090067_INSPECTIONS_20171231

G
4.,
Type of Visit 4P Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up 0 Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Z/ Og Arrival Time: .� M Departure Time: /D=/S County: Qa'9107 Region: FAV
Farm Name: Wr U1'f u� ''�i M Owner Email:
Owner Name: [� s s i I►'1S Phone: C//O/4401a —015
Mailing Address:
Physical Address:
Facility Contact: Po`el L_�v�� Title: Phone No:
Onsite Representative: Integrator:. _—
Certified Operator: Operator Certification Number:
I79.�6
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ e ❑ ' ❑ u Longitude: ❑ ° ❑ 1 ❑
Design C*urrent
Design Current Design Current
Swine
Capacity Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer ❑Dai Cow
Wean to Feeder
a38
❑Non -La er
❑Dai Calf
El Feeder to Finish
A
Dry Poultry
Dai Heifer
❑ Farrow to Wean
❑ D Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Layers
❑ Pullets
El Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Beef Brood Co
❑ Turkeys
Other
Turkey Points
Other
110 Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
V NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
1;9 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
J@ 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 adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
P6No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
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 Fyo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No WA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3,311
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes P 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 pNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes P9No ❑ NA ❑ NE
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Poriding ❑ 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 Acc��epjjtablle,, Crop Win//d''ttow�� [IEvidence of Wind Drift ❑ Outside of Area
12.
{{Appll�ic�a�ti�o-n
Crop type(s) L [ s- W �p'�'Mtq�a WHYS$ S.d( �h Ows,, f
13.
Soil type(s) ApK,Ctyn —Fy
l4.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
PC No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
[4 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
W No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
KNo
❑ NA ❑ NE
�t? tee... - .
Comments (refer to question #I) �tExplamy YESaaswersWand/or any recom.mendahans ar any other comments.
Use drawmgs of facility to4better explatn sttuahons. (usegaddthonal pages as9neeessary)
ReviewerA n spector Name �- Phone: O
Reviewer/Inspector Signature: Date: $
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 Rlo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes9No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ( No ❑ NA ❑ 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
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,M No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[6 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
BNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
91 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KI No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No.
❑ NA
❑ NE
I f 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? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Commentsiandlor Drswmgs: �q :F 4-
a
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
r Fft
Date of Visit: ArrivalTime: ff : �qw� Departure Time: Q ;DD(xw,, County: B n Region:
Farm Name: u} O Owner Email:
Owner Name: C✓ GQcJQn l &"rsPhone: '10 i 8``�
Mailing Address: �O VOX f� al �`[t'zgb •-lln�� NC 9,330 N) 6q!!;__gA01
t�
Physical Address:
Facility Contact: Title: Title: Phone No:
Onsite Representative: l integrator: MQArO�`f
Certified Operator: t 17Q� I Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = d =is Longitude: = ° = I = "
Design
C-urrent ...
DesignTC
urrent ,vT Design Current
Swine
Ca acizPo` elation R'et'Poultry
Cap'a
elation, Cattle Ga aci Po elation
P..:Rx,-..��.f P h' P
Wean to Finish
j Layer
Wean
B171
Non -La et
ss
Dry P
a
❑ La ers
`
❑ Non -Layers
❑ Pullets
T
4 Turkeys
Other_�o
e Poults
t[]OZer
❑ Other
Number of Structures:
to Feeder abo�
�
❑ Feeder to Finish
❑ Farrow to We
Discharges &Stream Impacts
1.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Cow
❑ Non -Dar
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Is any discharge observed from any part of the operation?
❑Yes
ANo
❑ NA
❑ NE
Discharge originated at: El Structure ❑Application Field El Other
a. was the conveyance man-made?
El Yes
❑ No
�,NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑Yes
❑ No
[� NA
1
❑ 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?
[I Yes
�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
�] No
❑ NA
❑ NE
other than from a discharge?
I2/.Z8/04
Continued

Facility Number: 9 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Ef No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Pp NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): F
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[� No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
I�B No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
W 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 A"lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
&No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
09 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) l L n .l Lm J a SsJ_ It [JI#.
13.
Soil type(s) f'nrh��D
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(SNo
❑ NA
❑ NE
15_
Does the receiving crop and/or land application site need improvement?
❑ Yes
F No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
F No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
P4 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ 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):
Reviewer/Inspector Name fik+-Mcwh e, Phone: `T/D 33r
Reviewer/Inspector Signature: Date: 0
12/28/0 L Continued

