finish
Layer DairyCow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
jf17
Da' Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D . P.otil Ca aci P,o
Non -Dairy
rl,-,
La era
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other'
Turkey Poults.
Other
J j
Other
Discharges and Stream Imoacts
1. is any discharge observed from any part of the operation? ❑ Yes EL No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
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)
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?
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
fa No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
Page 1 of 3 21412014 Continued

Facili Number: - Date of Inspection: L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
f
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes [RNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [—]Yes E2.No
[DNA
❑ NE
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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [g No
❑ NA
❑ 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 [:]Yes W o
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [gYes ❑ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift ❑ Application Outside of Approved Area
/❑
12. Crop TYpe(s){7i�
13. Soil T e s 22 ar v
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes IX No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2 No ❑ NA ❑ NE
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
❑ Yes 2] No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Ea No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
[Q No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E;� No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [&No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: 2 - 3 2= 1 jDate of Inspection. 3— lv
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E�]_No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [E�_No
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 to provide documentation of an actively certified operator in charge? ❑ Yes (3 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes i�No
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 file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 54 No ❑ NA ❑ NE
❑ Yes Ea No ❑ NA ❑ NE
❑ Yes No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:
21417014

Type of Visit: PICompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time:
Departure Time: �
County:. Region:�
Farm Name: _ A
lk .ti j J U fr .�l^��t ri►'�
_ Owner Email:
Owner Name:
j`1 orris
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: 19CVh r r Phone:
Onsite Representative: f.t� Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cat#Ee Capacity Pop.
Wean to Finish Layer Da' Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
a
IDairy Heifer
Farrow to Wean
D . P.oul Ca aci P,o
La ers
jDry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other
Pullets
Beef Brood Cow
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
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)
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?
❑ Yes EgNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes [:]No
❑ Yes [a No
❑ Yes [2FNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3
21412014 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes MNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in): 3 %
S. Are there any immediate threats to the integrity of any of the structures observed? [] Yes J, No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes ELNo ❑ NA ❑ NE
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 DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
J'No
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit?
[:]Yes
`No
❑ NA
❑ 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
❑ Yes
E] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
g] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
r] Yes
EA No
[DNA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s): �Z67e �__ - `
13. Soil Type(s): � L[/!f
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
S
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
,E Yes
Oro
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
(0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
L&No
❑ NA
❑ NE
the appropriate box.
❑WUP [—]Checklists [3 Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes N No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes � No ❑ NA ❑ NE
Page 2 of 21412014 Continued

Facility Number: 3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes No
f
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
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 to provide documentation of an actively certified operator in charge? ❑ Yes RjNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [&No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ 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?
I.Cominents (refer to. que
for any,.
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes CgNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes CoNo ❑ NA ❑ NE
❑ Yes No
❑ Yes No
[—]Yes allo
4
7—le
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
Phone:f/)--1f3��
Date:
21412014

DENR--FR(
NCDENR
North Carolina Department of Environment and Natural Resources
Pat McCrory
Governor
August 1, 2014
Allen Norris
Allen Norris Farm
92 Baldwin Branch Church Rd
Elizabethtown, NC 28337-5348
Al16 0 4 2PA
IW
Subject: Additional Information Request
Application No. AWS090032
Allen Norris Farm
Bladen County
Dear Allen Norris:
John E. Skvarla, III
Secretary
The Animal Feeding Operation Branch of the Division of Water Resources (Division) has completed a
preliminary review of your renewal permit application package. Additional information is required
before we may continue our review. Please address and submit the following item(s) within 30 (thirty)
days of receipt of this letter:
Missing Conies of Field Maps:
Our record show that the copies of the field maps are missing in your WUP or N]VIP.
Please reference the subject application number when providing the requested information. All revised
and/or additional documentation shall be signed, dated and sent to my attention at the address below.
Information can also be submitted electronicalty at [e-mail].
Please feel free to contact me at [phone] if you have any questions regarding this letter,
Sincerely,
Christine B. Lawson
Animal Feeding Operations Branch
cc: Fayetteville Regional Office, Water Quality Regional Operations Section
WQROS Unit Central Files - AWS090032
Murphy -Brown, LLC
1636 Mail Service Center. Raleigh, North Carolina 27699-1636
Phone: [phone]Internet: http)/www.ncdenr.gov/
An Equal Opportunity 1 AfTrtnative Action Employer - Made in part by recycled paper

