090075_INSPECTIONS_20171231

ivisioa of Water Resources
F ility Number - $ Division of Soil and Wa#er Conservation
� Other Agency
Type of Visit: Compliance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0"k-outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: [ Departure Time: !�
Farm Name: :J- 1t C ck ! tT Z Owner Email:
Owner Name: S R o(K i'7a rms L L C/ Phone:
Mailing Address:
County: QWeq Region:t
Physical Address:
Facility Contact: CC �-—tS l7 ,v Uj rCt Title: Phone:
Onsite Representative: Integrator: Wfl— S
Certified Operator: _-� p �� S� o �vll Certification Number: q 1 L�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity P,.ap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop. Cattle
Layer DairyCow
Design Current
Capacity Pap.
o Feeder
Wean tEEI
rzoa
D
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Design Current
ltr, Ca aci P,o
Layers
Dai Heifer
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
LFLa
ers
Beef Feeder
Boars
Turkey Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
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 Q-tdo ❑ NA ❑ NE
❑ Yes ❑ No NE
❑ Yes ❑ No ETA ❑ NE
[:]Yes
[—]No
2 AA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
[TNo
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facility Number: -Zq Date of Inspection:
Waste'Collection & Treatment
�4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 9,-` ! Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ 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 hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ❑ 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 [�rNo ❑ NA ❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ 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): 0 0 U i to Str D
❑ NE
13. Soil Type(s): L Go C.I
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[?'9-o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q'NO
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[21 o
❑ 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
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 4a o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[-]Yes Q'No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes Q'No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ,❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23_ if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes FTNo
❑ NA
❑ NE
Page 2 of 3 21412015 Condnued

Facility Number: 4 - _7EF-1 Date of Inspection: -Y r, /
24. D4 the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes 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
�"°
❑ 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
❑ Yes
[D_Ter
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[Q-Ko—
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewlMspection with an on -site representative?
YesElx�
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
F 1""
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain sltuations (use additional pages as necessary,).
7—z7— l6 S'l��yC,Cx_"rl} c� �I' - I d- 2,
7
CJ alo� 3oq- 4 � sf
Reviewer/Inspector Name:
Reviewer/inspector Signatui
Page 3 of 3
Phone: {}"I3 ` 3
Date: y r
21412015

Type of Visit: (3'Compliance Inspection U Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ; a Departure Time:
Farm Name: �L1C1�1'l'l Owner Email:
Owner Name: tT G Phone:
Mailing Address:
Physical Address:
County:ZLI—_Region: 1--- -0
Facility Contact: 63c2jr- �l�J�r-►/`- Title: Q U-In -er-- Phone:
Onsite Representative: �� Integrator:
Certified Operator: S'.+ Certification Number: 2/1Zdx_/
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
':w Design Current
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity P,op
Cattle Capacity Pop.
e%f
Wean to Finish
Layer
_;-
I I
Dairy Cow
Wean to Feeder
d
QEINon-Layer
Dairy Calf
to FinishHeifer
;'-
Design Cri urren
DairyFeeder
D Cow
Farrow to Wean
Farrow to Feeder
D . P,oultr.
Ca acet.1?0
"'
k
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Finish
Layers
Gilts
Non -La ers
Boars
Pullets
t Beef Brood Cow
Turkeys
Other
1111 °W
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 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 0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [] No
Yes 54 No
❑ Yes [. No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 oj3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes 12�1Vo ❑ NA ❑ NE
a. I f yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier -
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[0_No
❑ NA
❑ NE
(i.e_, large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[allo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
Nd No
[DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Jallo
❑ 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
EtNo
❑ NA
❑ NE
maintenance or improvement?
Waste A 2plication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EN No
❑ NA
❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes J;2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �r Q
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes C&No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes "--'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes IN -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 [K No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Z No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
L&No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
&No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Zallo
❑ NA
❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Lil-No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes RL 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 [A No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CR No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewerhnspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/inspector Name:
Reviewer/inspector Signatui
Page 3 of 3
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes a No ❑ NA ❑ NE
[]Yes 10-FRNO ❑ NA ❑ NE
❑ Yes fallo ❑ NA ❑ NE
❑ Yes MNo ❑ NA ❑ NE
❑ Yes 2 No
[:]Yes [a No
❑ Yes Pq No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:
21412015

