090065_INSPECTIONS_20171231

Facility Number p Date of Inspection
Time of Inspection ' aV 124 hr. (hh:mm)
Permitted 0 Certified [] Conditionally Certified 17 Registered C1 Not O erational Date Last Operated:
Farm Name: 1 lei+/.✓. ,lf� � .---- County:....... ��'v
ZK-
Owner Namc:.......... -,............. Z '4!'V ............... ......................... Phone No: •�. 0)...
Facility Contact: ........ 151.�.....-L/! ............ Title:......
Mailing Address: ...r��0
Onsite Representative ....... +/. 0�/ !
Certified Operator: ...........
jPA!��.1.
r..........................................
Location of Farm:
................................. Phone No:............_...................-.
.... A/C. ... ,a8f�/.............. .1........................
.... Integrator:... �RQ�
Operator Certification Number:,,,,, f,.,_....,-.,
Latitude 0 �` Longitude
Design Current Design Current = Design Cut rent
S�i+ine
Ga achy Population Poult . p = Capacit ' Populat,on =" jy Ca acit Po ulation Cattle
Wean to Feeder 2GOPS Z6] Layer ❑Dairy
❑ Feeder to Finish ❑Non -Layer ❑ Non -Dairy
Farrow to Wean
>-: ❑ Farrow to Feeder ❑Other _
_ ❑ Farrow to Finish Total Design Capacity
❑ Gilts,
... : ❑ Boars _ = Total "
Nttimber of Lagoons••.-. �- ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Freld Area
_Holding Ponds Solid Traps �.` ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes bi?�o
Discharge originated at: [:]Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes OKNo
h. If discharge is observed, did it reach Water of the State? (If ycs, notify DWQ) ❑ Yes 1;�No
c. If discharge is observed. what is the estimated flow in gathnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 19 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes O.No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 'gNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �(No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: h
Freeboard(inches): .....................................................................................................................
5- Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes %No
seepage, etc.)
3/23/99 Continued on back

F"
Facility Number: Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
XYes ❑ No
(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/improvement?
❑ Yes XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes f$CNo
� `
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
No
❑ Yes Pr
Waste application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ) j No
11. Is there evidence of over application? ❑ Excessive Ppnding ❑ PAN
❑ Yes JrNo
12. Crop type mil 4%zfixliv __
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 KNo
c) This facility is pended for a wettable acre determination?
❑ Yes No
15. Does the receiving crop need improvement?
aYes No
16. Is there a lack of adequate waste application equipment?
❑ Yes XNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes KNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes XNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) OfXAXYes
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes XNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes X No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
066is-or defciencies were noted• 00r;tng tbis:visit:• You WHI- •eeeiye tn© futth& ;
corres onuence. about. this ''sit. . .
se drawmzs of facility #o::better explarn situainens (use.addihonal pages as necessary) �;;�e-
- -
p,�!/ ,4�1R'•�p,✓,�/,E.�d�k?,rJ .y,��-� U' 1p�� �d[/F � .�C /�-�•�,C_
❑ Yes �rNo
o
❑ Yes
❑ Yes No
❑ Yes No
AL
4s cx d �r�/ � 5 �F � / rlo4.1
col c�
!l.
lNr�trZ•.'�� /� /'�Cl��� � w
Reviewer/Inspector Name
Reviewerlinspector Signature: ,..(� � Date: 6/_� /.P'— YY
3/23/99

.,
Facility Number: If, — 11�S— Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
KYes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes A No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
NO
`
roads, building structure, and/or public property)
(
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
KNo
30_
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
PQNo
31 _
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
JIo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Yes
❑ No
tion omments an o7.
r iravt�n - g -
�-
r
3/23/99

C'
' 14
Division of Soil and Water Conservation ❑ Other Agency
19 Division of Water Quality
10 Routine O Complaint O Fallow-uti of t)WO inspection O Follow-up of DSWC review O Other 1
Facility Number O
© Registered © Certified [3 Applied for Permit [3 Permitted
Date of Inspection I�—�
Time of Inspection L 24 hr. (hh:mm)
Not O erational ,?Date Last Operated:
FarmName:..... , e�!r✓............................................. County: ........ .U../.fF.................................................
OwnerName:.......-5......v�✓......................................................... Phone No: ...................................
Facility Contact: ....... -.......... r✓,ilre,�. Title: Phone No:
=de.z I�CMailing Address:...... ..!;; x.Q f........Z............ ..........................
Onsite Representative: ... !.�!� Integrator ... .... ... ?..t .........5......................
Certified Operator:....... �f!�1 ..!.... �e ... p .. O orator Certification Number: ................................... ....
Location of Farm:
Latitude Longitude 0• L_______Ic �"
°"Design; Current;
;' Design
;Current ;Design Current
Swine . � Capacity�Poptilateon
Poultry
Ca"pac�ty `Population Cattle, y r Capacityift la on,—,,
< Wean to Feeder
Layer
❑Dairy
.iffy i'
>. [I Feeder to Finish
❑Non -Layer
;. ❑Nan -Dairy
❑ Farrow to Wean
..� Farrow to Feeder
_ ❑ Other
❑ Farrow to Finish
4�r
Total Design W-11
2„ ❑ Gilts
z ❑Boars
Total SA",
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 --aUmin?
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 Lime of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes IQ No
❑ Yes N No
❑ Yes No
{
❑ Yes ,KNo
❑ Yes 4No
❑ Yes ,RNo
❑ Yes ballo
❑ Yes ANo
❑ Yes No
❑ Yes No
Continued on back

Facility \umber: 0? —
8. Are there lagoons or storage ponds on site which need to be properly closed'? ❑ Yeti PNo
Structures (La goons Iloldin fonds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure I Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier.
r........_ f./..
0 /
Freeboard tft): 3/ z-S................................................ .........
M Is seepage observed from any of the structures'? ❑ Yes N0
11, Is erosion, or any ether threats to the integrity of any of the structures observed'? ❑ Yes / 1 No
12. Do any of the structures need maintenance/improvement? PfYes ❑ No
(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?
❑ Yes
XNo
Waste .lnalication
14.
Is there physical evidence of over application'? _
❑ Yes
KC;o
(if in excess of WMP, or runoff entering waters of the State. notify DWQ) _
15.
Crop type ,i Q -. -#.....-
'
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
JgNo
17.
Does the facility have a lack of adequate acreage for land application?
I
❑ Yes
❑ No
18.
Does the receiving crop need improvement?
❑ Yes
❑ No
19. Is there a lack of available waste application equipment? ❑ Yes. OkNo
20. Does facility require a follow-up visit by saute agency? ❑ Yes N0
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes IBIINo
22. Does record keeping need improvement? ❑ Yes KNo
For Certified or Permitted Facilities Only _
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes KNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes] No
25. Were any additional problems noted which cause noncompliance of the Permit'? ❑ Yes No
No.violations or deficiencies were noted during this. visit. .You will receive no further
correspondence about this.visit:
Cotrtnments (refer to question #t): Explain any YES answers and/or any recommendations orany other catnmeietsf';
Use`diawings of facilitv:to better explain situations: (t se additional pag, es as necessary
rA,�� ,
7/25/97

10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number EH== J 6�/Z*92 1 i
Time of Inspection I //:- gOl::> 124 hr. (hb:mm)
Total Time (in fraction of hours
11 Registered 0 Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
Farm Status- El Certified [J Permitted or Inspection (includes travel and processing)
0 Not Operational Date Last Operated:
Farm Name: county:
Land Owner Name: Phone No:-.&
Facility Conctact: Tide: _,,;PPd2 A_&T.Y�_de_ Phone No:
Mailing Address:
Onsite Representative: ..... 1�?iefzy
Integrator:
Certified Operator: _-Deng Operator Certification Number: __A_2LF=_
Location of Farm:
Latitude 1 61 6 Longitude 4
Type of Operation and Design Capacity
On
Swineugn u
t -i Q u
n' g!! P�Qr
r iiiialciii;PoDUI A -P U
%ult
"AS 20'acl '4� o -yo a aW4� lation'�.y
❑ Wean to Feeder -ZAe:,V �,Z, 10 Layer El Dairy
0 Feeder to Finish Non -La M �'qQNon-Da
iryj I
0 Farrow to Wean
MEE",
Farrow to Feeder
N
.A0 Farrow to Finish 5 T 011Re_�"
SSL
at
#0 Other
10 Subsurface Drains Present
4TO Spray Field Area
General
L Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at, 0 Lagoon El Spray field 0 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 gaVinin?
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
4/30/97 maintenancelimprovement?
• Yes WNo
• Yes PNo
0 Yes No
El Yes �o
U Yes XNo
El yes �No
[I Yes 'KNo
El Yes No
Continued Continued on back