r type of visit: L- -Compliance inspection U uperateon xeview V Ntructure Evaluation U 'l ethnical Assistance
(Reason for Visit: 04foutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: p; Departure Time: O County:
Farm Name: �—�,, j`]prr�3 Owner Email:
Owner Name: 1�,��_ jJplr/"rt Phone:
Mailing Address:
Physical Address:
Facility Contact: /I-'r �l r f 15 Title: Phone:
Onsite Representative: :S0R____e
Certified Operator: -!5* u--<—
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
DesiInc.urren#•
Ca aPv
P P
WetPoul#ry
Capacity
Pop
Cattle Capacity PopSwine
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
�.:
D Cow
Farrow to Feeder
D . P■nul
Ga acity
P,a
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
Turkeys
Other
Turkey Pouets
}
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Ej�[ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
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)
[:]Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
R!�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
(Z No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: jDate of Inspection: —/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ZLNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ca No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [ c&No
❑ NA
❑ NE
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? ❑ Yes MNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0 No
❑ NA
❑ 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 ❑ Yes Z. No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance a]ternatives that need ❑ Yes [&No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes L&No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
`
12, Crop TYpe(s)=
13. Soil Type(s): T-) f -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [a No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[a No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
La -No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard MWaste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking[] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - 3 Date of inspection: (p —
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 to provide documentation of an actively certified operator in charge? ❑ Yes W No [DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes (8 No ❑ NA ❑ NE
Otherlssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes FZ;1 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
Ln 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
[Z-No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[&No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[5d No
❑ NA
❑ NE
Comments (refer to question ff p y y . y rgments t *
r Explain an YES (s�ers_and/or apages
n gadditional:re�ommendations or an other co
Use drawings of'faciLty`to'better ex lain_situatioas use additional a es as necessary).
G*f'r
..fh ICY-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: _�fp az3 _a o
Date:
21412011

L
Type of Visit: ompliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: L Arrival Time:�Ov Departure Time: ; p County: Region: lr—�/90
Farm Name-d"'e' o rr-i'-n� /5/'ept Owner Email:
Owner Name: r �n rr i2 Phone:
Mailing Address:
Physical Address:
Facility Contact: z /� 11 J frL _ Title: 6� (,Gr/1 c4Phone:
Onsite Representative: -5,0-1-e—
Integrator:OF
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Design Current
Capacity Pop.
Wet Poultry ''
De ign 'Current
Ca' pacty
,_9
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
�( Feeder to Finish
Farrow to Wean
D , P.oul
Design
CaPat i
CurrentDry
P,o
Dairy Heifer
Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Gilts
Boars
Outer
Other
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [�kNo ❑ NA ❑ NE
❑ Yes
[—]No
❑ NA
❑ NE
❑Yes
[:]No
❑NA
❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [:]No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
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.)
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes Cg No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 2] No
❑ NA
❑ NE
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? ❑ Yes [N No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 2] No
❑ NA
❑ 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 ❑ Yes Eg No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes 2] No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
/
12. Crop Type(s):
13. Soil Type(s): J—> 1A A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes UjNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes QNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes ' No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement'? If yes, check the appropriate box below. D Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZI No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[DNA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: t 3
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 to 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
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ 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?
❑ Yes 60 No ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®. No ❑ NA ❑ NE
[:]Yes ® No
❑ Yes 0 No
❑ Yes [Z No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or an eomments.�: ��
r� -na
luseArawings of facility to: better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
d_
Phone: /�G,��`�30�
Date: _
V412011