Type of Visit: ��m oi�pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
( Iteason for Visit: 'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: 73 0
Departure Time: County: �1 -
Farm Name:
f l c I
Owner Email:
Owner Name:
r
Phone:
Mailing Address:
Physical Address:
Facility Contact: 4zlei ram- _ Title: &V'UM"o'--I-
Integrator: Q h
Certification Number:
r
Region:
Onsite Representative:
Certified Operator:_
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
1 ILayer
I
Cow
Wean to Feeder
I INon-Layer
I
Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Dr. P,oul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
111MI ON
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Imlpacts
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 El No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Cj§-No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: - 7 Ds ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[—]Yes
M No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): l�
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[S 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
E[ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
t.No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
EINo
[DNA
❑ 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
[ANo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
O No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �64-
13. Soil Type(s). _ 4LK if
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 51 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [S No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
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 No
❑ Yes No
❑ Yes [Z No
❑ Yes ® No
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: f5jWof Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes (0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes ® No 0 NA ❑ NE
Otber Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [g No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes (3 No ❑ NA ❑ NE
[—]Yes ® No
[:]Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer=to gaestion #) Explain any. YES'answers and/or any additional recommendations:,or any other comments
Use drawings of faciliiy-to better explain situations -(use additional pages as necessary):
Reviewer/inspector Name-
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 33oC)
Date:
21417011

s
(Type of Visit: ('Compliance Inspection U Operation Review (-) Structure Evaluation U Technical Assistance
Reason for Visit: AE Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:I t�J Departure Time: County:l Region: / /L
Farm Name: irC FGt/ m, ( Owner Email:
Owner Name: e. �,�(rr' Phone:
Mailing Address:
Physical Address:
Facility Contact: clrj 7 TK,-/ Title: Phone:
Onsite Representative: >�r' Integrator: /�
v
Certified Operator: �jl.�.rJ Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Eurrent11
111jesign
Current
Design Current
Swine Capacity Pop.
WetEoultryCapacity
Pop.
Cattle Capacity P.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
D ' Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D Po.ul r�aaci
P,,oINon-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
I Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
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)?
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 B No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes No
[:]Yes ®,No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412011 Continued

Facility Number: -I 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):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[, No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify
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
i, No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [. No ❑ NA ❑ NE
maintenance or improvement?
Waste Aptcation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZLNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [Z 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)• _Zen�� A)-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ®No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes © 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
S No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes tallo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® 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: jDate of Inspection: 1,177/
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [Z No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes ® No ❑ NA ❑ NE
❑ Yes Co No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. r] Yes
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
KNo
❑ NA
❑ NE
®No
❑NA
ONE
No
❑ NA
❑ NE
® No
❑ NA
0 NE
Comments (refer to;question #a)i-Explain any YES answers and/or any additional recommendations or any other comments..
-Y
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:
Date: pR_
21412011

•4
hype of visit: (9"i ompfiance Inspection U Operation Review U Structure Evaluation V Technical Assistance
Reason for Visit: 01toutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: D
Departure Time: 3(7
County:�
Farm Name:
Y77G P72 ✓"I- %
Owner Email:
Owner Name:
��� S/b ���
Phone:
Mailing Address:
Physical Address:
Region: / /`p
FacilityContact: e�'Q 1 el, Title: Phone:
Onsite Representative: Integrator: /(
Certified Operator: l% Certification Numb . / /�g/
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I
ILayer
Dairy Cow
Wean to Feeder
qrj
Non -La er
I
Dairy Calf
Feeder to Finish''"`
Dairy Heifer
Farrow to Wean
I Dry Cow
Farrow to Feeder
D , P.oul
Ca aci
�Po ..
Non-Dai
Farrow to Finish
I Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
(Rher
Turke 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)?
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 M No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[-]Yes [:]No
[] Yes P No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

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

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1M No ❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [R No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes o No ❑ NA ❑ NE
❑ Yes 21 No ❑ NA ❑ NE
❑ Yes B No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes No
[:]Yes No
❑ Yes [F�1Vo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments: - • `-hs
Use drawings of facility to -better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: �TUr-c��J/prL Phone: ,3'
Reviewer/Inspector Signature: Date:
Page 3 of 3 2412011

Type of visit: t Mompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
RI
eason for Visit: erao-utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: (7 Departure Time: l fX7 County: Region: r�; D
Farm Name: Z C,4+'r+1.
Owner Name:yrG
Mailing Address:
Owner Email:
Phone:
Physical Address:
Facility Contact: Cf a ���j J ! o /rC�I"f Title: ,��� Phone:
Onsite Representative: 4S'C.� _ Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder 00
I
INon-Layer
I
Design
Current
Dairy Calf
Daig Heifer
D Cow
a Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dr, ] P,oultry
Ca aci
P,o
'
Non-Daify
Farrow to Finish
I Layers
Non -La ers
Pullets
Beef Stocker
Beef Feeder
Beef Brood Cow
$YS`
Gilts
[3oars
Turke s
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)?
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 §�j No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[::]Yes [:]No
❑ Yes 2INo
[:]Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
Page 1 of 3 21412011 Continued