' Fadflity Number: .... V.2.. —.... ....._
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
�(No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
0 No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
WO
Structures (La dons, and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
XNo
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
10. Is seepage observed from any of the structures?
❑ Yes
�No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12. Do any of the structures need maintenance m rovement?
Yes
❑ No
(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?
❑ Yes
KNo
_Waste Application
14. Is there physical evidence of over application?
❑ Yes
)PO
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type _ ... ..__-----..... -- .... -...... ..... ...... ......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
qNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
J No
18.
Does the receiving crop need improvement?
❑ Yes No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
To
Eff.
Certified Facilities, 0111y
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
24.
Does record keeping need improvement?
❑ Yes
❑ No
Cohimenii(refer to quest; 6 #) EXplatnjanyYES. answers and/or any Tecommendahotis'or any other comments: ;
Userdrawings of facility to better explain situahons:T{use additional pages as necessary)
yam.
f� was<v
Reviewer/Inspector Names5:��w�:�..`,
k�iA-��'
� :d '%''�
'�� .3yr�h 2��3�-
Reviewer/Inspector Signature:
�Y��
Date: 7
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention: N 0
Facility No. 0 9 - & S
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITAT10N RECORD
DATE: A4 u s'4- il_ , 1995
Time: i0 : 0 7
Farm Name/Owner: 13u M AJ /flu Ksc r .51c ve 811N Al
Mailing Addmss: lRt, Z Sox 3*z WC z8'337
County: ,Slade N
-Integrator: MuW{y 4 Phone: 1191/0> 2611 ~ Z!+
On Site Representative: Dctrre! 1 C-iolc_Phone: l,710 g6 2- - 'K& 5&
Physical AddresVIocation: 30oL ul a. L 'y j Rd e5'Zg57Og -- - .
Type of Operation: Swine 1/ Poultry Cattle
Design Capacity: z , pQo Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: ,
Circle Yes or No
Does the Animal Waste Lagoon hav sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) or No Actual Freeboard: Z Ft. Inches
Was any seepage observed from the Ia oon(s)l Yes o<D Was any erosion observed? Yes or(D
Is adequate land available for spray? =or No Is the cover crop adequate? (Y&or No
Crop(s) being utilized: ,8c,-AV EA_ dI,
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s? Y or No
100 Feet from Wells. (or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(p
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or(so
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or4§:) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? (Y No
Additional Comments:
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Type of Visit a Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit N Routine O Complaint O Follow up O Emergency !Notification O Other ❑ Denied Access
Date of Visit: o� Time:
Facility Number
O Not rational O Bellow Threshold
#Permitted [3 Certified E3 Conditionally Certified E3 Registered Date Last Operated orAboye Threshold:
Farm Name: .......-- P�v---•-----•------ -------•--•------
BUA A-... � .� � r5.�Count ....................................... y: -•--•- �l
Owner Name:.--= elL`-__._ -- �'� K11:.------- ---- Phone No: ----g- --I -y7------------------
//1� z
Mailing Address: X le..- gcr_X..... a7 I'V C
Facility Contact: ........... ...................... Title: ............................................... Phone No: ......................................
Onsite Representative: (¢_[c_Ivt r _ _ _ _ _ _ ._ _ Integrator.
Certified Operator. 13 +'l" /Gtc f,F Operator Certification Number. ........................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ��� • ��� t��K Longitude � ' ` f�_ ���
Discharges & Stream Impacts K
I . Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon [] Spray Field ElOther
a. If discharge is observed, was the conveyance man-made? ❑ Yes PC)
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes V-No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................. ..... ..
Freeboard (inches): ....... LJ_.._....._. _....._.._....._.

Facility Number:iin Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ 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?
(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 maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Wastr,Aj2ulicattuix
10. Are there any buffers that need maintenance/improvement?
It- Is there e,%idence o over applicatio ? ❑ ExcessivA Ponding ❑ PAN ❑ Hydraulic Overl ad
12. Crop type
13. Do the receiving crops differ with those desi ed ' the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a'wettable acre determination?
15, Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Rgguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
❑ Yes V No
❑ Yes VNO
o
❑ Yes
❑ Yes *No
❑ Yes No
❑ Yes o
❑ Yes 9No
Cl Yes qNo
❑ Yes No
❑ Yes No
El Yes No
❑ Yes ONo
❑ Yes 0 No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes +� No
❑ Yes ®\ No
❑ Yes , ` No
❑ Yes o
❑ Yes PYNO
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Field Copy ❑ Final Notes
/ arpm llrvks '
9
-
Reviewer/Inspector Name_
Reviewer/Inspector Signature:VL�f.Date:
r
—
05103101
Continued

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage.pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, aspbalt,
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blide(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
4Yes ClNo
❑Yes No
❑ Yes No
❑ Yes - 0
❑ Yes , 4` No
❑ Yes
❑ Yes ❑ No
05103101

Facility Number ,)ate of Visit: /�Q 'rime: � �'-.�� Printed on: 10/26/2000
�
Q Not O erational 0 Below Threshold
® Permitted ® Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
FarmName: ............... s(r.•!n1......f.t!il ri '�'��......................... .. County:...... . �..........................................................
Owner Name: � ..... ..ii. J Phone No: k/.�d�... `SO........... ..............
Facility- Contact: .......... .... ........ 4 ............... ,li.Ji� ........ Title: ............ Phone No:.... ...............................................
Mailing Address:........... tJ.� ....!`�!`. AE?7E`c�.tr�
......��.................................�..... .. ...... .... .............
Onsite Representative: ......................�...._--�............................................ Integrator:..... % / r...... .e���!�` .............
Certified Operator:.... l_....._ �! //4�� ....... Operator Certification Nu/mber:..........................................
�'¢'t..
Location of Farm:
IT
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' C�` �=� Longitude �• �° �46
Design Current
® Wean to Feeder ZGd
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy [ I
Total Design Capacity
Total SSLW
I
Number of Lagoons ❑ Subsu rface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharge- & Stream Im acts
1. is any discharge observed from any part of the operation? ❑ Yes VNo
Discharge originated at: ❑ Lagoon [I Spray Field El Other
a. If discharge is observed, was the conveyance ratan -made? ❑ Yes KNo
h. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑Yes )�No
c. II' discharge is observed. what is the esiimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes KNo
2. is there evidence of past discharge from any part of the operation? ❑ Yes NNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes , No
Waste Collection & Treatment `'
4. is storage capacity (freeboard plus storm storage) less than adequate? ElSpillway ❑ Yes XNo
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier: ............. 3.y..
Frechoard (inches):
S/00 Continued on back

Facility Number: v i — Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes P1 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes I$No
(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/improvement?
❑ Yes
RNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
X No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
CKNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
PfNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
�ffNo
12. Crop type Z7,W',- 4 04
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
jffNo .
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
XNo
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?
KYes
❑ No
16. is there a lack of adequate waste application equipment? ❑ Yes J! No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
19. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ 1U� elz�ots, des�m!p *­09
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Q ytoiattotis;or defeie�cies mere noted di>Ering Obis;visit' • Yoix Will-teeeive tio' fufrthcr ;
correspondence. about this .visit
>mnients (iwierto c itestlon'#) Explain any YES aniswers and/or any recommendations or'any other commeu
;e drawings:of facility to�better explain situations. (use additional pages as.necessary) T
r .?,Ecd�.f -� � vu � o t�ccaf��•
❑ Yes JR No
❑ Yes ;W'No
❑ Yes ;E No
❑ Yes No
❑ Yes No
❑ Yes ArNo
❑ Yes ,KNo
❑ Yes JjNo
❑ Yes (q No
r C3) �a.�•�/ems x6aw 4
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Z IIS_ d I 5100

Facility Number: 6 Date of Inspection
Odor Issues
26. 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?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes gNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes KNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s); inoperable shutters, etc.) ❑ Yes ,kfNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes KNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? $} Yes ❑ No
All
5100

(1) Division of Water Quality -
O Division of Soil and Water Conservation
O Other Agency - - -
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint ® Follow up O Emergency Notification O Other ❑ Denied Access
Facility NumberDate. of Visit: Time: .i •�U Printed on: 7/21/2000
O �
Not O erational O Below Threshold Q d
® Permitted ® Certified © Conditionally Certified (] Registered Date Last Operated or Above Threshold: ...................
Farm Name: /3 .�✓�z�,.�. County. ,e�/.a�.�.t�
......................-�,j.......a....... • .....-....-.--......). --.------.....-.... �./........................
Owner Name:.........5....I� �r!%........................................... Phone No:... S�� T„.................... ........ .... ......................... ......
Facility Contact: .........Z2,��•1 .........'Title Phone No: ......................................
Bailing Address: .......Y.... -�4 ....--.-. k//�!T! ._.. f.l�.r......-... zS�9�....--....
�-
Onsite Representative:........... /............................... -..................... ....-................... Integrator:...... 1-0 .. -..-.............-.......
Certified Operator; D,6"0 ... .......... 11E .- •• - - ,. Operator Certification Number: --
Location of Farm:
_1w
[]Swine []Poultry []Cattle []Horse Latitude �• �� ��= Longitude �• ��jj
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder pp 4" ❑ Layer I JE1 Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagrnn Area ❑ Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream impacts
I. Is any discharge observed from any part of the operation? ❑ Yes I'No
Discharge• originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance ntan-made? ❑ Yes IR No
b- If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c- II' discharge is observed. what is the cstimaled flow in gal/min?
d. Does discharge bypass a lagoon system'' (if yes, notifv 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 Structure 4 Structure 5
Identifier: Q .............................................................
....................................
.............................
Freeboard (inches):
5100
❑ Yes 5d No
❑ Yes Wo
❑ Yes' 10 No
❑ Yes RNo .
)9yes ❑ No
Structure 6
Continued on back

