090060_INSPECTIONS_20171231

FaFi1i Nu
lype of visit: V.)-Compliance Inspection U operation meview U structure Evaluation U l ecnnical Assistance
Reason for Visit: 0-1foutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: plt,r [Arrival Time: i1 S Departure Time: County: 1cLdrK
Farm Name: 0 5 rti/'�cy� �u✓ Owner Email:
Owner Name: S h Cc 'r) A o,; 169 Q !,,rAA!q 4 LC� Phone:
Mailing Address:
Physical Address:
Facility Contact: Lg, i f t 3 d✓ t zi' Title:
Onsite Representative: t
Certified Operator: GaV.& , (YS 0l1
Back-up Operator:
Phone:
Integrator: M I-?-- S
Region: (--I zV
Certification Number: '7 9 / 70 9
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine_
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
[Layer
Dairy Cow
Wean to Feeder
R
Non -La er
I I
Dairy Calf
Feeder to Finish
"' '
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oult : -'
Ca aci
P,a ,
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Soars
Pullets
Beef Brood Cow
-
ti
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes �o ❑ NA ❑ NE
a. Was the conveyance than -made? ❑ Yes ❑ No []'NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [A ❑ 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) ❑ Yes ❑ No �A ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes E3 "" ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes I -<O ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

lFacilityNumber: - O Date of Inspection: .Tv
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
,—,�
©
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�
❑ 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
o
❑ 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
to
❑ 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
l❑'lglo
❑ 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
❑
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[D-N-o
[DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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 n
Window / ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): CS I'l -j J" s�- a
13. Soil Type(s): WQ
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? 0 Yes [D'/� 0 NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [� 0 ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[D-1qo'
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q-lgo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�io
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
QKo
❑ 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
t,dd o-
❑ 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
to
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
6-<o'
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: C( jDate of Inspection. /,3Sv44_1-
24. Did tke facility fail to calibrate waste application equipment as required by the permit? [] Yes [D'NO ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes 0-5—o ❑ 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 g3 < ❑ 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:
❑ Yes ®-ivo ❑ NA ❑ NE
❑ Yes ❑KO ❑ NA ❑ NE
❑ Yes !. to [DNA ONE
❑ Yes En'No . ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
[r,<
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
[gam
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes
r7Ko
❑ NA
❑ NE
ommetits (refer to ueshon y and/or any ad�honil recommendations or au ot>feer comments.
U` q #}: Explain an I'ES an d : .
C„
se drawmgs�of fgcili y to better exp ain s ahons { �t dittonal Pages as neces_sa}ry1). j�
5 -1 I J / -- (/`C� ,��/f 11 �� r — r C) - 3 r cC 1 ` —3 —
- 6 S
Reviewer/Inspector Name: I 1 Phonelll)-, 3 3!
c
Reviewer/Inspector Signature: Date: I S u
Page 3 of 3 21412015

kvk 3 11 m
�m Wes—oilt' F vis'ion of Water rces
Facility Ntimber ,®- (, �Jw_,toortl)vision of Sail and Water Conservation
ff
�`" *"fi ®Other Agency
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: QlEoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: r 4 Departure Tim :o� County: r�
Farm Name: S. c-r ° Owner Email:
Owner Name: �rGlcl9Utyu �� �af Phone•
Mailing Address:
Physical Address:
Facility Contact: i, S \30uA LA}ctA Title:
Onsite Representative: 1
Certified Operator: C_Czeyz�:-✓`c.s S"
Back-up Operator:
Phone:
Region: _(7___f z i
Integrator:
7 1
Certification Number: T/y/
Certification Number:
Location of Farm: Latitude: Longitude:
_ "s .T
Design C•urreut
Design
Current
Design Current
S..
ine
Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Z(�'�
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D , Poultry
Ca aci
PAo
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Pullets
ke
Tur11 s
Beef Feeder
Beef Brood Cow
Boars
Other
,,.
Turkey Poults
Other
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 ofthe State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [❑ NA [:]NE
❑ Yes ❑ No [3'lgA ❑ NE
❑ Yes ❑ No MINA ❑ NE
d. Does the discharge bypass the waste management system? (If yes. notify DWR) ❑ Yes ❑ No []INA ❑ 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 [I'No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: - U Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [a-N75— ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No CTR_A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑j1qo ❑ NA ❑ NE
large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes l t"O ❑ 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 IJ'gVU ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �o ❑ 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 [ o ❑ NA ❑ N1
maintenance or improvement?
Waste AuaGcation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below. ❑ Yes [3No ❑ 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):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ o ❑ 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 [lNo ❑ 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
[i]'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Cn!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 El 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 I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes OTINo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes YNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - (; Date of Inspection:
24. Did the iaFility fail to calibrate waste application equipment as required by the permit? ❑ Yes B-N- ❑ NA ❑ NE
25. Isthefacility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes D-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? 0 Yes [jy'f o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CTlqo— ❑ 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 []-No ❑ NA [] NE
❑ Yes [J-1'0 ❑ NA ❑ NE
❑ Yes []-i o ❑ NA ❑ NE
❑ Yes [f No ❑ NA ❑ NE
❑ Yes �0
❑ Yes Ejj-No
❑ Yes DNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility, to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: t I 1 �l Phone:y Yf 3 }—
Reviewer/Inspector Signature: r ti?llG Date: f 1 {
Page 3 of 3 2141201

