090072_INSPECTIONS_20171231

type or visit: Ly-compitance inspection v operation Kevtew V structure Evacuation tj iecnmcat Assistance
Reason for Visit: 04 routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �� Arrival Time: o K s Departure Time: / 4 0 County: ` e- Ok Region:
Farm Name: ,�'0A, 4,`V>!^ A�aI/,SC✓� Owner Email:
Owner Name: _ e v cy`a < y -C TC ✓'S bQ� Phone:
Mailing Address:
Physical Address:
Facility Contact: C tt o+15 ��j ar/`GJ; Title: Phone:
Onsite Representative: t( JJ Integrator: =
Certified Operator: 1( �Cr �e,C t'�l t�1 Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
fiwine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish La er Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
o0
6 asI lNon-Layer
I
EE
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oul Ca aci P,o
ILavers
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [n` o ❑ NA ❑ NE
[:]Yes [—]No [] NA ❑ NE
[—]Yes [::]No [3NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑-1`lo
❑ Yes dNo
[] NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili ,Number: Ci - JDate of Inspection: i,43
Waste Collection & Treatment
4. lY storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M_Ne-❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No Q- IC ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): d
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[tom ❑ 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
[D-Ko— ❑ 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
❑-I o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2[jblo- ❑ 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
[3-1qo ❑ 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 [: 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): CL3 /[,JP SG a C-6Z
13. Soil Type(s): U V
T _
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D<o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EKo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FJINo
❑ NA
❑ NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
to
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ r o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers S"No
on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili umber: - Z Date of [ns ection: oc
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®.Ala- ❑ NA ❑ NE
25. A the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e_, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [Zj_Ni6-_ ❑ NA ❑ NE
❑Yes �i —❑NA ❑NE
❑ Yes Ql>e,- ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
❑ Yes D-15-65 ❑ NA ❑ NE
❑ Yes [114W- ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes © oo l ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No 0 NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [r-No ❑ NA ❑ NE
j===MQ=Ei_vSC&YMES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better expiain situatipns (use additional pages as necessa ,).
{._iOc rr b It 4f10.tl �' l S ( � J �c_ �v� y �� �z~✓� S r a -t ��-3I ;�
! J' VjA
j I(Vin
c,d 9(o- 3 o&- 6 (�-s
Reviewer/Inspector Name: } t
Reviewer/Inspector Signature: I
Page 3 of 3
Phone: I r O - q'3 3-
Date: 13
214YI2015

a i nn s 15 M.., V 7 i30
�•• Divtston�of Water Resources
�'"�Facility ir'umber .:- z, O+ Division of Soil and Water Conservation
Other Agency
Type of Visit: ()-,Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (3R'outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 2 Departure Time: 3 O County:
Farm Name: Sp� C4't'lJ`- f� u✓r`` y _ Owner Email: CA
Owner Name: e41 v-vt C ✓-l1 -'-e YVrJ 1 Phone:
Mailing Address:
Physical Address:
Facility Contact: C ,, `�t }'�JLV FCk Title: Phone:
Onsite Representative: [
Certified Operator: K ly ka, { E uA
Back-up Operator:
Location of Farm:
Latitude:
Region:
Integrator:
Certification Number: �(l,- d 0 1�
Certification Number:
Longitude:
Design Current Design Current
-.: Design Current
apacityPo. Wet Poultry Capacity Pop.
Cattle '; = Capaci
Finisb La cr
Dairy Cow
Feeder
rFe
t�U y
Nan -La er
Dai Calf
o Finish
-i ..
Dai Heifer
to Wean
Design Current
D , Cow
to Feeder
Dry Paultiy Ga aci P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
TurkeyPoults
Other
Other
Discharges and Stream Imuacts
1. Is any discharge observed from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other_
a. Was the conveyance man-made?
❑ Yes
❑ No
[JNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
I__J NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system'? (If yes, notify DWR)
❑ Yes
❑ No
[J 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
E�fNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - -7 Date of Ins ection:
Waste Collection & Treatment
Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): z 5
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[/] No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Oo
❑ 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 F PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window p`[] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): — L N, �'`"'t�[r S C, lj N. [f, � cly_B - — — —
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application'?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
Ej'*No
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
L3"7qo
❑ NA
❑ NE
❑ Yes L3 "'o ❑ NA ❑ NE
❑ Yes EEI<o ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ WUP El Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑Yes [] o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [FNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Fa0lity Number: jDate of Inspection:
24' Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
A Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [],No"' ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [] Yes [3 1" ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes to ❑ 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 �lo ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes 0'No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes LG"'o ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes [] No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E21 No ❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or°any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
r ( �I �j �c E' ruC � 1
AI a�t,14 opt— l
C Y
C el ?A,-
Reviewer/Inspector Name: 1 1 ! U kk
Phone I to --al
C
Reviewer/Inspector Signature: I L LLti
Date:
Page 3 of 3
2/4/201