® Division of Water Quality
C Division of Soil and Water Coitservation
O Other Agency
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint (D Follow up O Emergency Notification O Other © Denied Access
Facility Number p 9 6
Date of Visit:
�.--L'.G 'rime, -Z' 3U Printed on: 7/21/2000
'
O Not O erational Q Below,Threshold
M Permitted ® Certified 1] Conditionally Certified ❑ Registered
Date last Operated or Above Threshold: ....................... .
Farm Name /J G•�••.. Gr,PS.�T� .......................................
.....................................................
County: /.�.•e� ...--...---.....
Lam,/f (�..
Owner Name:..-...... r 1�F�....../? 1ZVA,1..................................I ....................
I..............-............-......-...
% )
Phone No:.. (... ��! .�c�....�... 30 ....................
Facility Contact: ........ / .Title:
�%�..
Phone `o:
......... .............................." .......
s yv . G �'��,�
Mailing Address: (�ar/�ir O ....
�............... ......--.....
�.�
..
Onsite Representative: ........... /V/•••A........................ .......... .............. ...........................
Integrator:.....�`!r......... ....-.-....-..............
Certified Operator...... ......... ...............
.. Operator Certification Number;,,,,,,,,,,,,,,,,,,,
Location of Farm:
;r
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° Longitude 0 V1 44
s Design Current Design. Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder "1&-P0 4 ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer I Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
[I -Boars Total SSLW
i
Number of Lagoons 10 Subsurface Drains Present ❑Lag-nn Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
❑ Spray Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
[]Yes
'R'No
`
Discharge originated at: ElLagoon [ISpray Field ❑ Other
a. if discharge is observed, was the conveyance man-made'?
❑ Yes
No
h. ]f' discharge it observed. did it reach Water of the State? (if yes, notify DV4`Q}
❑ Yes
® Np
c. If discharge is observed. what is the estimated flow in gal/min?
y\
d. Duet discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes
[2 No
2. Is there evidence of past discharge from any part of the operation?
❑Yes
g] No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
No
Waste Collection & 'rreatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'! ❑ Spillway
'Yes
❑ No
StrtlCturc� Structure; 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifie r:............. LF............. .................................... .... ................ .-................................................. ........... .........................
........... I........................
Freeboard (inches):
5100
Continued
on back

S
Facility Number: 8 —j Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, El Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes NNo
(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/improvement? XYes ❑ No
8. Does any pan of the waste management system other than waste structures require maintenance/improvement? ❑ Yes tZNO
i
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 10 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Pq'No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crap type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement'!
16- Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available'!
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20- Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
:'Vo vioiaficjris:oir ¢efficiencies were noted during iitis:visit; Yo>ir will receive Rio further •: •
: corres�oiideirce' about: this visit' • : • : :: : :: :
)KYes�No
❑ Yes *No
❑ Yes P�'No
❑ Yes %'No
, yes ❑ No
❑ Yes D^No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ,Qq'No
❑ Yes No
f ,
Yes ❑ No
Yes ❑ No
❑ Yes PC
Yes ❑ No
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):
Z..� dA�.c first ilL/4�.r•s i� �je c.���r/��.t1iC�jQ�=-�i�':��.J ,/i✓i
f
Reviewer/Inspector Name
Reviewer/Inspector Signature: s•� __ Date: 5/00

Facility Number: T9 —I Date of Inspection Printed on.• 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed'? (ic/ trees, severe erosion, Oyes A No
seepage. etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes tjNo
(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/improvement? XYes ❑ No
8. Does any part of the waste management system other than waste structures require maintcnance/improvement? ❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes IS] No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes NfNo
I. Is there evidence of over application? ❑ Excessive Ponding '❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13' Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? YesX—No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 4 No
b) Does the facility need a wettable acre determination? ❑ Yes ®'No
c) This facility is pended for a wettable acre determination? ❑❑ YesffNo
15. Does the receiving crop need improvement? es ❑ No
16. Is there a lack of adequatewaste application equipment? XV
❑Yes bR-No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20- Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 1�fNo
21- Did the facility fail to have a actively certified operator in charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(le/ discharge, freeboard problems, over application) AYes ❑ No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? Yes ❑ No
24. Does facility require a follow-up visit by same agency'? ❑ Yes [Si -No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? Yes ❑ No
yiolati¢tis:oi-• &FIciencies were n6tecl• during this:visit; You ;will ieb . ive 1io l'ueth&
corres oridence. a�outk this visit.. ' ...... ' ..... ' ....... .. ........ .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility/too beater explain situations. (use additional pages as necessary):
7 "CIA
22
' '7 � �/J.�.�i�/l�i� !//1.t /�,�1�s�f'l�ivey' /� f��/�ie Cr�����iL�/` ��r` �.+E-Tf�%/s�.rJ /�i✓/N.�'
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: �'�� ICJ 5100

© Db isian o€ Soil and Water Conservation - Operation Review
4
© Division of Soil and Water Consena�tori--Compliance-inspectton i�
® I)ivisiou of Water Quality r',Cnmphance Iitspectton s
3 Outer Agency Qperahon Review
Q Routine Q Complaint Q Follow-up of DWQ inspection Q Follow -tip of DSAVC review Q Other
Facility lumber .._...r.�..... � t?;ite of Inspection Z _
Time of inspection 2-4 hr. (hh:mm)
❑ Permitted a Certified ❑ Conditionally Certified C] Registered JE3Not O erationa! Date Last Operated .
Farm Name: ...........ls.diJ.... �j'/C�� Cnunt�':..........�•e ..................
Owner Name: ...............rr�r lsr/�J.................... .................... Phone No:..... ...................
r� _ _ .............................................. .•,,�
Facility Contact: ...-...✓ % /.-.. - ... Title: ..............................•---..---..... Phone No:
Mailing :address:..........�y..4....%/ir..... /`...� ..rq f V..��......�1it �..........................
Onsitc Representative:-_....�.... .. .. Integrator: .. ..,,tT�e.
....-...... / .. �..-.-..-...
Certified Operator . ..........
erator.......--_• Operator Certification Number. ....
Location of Farm:
......................................................................................................................•---................--.-....................----.............----•-.........-..--------------•----.....................................-... y-
.. .................................................................................................................. T
Latitude �� �` Longitude �� • �� �`: - --
Design Current Dcsigrr_.: Current . Design Current
Swine ' Capacity Population. :Poultry. Capacity Population Cattle . Capacity Po ulation
Wean to Feeder 40 ❑ laver ❑ Dairy
❑ Feeder to Finish [IN an -Layer ❑Nan -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other _
❑ Farrow to Finish
rotas Design Capacity
❑ Gilts
❑ Boars -Total SSLW
Discharges & Stream Impacts
1- is any discharge observed from any part of the operation?
Discharoe orisTinated at: El Lagoon El Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made''
h. If discharge is observed, did it. reach Water of the Sate-' (If yes, notify DWQ)
c. If discharge is observed, what is the eitiinated flow in gal/min?
d. Docs discharge bypass a lagoon system'' (If yes, notifyDWQ)
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:
I `i
-...........-............... Freeboard (inches): .............1.. .......................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed' (le/ trees, severe erosion.
seepage, etc.)
❑ Yes DV No
❑ Yes #No
❑ Yes 'f�VNo
❑ Yes No
❑ Yes M�No
❑ Yes �kNo
❑ Yes ❑ No
Structure 6
❑ Yes [� No
Continued on back
3/23/99

• Facility Number: 09 — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
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/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
)<No
❑ Yes
Xyes
❑ No
❑ Yes
X10
❑ Yes
�rNo
❑ Yes
XNo
❑ Yes
XNo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?-
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oc/ WUP, checklists, design, maps. etc.)
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: INO.. iolatigris ©i- deGciende $ -wire po(e#. ilu-r"ing this:visit. - Y:ou Will•receiye Rio furth&
corres� o deuce:a�au-i-t' ris visit . .. . • .. . . . :::: ::: :
nments (refer to question #) "Expliun'anyYES answers andlnr anyrecommendattons or y other comrF
drawings of factl�ty toybetter.explain sttuanons'(use additional pages as necessary)G;�r
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
❑ Yes *No
❑ Yes )WNo
❑ Yes RNo
❑ Yes �§No
AYes<_
❑ Yeso
KYes ❑ No
❑ Yes tWN0
❑ Yes tNo
❑ Yes '9No
❑ Yes j5jXNo
❑ Yes �o
❑ Yes [K No
❑ Yes tXNo
❑ Yes CYNo

Facility Number: d f — ' I)ate of Inspection 7Z lzo
Odor Issues
26. 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? IK
27. Are there any dead animals not disposed of' properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 1KNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �TNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ' /�o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? X Yes ❑ No
'Ndditional,,Coinments,and/or,-,,Drawtn r, - r'
3/23/99

r . 16
Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 4PRoutine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility -Number
Date of Visit: �`�� Time: Ii O� .be
ro ,S'
Not Operational Below Threshold
Permitted Of Certified © Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: &deo4z A/irst ehe County: 1004N
Ow-nerName: S I e IQ l _,j Phone No: !� Feo.2 IL/4 9S6
Mailing Address: 746 kc: Ile .dao� �� �i .ra�ir_�-�„ f d4,,
Facility Contact: Q&2,m le r Title:
Phone No:
Onsite Representative- (f Integrator: _13 44,014 „
Certified Operator: Operator Certification Dumber: /7 9 J% 7
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ tlorseLatitude �0 4 " Longitude ' �• ��
Design Current
Swine rnnarity Pnnnlafion
Wean to Feeder
60
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farroav to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle capacity Population
❑ Laver I I ID Dairy
❑ Non -Laver I I IEJ Non-D`
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ILI Subsurface Drains Present JIU Lagoon Area !U
Sprap Field Area j
Holding Ponds I Solid Traps JEJ No Liquid Waste Management System
I
Discharges 8- Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: I] Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
El Yes
❑ No
b. If discharge is observed. did it reach Water of the State? (if ves, notify DWQ)
[] Yes
❑ No
c. If discharge is observed. what is the estimated flow in traUrnin?
PIA
d. Does discharge bypass a lagoon system? (If yes. notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑Yes
Qq No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
j No
Waste llection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
No
Structure 1 Structure 2 Structure 3 Structure 4 Structure ;
Structure 6
Identifier:
Freeboard (inches): _I-23
05103101
Continued