[Facility Number: - Date of Inspection: p —/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [RNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in): ��-
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes ® No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
[DNA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify 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
r,7 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q5 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ 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): Z-,'" A0, f�r�
13. Soil Type(s): IA
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 P.No [DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes RLNo ❑ NA ❑ NE
❑ Yes ®-No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available`?
❑ Yes
[S No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EINo
❑ NA ❑ NE
the appropriate box.
❑ WISP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[?�No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Z No [] NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
g—1
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[] Yes
JR No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
E�[ 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
® No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ONo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[ 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
allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[K No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[3 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[allo
❑ NA
❑ NE
Comments (refer to'queshon'.# :: Explain :any YES answers and/or -any. additional recommendations or anyjotlier cotnmentsM�e� ��'A,,
Use drawings of facility to better explain situations (use ..add Mona].pages as necessary)....
�,�,�-r.i• Z G�t�l �In- Sprq�r/�. arm ��� . Cg�� ;fir` � 11'l�m''�5 >�/` /`L��.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 117—
21412011

Type of Visit ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ��� Arrival Time: %/ ; Q0 Departure Time: �;3� County: Z � �Region: u
Farm Name: V—T- �'*' t Owner Email:
Owner Name: U T; 1,4-Y Phone:
Mailing Address:
Physical Address: // �.
Facility Contact: l2� 1 . h �/ 1� i� '� Title: f_ Phone No:
Onsite Representative: ��'�-. Integrator: 'W l
Certified Operator: �� Operator CertiB tion Number: � /�0�'
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e Longitude: = c
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0No
❑ 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
,4No
❑ 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
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ,/
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [3No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [3 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 ZjNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
g No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
O,No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
CR No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
PS -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) ffr,,, AOv trSz r'�
13. Soil type(s) ,¢ 4,3
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[allo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ®--Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
ERNo
❑ 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
Jallo
❑ NA ❑ NE
�,5 •• C�i-�-�` K � � ilio �kc�g-rL.�'zrl�r �Q'
• Ga� j�O r� �'7=
Reviewer/Inspector Name �_`' Phone: �jy3 33_
Reviewer/Inspector Signature: Date:
Page L of .f 1 L1L61U4 Uunrrnuea

FT
Facility Number: — Date of Inspection 3_=2
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
0-Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
&Vo
❑ 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
[,No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
29,,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
fid No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
RNo
❑ 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
Q3,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
P�J-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
WJNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional Comments and/or Drawings: J
:.5 e s7a -�h 4 "- }/our a/'t toa5te' r •
Page 3 of 3 12128104

Type of Visit IMompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit i34outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: p�- - f Arrival Time: %ii : Oc7 Departure Time: 1 p t`� County: 'i— Region: 14-9 o
Farm Name:y�Z'��� ��a ��00V�-e- Owner Email:
Owner Name: Phone: ez
Mailing Address:
Physical Address: /
Facility Contact: A�aY " /7/9ll/lJ'sa Title:._ AL1/rnn'-- Phone No:
Onsite Representative: Integrator:
Certified Operator: J��+L Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 o = = u Longitude: = ° = I = U
. Destgu ent
Swine Capacity Population
Wet Poultry
-
Design Current; � �- .,,� " � Design � Current
Capacity Po�ulattaNA" the 5 Ca�pa�ci�ty Population
to Finish
❑ La er
❑Dai Cow
FE]nw�.ean
ear►toFeeder
❑ Non -La er
' ElDai Calf
eeder to Finish
+ ❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
_
Other .:
❑ Other
Dry Podttry
❑ La ers
❑Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
� ❑Beef Feeder
❑ Beef Brood Co
�' ^
Number of Structures:
Discharges & Stream Impacts
I _ is any discharge observed from any part of the operation?
❑ Yes
[RNo
❑ 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
rUNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
kNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes C3No
❑ 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: ��tno ! _
Spillway?:
Designed Freeboard (in): 119
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 59 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 ER 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?
KYes ❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes [XNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes ERNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes EN No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Z,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 ofWind
- Drift ElApplication Outside oflArea
12. Crop type(s) / /` & '_ 12&44Z e0l-ri
U. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Dd No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes R No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[-] Yes ®No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes f RNo ❑ NA ❑ NE
Lis}P�a'�$..� -• .: :-.v � 6 _y-= N. Jr`,a.,._ :�#,r r� f:_- ' _ 'rzYM�,.,�.-i.�i�.. x�' m�°TW,'�..-
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page-, of .f 1L/18/U4 c.onnnuea

. Facility Number: q — Date of Inspection
+ Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. gLYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield 91120 Minute Inspections ❑ Monthly and V Rain Inspections KWeatherCode
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
BNo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
W No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[N No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
allo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
BNo
❑ 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
[RNo
❑ 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
KNo
❑ 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
.R 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
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
®..No
❑ NA
❑ NE
Additional Camtnents and/or. Drawutgs r'
Page 3 of 3 12178104