M c
0 r dFA
type of visit: yd-campu cc inspection v uperanon meview v structure r vaivanon tJ t ecnntcat Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ` Arrival Time: f Departure Time: i County:
Farm Name: �e Owner Email:
Owner Name: �� Phone:
Mailing Address:
Physical Address:
Facility Contact: Erc Title: Phone:
Onsite Representative: (4 Integrator: wt. ( `J
Certified Operator: _& ( g �,�,� c.J_ _ Certification Number: A011al
6
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Regi41 —
Design Current
Design
Current
Design C•urretrt
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
[Layer
DairV Cow
Wean to Feeder B--
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D . iPoul
Ca I!'
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [(Ko- 0 NA ❑ NE
❑ Yes [:]No [:�NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [—]Yes [] No Eg-NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes 0 No E 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 ZIO'No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: - ( Z Date of Inspection: 9 p/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑-Ne---❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No [3-iv_❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z- _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes U4*Vo ❑ 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 �o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[2 `""
D NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
L2 1Ro
❑ 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
El"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
/
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�1 ""
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ej`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 pI❑ Evidence of Wind Driif�t D Application Outside of Approved Area
12. Crop Type(s): G _ jg7lD
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [;'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes gT'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 [2No ❑ NA ❑ NE
❑ Yes [D'No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[—]Yes
[ENo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[::]Yes
[5No
❑ 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
E2-'!�o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yicld ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[-]Yes
No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facili Number: -7 Date of Inspection: /
24'Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ 0 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑'Ro ❑ 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
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?
&'�66A' �
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ErNo
❑ Yes EfNo
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes 2fNo ❑ NA ❑ NE
❑ Yes E�/No ❑ NA ❑ NE
❑ Yes [�lo ❑ NA ❑ NE
❑ Yes ET'No
❑ Yes [;�No
❑ Yes &No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone: k3` .3 J
Date: 1
21412011

Type of Visit: moCompliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q<Outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time• Departure Time: County: Region: /Zo
Farm Name: sO4� TZ t'w'— tv trot-ql Owner Email:
Owner Name: Gj tzj 1 "-^"- Phone:
Mailing Address:
Physical Address:
Facility Contact: tom, �,,Fy� 1Jl:: tVW V Title: Phone:
Onsite Representative: Integrator:
Certified Operator: 6 W J ti((> C�
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
It
Design
CIt urrent
Design Current
Swine
Capacity Pop.
Ouui
Capacity
Pop.
Cattle Capacity PopiE
Wean to Finish
Layer
Dairy Caw
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
"° v 1
Dairy Heifer
Farrow to Wean
'`
Design
Current
Dry Cow
Farrow to Feeder
it
P,o .
Non -Dairy
Farrow to Finish
JLayers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
MI 113eef
Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[g'Na
❑ 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
Q A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
© NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

S
Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EJ_Nu---❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No O-N — ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): iLk
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 'E3--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 [ o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �o ❑ NA ❑ NE
S. 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 [E'hfo ❑ 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 ON ❑ 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):
ev "t� C- �
(U-_.
C
13. Soil Type(s): _G ✓ _ /
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q;io ❑ NA D NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ N5 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes Q No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes !!J <o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No 0 NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [i] 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 1� 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 n No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rambreakers on irrigation equipment? ❑ Yes �o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