2Z
Facility Number: q — 7 Date of Inspection 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 appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ 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
[;R No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PSNo
❑ 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
OR No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
N No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
50 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
[:1 NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
V] 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
IV No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1 .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
55 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

"i
Type of Visit 42rfo-mmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance 1
Reason for Visit (! Koutine 0 Complaint o Follow up O Referral Q Emergency 0 Other ❑ Denied Access I
Date of Visit: © Arrival7
Time: a� Departure Time: LLL—=J County: 1'^— Region: EA C
Farm Name: C—Lw 1=,grlOu $-Ae-' Owner Email:
Owner Name: 7R ma:a4 0 r 1"_ _ Phone:
Mailing Address:
Physical Address: /J
Facility Contact: IT DM �l &-ViJ~"" Title: Phone No:
Onsite Representative: Integrator: / V_.v*
Certified Operator: —._� Operator Certification Number: Z �9S1:P
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ A ❑66 Longitude: ❑ ° = 6 =
ig
Design Current
Design Current
Design Current
Swine Capacity Populatian
Wet Poultry Capacity Population
Catkle Capacity Population
❑ Wean to Finish
I ❑ Layer
❑ Dairy Cow
ElWean to Feeder Q 30
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El Dry Cow
El Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers;
❑ Beef Stocker
Gilts
❑ Non -Layers
❑Beef Feeder
E01 Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
IM 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'?
Page 1 of 3
❑ Yes [M-No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[9No
❑ NA
❑ NE
❑ Yes
C No
❑ NA
❑ NE
12128104 Continued

+ Facility Number. — Date of Inspection (�
j Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
R1 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
KNo
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[W 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
IN No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
� No
El NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
MNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Q 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 types)jy���fjY�/_-�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LR No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 4No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes [9 No ❑ NA ❑ NE
17. Does the facility tack adequate acreage for land application? ❑ Yes RNo ❑ NA ❑ NE
1$_ Is there a lack of properly operating waste application equipment? ❑ Yes 19 No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recorn mendations or any other comet, n "
Use drawings of facility to better explain situations. (use additional pages as necessary):^
..
Reviewer/Inspector Name f.0 Phone:
Reviewer/Inspector Signature: Date: —!?
ruge a of .3 116/Lp1V1! I-Unisnuca

Facility Number: Date of Inspection`, rp
�i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes DINo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 19 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® 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
E4 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
tO 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
14 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
EANo
❑ 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
q No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C,No
❑ NA
❑ NE
Additional Comments apd/or.DrawWgs:
Page 3 of 3 12129104

Type of Visit (9tompliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit O Routine 0 Complaint Q Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: p Arrival Time: DU Departure Time: County:
Farm Name: Caw Ebid P1 LLr-!5 t°r' Y Owner Email:
Owner Name: �".s G o od n-V j5tF kY:3 Phone: g%d ���—�d�
Mailing Address: � P.;5yx la�� _ __ _ �L•; ;���/�c•�i� _A4-. �37
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: , X 9'h
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish i
93-wean to Feeder 24,00 Ii
i
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts 4
❑ Boars
Other
❑ Other '
Region: !.20-
Phone No:
Integrator r
Operator Certification Number:
Sack -up Certification Number:
Latitude: = c = 4 ❑ Longitude: = ° E—T = u
Design Current
Wet Poultry Capacity Population
❑ Laer
❑ Non-Layet
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current; .
Cattle. Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
E]Non-Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
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
0 No
❑ NA
❑ NE
�1
❑ Yes
(K No
❑ NA
❑ NE
,t
❑ Yes
g No
❑ NA
❑ NE
i
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
[;4 No
❑ NA
❑ NE
❑ Yes
ER No
❑ NA
❑ NE
12128104 Continued

Facility Number: �5i - Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
[:]Yes
®No
❑ NA ❑ NE
through a waste management or closure plan?
if any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
0 Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[0 No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
RNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
EX 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 ElApplication Outside of
Area
12. Crop type(s) r s�.s�ct �+� f
13. Soil type(s) I—Zt-4 j''peq,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
51No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[21No
❑ 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
N No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R9 No
❑ NA ❑ NE
0 W"f 1 V1 k`C -T-d CO v C r` ,b tic ✓-e- ow rct- &-kv 1_1� V D -k�
Reviewer/inspector Name Yv �` 7,��� Phone: 73
Reviewer/Inspector Signature: Date: D$'
12128104 Continued