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: : /O
Departure Time: /p ; 1 p County: �ee
FarmName:
zl lk-,—
Jy o p c S Fa i'►71-
_ Owner Email:
Owner Name:
All Gin
big
Phone:
Mailing Address:
Physical Address:
Facility Contact: Al i r-yt r 4 X W6 5 Title: O} n e r Phone:
Onsite Representative: S'�,,�, Integrator:
Certified Operator: A,'a., �! Certification Numb r:
Back-up Operator:
Location of Farm -
Latitude:
Certification Number:
Longitude:
Region:
Design C+urrent
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
"
= =
-
Design Current
Dry Poul#rFv Ca achy Pla ,
DairyHeifer
W
Farrow to Wean
D Cow
Non -Dairy
w 1.
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
r Boars
Pullets
Beef Brood Cow
O#her
Turkeys
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes R+ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes El No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes EK No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili r Number: - 3 Date of Inspection:
Waste Collection & Treatment
' 4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): J 17
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes g No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes g No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-5 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
T Do any of the structures need maintenance or improvement?
.Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 0 No
❑ NA
❑ 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
❑ Yes allo '
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes CgNo
DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes PQNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window/ ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): S2Cy1""�/Licit e
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? D Yes IQ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes M No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Ug No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes [a No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KNo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [)jZNa
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo
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 CE No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZjNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ 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?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ZLNo ❑ NA ❑ NE
❑ Yes % No ❑ NA ❑ NE
[:]Yes EjqSio ❑ NA ❑ NE
[:]Yes [A -No ❑ NA ❑ NE
[—]Yes [&No
❑ Yes FA -No
❑ Yes R�No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question k): Explain an} -YES answer-Andlor any additional recommendations�or:any other comments ;
Use drawings of facility to better explain situations (use additional pages as necessary) �'
tjaf4-k--i Q" Lt w b work_ da, 1, i2k3 &-,gad
Reviewer/Inspector Name: Phone: 9%33Oa
Reviewer/inspector Signature: Date:
Page 3 of 3 21412011

Type of Visit EMompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit +d-rtoutine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: : 3 t7 Departure Time: I ZZ,_TC> I County: `'~` Region: r /�
Farm Name: _r_¢1%�+ JV p��' S F-"-n^— Owner Email:
Owner Name: AloLI Phone:
Mailing Address:
Physical Address:
Facility Contact: _ ,ff 1JL`,t )DLr' is_ Title: _ Lun Y _ _ Phone No:
Onsite Representative: ram' e�+-t Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= n = 6 = H Longitude: = ° = f = u
Design Current
Design Current
Design Current
Swtne Capacity Population
Wet Poultry Capacity Population
,.�
Cattle Capacity Population
❑ Wean to Finish
IQ Layer
I
I
Dairy Cow
❑ Wean to Feeder
I�E]
ILI Non -Layer
I
I
Dairy Calf
® Feeder to Finish I'd
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
.
Farrow to Feeder
❑ Non-Dai
❑ Farrow to Finish
❑ Layers
Non -La ersEl
❑ Beef Stocker
❑ $eef Feeder
Gilts
EBoars
Pullets
❑ Beef Brood Co
-
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures: 1
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Oyes
tlNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
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)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
R No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
El
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — �j Date of Inspection
F
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Q
Observed Freeboard (in): .3 i
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[NNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
J& No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? R-Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
® No ❑ NA ❑ 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 9Yes
❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes
[KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [--]Yes
[-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �Ssr/�iaos->tis �/�U�i y.����'Q r f-.--
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
53-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ES No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ER No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Reviewer/Inspector Name r S7— , ; Phone: 9/- ad
Reviewer/inspector Signature: Date:
Page 2 of 3 ll/15/U4 tanuuuea

Facility Number: Date of Inspection L U
Re uired Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 91 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes rV' No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
RNo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
&No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B& No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[R No
❑ NA
❑ NE
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?
❑ Yes
Rq No
❑ NA
❑ NE
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
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
MNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J.No
❑ NA
❑ NE
Additional Comments and/or Drawings:,,.. [7
T4
Page 3 of 3 12128104