,A�r.r..�
. NCDEINR
North Carolina Department of Environment and Natural
Pat McCrory
Governor
Nash Johnson
South River Nursery
P. O. Box 25
Clinton, NC 28329
Dear Nash Johnson:
May 18, 2015
Resourc
RECEiVED1DENPOWR
VftrQuWyRe*nat
MAY 2 1 ZZ
Donald R. van der Vaart
Secretary
Subject: Certificate of Coverage No. AWS090072
South River Nursery
Swine Waste Collection, Treatment,
Storage and Application System
Bladen County
In accordance. with your Notification of Change of Ownership received May 14, 2015, we are hereby
forwarding to you this Certificate of Coverage (COC) issued to Nash Johnson, authorizing the operation
of the subject animal waste -management system in accordance with General Permit AWG100000.
This approval shall consist of the operation of this system including, but not limited to, the management
and land application of animal waste as specified in the facility's Certified Animal Waste Management
Plan (CAWMP) for South River Nursery, located in Bladen County, with a swine animal capacity of no
greater than the following annual averages:
Wean to Finish: Feeder to Finish: Boar/Stud:
Wean to Feeder: 2600 .Farrow to Wean: Gilts:
Farrow to Finish: Farrow to Feeder: Other:
If this is a Farrow to Wean or Farrow to Feeder operation, there may be one boar for each 15 sows. Where
boars are unnecessary, they may be replaced by an equivalent number of sows. Any of the sows may be
replaced by gilts at a rate of 4 gilts for every 3 sows.
This COC shall be effective from the date of issuance until September 30, 2019, and shall hereby void
Certificate of Coverage Number AWS090072 dated. October 1, 2014. Pursuant to this COC, you are
authorized and required to operate the system in conformity with the conditions and limitations as
specified in the General Permit, the facility's CAWMP, and this COC. An adequate system foi collecting
and maintaining the required monitoring data and operational information must be established for this
facility. Any increase in waste production greater than the certified design capacity or increase in number
of animals authorized by this COC (as provided above) will require a modification to the CAWMP and
this COC and must be completed prior to actual increase in either wastewater flow or number of animals.
Please read this COC and the enclosed State General Permit carefully. Please pay careful attention to the
record keeping and monitoring conditions in this permit. Record keeping forms are unchanged with this
General Permit. Please continue to use the same record keeping forms.
If your Waste Utilization Plan (WUP) has been developed based on site -specific information, careful
evaluation of future samples is necessary. Should your records show that the current WUP is inaccurate
you will need to have a new WUP developed.
The issuance of thi's COC does not excuse the Permittee from the obligation to comply with all applicable
laws, rules, standards, and ordinances (local, state, and federal), nor does issuance of a COC to operate
under this permit convey any property rights in either real or personal property.
1636 Mail Service Center, Raleigh, North Carolina 27699-1636
Phone: [phone] \ Internet: http:/AvvW.ncwater.org
An Eouat Ouoortunity 1 Affirmative Action Emolnver — Made in oars by recycled oaoer

Per MRCS standards a 100-foot separation shall be maintained between water supply wells and any
lagoon, storage pond, or any wetted area of a spray field.
Please be advised that any violation of the terms and conditions specified in this COC, the General Permit
or the CAWMP may result in the revocation of this COC, or penalties in accordance with NCGS 143-
215.6A through 143-215.6C including civil penalties, criminal penalties, and injunctive relief.
If any parts, requirements, or limitations contained in this COC are unacceptable, you have the right to
apply for an individual permit by contacting the Animal Feeding Operations Program for information on
this process. Unless such a request is made within 30 days, this COC shall be final and binding.
In accordance with Condition 11.22 of the General Permit, waste application shall cease within four (4)
hours of the time that the National Weather Service issues a Hurricane Warning, Tropical Storm Warning,
or a Flood Watch associated with a tropical system for the county in which the facility is located. You
may find detailed watch/warning information for your county by calling the Wilmington, NC National
Weather Service office at [phone], or by visiting their website at: http://www.weather.gov/iIm/
This facility is located in a county covered by our Fayetteville Regional Office. The Regional Office staff
may be reached at 910-433-3300. If you need additional information concerning this COC or the General
Permit, please contact the Animal Feeding Operations Program staff at [phone].
Sincerely,
ft)�' 3.
Gd*
for S. Jay Zimmerman, P.G.
Director, Division of Water Resources
Enclosure (General Permit AWG 100000)
cc: (Certificate of Coverage only for all ces)
yettevtllerRegional Office, Water Quality Regional Operations Section
aden County Health Department
Bladen County Soil and Water Conservation District
WQROS Central Files (Permit No. AWS090072)
Murphy -Brown LLC

I
r I
F cifi Number: tf- Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [! go
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes [2-14o
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
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)
[] NA NE
[] NA NE
Yes �o NA ❑ NE
❑ Yes 014o_ ❑ NA ❑ NE
Yes LQ 1`"' NA ❑ NE
Yes [] No NA NE
❑ Yes [''NNo ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. Yes
C Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW?"? EJ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? C] Yes
34. Does the facility require a follow-up visit by the same agency? Yes
omments (refer to�quesdon ff): F.xvWn any
CAj c (1_ t6� _ I q
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
nes as necessan
L_J No
NA
❑ NE
ffNo
NA
F] NE
[/3 No
NA
Ej NE
ONo
NA
NE
Phone:
Date:
21412014

was
Type of Visit: (Or7Routiqe
Hance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: v Region:
Farm Name: .57�� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: a ,,'-41 o0oc 1 [(J 1. Title: �—�L.� Phone:
Onsite Representative: 't Integrator: fil t<
Certified Operator: Certification Number: /_7 [ J
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Cnrrent
Swine Capacity Pap.
Design Cffirre.n,
Wet Poultry @opacity
NDesign Gnrrent
Cattle Capacity Pop.
Finish
La er
DairyCow
Feeder
Non -La er
Dai Calf
Finish
DairyHeifer
o Wean
o Feeder
Design Current
D , P,ou! _ Ca aci P,o
D Cow
Non -Doi
P�eanF
o Finish
La ers
Non -La ers
Beef Stocker
Beef Feeder
Pullets
Turke Poults
Other
Beef Brood Cow
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
Z.,M� NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[D�NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[][IA
❑ 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
[ 11"
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
0 NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
0 Yes
9No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