IZJe-
Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
O Other Agency
F
f Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit 0 utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: /2.
Farm Name: 3"C, Favw.'
Owner Name: • C . 94-8 Ke'✓
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �.�,,
Certified Operator: To L Iv C.L&'—
County: A� e-Al Region: �;�
Owner Email:
Phone:
Phone No:
integrator:
Operator Certification Number: 111 Zp8
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: E-1 o =' = " Longitude: = ° 0 t =.'
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
119'Weanto Feeder 2 D
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: 1
E-0i
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 ErNo ❑ NA ❑ NE
❑ Yes
❑ No
JJ
❑ NE
El Yes
❑ No
�E/NA
L] NA
❑ NE
LSNA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
[9 A
❑ NE
❑ Yes
�_N�o
❑ NA
❑ NE
12128104 Continued

Facility Number: D 9 — 7 S Date of Inspection 2 -0
Waste Collection & Treatment
�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
1-J Na ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
D<o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
3No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental thre t, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
ElYes
�
B,o ❑ NA ❑ NE
maintenance or improvement?
Waste Ai mlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2 o ❑ NA ❑ NE
maintenancetimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�
E3 o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
BNo ❑ 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
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
LNo ❑ NA ❑ NE
illo�e �-1 Nctom+ .5.�..xre, �r<pa.r �d �+ ur-/V / 0 !�O S o Nr 5XXX�lI Gra•:✓{ L4 w c
-racju �4 T . t ij ave- be /rc cS t �I S�C a �!' �7•+ �"��"4., rrlv;�v.S 0 wI✓t �
G�' GCS N e;J D .a "C V S JA- V C. V- 4 .L C- NA a ,� O J. n 0-0 V L rti e--4 r
� 'J ! I ! p
Reviewer/Inspector Name I ;ej cK,L( Phone:
Reviewer/Inspector Signature: Date: '1-28' ZOo 7
Page 2 of 3 12128104 Continued

Facility Number: 0 y — i s Date of Inspection 57-Z D 11
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes r No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps [I Other
21 _
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E!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?
El Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes;�No
NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
10 ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
[]"No ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LI No ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C1 N ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
SNo ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E 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
E rNo❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
0 No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Additional Comments and/or Drawings:
AL
Hw
12128104

z7v_
a]
Type of Visit -&Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit .q Routine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ;'+Q Departure Time: "-�- County: VIA Region: Fe
Farm Name: Yc �G{/�'yt ! _ _ Owner Email:
Owner Name:IL -S I [:� k�.r Phone:
Mailing Address:
Physical Address:
Facility Contact: CQ1�?�'? �S'�t3k�- Title: Mriasp.-_ Pbone No: 5'M q_1VP
Onsite Representative: Integrator:`
�6hn 5 it11� n i q'91�GS'ca�
Certified Operator: _ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = f = u Longitude: = u [� g ="
Design Current L
. Design C+urrent Design Current
e
Capacity Population
�'et Pooltt:y Capacity Populationean
to Finish
rrawean
❑ La er
❑Dai Cow
to Feeder
a 6o
$ 0
❑ Non -La er ❑Dai Calf
airy Heifer
eder to Finish
Dry Poultry El Dry Cow
[] Farrow to Wean
'C ❑ Farrow to Feeder
El Non -Dairy
' ❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
El Gilts
"= ❑Non -Layers ❑ Beef Feeder
❑ Boars
❑Pullets
❑Beef Brood Co
„
�SOfher
❑ Turke s
�
a
❑Turke Po uits
ElOther htumber of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes t9 No WNA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
.® No
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
12128104 Continued

-1 Facih Number: ()Cj —0 j'
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in): 17
Observed Freeboard (in): m _
y T33 p, `�i ' Y R Is atr-b caietf-
5. Are there an immediate threats to a tnte rrt o an of the structures observed? ❑ Yes 1-No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 9 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes R'No ❑ NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE _
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 type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ERYes
J No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E;� No
❑ NA
❑ NE
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
FINo
[INA
❑ NE
Comments (refer to gnestion # 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}:
90 104931 tfled
AL
Reviewer/Ins ector Name, _ 0 Phone.
p N�
Reviewer/inspector Signature: Date:
Page 2 of 3 U 12128104 Continued