Facility Number: / — C , I —
Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ 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?
(If any of questions 4-6 was answered ves, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do anv of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
El Yes 0No
❑ Yes Up No
❑ Yes [10 No
❑ Yes UO No
❑ Yes ® No
VVaste Application �VV
10. Are there any buffers that need maintenance/improvement? ❑ Yes 00 No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [3a No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 00 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes C@ No
b) Does the facility need a wettable acre determination? ❑ Yes M No
c) This facility is pended for a wettable acre determination? ❑ Yes [jO No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes No
yu
Recnuired Records & Documents
17. Nail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[X No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[� No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
[� No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
[10 No
(ie/ discharge, freeboard problems, over application)
23- Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[� No
24. Does facility require a follow-up visit by same agency?
❑ Yes
119 No
25. Were any additional problems noted which cause noncompliance of the Certified AV1'MP?
❑ Yes
1p No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer td quesfion #) Esptain any YE$soswers andJor any romatendattuus or aav othercomQeents.
_
Ilse drav�zngs of facility: to better tx�►lant snuatrons: (use addetzonal pages as necessary): ;A pield Conv �❑ Final Notes
' _ r
Wt�S7G -��M�J ie ja fe_,
r!A2e_
4 k6"i rVi/�' je 4-6,Aw4rr f7D /UC,60 IaL a,,*- ► ce c' Vcse rC. 4, "f .
Aa k-r- dw+c evcq .2 -
�.., J"e CPA,.1was 9dvv� rCCOra�l.
Reviewer/Inspector Name -
Re,6ewer/Inspector Signature: Date:
05103101 C/ Continued

0
Jr Technical Assistance Site Visit Report
Division of Soil and Water Conservation
O Natural Resources Conservation Service
O Soil and Water Conservation District
O Other...
Facility Number _J - Date: 12/9/03 1 Time: 1330 Time On Farm: 7D FRO
Farm Name Bunn Nursery County Bladen
Phone: [phone]
Mailing Address 56 Fayetteville Road Elizabethtown NC 28337
Onsite
Representative Stephen Bunn Integrator Murphy Brown
Type Of Visit Purpose Of Visit
® Operation Review
Compliance Inspection (pilot only)
❑ Technical Assistance
❑ Confirmation for Removal
❑ No Animals -Date Last Operated: — — —
❑ Operating below threshold 1
® Swine ❑ Poultry ❑ Cattle ❑ Horse
Design Current
Capacity Population
® Wean to Feeder 2600 2600
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
Boars
Q Routine
Response to DWQ/DENR referral
O Response to DSWCISWCD referral
Q Response to complaint/local referral
O Requested by prod ucerh nteg rator
O Follow-up
Q Emergency
O Other...
Design Current
Capacity Population
❑ Layer
❑ Non -Layer
❑ Dairy
❑ Non -Dairy
❑ Other
GENERAL QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ® no
2. Is there evidence of a past waste discharge from any part of the operation that waste reached ❑ yes ® no
surface waters or wetlands?
3. Does any problem pose an immediate threat to the integrity of the waste structure (large trees, ❑ yes ® no
seepage, severe erosion, etc.)?
4. Is there evidence of nitrogen over application, hydraulic overloading or excessive ponding ❑ yes ® no
requiring DWQ notification?
5- Is there evidence of improper dead animal disposal that poses a threat to the environment ❑ yes ® no
and/or public health?
6. Is the waste level within the structural freeboard elevation range for any waste structure? ❑ yes ® no
Structure1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier
Level (Inches) 40
CROP TYPES Coastal Bermuda -hay mall grain overseed �—
SPRAYFIEiD
SOIL TYPES KeA
7. What type of technical assistance does the onsite representative feel is needed? (list in comment section)
03/ 10/03
❑ Dairy
❑ Non -Dairy
❑ Other
GENERAL QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ® no
2. Is there evidence of a past waste discharge from any part of the operation that waste reached ❑ yes ® no
surface waters or wetlands?
3. Does any problem pose an immediate threat to the integrity of the waste structure (large trees, ❑ yes ® no
seepage, severe erosion, etc.)?
4. Is there evidence of nitrogen over application, hydraulic overloading or excessive ponding ❑ yes ® no
requiring DWQ notification?
5- Is there evidence of improper dead animal disposal that poses a threat to the environment ❑ yes ® no
and/or public health?
6. Is the waste level within the structural freeboard elevation range for any waste structure? ❑ yes ® no
Structure1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier
Level (Inches) 40
CROP TYPES Coastal Bermuda -hay mall grain overseed �—
SPRAYFIEiD
SOIL TYPES KeA
7. What type of technical assistance does the onsite representative feel is needed? (list in comment section)
03/ 10/03
❑ Other
GENERAL QUESTIONS:
1. Is waste discharging from any part of the operation and reaching surface waters or wetlands? ❑ yes ® no
2. Is there evidence of a past waste discharge from any part of the operation that waste reached ❑ yes ® no
surface waters or wetlands?
3. Does any problem pose an immediate threat to the integrity of the waste structure (large trees, ❑ yes ® no
seepage, severe erosion, etc.)?
4. Is there evidence of nitrogen over application, hydraulic overloading or excessive ponding ❑ yes ® no
requiring DWQ notification?
5- Is there evidence of improper dead animal disposal that poses a threat to the environment ❑ yes ® no
and/or public health?
6. Is the waste level within the structural freeboard elevation range for any waste structure? ❑ yes ® no
Structure1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier
Level (Inches) 40
CROP TYPES Coastal Bermuda -hay mall grain overseed �—
SPRAYFIEiD
SOIL TYPES KeA
7. What type of technical assistance does the onsite representative feel is needed? (list in comment section)
03/ 10/03

Facility Number 9 - 65 Date:
12/9/03
PARAMETER
Q No assistance provided/requested
❑ 8. Waste spill leaving site
TECHNICAL ASSISTANCE Needed
Provided
❑ 9. Waste spill contained on site
25. Waste Plan Revision or Amendment
❑
❑
[110. Level in structural freeboard
El 11. Level in storm storage �
26. Waste Plan Conditional Amendment
❑
El
27. Review or Evaluate Waste Plan wlproducer
❑
❑
❑ 12. Waste structure integrity compromised
28. Forms Need (list in comment section)
❑
❑
❑ 13. Waste structure needs maintenance
Missing
❑
❑,
29. Components (list in comments)
❑ 14. Over application >= 10% & 10 lbs.
30. 21-1.0200 re -certification
❑
❑
❑ 15. Over application < 10%•or < 10 lbs_
31. Five & Thirty day Plans Action
❑
❑
❑ 16. Hydraulic overloading
of (PoA)
32. Irrigation record keeping assistance
❑ 17_ Deficient irrigation records
❑ 18. Late/missing waste analysis
33. Organ izelcomputerization of records
❑
❑
❑ 19. Late/missing lagoon level records
34. Sludge Evaluation
❑
❑
❑ 20. Late/missing soils analysis
35. Sludge or Closure Plan
❑
❑
❑ 21. Crop needs improvement
36. Sludge removal/closure procedures
❑
❑
❑ 22. Crop inconsistent with waste plan
37. Waste Structure Evaluation
El
El
❑ 23. Irrigation maintenance deficiency
38. Structure Needs Improvement
❑
❑
❑ 24. Deficient spraytield conditions
39. Operation & Maintenance Improvements
❑
❑
40. Marker check/calibration
❑
❑
Regulatory Referrals
41. Site evaluation
❑
❑
❑ Referred to DWQ Date:
42. Irrigation Calibration
❑
❑
❑ Referred to NCDA Date:
43. Irrigation design/installation
❑
❑
❑Other...
system
Date:
44. Secure irrigation information (maps, etc.)
❑
❑
LIST IMPROVEMENTS
45. Operating improvements (pull signs, etc.)
❑
❑
MADE BY OPERATION
46. wettable Acre Determination
❑
❑
1. One ton of lime applied to spray field in spring of
47• Evaluate WAD certificationlrechecks
❑
❑
48. Crop evaluationlrecommendations
❑
❑
2003.
2.
49. Drainage work/evaluation
❑
❑
50. Land shaping, subsoiling, aeration, etc.
51. Runoff control, stormwater diversion, etc.
❑
El
❑
El3
52. Buffer improvements
❑
❑
53. Field measurements(GPS, surveying, etc.)
❑
❑
4'
54. Mortality BMPs
❑
❑
55. Waste operator education (NPOES)
❑
❑
5'
56. Operation & maintenance education
❑
❑
57. Record keeping education
❑
❑
6
58. Cropiforage management education
❑
❑
59. Soil and/or waste sampling education
❑
❑
03/10/03

rd
Facility Number - 65 pate: I 12/9/03
COMMENTS:
Waste samples:
518103 — 1.7
10/10/03 — 1.3
11/19/03 — 1.1
to lagoon design and marker start pump is 31 inches. Stop pump is 58 inches.
?_ Apply pumping done in October, 2003 to 2003/2004 small grain crop on IRR 2 records. Waste plan shows that pumping
ndow for bermuda is March through September.
r. Bunn plan on adding topsoil and reseeding small bare area at comer of lagoon.
aminder: Be sure to recalculate IRR 2 forms with valid waste sample when needed_ Waste samples are good 60 days
More and 60 days after date of waste sample_ Recommend taking waste samples within 60 days prior to pumping.
)ply lime according to soil sample recommendations.
Sep freeboard levels with farm paperwork. October, 2003 levels missing. Mr. Bunn will get October, 2003 freeboard levels
)m Murphy -Brown.
god farmH
ell maintained!!
TECHNICAL_ SPECIALIST Danny Edwards
SIGNATURE
Date Entered: I I Entered Bv:
3 03/ 10/03

Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
TlateofVisit: ''�� Time: $' /0
Facility Number G
Not Operational 0 Below- Threshold
OT-e-rinitted. D<ertified 0 ConditionaEly Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: ✓rlrt &ur Scar v _ County:
Owner Name: _�D%7P'a - _ ✓.2a / /_ _i Phone No:
Mailing Address: _ $G__
Facility Contact:
Onsite Representative:
Certified Operator: _
Location of Farm:
Title:
Phone No:
Integrator:
Operator Certification Number:
Swine El Poultry ❑ Cattle ❑ Horse Latitude �' K Longitude 0'
Wtlecion '� finrirartt - Des"M -Current "Des
.Swine `- _=Ca acitrlPo
uhrition
E34ean to Feeder
:2 G v a
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
z'Poulin_ ' C>t iieaty .4Fo ulati©n Cattle '-.. caps
❑ Layer Dairy -
❑ Non -Laver ❑Non -Dairy
❑ Other
Totsl Design 0 a
C
= Total SSLW
C
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Svrav Field ❑ Other
a_ If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ves; 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 S Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I
❑ Yes ONo
❑ Yes ONO
❑ Yes ONO
I-
❑ Yes [3-No
❑ Yes [9-90
❑ Yes ❑ No
❑ Yes 0-90
Structure 6
Freeboard (inches): �2 .5
05103101 Continued

Facility Number: -- G 5 Date of Inspection '7.7 .a
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
d-No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
[J-No
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/improvement?
❑ Yes
[3-No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
0-No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
E Nd
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
❑ No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ 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
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ 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 ❑
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [9-No
95
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 9-N-0
Air Quality representative immediately.
0-Filed Copy ❑ Final Notes
yy�� 1 /'
Ol��✓O S1L,f 1✓+.1�Pc� Tr,�..-. 6ts 4 rt�t��t CT� 1 ��eir+i� �'v.� ,+✓r., �'o Pt-V61 Yci,w, +, vl_� t-_,
/ CGlOI`na /✓. ✓,'S +v r, UT- Spy I ri rl l� Zt�fc �t'r l +'1 ,de
r✓Ct�e
7 iC" 60a�� ��c ✓,`u+.; "n S"e {.'u, reloae 3 s`'c'w /v [i.,,�J lam!✓c' l �V 3
5 -rk- Vel,7•'P� /090C.1 /P✓il. wC+S of
LTG «Pc� w/. >�� 1 Mr, U ✓!!ii �. ,� !'es o o Li G� a ✓P L� , m A Tea c �l, n p ✓ram �r r
Ae 1%4-°f4C.110n 41; COfrIC� G.o-�c�h LC✓e?�. l
1'100,4 recta­1 f7- '7 -UV
Reviewer for Name
ReviewerA nspector Signature: .�%L��2 d 2{s. Date: 9
1211210.3 i onanuea

� Division of Water Quality -�fp
Facility Number ^ _--G�j � Q Division of Soil and Water Coflservatian
Q Other Agency ��
I
Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ��%� County: Region:
Farm Name: Owner Email:
�l
Owner Name: "aft Phone:
Mailing Address: 3 Z xN W,0
Physical Address:
Facility Contact: it �Gt'— . Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: `fi IU42=
Back-up Certification Number:
Latitude: = o =' = Longitude: = ° = { I=] u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
JZ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean i
❑ Farrow to Feeder j
❑ Farrow to Finish
❑ Gilts I
❑ Boars
Other
❑ Other I
❑ La er
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El structure ElApplication Field ElOther
a. Was the conveyance man-made?
Design Current ..
Cattle Capacity Population '
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non-Dai
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Conj
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)?
Number of Structures: mil
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 allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
L9No
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
12128104 Continued

f Facility Number: ,e
� h' � ry Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
tRNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
® No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: /
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
K 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
9No
❑ 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
10 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
10 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
J?�No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
J0 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
X No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �f j r mu JA _ X911z'%L rat!
13. Soil type(s) 14
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
9No
ElNA ElNE
15. Does the receiving crop and/or land application site need improvement? g Yes
Mr%o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[] Yes
�d No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application'? ❑ Yes
'2 No
❑ NA ❑ NE
18. 1s there a lack of properly operating waste application equipment? ❑ Yes
® No
❑ NA ❑ NE
-ems. 4 L We-eJ I 1 �` GD/nrr'V t4��
d-'FY0P'r'L�7 W�•t A arra.
Reviewer/Inspector Name �,SJ�rf/� �- Phone: 9yv-�3� 33p
Reviewer/Inspector Signature: Date: D
12128104 Continued

i Facility Number: — Date of Inspection .=a
i Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? is Yes M e00 NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes ESNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ;4 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 I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes IS No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J4 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,4 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
14 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
[ZNo
❑ 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
M 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
0 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
J91 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J3 No
❑ NA
❑ NE
Additional Comments and/or Drawings:;_,
Iq IY45 /77 ) A c.J/f Du/f , I%r- B �rsv
6A J. all �l�% 02 �/in3 6 q
Page 3 of 3 12128104

i
Type of Visit &compliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine O Complaint Q Follow up Q Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ;OO County: Region: _L-fL
Farm Name: od I,u04 `�—"°� Alaw��d�.�! n �r� Owner Email:
Owner ]Name: &Z" i w..... - � �r� «a•► � - Phone: c///D --,:csf -v,2;L 2 _
Mailing Address: 314q of 'e7Z,`15
Physical Address:
Facility Contact:
Title:
Onsite Representative: W 1.19�Dj
Certified Operator:
Back-up Operator:
Location of Farm:
Phone/No:
Integrator: A_
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = = Longitude: = o =
Design Current Design Current
Swine Capacity Population ' Wet Poultry Capacity Population
10 Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkets❑
Turkeults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Populatiop
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Da Cow
❑ Non-Dai
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 �B No ❑ NA ❑ NE
❑ Yes
PQ No
❑ NA
❑ NE
❑ Yes
[A No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
khio
❑ NA
❑ NE
12128104 Continued

r
Facility Number: - Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes 9 No
❑ Yes No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
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
KI No
❑ NA ❑ NE
(iel 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
4:ltbo 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
tO 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
9No
❑ 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 El Evidence of Wind Drifl ElApplication Outside of Area
12. Crop type(s) 2S eaftudA - /`ff�yyi� A -rat i •--- --
13. Soil type(s) jt -L— ` - -
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 W No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑ Yes U} No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
El Yes 4No El NA ❑NE
❑ Yes LK No ❑ NA ❑ NE
Reviewer/Inspector Name r� y _ Phone: D
ReviewerAnspector Signature: Date:
12128104 Condnaed

Facility Number: —J Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes X No ❑ NA ❑ NE
the appropiate box. ❑ \VUp ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes ❑ No ❑ NA ❑ NE
0 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 J4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes K No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ya No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
WNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
C&NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
X No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
W No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ 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
EgNo
❑ NA
❑ NE
General Permit? (ief discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
91 No
❑ NA
❑ NE
33-
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
fine Nt-e,4 `91-0 Rt-"1114 -r rAUcy�rlQ/ 1-1
12128104

4
Type of Visit: tff-Compliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 011fo-utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I at?-
Arrival Time: o+ a
Departure Time: l ; D
County,-- Region: C�
Farm Name: c�-{arn _F%
i.)urS Y
_ _ Owner Email:
Owner Name: �- �., { Q�Q.� Phone:
Mailing Address:
Physical Address:
Facility Contact: C9 try, Title: `�`� fp�� Phone:
Onsite Representative:
Certified Operator:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
iiiiiiiiiiiiiiiiiiiiiill�De—si Current
Design
Current
Design Curren#
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
airy Cow
Wean to Feeder
p
Non -La er
Dairy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,aWt .
Ca aci
Po
Non -Da'
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
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:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 54 No ❑ NA ❑ NE
[::]Yes ❑ No
❑ Yes ❑ No
DNA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes PS No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ej 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): _T y
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
® 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
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
54 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
fo" 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 or improvement?
l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes §�JNo ❑ 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)�LE-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [allo ❑ NA ONE
15. Does the receiving crop and/or land application site need improvement? R 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 detennination'?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ®. 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
allo
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes. check the appropriate box below.
❑ Yes
�Z 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
Callo
❑ 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
21412011 Continued

r
Facility Number: CIr jDate of Inspection: /-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes f No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Eg No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
allo
❑ 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
® 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
Z No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewhrispection with an on -site representative?
❑ Yes
E No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0 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 exalain situations (use additional naizes as aecessarv}.
Reviewer/Inspector Name:
Phone: ?It -#133 `—r—Ps9
Reviewer/Inspector Signature: .7_ �j�r-�� _ Date:
Page 3 of 3 21412011