FaciliNumber: L- Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
I — ❑NA ❑NE
❑ No Ea -NA ❑ NE
Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [2]Y . 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 Nc ___[:] 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
� ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q 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
❑,Nv--_❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E]_Va,— ❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D T ❑ 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 ❑ Iic tion Outside of Approved Area
12. Crop Type(s): ,: �� G V YW '�`C
13. Sol] Type(s): 0 or K
f
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ggN.o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ea'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[21No
❑ 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
g3No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
,__,�
❑ Yes [E o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes tla""
❑ 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 [25-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
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes❑
VNo
NA
❑ NE
Page 2 of 3 21412011 Continued

1
Facility Number: - Date of Ins ectio .
.s
24. Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes
EL-ble— 0 NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑LN6"' 0 NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 0 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
Ogl o ❑ 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?
6 -��C , I k 'I.,
0 PL
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes [I -No ❑ NA ❑ NE
❑ Yes E2pble ❑ NA ❑ NE
❑ Yes e,ele_ e ❑ NA ❑ NE
❑ Yes [R<o ❑ NA ❑ NE
❑ Yes �To ❑ NA ❑ NE
❑ Yes YNo ❑ NA ❑ NE
❑ Yes [210ONo 0 NA ❑ NE
Phorfe:` b � 1 JV
D P
21412011

t
Type of Visit: compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0-1 outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 3`! Arrival Time: : aD Departure Time: �� County:i9a2eera-~ Region:
OrFarm Name:1 <<!c/ �ut/,1 Owner Email:
Owner Name: 'd,�(,t.rc( Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: :r integrator-lrvr��
Certified Operator: ��X /�j�dul�rr� Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current
Design
Current
Design Current
Swine =Capacity
Pop.
Wet Poultry '
Cap'ac�ity:
Pop.
Cattle Capacity Pap.
Wean to Finish
I
La er
JNon-Layer
I
I
Dairy Cow
Wean to Feeder
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
©. I'oult
Ga aci
1'0 P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other -
Turkey Poults
Other
Other
Discharges and Stream Imoacts
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 3-No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
IN No
❑ NA
❑ NE
[:]Yes
E,No
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: - jDate of Inspection: —3
Waste Collection & Treatment
4. Is storage capacity structural plus storm storage plus heavy rainfall less than adequate? Yes No NA NE
g P ty ( P g P �'Y ) q ❑ � ❑ ❑
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): J �}
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes � No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes PR No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ® No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes [KNo ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes [B 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 QNo ❑ 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): Gpl/1 �GcJ� / 0 . s `;iw,. / ZW `l`lW__/_X-1_Aw&
i
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes gNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes fallo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [B-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(&No
❑ NA
❑ NE
Re uired 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
Q No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes ES -No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date ofinspection: — j3
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 [a No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes .2 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes My No
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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes [gNo ❑ NA ❑ NE
❑ Yes 2q No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [& No ❑ NA ❑ NE
❑ Yes No
❑ Yes ® No
[:]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: /Q LJ-33aQ
Date: ^ '- 3 �{�
21412011

Type of Visit: Q<ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01, routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 7 ��- Arrival Time: D' OD Departure Time: r County: Region: f�a
Farm Name: gve-'I- Owner Email:
Owner Name:—r�y,k� f,�/ jQ�� Phone:
110,
Mailing Address:
Physical Address:
Facility Contact: WAIV _ �cAJ Z PA Title: AW-nr l'
Onsite Representative: W%43G( 4ed Integrator:
Phone: Gcr-
Certified Operator: Say--'�� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
5w'trie
Capacity Pop.
Wet Poultry
Cap ity
Poi.
Cattle Capacity Pap.
Wcan to Finish
Layer
DairyCow
Wean to Feeder
Feeder to Finish
O
Non -La er
#°:"'
Design
Current
Dai Calf
Dai Heifer
Cow
Farrow to Wean
Farrow to Feeder
D . 1?oult ,
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0-No ❑ NA ❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
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
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: 9- Date of Inspection: p"
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes g] No [] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J. No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 01 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes n No
❑ NA
❑ NE
8_ Do any of the structures lack adequate markers as required by the permit? ❑ Yes RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes CK No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 4!�,No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes KNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drift+ ❑ Application Outside of Approved Area
%Window
12. Crop Type(s): JeIX0441I �!/A� ��� /ii� f1 CD/�t �t rt� ifi>•a.t s l �n�.L�(9�Ez+`h
-�ri!SGt(
r
13. Soil Type(s): T ]jp k
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 5E-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E. No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E -No ❑ NA ❑ NE
acres determination?
IT 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
fig No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E[ No
❑ 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 appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. C] Yes 10 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [[ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes MNo
❑NA []NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