Facility Number: Date of Inspection I I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes (9 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1P 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?
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
15kNo
❑ NA
❑ NE
❑ Yes
❑ No
CkNA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
[g No
❑ NA
❑ NE
❑ Yes
[No
❑ NA
❑ NE
❑ Yes ❑ No O NA ❑ NE
❑ Yes ERNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes CRNo
❑ Yes [RNo
❑ Yes KNo
❑ Yes ff No
❑ NA ❑ NE
❑ NA ❑ NE
[I NA El NE
[I NA El NE
T
Additional COmUlCntb andlar DTflWIRg6a m _
mi1Cr ama hlc� Aroh 0*6 1 ayoeh ,
i S ?Ifa e_ I Ne- -( r'eldi Sof j Cma �S1s
al, so,1 analysis, In r-w le,
yeas_ Si dye sVVe 4c41 s g jv-3)V o7e . -- hbf baC�
V,Tsold
'9I-fg,,t. c4 6Un I ootL G6ye o�©wlem, 04 Sek- Pul�tQl, F
Cock re(o-ds, 6MV
IAR&ral riko�Igrow�
chela�2ra 4ri� PAS Sho►- Gh�Zn-� abo�� �+�o CY+o�a
svt
h �j S ��mi'�5 (T�F7�rm,j �sSho.% �opl,p (�`�Ie of 111Sfef7ll�
Page 3 of 3 12128104

+ Facility No. Farm Name 7C �
Permit COC OIC
FB
Date
NPDES (Rainbreaker
PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
W.+,& Tvi7H;7pSc*"1
Emma
Soil Test Date
Wettable Acres RAIN GAUGE
pH Fields
WUP Dead box or incinerator
Lime Needed W I In amy.
Weekly Freeboard Mortality Records
Lime Applied M-he
Cu-1 Zn-I ) 4Pf
LL1in Inspections
"20 min Insp.
Needs P
Weather Codes
Croo Yield hr�
Transfer Sheets
Waste Analysis Date
Pull/Field
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
0,32
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 1-%-a Date last WUP at farm App. Hardware
� I Solid-t-��f � us a3`r
FRO or Farm Records }-� 1�� n r �- 1� S�
.
Lagoon # I r k �q (y) #0wt(r - m9-e (� � a$-30 r' bvj Mi-Fr?(O �Q®D7 (�Y&hh-j
Top Dike Q 1 �pn CO►� v 4 m Cm�
Stop Pump 0. j
Start Pump 7 -v/
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Iblac

FTMs -7-/& -og
Type of Visit OCo-mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 7 /S—oS Arrival Time: Departure Time: S:OO County: J&�66,^J Region:
Farm Name: +S • C •S+oKer I Owner Email:
Owner Name: — 5.6 �1 .✓ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: :1 . C S-6 94-41- Title: Dc)ke.-Y Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Integrator: Z11100/.1-, '8/2U&I
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [=e =. =As Longitude: =n =, = u
Design C►urrent:�' Design Current
Design Current
Cattle
apacity Population WettPoultry Capacity Population
„ Capacity Population
to Finish
rV[Feed
❑ La er
❑Dai Cow
to Feeder
2.&OO ❑ Non -La er
❑ Dai Calf
r to Finish
_
❑ DairyHeifer
❑ Farrow to Wean
yd
Poult .
Dry ry
❑ D Cow
4 ❑ Farrow to Feeder - "` " Non-Dairy
❑ Layers
❑ Farrow to Finish
❑Beef Stocker
Gilts
ElNon-Layers
ElBeef Feeder
>_
❑ Boars
El Pullets
❑Beef Brood Co
- ❑ Turkeys
❑ Turke Poults
-"
❑ Other
❑Other
I�umSerof,;Struetures
ism
.._ _.
. ... _;,,ems ._: _...._
Discharaes & Stream Impacts
1" Is any discharge observed from any part of the operation?
❑ Yes
B o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
El No
,�
E A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
0 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
�,�
L? NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[I10
❑ 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

Date of Inspection
Facility Number: O 9— 7 5
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
9%o ❑ NA
❑ NE
Structur90 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3 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
/
ONo ❑ 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
ETNo ❑ 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
ff No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�
2 o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L7No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZNo
❑ 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
ffNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Dl o
❑ NA
❑ NE
I� tTr< G C 'j 1 � 1 Ge.l "`C
Reviewer/Inspector Name �`G c.r S 7 _ Phone: 1/0. fL3- . 3330
Reviewer/Inspector Signature: Date: 7 — i.S-- ZeO a
Page 2 of 5 rl/l8/U4 t.onrinuea

Facility Number: Q 9 — %s Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N�o
[I NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
[IE Yes
Er
N_o
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,
L'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
E No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IS 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
BNo
❑ 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
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
,[,_3<oo
o
❑ NA
❑ NE
Additional Comments :and/ror D i60 5�; -
Page 3 of 3 12128104