F,
1510
(Type of Visit: 0 Corn 'ance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: URoutine O Complaint 0 Follow-up 0 Referral 0 Emereencv 0 Other _/0 Dcnied Access
Date of Visit: AArrival Time: Departure Time: a County: �_ Region: q�Al
Farm Name: CO&kA Owner Email:
Owner Name: 5UUAA "Jov Phone:
Mailing Address:
Physical Address:
Facility Contact: ` Title: Phone:
Onsite Representative: Integrator: 7't 4? `J
Certified Operator: S < 0 Certification Number: 5 t
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
*aParit-VINPop.
Cattle C*apacity Pop.
Wean to Finish
Layer
Da Cow
Wean to Feeder
a
Non —Layer
Da Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
P,oul
La ers
Ca aci
P,o .
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑~15-o— ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No E]�KA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [:]No E2,KA ❑ 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) ❑ Yes [] No dNA ❑ NE
2" is there evidence of a past discharge from any part of the operation? [:]Yes ❑�No ❑ NA ❑ NE
3" Were there any observabie adverse impacts or potential adverse impacts to the waters ❑ Yes 3 No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection: 'j 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes G- o�❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
- Designed Freeboard (in): ¢
Observed Freeboard (in): U
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 E3 5o ❑ 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 environmentaFteat, notify DWR
7. Do any of the structures need maintenance or improvement? CTYes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 5"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 [2 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes LA '"o ❑ 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): C'' 13 S (90
13. Soil Type(s): W
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2'1�o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [3 o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? [:]Yes ❑"Ro ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes dNo [DNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check ❑ Yes 7 No [DNA ❑ 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 ❑ 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?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

on
Facili Number: - Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[3""'11 o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
[3-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
[rt No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[JJ o
❑ NA ❑ NE
Other lssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[R*I�o
❑ 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
�10
❑ 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
[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
[2'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
�­No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
a/,No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Cat
4-a 7� t�- - 3, 1 P-31
7,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit: Q-C`ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01 routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 /Denied Access
Date of Visit: ttoLtj I IQ Arrival Time: OD Departure Time: J County: Region:( ?~
Farm Name: �-C9 Owner Email:
Owner Name: Ish t, �,ry G.f Phone:
Mailing Address:
Physical Address:
Facility Contact:a t^ f,� GC Title: Phone:
Onsite Representative: �l Integrator:
� r
Certified Operator: G'xr L('151001 Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pomp.
Layer
Design Current
Gattle Capacity Pop.
Daify Cow
Wean to Feeder Op
QQ
Non -La er
Dairy Calf
Dairy Heifer
jDry Cow
Non -Dairy
Feeder to Finish
Farrow to Wean
Farrow to Feeder
j' I!I
Design CuM n
D , P.oul Ca acity Po
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Outer
Other
Turke s
Turkey Poults
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)?
d. Does the 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 observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ NA ❑ NE
❑ Yes ❑ No � ❑ NE
❑ Yes ❑ No El "r' ❑ NE
❑ Yes ❑ No
❑ Yes ❑-No
[:]Yes EINo
E314A ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

lFacility Number: - Date of Inspection:
y�
Wastf, Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3.No--❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No [
❑ 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
[3-Nff- ❑ 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
E3-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
[g-Dda ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2-Nc, ❑ 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-6 ❑ NA
❑ NE
maintenance or improvement?
Waste Aoplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes
Q'Ro ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 ❑ 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): .S
13. Soil Type(s): LA-J'Vk —
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[J-N-o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1__I 9o-
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Lldl"o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q'15—o
❑ 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
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections El Sludge Survey
f
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment`?
❑ Yes
WNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

I
Facifi Number: - Date of Inspection: r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E�56­ ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes � ❑ 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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
EJ_Na- ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Ne— ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ss ❑ 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
[-N ❑ 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
[ 1' o ❑ 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
CTNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[]-Nu- ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[3'No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
c0 N/o ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature: I
Phone:
Date:
Page 3 of 3 121412014

r k&,9 ea to A . ,:
(Type of Visit: %])Tom ace Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: ORoutine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: ovl,A,-i A,,,, Owner Email:
Owner Name:
Mailing Address:
Physical Address:
d
Phone:
Facility Contact: II{.,,,4t S Re,—W L 1 _ Title: �/Phone:
Onsite Representative: C ( integrator: Vkff
Certified Operator: eZ�e op �r Certification Number: cc( (3
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
SwEne
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to WeanDesign
Farrow to Feeder
Farrow to Finish
Design C►urrent
Capacity Pop.
QJ .rI
Wet Poultry
Layer
lNon-Layer
D , P_oult ,
Layers
Design: .Current
Capaci x'Pop.
I
Current
..Ca aci . Popv
Design Current
Cattle Capacity Pop.
Dairy Cow
airy Calf
airy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
'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?
❑ Yes 044 ❑ NA ❑ NE
❑ Yes ❑ No � ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No []-19W ❑ 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 ONE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes Q'go ❑ 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 I of 3 21412011 Continued