Division of Water.+
FFacifio`-umber >.O,D �oaorSoilsiii
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
�utlne 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date otVislt: �0 Arrival l-ime: Departure Time: '• Q Cottnty: Region: F Ci
Farin Name: Al%ff''- )"J0 V- `s FaAfl Owner Entail:
Owner Name: 2!E �Q /` rI 5 _ Phone:
Mailing Address:
Plivsical Address:
Facility Contact: 9//e--X N o 4f -5 'Fide: n e / Phone No:
Onsite Representative: li�s �` integrator: 11
111
Certified Operator: a*-+—'--- Operator Certification Number:
Back-up Operator:
Location cif Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Back -tip Certification Number:
Latitude: ❑o =1 u Longitude: = ° = 1 = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
} ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
DairY Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: I / I
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?
❑ Yes JgNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
& No
❑ NA
❑ NE
❑ Yes
fallo
❑ NA
❑ NE
12128104 Continued

P,F
Facility Number: or—
Date of Inspection D
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
Identifier:
Stmeture 2 Structure 3 Structure .}
Spillway?:
Designed Freeboard (in): % g
Obsmcd Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure G
❑ Yes � No ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ 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?
,.Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
XNo
❑ NA ❑ 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
❑ Yes
,ZNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
2.No
❑ NA ❑ NE
❑ Excessive Ponding [:]Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of
Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
&No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
['No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Z No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
5�-No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
ewer/Inspector Name Phone:ewer/Inspector Signature: Date: /— ly° 1232/a
ERev
1Z12WU4 connnuea

PF
Facility Number: — Date of Inspection OltJ
' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J9No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
U No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
,allo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[SNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®No
❑ NA
❑ NE
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?
❑ Yes
Q No
❑ NA
❑ NE
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
❑ Yes
El No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
a No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
4 No
❑ NA
❑ NE
AdditionalEGommeris�sadlDrawmgs - °:
12128104

4"ivision of Water Quality
=Facilitymber {- O Division of Soil and Water Conservation
Q Other Agency
Type of Visit 0- ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: n��7q Arrival Time: Departure Time: County:
Farm Name: [��rl'J �ar _ --_ Owner Email:
Owner Name: �1 l�Yy! N�/Y'`/S Phone:
Mailing Address:
Physical Address: /
Facility Contact: �/le"t &) a Title:
Onsite Representative: `5.0k-,�e
Certified Operator: -fia -ta
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity .Population
❑ Wean to Finish
❑ Wean to Feeder
Weeder to Finish �rD
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other.
❑ Other
Phone No•
Integrator,K/'•
Operator Certi ication Number:
Back-up Certification Number:
Region:
Latitude: 0 0 = 4 = Longitude: = o = =
Design Current
WO Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a, Was the conveyance man-made?
Design 'Current.
Cattle Capacity Population_;
❑ Dairy Cow
❑ pgg Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Dumber of Structures: �D
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?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
U� No
❑ NA
❑ NE
❑ Yes
0�_No
❑ NA
❑ NE
12128104 Continued

Facility Number: —- Date of Inspection
c
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes � No [I NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes &[No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ,&Yes Woat❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes K No ❑ NA ❑ 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 ❑ Yes [N No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes MNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) L4 ;+
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[&No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑.No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18_
Is there a lack of properly operating waste application equipment?
❑ Yes
kNo
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name` [y- Phone: 33 ='O
Reviewer/Inspector Signature: Date:
72/2811)4 Continued

k Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [&No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®,No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2SNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P9No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CgNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Z No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment {PLAT} certification?
❑ Yes
B No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
t0 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
[K No
❑ NA
❑ NE
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?
❑ Yes
12 No
❑ NA
❑ NE
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
❑ Yes
JA No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
IR No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
allo
❑ NA
❑ NE
Additional Comments and/or Drawings:
r
H
12128104

Type of Visit tU-Compliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: w 1 Departure Time: t-1tI� County: Nac *' Region:
Farm Name: Q� ; Far v"­ Owner Email:
Owner Name: Ll 4) V f (A S Phone:
;Nailing Address:
Physical Address:
Facility Contact: '/e--D✓ Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: - Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = O = , = f1 Longitude: = ° 0 i =
td
Design Earrent
Design Current
Design
Current
C•pacit} Population
'Vet Poultry Capacity Population
Cattle Capacity
Populati
Finish
❑ La er
❑ Dai Cow
Feeder
rE
❑ Non -La er
❑ Dai CalfGa
o Finish
❑ Dai Heifer
o Wean
DPl
❑ Dry Cow
o Feeder
❑ Non-Daio
Finish
❑ Layers
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood CodTurke
El s
Qther
❑ Other
❑ Turkey Poults
I JE1 Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 0,No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[,XNo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
12128104 Continued