OUT c-
Type of Visit: &Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (j Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: S 8 . Arrival Time: Departure Time: ; County: Region:
Farm Name: J � Z Owner Email:
Owner Name: �J\ a�tfu om s f LL Phone:
Mailing Address:
Physical Address:
Facility Contact: Cit4ts .Awl of ` Title:
Onsite Representative: 1 f
Certified Operator: Ca (le b 54 k%
Back-up Operator:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design gurrent
Capacity Pap.
Wet Poultry
Layer
DesiEg"111CUrrent
gapacity
Pop.
Cattle
DairyCow
Design gurrent
Capacity Pop.
Wean tc Feeder
3elpo
/ 1'.Z
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
D . P,oul
Layers
Non -Layers
Pullets
Turke s
TurkeyPoults
Other
1 sigo
Ca ac'
Current
P,o .1
i1Fiki.A�YfY2,n
Dairy Heifer
D Cow
Non -Da'
Beef Stocker
Beef Feeder
I jBeef Brood Cow
Farrow to Feeder
Farrow to Finish
Gilts
,Other
Boars
Other
'.�yy;Lunw[io '
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
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 ❑-iQo ❑ NA ❑ NE
[:]Yes [ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []'"lo
[:]Yes [3-No
D-NA ❑ NE
NA ❑ NE
ETNA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Page I of 3 21412015 Continued

Facili Number: - 15 Date of Inspection: p [
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA 0 NE
�r.
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ET'NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spi I l way?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [Q-N'o` ❑ NA ❑ NE
(i_e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
LD K6
❑ 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
Io
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Io
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[:J
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�o
❑ NA
❑ NF,
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Dlo ❑ 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): T./`Nt [ `� j 6 O /iT
13. Soil Type(s): �i�'''!� (•`JC� _...
r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�o
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
EDmoo
[] NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[�JI o
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[D1Vo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Eal�o
❑ NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
�No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E]-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 B-go—
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EP'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [Z No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFacility Number: - $ Date of Inspection:5_0,,/17
24, aid the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[[`iqo
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑-No
❑ NA [] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
P;;Mo
❑ 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
0 Yes
0<0
❑ 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
B No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ 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
[�frNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LI/No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
I�o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[�fNo
❑ NA 0 NE
6 q ) Ex y ddition�ilireconunendations or: any other comments.<;
Gomm qts refer to' .uestron # sEa lam an4 YES answers=and/or. an ad 3
+' a I"
Use drawui s of.,facility to Better explat©,situation ,'(useiaddttional pages as�necessa
r
Gt
Reviewer/inspector Name:
Reviewer/Inspector Sigmatui
Page 3of3
Phone:�3. ]�
Date:'5 on-T
21412015

e Z"JA".a 67 RR_ 7-23-LO07-
W Division of Water Quality
Facility Number Q 9 %S Q Division of Soil and Water Conservation
n Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -71-0 ] 1 Arrival Time: : QO Departure Time: 3; 30 County: Region:
Farm Name: 130h Br f brw Owner Email:
Owner Name: o-C^ 0 b 13,
Apey Phone:
Mailing Address:
Physical Address:
Facility Contact: bett C- AA Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No: %OT77- - 9o92-
Integrator: _. AU rip kh-tj r✓
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = {f Longitude: = ° = =
is
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer 2 1p Q ❑ Non -La et
❑ Wean to Finish
Wean to Feeder
El Feeder to Finish
El Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
El Boars
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
❑ Turkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made`?
Design "0Cattle Capacity Popula
❑
DairyCow
❑
DairyCalf
❑
Dai Heifer
El
Dry Cow
El
Non-Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: LL
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
W No
❑ Yes
00 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: Q g —75 Date of Inspection 6 z9—O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
VI No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
m No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3(,, Al
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
PI No
❑ NA ❑ NE
(icl large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ONO
❑ 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
[,Y No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 o Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cr/op Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) ��rs tk d 4 Ss+ef lI (l ; �i✓ CD UwSr �c
r —
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
[A No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
WNo
❑ 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
WNo
❑ 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):
/J O p. nj i w« l $ re ��� c� �/ 4Z ✓ w^
L;jC i
Reviewer/Inspector Name c k ��V 'e- s Phone j� 0 V33 --330D
ReviewertInspector Signature: Date: -Z`% -Zd0 %
1212SIO4 Continued

Facility Number: 0 9— %s Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [A No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [,VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Main Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 7 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�g No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Comments and/or
12128104

✓�i,/ v-rd. L") P_ 2 Z/Zcu 4,
a
Type of Visit 0 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: / -x Q Arrival Time: DI ; 3 D Departure Time: County: Region: 0C/ZQ
Farm Name: 51A��b i► f q f7ct r� Owner Email:
Owner Name: Pe v Phone:
Mailing Address: CC'•_AaI �{Ly {,;� Imo,D• �( Z3$ 0-iz%.Jfj C Z8337
Physical Address:
Facility Contact: 000 C 1'kkM-?_ V_ Title: �� Ni•�i i� ,,` Phone No:
Onsite Representative: �G t y V Integrator: 1"1 uyD tom4 five W �_
Certified Operator: �a�� ""� e- Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = + = " Longitude: E__1 o =' E__1 K
Design Current Design
Swine Gapacity Population Wet Poultry Capacity
Current Design Current
Population Cate Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
I Z-6 0
124109
1 IE]Non-Layer I
I
❑ Dairy Calf
El Feeder to Finish
I
I
Dry Poultry
❑ La ers
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
ElBeef Feeder
❑ Beef Brood Cot -
Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
[:3Boars
❑Non -La ers
❑ Pullets
Li ur es
Other ❑ Turkey Poults
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
q 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
7NA
❑ 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
E'NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
N NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
[9 NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