Facility Number: Q — Date of inspection I /a-i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PlNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5�No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement'? If yes, check the appropriate box below. J9Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections DO Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
(0 No
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
P"Yes
El No
,❑lNNA
L9 NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
MW
Yes
®�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
JZYes
❑ No
29 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
fM 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
F;Z 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
Q No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/[nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
W No
❑ NA
❑ NE
�►ddi tiiioal Comments and/,orSDrawtngs y�.
. _' ., LL = r _•:;
Srk4 e trn-C i 5 cpit .5"rY-r
au�r �•K ry r�✓r>�
-toq Cd"ira4r- �'
-77
71Ym r'm �Yr S �. G1Orq S u� ✓may Y �` 4 �,.
12128104

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
Facility Number Date of Visit: Time: % A
O Not Oper2tiOU91 O Below Threshold
ja Permitted 01 Certified ([3 Conditionally Certified 13 Registered Date - Last Above Threshold:
Farm Name: �L CA i& If 11 s Yom•• 1� a r County:
_.5
i R+.*+
CC L
Owner Name: _ _1..� o v a' �1"^ j Phone No:.
Vladiag Address: _ P�Q a " a ;?L �--------
Facr3ity Contact:
Title:
Phone No:
Onsite Representative: , b . Integrator: r 19 eo ca r—.)
Certified Operator. _ ,� �iy... � b O �_g„ ra ,. _ _ Operator Certification Number: ,2!!1. 7 Z.Q4
Location of Farm:
L
14 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 Ou Longitude 6
DischarEes 8 Stream Inigacts
1. Is any discharge observed from any part of the operation? Yes o
Discharge originated at: 0 Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance roan -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 yes, notify DWQ)
P(Yes ❑ No
Yes ❑ No
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 E� No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): .3 O 0
12112103 Continued

Facility Number. —7 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ 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 nerd maintenance/improvement? ❑ Yes ❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
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 Pondwg ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crap type U�t/rruca!�a R r z Z Sr►,Q l l fa ru ;.y
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 ❑ No
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
Feld Copy ❑ Final Notes
�
L V"y +�1�4 rC
Vc-s+e—
�GfiL4J cr111"�vQNF.'�a6Jt_Ga+ti�CQ��xa
nrGjpe-c - c7CG�C
t�si`r�cp4i�Tjn
�
jt,. n �a -C. u.�,.� Gxp lo..P� �a �a p(A-t
.i -,-A r. G a G c:C Gy..
-LA- K D w c? S irate W : ► t .aV 1 -#•or-
r � Q � U r. a L Q � 4 i GC �!U G� � A'�C Ga L 'U �•.t o T K D � r � n^ � L 4'�` iw? � �t' :� 1 R "" 1�p t G-
e?oZS
Reviewer/Inspector Name <;
Reviewer/Inspector Signature:
Date:
12112103 A/ ' Confinued

-I Facility Number: -- G Date of Inspection M ,? lei
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
22. 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
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility.not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27. Did Reviewer/lnspeetor fail to discuss reviewlinspection with on -site representative?
❑ Yes
® No
28. Does facility require a follow-up visit by same agency?
Yes
❑ No
29_ Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
[I No
31. If selected, did the facility fail to install and maintain raintmakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33_ Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit: Qtompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: l.' Departure Time: , fl County:
Farm Name: C,J ]� u fSr y _ Owner Email:
Owner Name: C 4' �fX�dc.-�- fdt/ tj Phone:
Mailing Address:
Physical Address:
Region: �xz)
Facility Contact: /�1t3n—pp��.-� Title: Qct,,.jjr Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: % %g
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current .
Swine Capacity Pap. Wet Poultry Capacity Pop.
Design
Cattle Capacity
Current
Pap.
Wean to Finish
Layer
I
ow
Wean to Feeder l7
Non -La er
I
alf
Feeder to Finish
Farrow to Wean
T
Design Current
I Ca aci Pao _.
Da' Heifer
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other
Pullets
I
Beef Brood Cow
Turke s
Turkey Poults
Other
Discharges and Stream Imaacts
1. Is any discharge observed from any part of the operation? ❑ Yes CR 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 [DNA ❑ NE
2. Is there evidence of past discharge from any part of the operation? ❑ Yes D? No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E& No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