Type of Visit: Q'Compliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: 01 routine 0 Complaint 0 Follow-up 0 Referral 0 Emereencv 0 Other 0 Denied Access
Date of Visit: Arrival Time: DO Departure Time: County:
Farm Name: �� �.e,�,Q JCJU, •-� _ Owner Email:
Owner Name: �� � o ��� Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: 6-?-gC `,L�,� Title: �+w� �/ Phone:
Onsite Representative: Integrator: �� w,, --
Certified Operator: h/s Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Capacity
Wcan to Finish
Current
Pop.
Design
Wet Poultry Capacity
Layer
Current Design C►urrent
Pop. C*attle Capacity Pop.
DairyCow
Dairy Calf
DairyHeifer
Current D Cow
P,o . Non-Dal
113eef Stocker
Wean to Feeder
Non -La er
Design
Dry Poultry Ca achy
Layers
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turkey Pouits
Beef Brood Cow
Other
ll Other I
f0ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes CK 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 CaNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ® No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facilit Number: - Date of Ins ection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in):�
5_ Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Z 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 (2 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �H No ❑ NA ❑ NE
8. Do any ofthe 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 IR 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 or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes .0 No 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): _%1rUj'W Ajl- i/j
13. Soil Type(s): &,&
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 25 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?
18. Is there a lack of properly operating waste application equipment?
Reouired Records & Documents
❑Yes ®No ❑NA ❑NE
❑ Yes ® 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, checkes 54 No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design JgMps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ® Yes ❑ No
Waste Application 19 Weekly Freeboard ®Waste Analysis Soil Analysis ❑ Waste Transfers
.Rainfall ❑Stocking Crop Yield ❑ 120 Minute Inspections �lonthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes S No
[,] NA ❑ NE
❑ Weather Code
® Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection. /.;L-
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 ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification'? ❑ Yes [� No
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative`?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Yes E§ No ❑ NA ❑ NE
❑ Yes r171 No ❑ NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes [NNo ❑ NA ❑ NE
❑ Yes JZ No
❑ Yes g No
❑ Yes jj3.No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question-#) Ezplatn any` YES'answers and/or any,addttional recb-mmendations or:any other comments
Use drawings of facilityto better, explain situations -(use additional pages: as necessary):
/� ��� ��w Cot✓ r � ya�r rr
A,l/
T y � �;p
A-*. 4, �� s
��Ga r�I '�!� y�►��s L
A.ei&z
Reviewer/Inspector Name:
Reviewerllnspector Signature:
Page 3 of 3
YA_ oil -7- �/ � C
Phone:
Date:
a 21412011

Type of Visit Q,omffpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit GwoUtine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: ji: Departure Time: s3'J County: A4144f''L- Region: ffErL)
Farm Name: l.Lr t�/SrN r�—� _ Owner Email:
Owner Name: -7917 n Phone:
Mailing Address:
Physical Address:
Facility Contact: ' i%�4X Title: AG/r7/.— Phone No:
Onsite Representative:Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ED 0 0' = u Longitude: = o [� [ = it
Design CurDesign
Current Design Current
"FTW�ean
Capacity Population
Wet Poultry
Cappulation Cattleinish
ba
❑ La er
❑ Non -La er
❑Dai Calf
eeder
Da' Heifer
❑ Feeder to Finish
Dry Poultry
❑ D Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑Beef Stocker
❑ Gilts
❑Nan -La ers
❑ Beef Feeder
❑ Pullets
❑ Turkeys
ID Beef Brood Co
❑ Boars
- .._ .
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:FLI
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
rRNo
❑ 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
ELNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

%5--
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes ;RNo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
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
10 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
,R[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
,KNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
KNo
❑ 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
RNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M�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 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)/6c
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [KNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
JKNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
&No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
JgNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
P�No
❑ NA
❑ NE
Reviewer/inspector Name I Phone:
Reviewer/inspector Signature: Date: 'Z --�3 —
rage -, o> .s 1.6iaaivg 4.uniinuea

v,
Facility Number: — Date of Inspection
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JQNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes §ZNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ 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 J4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5kNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ANo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
14No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
1KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
bkNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
NNo
❑ 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
CkNo
❑ 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
KNo
❑ 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
JkNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Wo
❑ NA
❑ NE
Additional Comments and/or Drawings:
.. r
Page 3 of 3 12128104

r Facility Npmbeii
��iviston ofWater(
�•• 0<Diyiston of Soil and
Q Otther Agency
Type of VisitO�Co—mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 64outlne Q Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
pate of Visil: �'�irrival Time: D Departure lime: �Q County: JiLQa/r+z Region:
Farm Name: (?caner Entail:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: // � �/ /�/ ur%'L _Title: �,�fdl,Iit�'� Phone No: 20 9�N, 3,;ZY,�?
Onsite Representative: _� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: ❑o u Lonryitude: ❑o ❑ ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ a er
p0 S'D ❑ Non-] aver
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Pullets
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dal Cow
❑ DairyCalf
El Dairy Heifer
[ID Cow
ElNon-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: a
b. Did the discharge reach waters of the State? (Yves, 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 A -No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
No
[I NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
54-No
El NA
El NE
❑ Yes
PINo
❑ NA
❑ NE
12128104 Continued

Facility Number: -(rg Date of Inspection �D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
9No
❑ NA
❑ NE
a. If yes. is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Stricture 4
Structure
i
Structure 6
Identifier:
Spillway?.
Designed Freeboard (in): C3�
Observed Freeboard (in): 3 ,3
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[9 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
9No
❑ 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
LX No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[9 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 Aoplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[9No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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 types)
13. Soil types) 7f.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [8No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 29-yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
D�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
9No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
94No
❑ 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):
/ D Yet Cf3 /j �rryra �r'0
o7"L�
o (cnnt�cNY�)
Reviewer/Inspector Name Phone: 9119—ffL3
ReviewerAnspector Signature: Date: a 3:�_�D
]Z/2&04 Continued

Facility Number: Z — 1"51 Date of inspection I a
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 JZ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. E9 Yes ❑ No ❑ NA ❑ NE
9 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
O No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Z No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[gNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
[R Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo
❑ 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
0 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
B 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
El No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
/�,J, y year. ff� o� ��- i -j' i��•., -�3 �w . �y -mom- 4,5
,� S
�-r�
12128104

3-1D-ap' D
9
O'll�ivisron of Water
Facility Number � w0 Dfvisron ot5oll aQ
� Other Agency. "
'ater.;Gonservatitrn
Type of Visit Orcompilance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint at'Fiollow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: {d Arrival 'lime: (Departure Time: County: e- - Region:
30
Farm Name: Owner Email:
Owmer Name: 'N1 12 M Phone:
,'Mailing Address:
Physical Address:
Facility Contact: V19 t W`� Title: 11 1' Phone No:
Onsite Kepresentalive: Integrator: fAve PL
Certified Operator: �q.1- Operator Certificsti n Number:
Back-up Operator:
Back-up Certification Number:
Location of Harm: Latitude: =O Longitude: ❑a ��"
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
❑ Layer I I ::d
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Pouets
❑ Other
Discharges & Stream Impacts
lets
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 Heifet
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: a
b. Did the discharge reach waters of the State? (ifves, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? of 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 ❑ No ❑ NA 29.NE
❑ Yes
❑ No
❑ NA
❑ NE
[I Yes
El No
El NA
El NE
❑ NA
0 NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
[0 NE'
❑ Yes
❑ No
❑ NA
ENE
12128104 Continued

} Facility Number: q — LFj
Date of Inspection
Waste Collection & 1'reatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. 1f yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Stnicture 4
Identifier:
Spillway?:
DesiLmed Freeboard (in):
❑ Yes ❑ No
❑ Yes ❑ No
Structure 5
❑ NA ;5-NE
❑NA ❑NE
Structure 6
Observed freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? �E
e/ large trees severe erosion El Yes ❑ No ❑ NA
(�t� � seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA 9NE
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 ONE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA &� NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA [9-NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA LN NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 21'NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
K NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
RTNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
❑ No
❑ NA
6� NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[ONE
I8. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
JK 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):
!" T �i D r�?
C�! 1 �' Y' c� tj a (i; 1� I� % � � = � •� i'f� r't �} � ors �t r - /J 7 y z.:! of b ,,i -e-
i;i ig
c
� !
IZ I'irrc�v�.
i
Reviewer/lnspectorName Phone:'1LI�-1I
Reviewer/Inspector Signature: . �"" " ., : ,. Date:
12128104 Continued

Facility Number: - Date of Inspection JD
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA (Z NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ❑ No ❑ NA [S NE
the appropriate box. ❑ W'Up ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 0 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
0 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
C9NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
ERNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
® NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
® NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
® NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
JRNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
M 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
E[ 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 reviewlinspection with an on -site representative?
❑ Yes
K No
❑ NA
E&E
33.
Does facility require a follow-up visit by same agency?
❑ Yes
®No
❑ NA
❑ NE
NO' 1i7
FAO
�-� do
JLu04� fus�ll��
al
Sc�%U101
12a&04