X
Facilitv Number: IDateof Inspection: 3D—�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �Z No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [&No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes � No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than nonnal'I
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 GAWMP?
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?
.5WfF y l � or re-6"
l/ `"'� r
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes 5e No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes ®.. No ❑ NA ❑ NE
[:]Yes ® No
❑ Yes No
[:]Yes � No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: %-.�"-33Cw--
Date: !l
21412011

Ll
Type of Visit C}Compliance Inspection O Operation Review C) Structure Evaluation O Technical Assistance
Reason for Visit 42rRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ` Departure Time: County: Region:
Farm Name: `d Owner Email:
Owner Name: t��G �. vw Phone:
Mailing Address:
Physical Address: //LL
Facility Contact: � i�� s J2 Title: �CU�7 �/' Phone No:
Onsite Representative: ��Integrator: AWLz1W,4
Certified Operator: ,� _ Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = ` = Longitude: = ° = ' =
Design Current
Design Current
Design Current
5vvine
Capacity Population
Wet Poultry Cap city y"Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dairy Cow
Weanto Feeder
O W
❑Non -La er
❑Dairy Calf
❑ Feeder to Finish
f
❑Dairy Heifer
❑ Farrow to Wean
5" a
Dry Poultry k*
❑ Dry Cow
ElFarrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
El Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
B
❑Boars
El Pullets
❑Beef Brood Co
-
❑ Turkeys
Other
_
-'
❑ TurkeyPoults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
9INo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
L 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
F&No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[ANo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection
I Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes P -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): o`er
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ yes ONo
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes R No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes A No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ®,No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes RNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes KNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes BNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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) / w r
i
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
acre determination?❑ yes
SNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
®.No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
®.No
❑ NA
❑ NE
jop�qe_ ay.-W ade d—
Reviewer/Inspector NamePhone:
Reviewer/Inspector Signature: Date:
Page 2 of J 11/l5/U4 4onnnued

Facility Number: -- 7 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ®No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes BNo ❑ NA ❑ NE
the appropirate box. ❑ WUp [] Checklists ❑ Desig
n ❑ Maps p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ZYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ SoiI Analysis ❑ Waste Transfers ❑ Annual Certification
[:]Rainfall ❑ Stocking ❑ Crop Yield R120 Minute Inspections ❑ Monthly and V Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 9No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [$ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
®No
[INA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
allo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E]No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 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
EgNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E&No
❑ NA
❑ NE
I _W. - Q,� c , f
la Yr5 P& sm
Page 3 of 3 12128104

t
Facdity`Number O.Division of
- - w
Other.A.ge
Type of Visit Omd-ompliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 0 "One O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Dmc of 1'isil: c3 Q Arri►•al Time: I?: GV Departure rime: /dam: 0 M Countr
Harm Name: v / Owner Email:
OwnerName: Phone: _
Mailing Address:
Region:
Physical Address: �q r
Facility Contact: �/iJ /lam t[10 _ Title: 1y�1%� y __ _ _ - _ Phone No:
Onsite Representative: �5 �-*-�- Integrator: , f� ✓ �,p -
Certified Operator: Operator Certification Number: %/ 7
flock -up Operator: Bnek-up Certification ;lumber:
location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finisl
Gilts
Other
❑ Other
Latitude: ❑° ❑ T = N Longitude: Q° ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non —Layer
Dry Poultry
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: IT—]
b. Did the discharge reach waters of the State? (Ifyes, 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
JKNo
❑ NA
❑ NE'
❑ Yes
JgNo
❑ NA
❑ NE
1228104 Continued

Facility Numher: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes. is waste level into the structural freeboard?
Sinieture I Stnicture 2 Structure ? Structure 4
❑ Yes Cil--No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Ohsmed Freeboard (iny p21{
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
,;[ No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
ERNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑YesNo
❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
[�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
J-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)
13. Soil type(s) gip A-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�&No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CgNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
9No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
Cl Yes
_ANo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ 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):
f
Reviewer/Inspector Name Phone: h/3�-33 DD
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 E,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 El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Wcather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
O No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
allo
❑ 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
RNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ED No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Pallo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
I,.No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
B No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
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
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
1212&104