` Facili Number: - Date of Ins ection:
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[LNo
❑ 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): 9-
Observed Freeboard (in): _b
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
fD No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
C No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Qff-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)
jo
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Aaolication
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 M 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): &/' wU? Z Q I/Z!V-
13_ Soil Type(s):-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes R) 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?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes Q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [K No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: -& Tj Date of Inspection: ,/ /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 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 [R No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document []Yes ®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
JANo
❑ 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
0 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
BNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
0 Yes
O No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[Z No
❑ NA
❑ NE
Comments (refer to, question #): Explain any YES answers and/or any. additional recommendations or any other comments-'
Use drawin2s_0'ifactlity to better.'egnlain situations fuse additional_naaes as necessarv). �.
ReviewedlnspectorName: 10— Phone: D J3-330'--)
Reviewer/Inspector Signature:
Page 3 of 3
Date: :z — /3-
2/4/2011

"i
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: — Arrival Time: dD Departure Time:. i = County: 25Lr,L Region: JZ
Farm Name: !1 ��t ��if tj 0 47 f PI Owner Email:
Owner Name: � p� '� eZc��l 3 . Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
&Dgpi,P,-..- Title: Ownel-
Integrator: 1W Lc
J4�er
Phone:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current_'
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop:
Cattle
Capacity Pop.
r
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Q
Non -La er
Dairy Calf
Feeder to Finish
- '� '
',
Dairy Heifer
Farrow to Wean
Design
Current """,
Cow
Narrow to Feeder
D Poll
Ca aci
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
t ` Gilts
Non -La ers
Beef Feeder
Boar"s
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
OtherjjrjOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [KNo DNA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes [—]No
❑ Yes [ No
[:]Yes No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ 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
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
D Yes
54No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[g No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[A No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Callo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ 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 /gym 4e[- /0V
13. Soil Type(s): %r e5T—?) .
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 53 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® 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?
Reauired 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
M 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
[@ No
❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [allo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - (p Date of Ins ection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes (3 No ❑ NA ❑ NE
' 25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [] Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [,;jD No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes CRNo ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes 0 No
❑ Yes [g No
[:]Yes [allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
( A. P... 3. Y._ Y ��
Comments. refer to uestion. Ex lain an YES answers and/or any additional recommendations or an other comments ; ,ed
Use,"irawin s of facility to better explain sstuati s (use additional paites as necessary).
Reviewer/Inspector Name:
Phone: / l D G{33`-3300
Reviewer/inspector Signature: I �^ Date: 1_7? _,Irl_�Z�FDZ3
Page 3 of 3 21412011

Fype of Visit: Urompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ' .3 Departure Time: ,qQ County: rt Region:
Farm Name: ���tJ�! X�-� yQr,.,�..1 Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:eo�wwr.,-- Title: Phone:
Onsite Representative: ;LEI& Integrator:
Certified Operator: Certification Number: /
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
D s�igii C►urrent
Wet Poultry Capacity Pop.
Design Current
C►attle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
/n
Non -La er
DairyCalf
DairyHeifer
Feeder to Finish
Design, C•urrent
Dry P,ault . Ca achy P.o
Farrow to Wean
D Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Gilts
Boars
Other
Beef Feeder
Beef Brood Cow
Pullets
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 2g 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)
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
[] Yes 21 No
❑ Yes R_No
❑ NA ❑ NE
j ❑ NE
❑ NA ❑ NE
Page 1 of'3 21412011 Continued

Facility Number: - 7 Date of Inspection:,:!Z-2_/24
Waste Collection & Treatment
t 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 l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f 9
Observed Freeboard (in): 0? Z
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
D 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
[X No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[g No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
MNo
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[R'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes rRNo ❑ 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):�+yfj,Y•�y�rl�fs/
13. Soil Type(s): l
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [K No ❑ NA ❑ NE
acres determination?
l7. Does the facility lack adequate acreage for land application?
❑ Yes
[3 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[g No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
rM 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 0 Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
N No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[X No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: 9L- Date of Inspection: r/ 2-
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 0 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 CgNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [ff No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes 25 No
❑ Yes rM No
❑ Yes 5?.No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to,�questtott Explain any YES answers,and/or'any additional reCoriiiuendahonstor any other commeiit`s.
� ... —sr.. !: �1�b1., .. ': .� '.,'
Use drawings of Facili to better.:ex lain°s�tuahonsy use additional' a es as necessa
g tY, p ( P g
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �p 3SZ)C�
Date: ,=?
21412011