.*z
f
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E7 ,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): r —/
Observed Freeboard (in): 9`
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
t[ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
R[No ❑ NA ❑ 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
❑ Yes
KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[$ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Croptype(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[&No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[\ No
❑ NA
❑ NE
17. Does the facility tack adequate acreage for land application?
❑ Yes
[p No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[9No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or an} other comnnents =
' *ft •M - -
Use drawings of facility to better explain situations. (use additional pages as necessary) Fo? 7/; 'Z& R�� Fi
a.
y
Reviewer/inspector Name —� ��d� f"- Phone: 5j0— .—
Reviewer/Inspector Signature: - Date: -- /
rage z of .3 1 aia61o4 i uneerruru

r
I~ acility Number: — 3 Date of Inspection �/ a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®.No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 5Q Yes ❑ No ❑ NA ❑ NE
E!�Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Up No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
qNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[S No
❑ NA
❑ NE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
U, No
❑ NA
❑ NE
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?
❑ Yes
U No
❑ NA
❑ NE
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
❑ Yes
[&No
, ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[A No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C No
❑ NA
❑ NE
Additional Comments andlor
AL
Page 3 of 3 12128104

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: � a Departure Time: 3V I County: La Region: /�_Ar 0
%% G �
Farm Name: !-/Z _,���; 5 ! Yi��rlik l Owner Email:
Owner Name: �;�/ /U n ri/�S' Phone:
Mailing Address:
Physical Address: /
Facility Contact:,/mil %�Dli�_S_ Title:
Onsite Representative: S'Integrator:
Certified Operator: !Lgn= L _
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = O = ` ❑" Longitude: =1 ° = f = "
Design
Current Design Current
Design Current
Swine _ Capacity
Population Wet Poultry Capacity Population
Cattle �_� i
Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La et
iry Calf
Feeder to Finish t'�
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ D Cow
El
Farrow to Feeder
❑❑
Farrow to Finish ❑ Layers
❑ Beef Stocker
�•: ❑ Non-Layers
a; ❑ Gilts❑
Beef Feeder
❑Boars ❑Pullets
❑ Beef Brood Co
❑ Turke s
Other ❑ Turkey Poults
s
E
"Number of Structure
Qther Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
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)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
UQ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
JZ No
❑ NA
❑ NE
other than from a discharge'?
12128104
Continued

1
Facility Number: — Date of Inspection 1 T:—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
JZ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
4 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No ❑ NA ❑ 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
❑ Yes
10 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
No ❑ NA Cl NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) (Trg�
13. Soil type(s) Vt1 ..
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
I& No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
C,No
❑ NA
❑ NE
Cariiments (refer fo question : Explain any YES an veers andlar any recommendations or any other comments ,.x, " ,
Use drawings. of_facility.to better explain situations. (pse.additiodai pages as nec'essary): �''
Reviewer/Inspector Name �! d--� _ Phone:
47—J.33 --33 0
Reviewer/Inspector Signature: Date: /�,_�
Page 2 of 3 12128104 Continued

Facility Number: T— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes fqNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [KNo ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists [I Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. &es ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Cade
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ®No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®.No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
&No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
IqNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
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?
❑ Yes
93 No
❑ NA
❑ NE
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
❑ Yes
[4No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
HNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
K No
❑ NA
❑ NE
Additional Commentsand/or: Drawings:.
Page 3 of 3 12128104