Q
Type of Visit QKompliance Inspection O Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit tontine O Complaint Q Follow up O Referral C) Emergency O Other ❑ Denied Access.
Date of Visit: Arrival Time: 3 ; Departure Time: s,'[YL7 County: Region:
Farm Name: J Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:Title:
Onsite Representative:`'°"
Certified Operator:
Back-up Operator:
Phone No:
Integrators^ f
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 6 = Longitude: = ° = + I --]"
,a
Design Design Current Design Current
Current =
-
Swtne ;yi Caat
p:.P�
Po ulation Wet Poultry„ Ca aci Po Mahon
p h p
Cattle y Capacity Population
❑ Wean to Finish
..:
❑ La er
❑Dai Cow
Wean to Feeder D
❑Non -La et
❑Dai Calf
❑Feeder to Finish'
❑Dairy Heifer
Farrow to Wean
❑ FWEl
=QryPou�li,
Dry Co,
❑ Farrow to Feeder
,: ,
7 ❑ Non-Daity
❑ Layers
p ❑ Farrow to Finish
w
❑ Non -Layers
❑ Beef Stocker
❑ Gifts
❑ Beef Feeder
❑Boars
El Pullets
P
❑ Beef Brood Cowl
5
.=
� ❑ Turkeys
❑ Turkey Poults I
❑Other
❑ Other
Numberof,Structures:
.
.w
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Q_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
(__1 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
SNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
JgNo
❑ NA
❑ NE
other than from a discharge'?
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): %g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes t? No ❑ NA ❑ NE
❑ Yes ❑ No Cl NA ❑ NE
Structure 5 Structure 6
❑ Yes &No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes OLNo ❑ 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 [ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need []Yes [NNo ❑ NA ❑ NE
maintenance/improvement?
]I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
f
Soil type(s)
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
LSNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
4 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
fK�No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name ` Phone: 2 --3�30
Reviewer/Inspector Signature: Date: 5 Z'y n9-

i Facility Number: — Date of Inspection — —a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ yes [&No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ ❑ Maps
Design
g p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22_
Did the facility fail to install and maintain a rain gauge?
❑ Yes
9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
S No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[A 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
ES 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? (iel 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
JKNo
❑ NA
❑ NE
Page 3 of 3 12128104

/-¢ wso9oo 7�
Type of Visit otnpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:Wr Arrival Time: !31a1 Departure Time r 32� County: ✓" Region: o
Farm Name: et/ I v Ur r V Owner Email:
Owner Name: cz, Phone:
Mailing Address: _%:'fir �rZ'G✓t a�r'4t° G �� «Gt/�ynd Iy�' • ��`�"I
V
Physical Address: ✓✓,,
Facility Contact: �prle_ lT�UAZed Title: Phone No:
Onsite Representative: Integrator:,U ✓
Certified Operator: e5�--^� Operator Certification Number: 1 7 9-54""
Back-up Operator: _ J �0✓� � cWQo-� Back-up Certification Number: 7 J�
Location of Farm: Latitude: e = = i{ Longitude: [� 0 = 6 0 fl
t
Design Culrrent,W
Swine Capacity Poptioet
Design Current
PoultryGap ty Population
Design Current
C+attle Omeity Population
❑ Wean to Finish
❑ Layer
❑ Daia Cow
Wean to Feeder O
Non -Layer
❑Dai Calf
❑ Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry,:x
❑ DEy Cow
❑ Farrow to Feeder
-
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
- — -
❑ Turkeys
Other -_
❑ Other
❑ Turkey Pouits
❑ Other
Number of Structures:
Discharp,es & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2, No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application I� icld ElOther
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'? (li-yes. notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
L,NO
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
(K No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

f
jFacility Number: 91-- Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[►No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
MNo
❑ NA ❑ NE
(ie/ iarge trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
RNo
❑ 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'?
Ryes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
gNo
❑ 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
R No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
'001No
❑ 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) N O "
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ERNo
.❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
RNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
JLNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
LgNo
❑ NA ❑ NE
C,d r,Q+ �� 4&f) Z
FReviewer/Inspector Name Jr � � � Phone: /Q1 3 -3"V
eviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

I
' I Facility Number: C?. —�� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [gNo ❑ 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 Cl Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? 1f yes, check the appropriate box below. 19 Yes ❑ No ❑ NA ❑ NE
N-Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield 9 120 Minute Inspections ❑ Monthly and V Rain inspections ® Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ESNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 9 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
0 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
ff No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ 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
[allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[A No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[KNo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit la -Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O<Lutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
&IdDate of Visit: Arrival Time: Departure Time: County: Region: i�C
Cc�
Farm Name: Jct —R * r d er yj (%ii:l! e"x f Owner Email:
Owner Name: &—e 1't 5 CA-) 0���. Phone:
Mailing Address:
Physical Address:
Facility Contact:U Title:
Onsite Representative:
Certified Operator:
Phone No:
Integrator: /i7ur-4
Operator Certification Number: m
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = o = 6 =" Longitude: = O = I
Design Current
`'; Design Current
Design Current
Capacity Population
Wet Poultry 'Capacity Population
Cattle
Capacity Population
ffETFinish
❑ Layer
' '"`
❑Dai Cow
❑ DaCalfFeeder
❑ Da' Heifer
toFeeder
pa
6�
' ❑ Non -La er
FWean
to Finish w
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
.,._ ...
,
❑ Layers
El Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
Gilts
ElNon-Layers
❑Beef Feeder
FEIBoars
❑ Pullets
❑ Beef Brood Cowl
a�7�
❑Turke s
Other
❑ Turkey Poults
❑ Other
F I
❑ Other
Num er of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes (9No ❑ NA ❑ NE
❑ Yes
d No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
,a No
❑ NA
❑ NE
❑ Yes
[ffNo
❑ NA
❑ NE
12128104 Continued