Facility Number: - Date of Ins ection-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l 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
�lo
❑ 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
[E1 o
❑ 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
ESNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
t ram"'
❑ 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
❑ 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
t dam""
❑ 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):
14. Do the receiving crops differ from Yose designated in the CAWMP?
❑ Yes
0-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E]-N-6"
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑•hfo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Ergo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EJNo
❑ 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
❑ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑ Other-
2 1. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [Z?Z05
❑ 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 11lo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes �o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes C_I "`� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [D-N-0 ❑ 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 Fe l o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑-lQo ❑ 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:
❑ Yes IrQ <o ❑ NA ❑ WE
❑ Yes Q>h�— ❑ NA ❑ NE
❑ Yes [3'lqo— ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
Reviewer/inspector Name:
❑ Yes
No ❑ NA ❑ NE
[TN . [DNA ❑NE
LJ "' o ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
21412011

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:Arrival Time: 7; Departure Time: '3•p County: Region: ZED
Farm Name: Owner Email:
Owner Name: ���,r �a�.._� r ��/irt} G Phone:
Mailing Address:
Physical Address:
Facility Contact: rt�r`fi7� Title: 229/3, 5Phone:
Onsite Representative: �j � Integrator: 1"jv.1,'
Certified Operator: �j'� [ � }7��` Z r' % Certification Number: ©%QpG
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
WetPoultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
La er
DairyCow
DairyCalf
Wean to Feederf,1Sa
���
Nan -La er
Feeder to Finish
".' '"
DairyHeifer
Farrow to Wean
Design
Cnrrent
D Cow
Farrow to Feeder
Farrow to Finish
Dr.P,ou�
Ca aci
P,o
Non -Dairy
Beef Stocker
La ers
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars _.
Pullets
Turkeys
Other
Turkey Poults
Other
Other
Discharaes and Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[5�.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
® 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 I of 3 21412011 Continued

Facili Number: jDate of Inspection: -- j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes ELNo ❑ 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):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 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
® 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
to No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
f�j 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
❑Ycs
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
L&No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes S 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): I rmJa /'$
13. Soil Type(s): ' {&�
14. Do the receiving cro# s 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
® 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
[Z No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[XNo
❑ 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 [:]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 Dg 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 ONE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - e, 0 1 Date or Ins ecdon: — b — 43
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 KA No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 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 ®No- [DNA ❑ NE
❑ Yes R] No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes ® No
[-]Yes No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better exalain situations fuse additional naves as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date: /l- /-3. _
21412011
Page 3 of 3

type of Visit: JZYCornpliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: , A. County: Region: / 2Z -
Farm Name: %1Ld�S�r/" 3CGi rrYL. Owner Email:
Owner Name: rrD Y Vo 7;4,/ Phone:
Nailing Address:
Physical Address:
Facility Contact: {/p��L� 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
DairyCow
Wean to Feeder p
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
"
Farrow to Wean
Design
Current
D Cow
r
Farrow to Feeder
D , P,oultr
Layers
Non -Layers
Ca aci
P,o ,
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Finish
Gilts
`i
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and 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 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 I of 3 21412011 Continued

Facili Number: 2 - 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 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): - 19
Observed Freeboard (in): _.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
KI 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
[KNo
❑ 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
0 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
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [K 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): A -1j?1 *.4
13. Soil Type(s): 4!2 2 `
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 Q 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?
Reauired Records & Documents
❑ Yes Eallo ❑ NA ❑ NE
[::]Yes S No ❑ NA ❑ NE
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
® 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
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall []Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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 [0 No ❑ NA ❑ NE
Page 2 of 3 2/412011 Continued

I
Facili Number: 17 - Date of Inspection: : /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 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 MNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ELNo
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 (4 No ❑ NA ❑ NE
❑ Yes [5g No ❑ NA 0 NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes JZ No ❑ NA ❑ NE
[:]Yes No
❑ Yes No
❑ Yes A No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer #o question #): Explain any YES answers andlar aoy additional recommendations or any other comments.
Use ow
Idrawings of�fa-cili_ty to better explain situations (use additional pages as necessary,}.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:`�f3�'-33.
Date:
21412011

I ype of visit: k_�Fc.ompliance inspection u uperanon KeV1eW u atructure Lvaluation V I ecttmcal Assistance
Reason for Visit: (D outine Q Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: 14 1 Arrival Time: T( Departure Time: 'dd County:
Farm Name: �pfLQ fl >`j NU&RA,' C Owner Email:
Owner Name: 6114infiew, / Ra^r) K TA.Z.S LUC Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: ���(ZRQ_�.f�s-�a rr\ Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Region: Fla
Design Current
Design Current Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
11
Layer Dairy Cow
INon-Layer I airy Calf
Wean to Feeder
Feeder to Finish
airy Heifer
Farrow to Wean
iJesign Current Dry Cow
a
Farrow to Feeder
Dry Poultry--_ .. _Ca aei Pao Non -Dairy
�3
Farrow to Finish
I Layers I Beef Stocker
Gilts
Non -Layers Beef Feeder
Boars
Pullets I Beef Brood Cow
Turkeys
Other
Tur ey Poults
Other
Other
-
.3::.TkWSTtix':Ppitl.-
Discharges and Stream 1mDacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[INo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
E14A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[�iA
❑ NE
e. 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
&I/NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
O No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ff 'No
❑ NA
❑ NE
of the State other than from a dischar=e?
Page 1 of 3 21412011 Continued

Facility Number: jDate 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 L NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): j
Observed Freeboard (in): et
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ffNo ❑ 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 E 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 2 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes El"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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ 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): 1�{Lt�.3pA, 1-lA.(� G U
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[allo
❑ 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
[3'�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
[WNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
(S"No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[TNo
❑ 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 [gNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes [�o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes [:]No [11�A ❑ NE
Page 2 of 3 21412011 Continued