Type of Visit '0 Compliance Inspection 0 Operation Review U Structure Evaluation 0 Technical Assistance
Reason for Visit l3Ffoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /l Arrival Time:
y $� D C7 Departure Time: l7 `• County: gYNiolr-- Region:
Farm Name: t ptt.) N 11t i��C�"`> Owner Email:
Owner Name:wQ "'j Phone:
Mailing Address:
Physical Address:
Facility Contact: A2r)jv i, A- 6ma-1 -- Title: j L1 l,OtYf Phone No:
Onsite Representative: 51- Integrator:
Certified Operator, S'er_� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e 0 A Q it Longitude: = ° 0 f = "
DesignEAMMUM Current
Design Current
rr Design Cuent
Capacity Population
Wet Poultry
Capacity Population
Cattle Capacity Population
ish
TFeeder
PQ
❑ Layer
Dairy Cow
eder
I0
❑ Non -Layer
❑ DairyCalf
nish
El Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
Non -Daily
ElFarrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
MTo
❑ 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
MNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — 6 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes B-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /19
Observed Freeboard (in): 4Z 7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes t,No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [0 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 E9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
91 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 [:1 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
k] 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 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
14 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[KNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
R No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
W No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
10 No
❑ NA ❑ NE
V211, ea4�r '-- b-Z)�1�
Reviewer/Inspector Name �-r" �"_ j Phone:O_O
Reviewer/Inspector Signature: Date: -d II
rage -, of s 1Z1'Z6/u4 i,onunuea

Facility Number: —[, Date of Inspection `
Required Records & Documents
19. Did the facility fail to have 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 &No ❑ NA ❑ NE
the appropirate box. ❑ W UP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes R�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
Jallo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0,No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
19Yes
Oo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[' No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
5,No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
10 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
0 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
MNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
V.No
❑ NA
❑ NE
Addifaona —Comments andlor Drawings:... < .: .*
�' -DrQ: , 'T'j \_ C pr� D
Page 3 of 3 12128104

ivision of Water Quality �� ' `- �` � �
11F.7R1ff'yh:uMWer 67 oil and Water conservation cI
Q Other Agency
Type of Visit fp'GOmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 01 outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -'u- D Arrival Time: e7 i> Departure Time: 1 p County: Region:: 1'
Farm Name: COW 'FDfj IQ V [firy2+4 Owner Email:
Owner Name: C — r►►'t _, Phone:
Mailing Address:
Physical Address:
Facility Contact: �„ a �K— Title:Phone No:
Onsite Representative: LZ� ,9d,- I,--' Integrator: /W a
Certified Operator: +'1a2d &200dfw Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =o = 6 =16 Longitude: = 0 0 1 = u
Design Cnrreut
Swine �C•apacity P,�pul�att'o�ny
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
�Po
ent
WetfflP&Uii1.fr._U�Y@ap�2cijy
❑ La er
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf j
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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 RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[&No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
12128104 Continued

Facility Number: q— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
R[Vo
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard'?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure .1
Structure
j;
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
&4No
❑ 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
X No
❑ NA
❑ NE
8. Do any of the stuctures 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
E2�No
❑ NA
❑ NE
maintenance or improvement?
Waste_A-Pplicaiion
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [SNo ❑ NA ❑ NE
maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. RYes ®�'❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
B PAN ❑ PAN > l0% or 10 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) -A-rnu
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes LgNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 0-Yes Wo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes L�; No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
19. Is there a lack of properly operating waste application equipment?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes E�NO ❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
dY GIJaS C'` macacc
q5b V ✓—%-
7/L?e,% 3 2l [ r Lol ewyr- ���'c'�'--� �wa� by v'Z
Reviewer/Inspector Name � Phone:
Reviewer/Inspector Signature: Date: Lf / D
I1aavu4 [.onnnuea

Facility Number: -(9 Date of Inspection S '77[
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2[No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EINo ❑ 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
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® 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
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
tA 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
ER 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
EQ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
moll'•
I2a&04