• Facility Number: — 7 Date of inspection 2-Q070
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 4 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard'? ❑ Yes 7No Cl NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2. p
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
1� 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
[P No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
EpNo ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
PNo ❑ 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
[)a No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
0 No ❑ NA
❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes
[XNo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) &4eV^4 SnJaf� GWf � A✓ (0.5_
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
§P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
WNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Comments {refer to question' ft Explain any YES answers and/or any recommendations or any other comments
use drawl Oof facility to better explain situations. (use`addihonal peg es necessary):
i v cy , �cj
, ..r 5 ., � n.. c.r ? c c: ' ZLi v , >, I a WI c j ,G 4r r S � r S e-a.
iM a�v� v
w , ti ro rev ; e.....; .] i d i...1a s r<e t: 1c...i Vo,. c �.. �
A% I GC1 � a ✓V4�-•f °'� N , 6+/i V
. lu t V I V :oJ ,' l � r..� s�C. � ry t_ C_ el e.' e • ✓ Vie. : ivy � dull . w ` �� r s f
I. r.1:r..r! o-/+ZCJ o�- WL v .
NA
-4Zfrs -9yr . (z)
Reviewer/Inspector Name I i'C j '
e. is Phone: C410) V33-333 O
Reviewer/Inspector Signature:
Date: ! Z - ZO —2 00 (v
Page 2 of 3 12128104 UonUnued

Facility Number: Q q Date of Inspection i7 Zo-C!v
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [� No ❑ NA ❑ NE
the appropriate box. ❑ W­Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (N No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
T No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[P 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
[XNo
❑ 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
00 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[gNo
❑ NA
❑ NE
Additional Comments -and/or Dr$wEngs'':-
Page 3 of 3 12128104

-- Division of Water Quality
iFacility Number Q y - S 0 Division of Soil and Water Conservation
� Other Agency
Type of Visit 0 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: t3!) Departure Time: County: 46/4 Region:
Farm Name: Bak) 'a � Owner Email:
Owner Name: F)0I0 S; i_kISPhone:
Mailing Address:
Phvsical Address:
Facility Contact: 13OlO G-1 1 b e_i Title:
Onsite Representative:
Integrator:
Phone No:
Certified Operator: 13010 b►re Operator Certification Number: 2 %3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = , =SA Longitude: ° =
gn Current Domes#ign z Current
city Population Wet Poultry Capacity, Population
..
f0mw
Digs C►orient
Cattle Capac ty Population
❑ Wean to Finish
❑ Layer
❑
DairyCow
Wean to Feeder
Z (000
Z bOO
❑ Non -Layer
❑
Dai Calf
El Feeder to Finish
❑ Farrow to Wean
• ❑ Farrow to Feeder
'�z
❑ Farrow to Finish
y
�'
� .: � ,
Poultry
El
❑
El
Dairy Heifer
Dry Cow
Non-Dairy
❑ Layers
❑
Beef Stocket
Non -Layers
❑
Beef Feeder
Pullets
.-4 Turke s
Outer TurkeyPoults:
❑
Beef Brood Co
x 1.
NumberoffStructures .;.�
❑ Other
FERI Other
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El 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 &No ❑ NA ❑ NE
❑Yes
0No
❑NA
❑NE"
❑ Yes
®No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
Wo
❑ Yes
ER No
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NI;
12/28/04 Continued

Facility Nomher: 09— 75 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes [A No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5_ Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes Z No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Q No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes jX 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 W1 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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) B e "-V" , -� -'_
13. Soit type(s) �-- x 4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[29 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
[A No
❑ NA
❑ NE
1T 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
PI No
❑ NA
❑ NE
Reviewer/Inspector Name ` KiGk ' keve_IS Phone: F1/Z1JWi--0.9'Y1
Reviewer/Inspector Signature: Date:oI-
I ZIZNI04 Cbnnnued

Facility Number: 0 —7 j Date of Inspection Il-O3-O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes rA No ElNA ElNE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps ❑Other
2I . Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LN 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?
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 9 No ❑ NA ❑ NE
❑ Yes
❑ No
DO NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
�9 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes [ZNo ❑ NA ❑ NE
❑ Yes IgNo ❑ NA ❑ NE
El Yes
[)?No
El NA
❑NE
❑ Yes
PJ No
❑ NA
❑ NE
❑ Yes
[N No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
Additiiina! Comments and/or Drawtu S yp+ it gym''
12128104