Q No
}
Facili Number: -66 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge'? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes L'
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)
❑ Yes C No ❑ NA ❑ NE
❑ Yes �No
❑ Yes [ No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

type of visit: %d-uompuance inspection U Operation Keview U structure Evacuation U i eenmcai Assistance
Reason for Visit: tine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ` Departure Time: County:_,/3
Region:
Farm Name: L._C� Owner Email:
Owner Name: W, do 1,,51%ok Phone:
Mailing Address:
Physical Address:
Pacility Contact: l_.wy.�5 d JG XILA.+�L�_ Title: Phone:
Onsite Representative: �-� Integrator: fL
Certified Operator: S �L� t Certification Number: � Q
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
- Design Current
Swine Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop..
Design Current
Cattle Capacity Pop.
Wean to Finish
?UU
Layer
Non -La er
D , P�o_ult .
La ers
Non -La ers
Pullets
Turkeys
Turke PouIts
Other
"- "``'`'"''' "-
Design` Current
Ca aciPop
DairyCow
DairyCalf
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
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 DWQ)
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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page I of 3
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
EE "" '
❑ NE
❑ Yes
❑ No
L`_7 "'t'
❑ NE
❑ Yes [] No 5?''f' ❑ NE
❑ Yes Bo ❑ NA ❑ NE
❑ Yes 2<0 [ NA ❑ NE
21412011 Continued

Facifl Number: - Date of Inspection:
Vaste Collection & Treatment �-
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ [ET'go No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ 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 O;Jl�o ❑ 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 i. o
❑ 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 Q1110
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes C3'5'o
❑ 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 �o"
❑ NA
❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [E o
❑ 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 ❑ Evi nce of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil T _
Ype(s)� �`L—�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [+D No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes o ❑ 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 �o ❑ NA E]-NE
❑ Yes 02 < ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[tKo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[Def"o
❑ 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
Ll,""
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ 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 To ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ No lA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of inspection:
�4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ®'No ❑ NAB ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No g3- A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes gi'No D NA D. 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
@'1C
❑ 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
2' oo
❑ 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
CJOfio
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q Xo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[5'5�
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments refer,to question . Explain ( q #r)•-any YES answers and/or. any additional recommendations or any other comments
Use drawings of f icility to'better explain situations (use additional pages as necessary)
Pi'ect-4U,
�� t� � •e�d�S �c� QcQo� t�� �� � � �'�--� a
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:1/47 - 333�I
Date: 4 AI I //
2,14120111

Type of Visit compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit 4Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: _ - y-/I Arrival Time: Departure Time: . 00 County: Region:
Farm Name: Owner Email:
117
Owner Name: f / k � ?, Phone:
Mailing Address:
Physical Address: /?
Facility Contact: Title: OZOI ":_ — Phone No:
Onsite Representative: S'w-t Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = c = d = Longitude: 0 ° = ' E_—] µ
Design Current Design Current
Design Current
Swine
Capaci#y Population Wet Poultry C►apacity Population
Cattle Capacity Population
❑ Wean to Finish
Layer
❑Dai Cow
can to Feeder
-v
❑ Non -Layer
❑Dai Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non
❑ Layers
-Dairy
El Farrow to Finish
El Beef Stocker
❑ Gilts
Non -Lavers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
[Z 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
(R No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
® No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — 60 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes A 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 ® 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 tg No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Z 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 ,gj No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes (KNo ❑ 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 types)�rl1�u��
13. Soil type(s) g
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes WNo ❑ 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 acre determination?❑ Yes
J,No
❑ NA
❑ NE
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
RNo
❑ NA
❑ NE
Reviewer/Inspector Name 1 11 11e�1 I... Phone: O 3.��3ad
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Lontlnued

Facility Number: QI Date of Inspection �7
1 Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [X 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 yu
No ElNA ElNE
❑ 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
[RNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[9No
❑ 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
Q No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[gNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Eg-No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ 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
allo
❑ 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
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
5�No
❑ NA
❑ NE
Additional Cowmen#s and/ar D�awui s '~ - Y
aa
b. '� .: w".`s:7 . ... '._.' -.Y'"'"'i ,'krs':'�M . -sIL - -
i
Page 3 of 3 12128104

. ... - �iivtsron of Water Qushty t�
Facility Number a .0 Dl,;isioo oiStorl and Rater Conservation
- Other Agtncy - - e�
Type of Visit Otompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit "oudne O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date ofVisit. 3- -% :#rri.'al'l'ime: 1)eparturcl'iroc: /i7r E) County: �`- Region: )zC9
Farm Name: Owner Email:
O%rner Name:y/tGLs eA /� ��Jrls: Phone:
Mailing Address:
Physical Address:
Facility Contact: 'I'ille: Phone No:
Onsite Representative- Integrator: ✓
Certified Operator:. = Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location cif Farm: Latitude: ❑o = 1 ❑11 Longitude: =o ❑ 1 = u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
�` (o 00 J LgZ ❑ Non -La er
Dry Poultry
Pullets
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 Heifei
❑Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: 57
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 5!�No ❑ NA ❑ NE
El Yes
El No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[:]No
❑ Yes
ANo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection /a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[2�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑Yes
❑ No
❑ NA
❑ NE
Stntclure I Stnicture 2 Stniclure 3 Structure 4
Struclur4
5
Structure 6
Identifier-.
Spillway?:
Designed Freeboard (in): _ �j 51
Observed Freeboard (in): .Lg
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P�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
2�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?
N Yes
❑ 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 I0 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) 2r-,e-t"
13. Soil type(s) 14?0 s
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes f $ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? �9 Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: [] Yes
54 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
JKI..NO
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
14 No
❑ NA
❑ NE
Comments (refer to question ft 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):
7
%C�LIi /" rr� Q /r�l l9�t ^ li4r.�T�
r�5 �cz f l DI -(/ Lido
1�rB�'ti_
qV
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: %d
12(28 (14 Contrnuea