Facility Number: —
Date of Inspection - 2 b r
.' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
MNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 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
J;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
q 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
XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
,,No
4. Does any part of the waste management system other than the waste structures require
❑ Yes
R No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EkNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types)/`izt
13.
Soil type(s) C�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
XNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
N No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
2,No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to question #1): 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/Ins ector Name 1
P c7� �—+L- Phone: 9/D— y.33- 3_-,;b'd
Re-viewer/Inspector Signature: Date: 6;9 _/�k c�
r�i�aivg c.onunuea

z
' Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. C9 Yes ❑ No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ej No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P 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
EgNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
.KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
W 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
VNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
UNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
(R No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit: compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit a outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: jArrival Time: ; �,t�f Departure Time: ; Q � County: �`"�' Region:
Farm Name:{ern �� J_ NGrCrf j� ___ OwnerEmaii:
Owner Name: �[ f rA •/ Phone:
Mailing Address: 6-0rY^- r i �� %� tea, •
Physical Address:
Facility Contact: %/ h/�sils /�i0-i�i�� ^ Title:
Phone No:
Onsite Representative: y __ _ _ _ Integrator: A"a oc4 !(e
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 [= , = Longitude: F] o E_-1 ,
Design Current
Design Current
Design Current
ne
Capacity Population Wet Petry
Capacity Population
Cattle Capacity Population
rFilWean to Finish
❑ La er
❑ Dai Cow
Wean to Feeder
O
❑Non -La er❑
Da' Calf
❑ Dai Heifer
Feeder to Finish _
Farrow to Wean
ElD Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
El Gilts'
ElNon-Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑Turke s
Other
❑ Other
❑ Turkey Poults
' ❑ Other
iNumber of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
U4 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
([No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: ? Date of Inspection S 6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes X No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes D9 No ❑ NA ❑ NE
..,Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(iel 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 $0 No ❑ NA ❑ NE
8_ Do any of the stuctures 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 M No ❑ NA ❑ NE
maintenance or improvement? jCq
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenanceli mprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ YesJK 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)
&U
13.
Soil type(s) /" p 14
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Reviewer/inspector Name Phone: 2ZL:4,*33 -333--L-
Reviewer/Inspector Signature: Date: 4P�_fe
rage L of } LL/16/W Lununuea

Facility Number: — Date of InspectionG
t 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 9INo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J,No ❑ NA ❑ NE
❑ Waste Application Cl 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29_ Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
®,No
❑ NA
❑ NE
❑ Yes
JANo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
14 No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
O-No
ANA
❑ NE
❑ Yes R.No ❑ NA ❑ NE
❑ Yes Q,No ❑ NA ❑ NE
❑ Yes Jallo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
Additional Commemts and/or Drawings:
r
Page 3 of 3 12128104

Type of Visit ®"Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: [�i�J Departure Time: � t ti County: '151-4 dr PL Region: Ft4` �
Farm Name: SO ut-A 11 i V elf— �% L[ a� �% Owner Email:
Owner Name: v � 'I T C I,ug r _ _ _ Phone: 9 1 O
Mailing Address: FZUg,� ,q *,qqr
Physical Address:.57,- 1 SD 3 Ce-ne-n , i3f t'al -�_
Facility Contact:
Title:
Onsite Representative: Integrator:
Certified Operator:�_,e
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o ❑ ' ❑ « Longitude: = 0 0 I = "
Swine
Wean to Finish
'VVean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La el
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b, Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity. Population,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ 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 A No ❑ NA ❑ NE
❑ Yes
KNo
[I NA
El NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
ElNE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
;kNo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
JRNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
R.No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): fo
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ yes
V 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
®No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
U 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
[9 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
WNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window D. Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) 0.4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes WNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ yes 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 .4 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 16 No ❑ NA ❑ NE
Name Reviewer[Ins ector /
P `�.i Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: p Date of Inspection
Izo-
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes 64 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. JR Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ;4 120 Minute inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[Z No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
119 Yes
❑ No
6-
NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
10-Yes
El NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Yes
OM
OM
❑ NA
[I
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
_fid Yes
❑ No
RINA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
� No
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EX No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
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
H No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Addtti 4u I Commenis5and/orrM�
0 ! � u n Yrd �v Gs�ni� � 7 r ERR w ��h o 0 m%
�.�-�- C�,�'�>"�� �� ban_ � �"-I> to•
71, .544
61
12128104