0 Division of Water Quality
I.Facility Number d 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 *Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
CS
Arrival Time: Departure Time: ® County: 0")F-4 Region:
Physical Address: i
Facility Contact: � "—Title:
H
Onsite Representative:
it
Certified Operator:
Owner Email:
Phone:
Phone No:
Integrator• WI' 1 uj�
Operator Certification Number: j jqg
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = o ❑ i Longitude: ❑ ° ❑ 1
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
Wean to Feeder L9Q 2od0
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other.
❑ Other
PEOLa er
Non -La et
DryPoultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharzes & 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?
Cattle
r4..
Design Current >
Capacity Population :s
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowf
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 �No ❑ NA ❑ NE
❑ Yes
❑ No
NA
T
❑ NE
❑ Yes
❑ No
�NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
EkNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 9 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No t NA El NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 5 cture 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 220y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0No '❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes c'ZIo El NA El 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
F No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
jNo
❑ 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
Pl No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? 1f 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Ev 4cnce of Wind Drift ❑ Application Outside of Area
12. Crop type(s) i( �Yu�(p Tf - Q S►►'L'i 6ra' S'1 1 wsr-
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
`P'' No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
ERNo
❑ NA
❑ NE
W Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
ONo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
§lNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E�No
❑ NA
❑ NE
ll
-anyj=essaitions ry}:ornhrmmtipamaES answdrecommendComYe--rnstr#oien#E
Y tlt .
dtytoNterpls�tUaueda'
3Usedrwingf facm nlIpagesas necoy
CodrJ ffI f\ ^
�a/} /'� _ t j �/ 1 e � ,, �{
T
Reviewer/Inspector Name — -�., Phone: 1/0-
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents ��,,yy
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes tj No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes -j4No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�&No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EjNo
ElNA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
El�
LTNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PO No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
19 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
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
MNo
❑ NA
ElNE
Page 3 of 3 12128104

ivisiou of Water Resources
Facility Numation
OO Other�Agency ..aW ..
Type of Visit:()Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 11 Arrival Time: ,t a Departure Time: County:Region: C
Farm Name: ac"Ar ( i�U d``Sr.� y �iZ.rii'L- Owner Email:
Owner Name: G hQ vl� �n Y C" : ro(I Phone:
Mailing Address:
Physical Address:
Facility Contact: / "'�I' J G-rojI. 4 Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design` Current Design Current
Svvme "
YIt
Capacity''
, s
Wet=Poultry Capacity Pop; Cates e, Capacity
Wean to Finish
1)
`DC-"
La er
Dairy Cow
Wean to Feeder
on -Layer
Dairy Calf
Feeder to FinishWD
', ';'
DairyHeifer
in1.1
Current
n:u,
1't�
Farrow to Wean
D Cow
to Feeder
D . Poulti , l'o .
1.Farrow
Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
1
Beef Feeder
i,•__
=gig
Boars
Pullets
Beef Brood Cow
Turkeys
a
, .
Other`=I
frurkey Poults
Other
FTOther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c_ What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [a-NS ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes D No [:]NA [:]NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ENo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes I__l 1Vo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection:
--1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑`Ko
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
D 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
E3 o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E] No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
es
❑ No
❑ 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
to
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [T No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):l%r S
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �lo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [a -Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes F7 "U ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[Df�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ED"'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 " Rainfal I Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? El Yes �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LJ 1"o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - & I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [jNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ o
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 B- o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E]"'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 the 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. �Io ❑ NA ❑ NE
❑ Yes [ETVo ❑ NA ❑ NE
❑ Yes [�'�lo ❑ NA ❑ NE
❑Yes F-jKo DNA ONE
❑ Yes
[3-1'Z-o
❑ NA
❑ NE
❑ Yes
❑r -No
❑ NA
❑ NE
❑ Yes
[ oo
❑ NA
❑ NE
Comments (refer.to question ; Explain any YES,answers andloi�any�additronal recornmendatrons or any other comments. su
Use drawings of facility to'bettefeinsiUti-'sdinonpl a�
jlJ�ccJ %-7011_•
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: 22v_ —_*5'0,J 1-j r,j j
Date:
21412015