I Facility Number: Date of Inspection c l
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CRNo ❑ 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 ❑ Desig
n ❑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 [&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
JONo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R1 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ 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
O 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 ReviewerlInspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
[I NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
]Z'28/04

B I Ns W 00T(oq
Type of visit T9 Compliance Inspection Q Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit 12rRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I t_U rrival Time: � Departure Time: 10. R County: 9 Region:
Farm Name: 1 N �S$ Owner Email:
Owner Name: Q-iGI i oh - _ i _ Phone:
Mailing Address: '
Physical Address:
Facility Contact: s Title: _Owntg- Phone No: 5` 7 (i
Onsite Representative: Integrator: M- Q _
Certified Operator: R&JQ(12h Operator Certification Number: @00-7 _
Back-up Operator:
Location of Farm -
Back -up Certification Number:
Latitude: [= c = 0« Longitude: 0 0= I 0 u
; ygr Design Currentr
Ca sei Po ula[ion
p
an to Finish
an to Feeder CYi
„ *- ' Design Current
We[ Puultr o-
y Capacity Population
' ❑ La er
❑ Non -La er
Design Current
•
Cattle Gapac�ity Population
❑Dai Cow
❑Dai Calf
der to Finish
airy Heifer
row to Wean
_A x.
Dry- Poultry-
❑ D Cow
ow to Feeder
_. .d . T_ .: a,., .
❑ Non -Dairy
ow to Finish
❑ Layers
❑ Non
❑ Beef Stocker
s
-La ers
❑Beef Feeder
❑Pullets
-, ❑ Turke s
❑Beef Brood Co
,Lrs
er
Turke Poults
El Other
Numherof Structures:
Discharges & Stream impacts
_ Is any discharge observed from any part of the operation?
❑ Yes
CkNo
❑ 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
®"No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
1KNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: QC[ — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ES No ❑ NA ❑ NE
a. 1 f 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): q
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Sr 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 VNo ❑ 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? t9Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [WNo ❑ 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 Wo ❑ 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?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or t0 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 types) (.uajta f Up"M-d 6L May,
13.
Soil type(s) WQLh -f?S'
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
W No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Rf No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
ERNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[KNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
5allo
❑ 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):
Reviewerlinspector Name fy Phone: 1 j23-3
Reviewer/inspector Signature: Date: p10Q
12/ 04 Continued

Facility Number: o Date of Inspection
Required Records & Documents
19. Did the facility fail to have 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 $aNo ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. f5j Yes ❑ No ❑ NA ❑ NE
❑ Waste Application J�j Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Wo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
CZNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JRNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
V No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[RNo
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
EkNA
❑ NE
Other Issues
29.
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
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
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1 .
Did the facility fail to notify the regional office of emergency situations as required by
ElYes
An
UJ 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
� No
[I NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
e- woak a-) bares sflb on I Qq� NO 1 L , 10 -off fsof; Sled 44!9 o�
✓ )n1I -riles ha.e M00 ,gam( c°'�-'
rn 1 c� � �
py,3, cu+s mat I+eej 4 habei back -Frog, asidin e16?oco
I
. Pjje6, e Cj),W L, soil S tlIVIe whey �� cal bad -�. l i e nee�lta
al , Unab to `+o 10 Ca4e, I a9Qa1 I -eve I reciyd r - too Do g,
i�ay�eld i� �� shad ,
Page 3 of 3 12128104

ChCVA(mo sc,
Facility No. ©Farm Name Ar Date
Permit COC iC NPDES (Rainbreaker PLAT Annual Cert }
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard jipj
Sludge Survey Date
Sludge Depth ft & %
Liquid Trt. Zone (ft)
-Calibration Date
Design Flow
Design
-�'i�--�---
Actual Width
Soil Test Date OAA va y
pH Fields
Lime Needed
Lime Applied
Cu Zn
Needs P
Crop Yield
Wettable Acres ✓
WUP
Weekly Freeboard ✓
Rainfall >1" _sue
1 in Inspections
120 min Inspections
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Waste Analysis Date
M=Wgir_
RMI
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
1006
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 3--�q-Oq Date last WUP at farm
daw Farm Records
Lagoon #°
Top Dike
qqy
Q5'3
Stop Pump
Start Pump
App. Hardware