IType of Visit ,&'Compllance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit &Ko" tine Q Complaint Q Follow up Q Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: t7 Departure Time: fl ; / County: Region:
Farm Name: _Z kt D S Owner Email:
Owner Name: 74 ,k) D ! 1 S Phone:: / f
Mailing Address: , "�!� !,;�
Physical Address:
Facility Contact: ZULk t !v o r r .S Title: Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator: "'7111 V/
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0= u Longitude: Q o== u
Design C►urrent Design
C•uerent
Design Current
Swine Capacity Population Wet Poultry Capacity
Population Cattle
Capacity Population
❑ Wean to Finish
a e
❑Dai Cow
Wean to Feeder
-Layer I
LIEEI:Nonr
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑DryCow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Beef Feeder
❑ Gilts Non -Layers
❑ Boars ❑ Pullets
El Beef Brood Co
- ❑ Turkeys
Other ❑ Turkey Poults
Number of Structures:
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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?
❑ Yes gNo ❑ NA ❑ NE
❑ Yes
(q No
El NA
El NE
❑ Yes
(gNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: - 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [SNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [.No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes � No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed andlor managed ❑ Yes X[No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes EX No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ NA ❑ 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
❑ Yes
� No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window [:)Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s)-
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JKNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
gro
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LQ No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J4 No
❑ NA ❑ NE
Comments (refer to question #):. Explain any YES answers and/or any recommendations or. any other cominebts-7 r
Use drawings of facility -to better explain situations. (use additional pages'as necessary):`
ReviewerlInspector Name # — Y✓� �._. Phone:/j�-13 `�3�3�
2l
Reviewer/Inspector Signature: Date: 2 ;zYL -Ja 6-
Page 2 of 3 12128104 Continued

Facility Number: 9— Date of Inspection
` Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes WNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RfNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design [:1Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. r�•Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soi] Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit 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
General Permit? (iel 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?
❑ Yes
0No
❑ NA
❑ NE
El Yes
WNo
El NA
El NE
❑ Yes
g No
❑ NA
❑ NE
❑ Yes
CgNo
❑ NA
❑ NE
❑ Yes
JKNo
❑ NA
❑ NE
❑ Yes
PU No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [ZNo ❑ NA ❑ NE
❑ Yes [ANo ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
[RNo
❑ NA
❑ NE
Additional Comments aad/or Drawings ;'
N e w 4Ac ; 7�- ff na.Qys;s
-r
Page 3 of 3 12128104

(Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit f Routine O Complaint O Follow up O Emergency NoWiication O Other ❑ Denied Access
Facility Number Z iitate or Visit: n Z D Tune: B = 3v
.,. O Not Operational C Below Threshold
F, Permitted JIM Cerr,Med © Con
ditionally Certified 13 Registered Date Last Operated orAbove Threshold:
i
Farm Name: ------�.t +, o rS ! wl County: �[ 112
Owner Name: 854p Lam _. I "Phone No: _._... �%D - L'YE Yd YZ
!Marling Address: ..__22- €sui A ---Br CkU rt� Rj. j?.� �L 2833
FacHih Contact: _ _ —Title: . .
Onsite Representative: /`C+LI-a...� fU Arr- S
Certified Operator.
Location of Farm:
Phone No:
Integratoir: M u n�— C" i..f�
Operator Certification Number. ^ (D 3
%swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • �' �" Longitude •
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes &No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes &No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ,[No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Wo
Struc e l Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:.
Freeboard (inches):
12112103 Cowed

Facility Number: — g Date of Inspection yf a
5.- Are there any immediate threats to the integrity of any of the structures observed? (e/ trees, severe erosion, ❑ Yes B,No
seepage, etc.)
6. Are there strictures on -site which are not properly addressed and/or managed through a waste management or 0Yes Wo
closure plan?
(If any of questions " was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7_ Do any of the structures need maintenancelimprovement? ❑ Yes ff No
8. Does any part of the waste management system other than waste structures require maintenancerunprovernent? ❑ Yes ER No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 19 No
elevation markings?
Waste Arjuliration
10. Are there any buffers that need maintenancefrmprovement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes R No
b) Does the facility need a wettable acre determination? ❑ Yes ZNo
c) This facility is pended for a wettable acre determination? ❑ Yes 5ZNo
15. Does the receiving crop need improvement? ❑ Yes P No
16. Is there a lack of adequate waste application equipment? ❑ Yes 19 No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Wo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes $2 No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? if yes, contact a regional ❑ Yes 0 No
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
P6w, r,t6, 'fie se,( �{'� � �r:�a'�r-i a,r. Pvw�� `�a wt i V% wt i Le �.2
t,U[# he_ Frex.sure i s 0-K.
/'c.:♦ wU-s �! a*_s�.� �' lre.d
/�`�
GhJre5. /�lr. Ndt`r'is S+r.`o a�'� t/ vse rer_ye_� ws+�Fe, -1 wa-5i, do ,
t7,e aa-e a.. Plea -se P rkP � -r.
-rt - 1e3 otlr^ - Please cvv,_s aerr u e k ,
o-46+ poss i f Ie_ of
ReviewerAkspector Name r-
Reviewer/inspector Signature:
Date:
12/12/03 /_ ConAnued