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up Q Emergency {Notification O Other ❑ Denied Access
Date of Visit: - O Time: S'. Oo
Facility Number a
Q Not Operational Q Below Threshold
MI;ermitted [�ertified p Conditionally Certified p Registered Date. Last Operated or Above Threshold:
Farm Name: NcaerCounty: �
, la elm
Owner Name: G e ir!4 � .._ How all Phone No: 7 -
Mailing Address: _ SS GrerA -rra,LrX 9 `t LJ I .
Facility Contact: —_...Title:.._......__ . Phone No: J t - 87Y'zR.A'yi
Onsite Representative: —W-&-m - r �9=.� r,i• ( Integrator. A%4X
Certified Operator: ^ HOuia rz Operator Certification Number:
Location of Farm:
[1Slwine ❑ Poultry ❑ Cattle ❑ Horse Made 0 Du Longitude • < �u
Discharges &Stream s
1. Is any discharge observed from any part of the operation? ❑ Yes DIM
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Ewo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes EI'do
c. If discharge is observed, what is the estimated flow in gal/min? =r
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes
Ergo-
2. Is there evidence of past discharge from any part of the operation? ❑ Yes E No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [:]Yes B'90
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes B1q0
Structure 3 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
r
Freeboard (inches): 3 S
12112103 Continued

FacRity Number: Ct — 7 ,2
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes E?Iqo
seepage, etc.) i
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 5140
closure plan? questions 4-6 was answered
f � any of tl yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes U-No,
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 0<0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes MKO
elevation markings?
Waste AmAication
10. Are there any buffers that need maintenancelmrprovement? ❑ Yes EClo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes M4<0
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
.249- Grp /ZIP Pro
12. Crop type Re,,5..,s I/ G��. CI..,-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 9-No
14. a) Does the facility lack adequate acreage for ]and application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre detern ination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑moo
16. Is there a lack of adequate waste application equipment? ❑ Yes EI-W
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 2'Ko-
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �fit5
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 QJ.
Air Quality representative immediately.
Cam {reftr to q�on:�)'E�iam atty YES a amudJor sa3r oz arty o#� .*..— �s -�
Use drarvrngs`of %et�t#y to lE �� sa.. %'� �� � } �� [-�irteld Copy ❑ Final Notes �.�
Waste ply„ Ae ;75 -e �.•/', tuft✓! fo /tee% ry&
Ple�csc wtorr,%or OarG ae43 110
Mvn a ee, 4i1 /� aim
s
9 P a s e c
Reviewer r Name Y y -6 iv
°, fi 3 f a g : a x
V.
Reviewer/Inspector Signature: Date: -y y
12/12103 Continued

Fatciiity Number: — r/ A Date of Inspection
lKeguired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel tc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
O-Vhnts-�� O-F�d ❑ VkSM-Amdysis ❑
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did ReviewerAnspector fail to discuss reviewlinspection with on -site representative?
28. Does facility require a follow-up visit by some agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33_ Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
❑ Yes [moo
❑ Yes &A+ e-
❑ Yes ❑ No
❑ Yes 93-No
❑ Yes 93-No
❑ Yes GWo
❑ Yes 8-No
❑ Yes ENO
❑ Yes Q-Ko
❑ Yes siq-O�-
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Site Requires Immediate Attention:
Facility No. o
DIVISION OF ENVII2ONTNMNTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: ?'` , 1995
Time: ID' YE -- /O: sz .TR tl z 90/
Farm Narne/Owner:
Mailing Address: ,,-7— 0DK / 3 �15E'��ri vl] A�L� Z'
County: —
Integrator: P Phone: J./,o -- ZVI
On Site Representative: �l� �ohqz Phone: _!o - SWT - � ?3
Physical Address/Location:
o' ST e
Type of Operation: Swine _� Poultry Cattle
Design Capacity:. Quo 6&& r-er5y Number of Animals on Site: t Z�Sg9
D&M Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude:
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches Yes or No Actual Freeboard: �? z Ft. Inches
Was any seepage observed from the lagoon(s)? Yes OCRWas any erosion observed? Yes or(S)
Is adequate land available for spray? es r No Is the cover crop adequate? es or No
Crop(s) being utilized:
-6 &/
Does the facility nicet SCS minirnurn setback criteria? 200 Feet from Dwellings : Ye or No
100 Feet from Wells? (�jDor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or(
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o NS
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o�a If Yes, Please FXPWn.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes of
Additional Comments: / Jdrv� =i oV A,_g .
Inspector Name Si
cc: Facility Assessment Unit Use Attachments if Needed.

MENLIra.

I