'.F71"-Pd13i1Vl 013108 bye
Type of Visit (2cCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit RRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q� Arrival (Time: ® Departure Time: r� County: Region: FA_
Farm Name: D J� 'a Owner Email:
{�
Owner Name: 1 acJdnh s 1 `Phone::1
Mailing Address: �U BQ )c yy� h
_ C 1L:1 tom. NC,
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Rdn& sin Integrator: Hwpht Fa ! Iy FQ.&�S
Certified Operator: 61doieh SMLLb Operator Certification Number: AWA aoo*
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = A = it Longitude: = ° = I = "
Design Current
Design Current
Design
Current
Swine Capacity Population
Wet Poultry Capacity Population
�-
Cattle
Capacity
Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
® Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
DrY Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Non -Layers
❑ Beef Stocker
❑
❑ Gilts
Beef Feeder
,,
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
Uiurkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Wo ❑ 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)? 1.
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 19No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes CYNo ❑ NA ❑ NE
other than from a discharge?
Page 1 of 3 12128104 Continued

t
Facility Number —00(00
Date of Inspection ISl� J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑Yes ❑No El NA ❑NE
El Yes El No El NA El NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes t@ 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 W 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?
CR Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ER No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
[:]Yes
R No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
V No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes tWNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ FAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window D Evidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) (2a& 1IIQ I �'Ai u(� GC l7TLr� 1 1 SG
13. Soil type(s) 0 1 1 f a
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
J�a No
❑ NA
❑ NE
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
2INo
❑ NA
❑ NE
Reviewer/Inspector Name Phone: ` 1Q C33.'i3
Reviewer/Inspector Signature: Date:
Paee 2 of 3 U 12128104 Continued

ti
Facility Number: Oq p Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes R[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 approprrate box. ❑ WUP ❑ Checklists ❑ Design El Maps El 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
g] No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
O NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ERNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
&J No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
EZNA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ 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
[5No
❑ 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
❑ 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
1D 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
®No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
©No
❑ NA
❑ NE
Addil
k�cr� aee� 1 1 a .
w11I ma, 4t Wtq slt djesWver + & ,G e, VyardMe b7 st? )
rrin)'s pF r4w f,7
�Uo0
Fa V�llt'1��a�3o�
Page 3 of 3 12128104

Facility No. Qq Qo&p Time In Q Time Out Date
Farm Name U/ka Bro, rA K/Leiirry Owner
Owner BIMS Address & Phone Cell Phone
Site Rep Integrator Operator No.
Backup No. BIMS OIC No.
COC Circle: General or NPDES (Rainbreaker PLAT
Annual Cert )
Pop. Type Design Current Pop. Type Design Current Pop. Type Design Current
Freeboard V
1
2
3
4
5
6
7
Design
BIMS
Observed in
Sludge Survey Date Perm Li . ft
. - .. r
■ . I
------�
a o�lmrotb V�►i 115a►c� �7Slvdi� l��r^— SUrn �n
Soil Testa Crop Yields ✓ 120 min Inspections
PH Fields Lagoon Rain Gauge Transfer Sheets IVl�4
Lime Needed Weekly Freeboard �— �ay1FB Drop
Cu ✓ Zn ✓ Rainfall >1"
Wettable Acres 1 in Inspections _ So
WUP y.l(r AC Or �1
M'��
m.,�,.�-If,1��r'.
.1 r.
Pull/Field
Soil
Crop
Pan
Window
NWAVA
3 ,50
(h-Aa
1,
��
Comments
C,,.} +7In, 51og

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agencv
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine O Complaint Q Follow up Q Referral O Emergency O Other ❑ Denied Access
J
Date of Visit: 'I Arrival Time: OB',3o Q Departure Time: County: Ala en Region: dclw
Farm Name: LOYIn 13r-ax ck Owner Email:
Owner Namc• Qn wti.! Phone:
Mailing Address:
Physical Address:
Facility Contact: + Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
m
Phone No:
Integrator: +� �+/
Operator Certification Number: _ oS W fib__
Back-up Certification Number:
Location of Farm: Latitude: a o =] ' 0 Longitude: 00 = ' = «
Design Current
Swine Capacity : Population
❑ Wean to Finish
Wean to Feeder
El Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
Non-L
Pullets
Other
Discharges & Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: [I Structure ❑ Application Field El Other
a. Was the conveyance man-made?
Design . Currents
Cattle Capacity Populati n
ElDai Cow
El Dairy Calf
El Dairy Heifer
El Dry Cow
ElNon-Dairy
El Beef Stocker
El Beef Feeder
❑fC
Be
ef BroodCo
Number of Structures:* ��
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 PO No ❑ NA ❑ NE
❑Yes
❑No
XNA
ONE
❑ Yes
❑ No
YINA
' ❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
nNo
❑ NA
❑ NE
12128104 Continued

r
Facility Number: — 6'D
Date of Inspection r /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Vpo
❑ NA [INE
a. If yes, is waste level into the structural freeboard?
❑Yes
❑No
_RNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 i "
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
KINo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage. etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
'Z] 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?
Myes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ yes
CgNo
❑ 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
;KNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
09 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 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)
a — 1
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5LNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
1� No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?E]
Yes
V9 No
❑ NA
❑ NE
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
�] 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):
1 • G�6rk or) 5ii&a(( f10*4- p.r�5 on to
yoon .
Reviewer/Inspector Name Phone a).77..�GiIT!
Reviewer/Inspector Signature: Date:

Facility Number: — jJ Date of Inspection 4
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 P.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 �ONo ❑ 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 Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
qNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E-No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
09 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
S No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
17LNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
El 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
❑ 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
T 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
qNo
❑ NA
❑ NE
12128104