Facility Number; — 32 Date of Inspection y O
Reouired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes j4No
22. Does the facility fail to have all components of the Cerdfied Animal Waste Management Plan readily available?
(ie! WUP, checklists, design, maps, etc.) .❑ Yes Jallo
23. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes 14 No
❑ Waste Applicatiok'❑ Freeboar* ❑ Waste Analy*et Soil Sampline'
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes Z No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 5(No
27. Did Reviewer/Inspe= fail to discuss reviewimspection with on -site representative? ❑ Yes M No
2$_ Does facility require a follow-up visit by same agency? ❑ Yes QNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes RNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ERYes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes JRNo
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes RNo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes H No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. HYes ❑ No
❑ Stocking For Crop Yield Form ❑ Rainfir ❑ Inspection After 1" Rii6
❑ 120 Minute InspecUoAt"NAnnual Certification Form
113 No violations or deficiencies were noted daring this visit. You will remove no farther correspondence about this visit
z3. a., see -a for-►A5' prose.
grrvv- l - lb PAN 4-o
35.
t�.re�tl
e, -#'fie. `r ri I wk e,�,+ I
I,7 lb PAtJ ccr-bF ; .._I J m
L'.�1'k ay - S A +e- r e_ c_c S a-e.G" ; ,t
40 tf f. bti- - S t prrf 5 c' S
12112103

Type of Visit *Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3/ Arrival Time: Departure Time: County: Region:
Farm Name: 1_440 —_.N e r r 1-1 Fa r V%_ Owner Email:
Owner Name:1t_c.1, $j r.-16 Phone:
Mailing Address: of r3 �.1.4wti M a C .aS3�7
ra.CG '
Physical Address: �� _ �� �.7-_ __ �-- ►-� �o_ _ C
Facility Contact: Title: Phone No:
Onsite Representative: n i iG, Aj o >~t 3 Integrator: MCA_ r n 1 u rQ r o" ,y
Certified Operator: or ► 5_ _ Operator Certification Number: _ / 303
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= o =1 Longitude: = ° =1 = u
Design Current Design . Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish o
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts i
❑ Boars i
Other
❑ Other _
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: V Structure ❑ Application Field ❑ Other
a. Was the convevance man-made'?
Cattle
Design Current'
Capacity Population
I;
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: 0_1
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?
I
Yes ❑ No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
L a //o
10 Yes
❑ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
® Yes
❑ No
❑ NA
❑ NE
12128104 Continued

t
y

t
I{acility Number: 9 — 3r2 Date of Inspection 3 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ONE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
® No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? P Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ 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 ❑ Yes]
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers. setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No
❑ NA NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 tbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
® NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
P NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
❑ No
❑ NA
® NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
ill NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
g] NE
I- J 1I" O L -s ea Ic�jo v-mot d� �`y o,a � ai l a 11 R+ j l e. a l<4 , K ar,, , a -
(cam
/ 1.6T Q[ cicel c a W G:,+G 6 r-G 1 vk f b tJ i�S C. -Ak- r c a+ v G µ+ Gv[+�
7- Repart Aoct5r__! 1. 4w' p) {��. Npr.rs �a� S�+cur w�llCd a -A
to 10 e crk c la� o� 10us
Reviewer/inspector Name a r .a %` t k "�' Phone:
Reviewer/InspectorSignature: Date:
12/28/04 Continued

�f
Facility Number: Date of Inspection l�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [2$No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 9 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V. Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
[E NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
® NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
® NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
m NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
[4 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
R1 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
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?
❑ Yes
[�] No
❑ NA
[__1 NE
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
❑ Yes
Fg] No
❑ NA
[:1 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
rt] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
❑ NA
❑ NE
Q—".e A '>'-Z .'
12128104
I