Type of Visit QL4Mo-m- pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine 0 Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date o€Visit: ���9 Arrival Time: l%. U Departure Fiore: D p County: '� Region:.
Farm Name: Xi L.y`b r Owner Email:
Owner Name: h o 2 / Q __- Phone:
Mailing Address:
Physical Address: /�
Facility Contact: rI d/ ZW./ �.ril �A_P'-- „ Title: Phone No:
Onsite Representative:
Certified Operator: 5'r�
Back-up Operator:
Integrator: .0,
Operator Certification Number:��35'
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 ' a .. Longitude: [—] ° 0 ` 0
�,
,Design Current'
Design Gnrrent' Design Current
Swine �
Capacity Population Wet Poultry
Capacity Population Ca l`e Capacity Population
❑ Wean to Finish
❑ Layer
z ❑ Dairy Cow
Wean to Feeder
(0001 JE1 Non -La ei
X ❑ Dairy Calf
❑ Feeder to Finish T
❑ Dairy Heifer
❑ Farrow to Wean
_...
EiPoi #ry
❑ Dry Cow
❑ Farrow to Feeder.
' ElNon-Dairyx;
❑ Farrow to Finish
❑ Layers
El Beef Stockez
`:; ❑ Gilts'
❑ Non -Layers
❑ Beef Feeder
r-- ❑ Boars
❑ Pullets
El Beef Brood CoLd
❑ Turkeys
ME 02 MU-1
❑
❑ Othcr�
Turke Poults
❑Other
��
?Numberof Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes NNo ❑ 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
[9-No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
0 No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Faciiity Number: - 1 Date of Inspection
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): ,
Observed Freeboard (in): �}
5. Are there any immediate threats to the integrity of any of the structures observed?
(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 Mdo ❑ NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes P No ❑ NA ❑ NE
❑ Yes [&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? ❑ Yes [ZNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
allo
❑ 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
CR.No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
54-No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s)
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 acre determination ?
❑ Yes
0 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[9 No
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
®-No
❑ NA ❑ NE
Comments (refer to question #) IYplatn any YES answersand/or anyArecammendations or any other comments.
,Use. drawings of facility to better ex lain situations. use ddttt a e ecessary} .� {
P ( tl? g
rr s as�n
!l/Q S %s., i �c z��+- S`TDrm- S /�. a� �iro^v� A
h r. A03 ativ�� � � barn /�' (�JCL4L) C)Gv nrf) GUa� .,v/o7�au r�%�
OF 74, 3 1 L;i._, ryrarf�,.- Thau ! 1-wd5 /'�' 1-;,ke- 7'/Z::, 49
A ,e 4 4'j Tui f' 89 u ,046 /v6�Ct rA /.rr�— lvt it hr r � sm s•� �
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection S-7-O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®-No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. R Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
Wainfall ❑ 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
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[.No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[9No
❑ 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
[gNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EgNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[Z 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
[A 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
RNNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[&No
❑ NA
❑ NE
Additional Comments and/or Drawings:
76-71)
yfl tA-
IP, //dS01t� tt'I�Lti✓t� j'L R %�asvL� xeCc(��
12128104

J
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S « Arrival Time: 7-r! Departure Time: I 1,(.. 44 County: R/Qu w Region: AZO
Farm Name: B 4ln t Y j� Owner Email:
�L/
Owner Name: l �� 0,4o„'1 Phone: V/o) 5S8 r 2
Mailing Address:
Physical Address:
Facility Contact: w i !! i 1 10W n'1 _ Title:
Onsite Representative:
H
Certified Operator: 'U"Id4 s mom
Back-up Operator:
Location of Farm:
Phone No:Cj1° R7V oa6
Integrator:
Operator Certification Number: �$✓r�%� _
Back-up Certification Number:
Latitude: 0 e = ' 0 " Longitude: Q ° Q ' =
Design Curreut Design Current Design Current
Swine
Capacity Populatton Wet Po lily CaRacity Population Cattle Capacity Population 11
❑ Wean to Finish
❑ La er ❑Dai Cow
Wean to Feeder
3
/i�
❑Non -La er
❑Dai Calf
❑Feeder to Finish
Dai Heifer
F_ ❑ Farrow to Wean
D . Pout ". ` ❑ Dry Cow
❑ Farrow to Feeder
❑ Non-Daity
❑ Farrow to Finish
❑ Layers
❑Beef Stocker
❑ Non -Layers
El Pullets ❑Beef Feeder
❑Beef Brood Co
❑ Turke s
❑ Gilts
❑Boars
_
21aOtherft
❑ Turkcx Poults
Other
❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes *1 No ❑ NA ❑ NE
❑ Yes ❑ No 1PNA
❑ NE
❑ Yes ❑ No 91NA.
❑ NE
❑ Yes ❑ No f9 NA
❑ NE
❑ Yes P No ❑ NA
❑ NE
❑ Yes— *No ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection S (p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ YesIo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
I❑ No )a 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
ViNo ❑ 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 ElNA ❑ NE
through a waste management or closure plan?
r_
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
22 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
Mo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s) 61151'ArO — , KIZL 06_ _RO 1 UOn ram —WQ
14. Do the receiving crops differ from those designated in the CAMP?
❑ Yes
19 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IN No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
MNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�9No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YiNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YE5 answers and/or any recommendations or any other comments.
Ilse drawiags of facility to better explain situations. (nse additional pages as necessary,):
r
Reviewer/inspector NameA-022-2-6_� Phone: 9iD 33oi�
�t
Reviewer/inspector Signature: Date: (w
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes INo ElNA [INE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather 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
tg-No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�jNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ON No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
V No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KI 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
kjNo
❑ 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
ER No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
C„No
❑ NA
❑ NE
Page 3 of 3 I2128104

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ORoukne O Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: S Q Alrrival Time: Departure Time: �County: 131(lde 1_ Region:
Farm Name: l,lX11'1 Nldllf Owner Email:
Owner Name: � � I-.�o � + ya
t d Phone: � � a I
Mailing Address: 31 tiq � `i _ p '- ub�i'k "h A% L ab 337
tt
Physical Address: p ,/,,�
Facilitv Contact: wt It ` Ilam ��`h Title: Phone No:Q0,0 :qa- `'7
Onsite Representative: U 11 Integrator: IVV
__�i _!
Certified Operator: IQQ �' Odd Operator Certification Number: 9`e�1A
Back-up Operator:
Location of Farm:
Design. ':Current
Swine 'Capacity.,Yopulation
❑ Wean to Finish
91 Wean to Feeder
Ej Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Ciits
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: == 6 Longitude: 0 0= s
Design Current
Wet Poultry Capacity Population
❑ La er
❑ Non -La er
Dry Poultry
Non-L;
Pullets
LJ Turkey Poults
❑ Other
Discharges & Stream Impacts
- Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Cu
Cattle Capacity Popt
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 Vq No ❑ NA El NE
❑ Yes
❑ No
10 NA
El NE
❑ Yes
❑ No
[PNA
❑ NE
P NA
❑ NE
❑ Yes
❑ No
❑ Yes
PNo
ElNA
ElNE
ElYes
�INo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NoNA ElNE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 S ructure 6
Identifier:
Spillway?:
Designed Freeboard (in):
it
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No El 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 ElNA ElNE
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
1PNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
71 No ElNA ElNE
(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 [IN E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
( No El NA ❑ NE
maintenance/improvement?
I
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Dd 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 El Application Outside
of Area
12. Crop type(s)
W EfY�Ai A &CMM6,S �SWI(U
/
&WV 09&Q
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�DNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
%No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
53No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[PDNo
❑ 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):
ReviewerAnspector Name Phone: 5!d Y.ZT33m
Reviewer/Inspector Signature:ZVLA_aP Date: 3D O%
12128104 Continued

Facility Number: — �p Date of Inspection 'S 07
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes FNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1PNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes '5) 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
In No
ElNA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
6No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R] No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
❑ NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
Q5 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ 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
K3 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
U9 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

B
0
Type of Visit: OrUompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:(} / Arrival Time: s eparture Time: ; t County: �. ,� Region: `
Farm Name: ���-� ����`��d-Y Owner Email:
v
Owner Name: _�D c4A:c- Phone:
Mailing Address:
Physical Address:
Facility Contact: _lam /',n=f Title:
Onsite Representative: ` j 't�
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator:it-
J- 7
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Design
Curren#
Design Current
'
Swine
Capacity Pop.
Wet Poultry
'Capacity
Pop.
Cattle
Capacity Pop.
�..,
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
1 jNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,oul .. °; ;MCa aci
P,o
Non -Dairy
qf
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Broad Cow
1'
Turke s
Other
Turkey Poults
Other
Other
Discharzes 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 Ug No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
1�"o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
,21,No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: - Date of Ins ection:
—j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®_No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
[] NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
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
ELNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
2,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
UNo
❑ 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 ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Eallo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes gjNo
❑ 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): _ mod-'
13. Soil Type(s): A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes K[ 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
S No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[allo
❑ NA
❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
allo
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
RNo
❑ 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
RNo
❑ 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
[allo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
InL No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