A
Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 6Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other El Denied Access
Date of Visit: ® Arrival Time: I Ct: Q� Departure Time: ,9r 0 1 County: Region:r--
Farm Name: % �qqs�� �3rat r! r—k Far,vi-, Owner Email:
Owner Name: a " Otte Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: Ovid a 7
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ 3 EJ N Longitude: = e 0 t = "
Design Gurgent
Design Current
Design Current
Swine
Capacity Population
Wet Poultry Capacity Popul
❑ Wean to Finish
El Dairy
❑ La er
Wean to Feeder to 1,2 � ,� ❑Non -La er
DischaDischarges & Stream Imp
1.
Cow
Beef Brood Co
El Dairy Calf
[I Dairy Heifer
❑ D Cow
[I Non -Doi
❑ Beef Stocker
El Beef Feeder
Is any discharge observed from any part of the operation'? ❑ Yes � No El NA El NE
Discharge originated at: El Structure ❑Application Field El Other
a. Was the conveyance man-made? ❑Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El Yes ❑ No El 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) El Yes El No El NA El NE
2. Is there evidence of a past discharge from any part of the operation? El Yes 0No El NA El NE
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes (9No ❑ NA ❑ NE
other than from a discharge?
Page 1 of 3 I2/28/04 Continued
DischaDischarges & Stream Imp
1.
Cow
Beef Brood Co
El Dairy Calf
[I Dairy Heifer
❑ D Cow
[I Non -Doi
❑ Beef Stocker
El Beef Feeder
Is any discharge observed from any part of the operation'? ❑ Yes � No El NA El NE
Discharge originated at: El Structure ❑Application Field El Other
a. Was the conveyance man-made? ❑Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El Yes ❑ No El 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) El Yes El No El NA El NE
2. Is there evidence of a past discharge from any part of the operation? El Yes 0No El NA El NE
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes (9No ❑ NA ❑ NE
other than from a discharge?
Page 1 of 3 I2/28/04 Continued

Facility Number: — D Date of Inspection 6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ER No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
91 No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in): , (o
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[Z No
Cl 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
® 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
B 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
0 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) a / B V e r"4
13.
Soil type(s) 66L ©r:
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
fO No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? RYes
No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
14 No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
A No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
[KNo ❑ 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):
Lv J r k, r�- igy`' /j�rrn � Ja i r
a
�`? �" S L�/ar E f �— may— ct C'%ta mil' r ► TS
Reviewer/inspector Name Tz'k/ Phone: /p-- 3 33[)t7
Reviewer/Inspector Signature: Date: /,;'— 7 — h L
Page 2 of"3 12128104 continued

Facility Number: 0 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [Ij No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 79 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. ❑ Yes J& No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EK No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes fK No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
aYes
❑ No
❑ 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
t@ No
❑ 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
V9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EgNo
❑ 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
09 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
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EgNo
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

I
Type of Visit compliance Inspection O Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �/- D r_rrival Time: / `p0 Departure Time: �. (7 County: � Region:
Farm Name: L/7, Ira H C- u��T . Owner Email: r q !
Owner Name: 9Q�rI(- L ), _- 51'YI �� Phone: ���� �7/ /a / •' [� �r�
Mailing Address: t', 4 � �"" � �i �.�, t��� t 1-a J4
Phvsical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =o .=, 0" Longitude: 0° =, E-1 u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
Player
a S`pp ❑ Non -La et
Dry Poultry
Layers_ _ —
Non -Layers
Pullets
Turkeys
Turkey Puults
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 Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
—11
Number of Structures: Ut
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? (1 f 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 [A No ❑ NA ❑ NE
❑ Yes
2jNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Ycs
9 No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
it No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Q Date of Inspection O — 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 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway'?:
Designed Freeboard (in):
Observed Freeboard (in): 3
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 [9No ❑ NA ❑ NE
❑ Yes IR No ❑ NA ❑ NE
Structure 5 Structure 6
❑Yes ®No [I NA [I NE
❑ Yes 10 No ❑ 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? 9 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures 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 D4 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes (XI 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 Drill [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s) LV or 1)
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 M No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18_ Is there a lack of properly operating waste application equipment?
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
b4tF r a rx a ern- Tis-op Is ba CX o�-
Reviewer/inspector Namea :w _ Phone:3
Reviewer/inspector Signature: Date: p_ 19 — O
12/28/04 Continued

F
1
Facility Number: — Q Date of Inspection / li" / D S
ReQuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 19 Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropiiate 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 KWeeklyFreeboard ❑ 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
® No
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
OYes
El No
�NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
"Yes
21 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PfNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;K No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[X 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
IQ 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
14 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
M No
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
El Yes
, No
❑ NA
❑ NE
Y►dditionalComentszandlorfDrawiags
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12128104

jType of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
IReason for Visit • Routine O Complaint O Follow up Q Emergency Notification O Other Cl Denied Access
Facility Number cy
Date of Visit: / I ' - o Time: : d0
•- — •.-..-�0 NNot erational O Below Threshold
[3 Permitted © Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: ..n3ns ..w.e/Gs �t�1
-_ - . _ County: _
Owner Name: _ .______6r1O/ , - .sihl f%i/ 'Phone No:
Mailing Address: _ f. -1 A16-
Facility Contact R a/ SM. /� Title: Phone No:
Onsite Representative: Integrator. /i�✓t1011
Certified Operator: Operator Certification Number:If
�l107G
Location of Farm:
04vWne 0 Poultry 0 Cattle ❑ Horse Latitude • Du Longitude •
Dm arges & Streams inu arts
1. Is any discharge observed from any part of the operation? ❑ Yes 9No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made? ❑ Yes M-No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: _-_ 1. _ _-- -_ _. _. -
Freeboard (inches): 301 el
12112103 Continued
❑ Yes
[3No
❑ Yes
E No
❑ Yes
E No
❑ Yes
BNO
❑ Yes [ -No
Structure 6