f
61
Type of Visit: Q'Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 171toutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: / 0 Departure Time: ; County:
Farm'Name: �r►Dlo1 t'�i�/`5r-ry Owner Email:
Owner Name: G�j�,r%Y�� �a r/p�l �.-^— Phone:
Mailing Address:
Physical Address:
Region: .'_. D _
Facility Contact: Title: QWp— Phone:
Onsite Representative: J`�,,�� Integrator: . ' zv
Certified Operator: 5r—e—
Back-up Operator:
Location of Farm:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current.:°: = Design
Current
Design Current
,R
Swine
Capacity Pop.
Wet Poultry' Capacity
Pop.
Cattle " '' Capacity Pop.
We to Finish
Laver
Dai Cow
Wean to Feeder
a
Non -La er
I
f
Dairy Heifer
s
Feeder to Finish_
Farrow to Wean
Dry Cow
" Design Currenf
w
D poult Ca acit P`o ,
Farrow to Feeder
Non -Dairy
}'M
Farrow to Finish
La ers
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
FFl
Turke Poultser
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? (Ifyes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes � No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
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 � No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Ea No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili , Number: -
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):-----JW�
Observed Freeboard (in): _3
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
EFI.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
JZ.No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
JZ�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
P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
0 Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application`? If yes, check the appropriate box below. ❑ Yes F;1 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): C,4_ rSrYp�
13. Soil Type(s): Tl/,-., n�2
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E�jNo ❑ 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 allo ❑ 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 Callo ❑ NA ❑ NE
❑ Yes fiqNo ❑ 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 [Z 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 C, No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes [K No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes 53-No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

! Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E21,No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Eg-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 C, No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Z 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 2 No ❑ NA ❑ NE
❑ Yes ®. No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
®-No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:
Date:
21412015

A - � Other Ag- i
eQ ency
Type of Visit: om ance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: 7 Arrival Time: ! t) Departure Time: County: Region: �
Farm Name: O W ry 14 /Q u r Owner Email:
Owner Name: L��'1 Gt i^- r C ✓y®ems �- Phone:
Mailing Address:
Physical Address:
Facility Contact: r_ Uv1 �tii �,— Title: (9 Ct) tie r" Phone:
Onshe Representative: Integrator: 22
Certified Operator:-�� Certification Number: /��
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
C*urrent
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Da' Cow
Wean to Feeder
p'z(pQp
t7
Non -La er
Da' Calf
,mil(
Feeder to Finish
=
Design
Current
Da' Heifer
Farrow to Wean
Cow
Farrow to Feeder
D P,oultr
Ca act
P,o ,
Non -Dairy
Layers
Farrow to Finish
Beef Stacker
Gilts
Beef Feeder
Non -Layers
Boars
Pullets
Beef Brood Cow
Turkeys
=.
Uther
Turkey Poults
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes ®,No
0 Yes E&No
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
Page I of 3
21412014 Continued

Facifi Number: -Z,0 jDate of Inspection: — 3 /
Waste Collection & Treatment
l� 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RjNo ❑ NA
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): -
Observed Freeboard (in): 1'
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ NE
❑ NE
❑ Yes M No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[a 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
0No
❑ 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
� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ' ❑ Yes FZLNo ❑ 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 Wi//ndow% ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): l�iY°�?u d /�yt►r�Yr
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes -t&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 l.Z31No ❑ 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 [gN0 ❑ NA ❑ NE
❑ Yes RNo ❑ 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 MNo ❑ 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 7" t No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes m No
23. If selected, did the facility fail to install and maintain rairibreakers on irrigation equipment? [-]Yes E.No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

]Facility Number: IDate of Inspection:
,�4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes tg No ❑ NA ❑ NE
f125. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes FKLNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
P"'if i-e-
Reviewer/Inspector Name
Reviewer/Inspector Signature
Page 3 of 3
❑ Yes kQ No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes j2g-No ❑ NA ❑ NE
❑ Yes W] No ❑ NA ❑ NE
❑ Yes P No
[:]Yes Ea No
[-]Yes 10 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date: Sr/ / 6
21412014