[Facility Number:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E,No
❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
allo
❑ 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
KNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Q 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 No ❑ NA ❑ NE
❑ Yes 50 No ❑ NA 0 NE
❑ Yes JKNo [DNA ❑ NE
❑ Yes Lallo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
[KNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
P No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
0,No
❑ NA
❑ NE
CL lGrt�T ���r'T� 1 z°' i I£�� �vt� PXc��lj ]•—��
Y
/ C d r
LetU� /`r 0
V f
C l
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Phone: �flJ 3�3-QJS/
Date:
21412015
Page 3 of 3

Type of Visit: Compliance Inspection Q 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: /�� Arrival Time: Departure Time: County: egion:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �i/z� t� / t�r7r`C� Title:
Onsite Representative: S�
Certified Operator:
Back-up Operator:
6!_� Phone:
Integrator:
Certification Number: i i l 070
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Wet Poultry
[Layer
INon-Layer
Design
Capacity
I
Urreni
Pop.
it
Cattle Capacity Pop.
IDairy Cow
Dairy Calf
can to Feeder
I
Feeder to Finish
D , P,oul
Layers
Design
Ca aci
Current
P.o
Dairy Heifer
Farrow to Wean
Farrow to Feeder
D Cow
Non -Dairy
r;
Farrow to Finish
Beef Stocker
Gilts
Boars
MOther
Non -Layers
Pullets
Turkeys
Turkey Poults
I
Beef Feeder
jBeef Brood Cow
-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 DWR)
❑ Yes ®'-No ❑ NA ❑ NE
[]Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes T2jNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

[Facility Number: Z7 - Date of Inspection: f'J/
Waste Collection & Treatment
,,4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA [3 NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: _
Designed Freeboard (in): ✓� _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes rNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes �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 V3-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes allo
❑ 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 tZ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[]Yes ffT-No
❑ NA
❑ NE
maintenance or improvement?
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 6 ' 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): /9_C 5_Z_e)
13. Soil Type(s): \Z
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
EgNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
F,,L;No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
f&No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
�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 O-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 ff .No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5§No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facilitv Number: - + Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ID —No
❑ NA ❑ NE
,25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
JZ'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
o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
J2--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 ®-No ❑ NA ❑ NE
❑ Yes Wno ❑ NA ❑ NE
❑ Yes P�,No ❑ NA ❑ NE
❑ Yes ERZNo ❑ NA ❑ NE
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 JZ�No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes J��o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinus of facility to better explain situations (use additional eases as necessarv). °
c
Sa L.s a ;btl —
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 97yvf-3° 3-0 f c-51
Date:
21412015

3
0
1
Date of Visit: I Arrival Time: '1� Departure Time: ,' S County: , Region: �1z_o
FarmName: Owner Email:
Owner Name: 'a-c-: G � %� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:--��,-�/� !7
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: �j`'rnr -dal
Certification Number: 1�7`1_>'p 11-70 _
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
FWean to Finish
La er
DairyCow
can to Feeder
-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Wurren
Dry Cow
Farrow to Feeder
a aci
R.6 .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turke Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
U No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[—]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
P-No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
r-No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

FaciliNumber: - Date of inspection -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes 0 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): 71
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [!.No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
allo
❑ 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
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[]Yes
[D No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance altematives that need
❑ Yes
S No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EjNo ❑ 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): ` e,/©C" rr�r7�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ES No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E[No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes [allo ❑ NA ❑ NE
[:]Yes [allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes gjNo ❑ 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 ED No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EjNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facility Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 2[ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ej No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[—]Yes allo ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes [2-No ❑ NA ❑ NE
❑ Yes B No
❑ Yes ® No
❑ Yes EC .No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Phone: %D 3jc t7
Date:
21412014

�A �,; ` ' ' Evi.-sign of Wa#er Resources
�, Facilaty�Number _ ,C� -- ® ®Division of Soil and Water Conservation
Q Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: a, routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: — Arrival Time: ; p Departure Time: County: Region: 147-- 0
Farm Name: Owner Email:
Owner Name: G -�-p�`sj Phone:
Mailing Address:
Physical Address:
Facility Contact: �� /Y Y �' �'!'!l��I`C� Title:Phone:
Onsite Representative: - lr..(� Integrator: Wl,t yy,T
Certified Operator: �7--� /yam_ Certification Number: 222070
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current Design Current
SwineCapacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish Layer DairyCow
Wean to Feeder
Non -La er
DairyCalf
Design Current
Dai Heifer
Cow
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D . P.oW . Ca aci P.o
La ers
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
-
O#her;
Turkey Poults
Other
Other
Discharges and Stream Imnacts
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 DWR)
[:]Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
JRLNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
[A No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facilit lumber: Z5F - V Date of Inspection: /1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA D NE
a. if yes, is waste level into the structural freeboard? [:]Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): - (�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 07 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[S No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
05-No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes L-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): /hzu ¢ / g u r7'-4 !
13. Soil Type(s):
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Pq No ❑ NA ❑ NE
15. Does the receiving crop an&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 0 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 0 No ❑ NA ❑ NE
❑ Yes 0 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 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[] Yes
ZNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
;�]_No
❑ NA ❑ NE
Page 2 of 3
21412014 Continued

lFaciHty Number: jDate of Inspection:
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 1Z No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes ®, No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes RNo ❑ 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes gNo ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
[:]Yes C&No ❑ NA ❑ NE
❑ Yes
�g No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
Ph
21412014

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: �utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1� - Arrival Time: C7 Departure Time: ; -70771 County Region:
Farm Name: .Az& d%1_5 Owner Email:
Owner Name: ��C ps^�j G / %T�X� Phone:
Mailing Address:
Physical Address:
Facility Contact: /'-7 �rrrd JWaerLT-- Title: Phone:
Onsite Representative: PCB_ Integrator: 'O'Y 174g
Certified Operator: 4f-�j"�a Al Certification Number: 2ZOO ;7 a
Back-up Operator: 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
O
—•o
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P.ou!
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
lBeef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream ImDBCts
i . Is any discharge observed from any part of the operation?
❑ Yes
[21 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
L&No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�allo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
❑NA ❑NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r�
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 ZLNo ❑ 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 [R] 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 K] 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 or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes nn;'j 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): • ��/ � �4 C/ ��"
13. Soil Type(s): A%14
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes Q 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 Enk
No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment`?
❑ Yes
�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® 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 1 ° Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
MNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C&No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Y Facility Number: - 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(cs) 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 [a No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [&No
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Comments (refer to question #): Explain any YES answers and/or any addi
Use drawings of facility to better explain situations (use additional nacres as
7�,-ewv� 3 { vi rulzj �'�- ,/—
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
recom
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 54 No ❑ NA ❑ NE
[:]Yes (ZNo ❑ NA ❑ NE
❑ Yes 2(No ❑ NA ❑ NE
❑ Yes 2&No [] NA ❑ NE
❑ Yes KNo
[:]Yes [�No
❑ Yes 0 No
ons or any other
❑NA ❑NE
❑NA FINE
❑ NA ❑ NE
comments.
Phone: 9JYhf3�'� 31}0
Date:
21412011

GOAS 3�'iJNtz i
ivision of Water Resources
Faciliit , uutber ©Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ®-Co-mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: c!d'xoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 3 Arrival Time: rl Departure Time: 1.O County: gi ud l Region: r_�:{ Z4D
Farm Name: G e �.P �[� `l Nu ✓Y Y✓"J Owner Email:
Owner Name: G -C L. /-4(( Phone:
Mailing Address:
Physical Address:
Facility Contact: Ct4yL ATi,,,..
Onsite Representative: t i Integrator:
Certified Operator: & V-10 L t Ltf
Back-up Operator:
Location of Farm:
Latitude -
Phone:
'F (3` s
Certification Number: 3 7Q 7 O
Certification Number:
Longitude:
Design Current Design Cnrrent
Swine Capacity Pop. Wet P,onitry Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Pap.
Dairy Cow
Wean to Feeder
f 1
Non -La er I
Dairy Calf
Feeder to Finish
Design Current
D Poulti. Ca aci P.o
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Daily
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood ("A —
Other
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
L Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes
[:]No
❑ Yes
❑ Yes
No
❑-1 A ❑ NE
Q'1\iA ❑ NE
'NNA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility Number: - �` Date of Inspection:
�Y
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3-i,M-
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[D-bLk-
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑,?4b
❑ 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
[Z[,dii
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4fi 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
[Bl�o
❑ 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
Q,Pto
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[DNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �io ❑ 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 Is Eta 0 _
13. Soil Type(s): rl Ne' r tru+ (4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ Wo ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes Q.No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 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?
❑ Yes [allo ❑ NA ❑ NE
❑ Yes [c] o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes �o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E j 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 [3No
❑ 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 �o
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 21412015 Continued

Facility Number: - Date of Inspection: v t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes OKo [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 21" 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?
D Yes
i
[]-No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
To
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
M' limo
❑ 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
I__I "'o
❑ 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
[�o
[DNA
❑ 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
[ErWo
[] NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3'10o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E3 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[g-K-o
❑ 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 additionalpages as necessary).
fog F K.0
cP7D
at 10-- 30 �- 6 k 5t
Reviewer/Inspector Name: �3[ L[ 1'3U
Phone:' t t O—q.33`3,334
Reviewer/Inspector Signature:
Page 3 of 3
Date: 13 ]ot,r ` D
21412015