Facility Number: Cf. — (,,fl I Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes EJ-lGo
seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑yes L3�Qo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/unprovement? ❑ Yes 2Vo
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes O-No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 2No
elevation markings?
Waste AtmEcation
10. Are there any buffers that need maintenancefunprovement? ❑ Yes 096
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes BNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
3 Sa
12. Crop t)w Q,or.A'. 1.
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
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
B'Fio
16. Is there a lack of adequate waste application equipment?
❑ Yes
O-NO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or 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
BNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
L 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
E'No
Air Quality representative immediately.
Use drams of'�iy to abetter s�.m f she � �� � 'rk � Meld Co ❑ Final Notes ��
Reviewerihmpector Name
ReviewerAnspector Signature: _ Date: /- H -
17./1l/UJ C.Onuriuea

Facility Number: C7 -- p 1 Date of Inspection - -d
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes DING
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WCiP, chc�, , . etc.) ❑ Yes Q-Nof
23. Does record keeping need improvement? if yes, check the appropriate box below_ ❑ Yes Cg�No
❑ fasee->'rppliee�ioa ❑ Sk is ❑�So
S� f 1.3
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 0,Na—
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
28_ Does facility require a follow-up visit by same agency?
29. Were any additional probleL_: noted which cause noncompliance of the Certified AVAM P?
NMES Permitted Fac ities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32_ Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ W
❑ Yes
❑ Yes E;[M
❑ Yes G4ft
❑ Yes Q. Ko
❑ Yes ONO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35_ Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112M3

�[3 Division of Soil and Water Conservation [3 Other Agency
k
m r
�
�� Division of Water Quality
�*^
„�,�, s[�t..,: ,o*>
O Routine O Complaint O Follow-up' of DWO inspection O Follow-up of DS%VC review O Other
Date of Inspection
Facility Number O 4 ,
Time of Inspection !dam 24 hr. (hh:mm)
© Registered IN Certified [3 Applied for Permit' © Permitted 113 Not O erational Date Last Operated:
r ,
Farm Name: ........ �!�Cl........11.. �` f oanty:....... .lt1 ................................................
z.
Ortner Name:....... ............... ... !"`................................................ Phone No: ......
.�I....................................................................
Facility Contact: ...... 4""`�r� . �.. `d�'YS....... Title:......... ----- Phone No: ...................................................
Mailing Address:.......,1...�Q•....Q Yi?� �1�"� I /UG ...R/�. ................... . ................... ..........................
....... ... ........
Onsite Representative: ..... o•✓ •�.aESSIJ.�rs Integrator:--. /..................
.......................•----.. / .......
Certified Operator. ------ le _z/1 Z..........,!;µtT.......................................... Operator Certification Number:....�
............ ....................
Location of Farm:
Latitude 0•.0' 0" . Longitude
General
1. Are there any buffers that need maintenance improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State -other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes XNo
❑ Yes )KNo
❑ Yes WNo
❑ Yes P(No
❑ Yes XNo
❑ Yes 9No
❑ Yes A No
❑ Yes al'No
❑ Yes M No
❑ Yes JO No
Continued on back

Facility N umber: O
S. Are there lagoons or storage ponds on site which need to be properly clotted? 0 Yes No
Structures (Lagnott.01olding Ponds,. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes �No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure (,
Identifier: /
Freeboard(ft):.............. ��...'4..:.r....................................................................................................................................................I....................
10- Is seepage observed from any of the structures? t� Yes NN,
o
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes 10 No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers'?
Waste .application
14. Is there physical evidence of over application?
(If in excess off WIMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...b, f. ,r%� � ,+t¢(N............................................................................ ............................
16, Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AW.MP?
25. Were any additional problems noted which cause noncompliance of the Permit'?
❑ No violations or deficiencies were noted -during this.visit. You.will receive no further
correspondence about this visit
X Yes ❑ No
❑ Yes
No
❑ Yes
No ;
9.Yes
❑ No
❑ Yes
1KNo
Yes ❑ No
❑ Yes )II -No
0 Yes KNo
❑ Yes 19NO
�( Yes ❑ No
❑ Yes RNo
❑ Yes J4 No
❑ Yes gNo
Comments (refer t6.question #): Explain any ,7r ES atiswers and/or any recommeri&66"S or any ether comtuen#s x } ��
U5 urawmgs of facility to better ex'plain' situations (use additional pages as necess3rv)
!G. �'y� �.�is.�/r-•� � C�/.r�.s,••��H�J/ r� � s.�c�a��1r�'j4��,��.
- /ZC A~-w--/O c7,�_
Ae
7/2 /97
Reviewer/Inspector Name
Reviewer/Impector Signature: Date: .
I/— l a Ze_ ra 0 �/ _� �r�/�s,�` is a%.�✓ i.� isrG�. ri /.�J tom' .c�iffl�'