Type of Visit: Q Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: - k Arrival Time: Departure Time: ' I- t) County:
Farm Name: COkJ �D0,01 Ncc/:fk__f y Piu-41,09-1— Owner Email:
Owner Name: CL &iot r_- gf*'� r ro ll (!;rz7o/e— Phone:
Mailing Address:
Physical Address:
Region: r-]� O
Facility Contact: �i�t�d'jD�Y� Title: Qt4,r'4 �� Phone:
Onsite Representative: Integrator:
Certified Operator: ,' .ems Certification Number: 17 /5 b
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Design Current
Eattle Capacity Pop.
Wean to Finish
La er1
1
Da' Cow
Wean to Feeder
GO
Non -La er
Dairy Calf
U
Feeder to Finish
Design Current
Dr.. Foul IRA P,o
Layers I
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
I
113eef Stacker
Gilts
Boars
Other
Other
Non -Layers
I
I Beef Feeder
Pullets
I
1%pf Brood Cow
Turkeys
Turkey Pouets
Other
Discharees and Stream Imuacts
1. Is any discharge observed from any part of the operation? ❑ Yes [?S No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) [:]Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[-]Yes [-]No
❑ Yes C-No
❑ Yes E�J_No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412014 Continued

r
[Facility Number: jDate of Inspection: !
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Jallo
❑ 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
KNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
ffj No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3-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): 3�,P;o-W41eL 10clr+-51-a
13. Soil Type(s): �`Z,T f/�H--
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 2!.No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes jZ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes JDNo [DNA ❑ 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 N No ❑ NA ❑ NE
❑ Yes D4No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �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 JEkNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [-]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

r
Facility Number: jDate of Inspection: f (o--
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P"o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
2& Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
2-No
❑ NA
❑ NE
❑ Yes
[&No
❑ NA
❑ NE
❑ Yes D, No ❑ NA ❑ NE
❑ Yes RA No ❑ NA ❑ NE
❑ Yes &o ❑ NA ❑ NE
❑ Yes a No
❑ Yes R No
[]Yes 5 No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comments .(re er to question+ ,):. Explain; any XES answers and/or any additional recommendations: or any outer comments'
Use drawings of facility to.betfer explain situations (use. additional pages as necessary).
Reviewer/Inspector Name: a e e-- f"e—
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Facility Numh6
-LT�ivision of V4'ater.Quahty ;"` � �;� f� x�s;�
.° � Dinsion,of So�l`and;Wateir Conservai�ttn -�-:�
x , ,
Type of Visit O'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Ql outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: l7 = 4f - v Arrival Time: t:? `- Departure Time: f3 County: -J--- Region: C�
Farm Name: �%t-}� 4 �Ij -'v'Yrrs" Owner Email:
Owner Name: t- �'�-- u rem Phone:
Mailing Address:
Physical Address:
Facility Contact: a - G � _ Title: a vi, r-�' — Phone No: _s ly - �� f
Onsite Representative: n� ` i ���G'it� �—� integrator: /mil u izlg:�z
Certified Operator: _ --�� t=CEi r s.1 Operator Certification Number: its
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = e = ' Longitude: = ° = [ ❑
.r Design a .Cnrr'ent t Design tCurrent y § r=tDesgn b Cnrt eats
j` .t : a -' ` 4 • zk i':L' -fi#.
~Srv1ne 'CapacityPopulation �'►'et Pgiiitry .Capacity Po}�ulahon YCaftie ` Y�srtwCapacrty Population
❑ Wean to Finish
Wean to Feeder
cz, C,
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Other
JLJ Non -Layer 1 f
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
'
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance elan -made?
❑
Dairy Cow
❑
Dairy Calf
❑
Dai Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
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 [KNo ❑ NA ❑ NE
El Yes
El No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
4,No
❑ NA
❑ NE
12128104 Continued

Facility Number: 1— — (�; Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
R,No
0 NA
El NE
a. If yes, is waste level into the structural freeboard?
[] Yes
❑ No
❑ NA
D NE
Structure I Structure 2 Structure: 3 Structure'l
Structure
titructure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): rJ�r `' tom:`" t d• 6t'�- g ; r�ltc : Try
r it ;'� i
1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
D� 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
F24No
❑ 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
I No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
F;7, 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
O-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
LgNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. SlYes 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
fi f
12. Crop type(s) e,-j4V-c
13. Soil type(s) _ a'1`n
TS
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes O-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? 2�Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes n No ❑ NA 0 NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ®.,No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? [f Yes Flo ❑ 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):
Reviewer/inspector Name Phone:
Reviewer/inspector Signature: _} Date:
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage &: Permit readily available? ❑ Yes O No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes FjNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[,No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® 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
�A 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
0 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
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
D9 No
❑ NA
❑ NE
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