Facility Number Date
Name EOL.
Farm Name 171116 J- 64, f -7 4--1
C.O.C.
Waste plan
Sol type
permitted
Soil Test PLAT
//-0 �- d S—
on hand
— Deep Soil test
i
Crop types B ZA-
r
Designed Freeboard / % Observed Freeboard 3
Rain gauge v Rain breakers /y/#- Daily Rainfall
Calibration of spray equipment % I G.P_M.
Sludge Survey Crop Yield 120 minute Inspections
1 in. rain inspections Weather code �-�`Weekly Freeboard
Waste Transfers PZ - Waste Analysis
Pumping time Vc,_._..... _..__
Waste Analysis % & Month
Comments:

JV1Es,o1► oLWeter Quality
Di*Rion of Soil,and Watec -dose tioa
--- ��-O=Otf►er ` e_ncy---
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Date of Visit: 812U121H14 Time: 10:45 am
Facility Number 9 75
O Not Operational Q Below Threshold
® Permitted ® Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
Farm Name: Bi:lbxey..Ear.##.1....................................... ...... County: Bladen ............................................... FRO ............
Owner Name: fib .......................................... BilbrAy ........................................................ Phone No: Q1".45-2,Q#4--------------..............
Mailing Address: 65.10Jd.1X,tlllGl.R0Ad.......................................................................... 0Ark1Qjm.NC......................................................... 28433.............
FacilityContact: .............................................................................. Title:....................................... Phone NO:
Onsite Representative: .......................................... .. integrator: Kurphy..Eatlutly..Earju....................
Certified Operator:Illoh.......................................... Bilbr.cY ............................................. Operator Certification Number:JL6.Z73 .............................
Location of Farm:
Farm location: 2 miles out of Elizabethtown on Hwy. 87S first state road to the right is Coley Road, turn right on Coley Rd. +
Go to stop sign. Go straight at stop sign, still on Coley Rd., until get to another stop sign, turn left on Rosendale Rd. Approx.
® Swine ❑ Poultry [I Cattle [I Horse Latitude 34 • 32 � 45 � Longitude 78 • 35 � 15 k
-: Design Current Design'_ Current Design ' Current
Swine Ca aci Population. ;Poultry- . . , Capacity .Popolahon -Cattle,- Capac�ty_'Papulation '.
® Wean to Feeder
2600
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts _
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) El Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112103 Continued

Facilitynumber: 9-75 Date of Inspection 8/20/2004
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
-� __�.__ -max _ .;�==�_:�. �--•"--�--- ��.,,�--_
Reviewer/Inspector Name-
Reviewer/Inspector Signature: Date:
12112103 Continued

v Ya.� .�._ ._• �i_aL4�- �Y+w-ri.` '�' ,Iyr ',..r:Y'+ 'Rii].C:.����� �_1��"3Y'a� {^k.�. %Cc' MLI� - 1'Y.:OdtwN.
r
peof Visit Compliance Inspection O Operation Review O L a9oon Evaluation
ason for Visit O Routine O Complaint *Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: $ T.lO tl Time: /O = � D_=1 __ ] O Not Operational 0 Below Threshold
ItPermitted [3 Certified 0 Conditionally Certified 13 Registered Date last Operated or Above Threshold: —
�,t I r �•, �d Try. L g[aAty.
Farm Nance: County:
_ _ _
Owner Name: ----go Phone No:
?Mailing Address:
Facility Contact: __ _
Title:
Onsite Representative: Integrator:
Certified Operator:
Location of Farm:
Phone No:
Operator Certification Number:
❑ Swine ❑ Pouttry ❑ Cattle © Horse Latitude • " Longitude • 0"
Discharges & Stream ha cts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Feld ❑ Other
a_ if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2_ Is there evidence of past discharge from any part of the operation?
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112103 Condnued

Facility Number: Date of Inspection GZO O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
❑ No
Closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or euvironmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures acquire maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑ No
elevation markings?
Waste ABiLication
10. Are there any buffers that need maintenanorrunprovement?
❑ Yes
❑ No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
0 Yes
❑ No
14. a) Does the facility lack adequate' acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
I5. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge 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 ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately_
❑ Field Copy ❑ Final Notes
+E e '.ve".Js 6. a . '�o tom. oveP
a. �. reatsv vt - - dal .- D •�
1: c-v LI a A4, -tLe- 4-�~A4v,-v, 4r- 4+ -eAoL # Z 'Cvv *.+e om S `4
GO0.`'1 A.1
�oKrC, Mc. Q lla r" o- Coe Zl
Gower. •� h � Ki rw� a�.Kv.,�,[S .
Reviewer/Inspector Name Z
ReviewerAnspector Signature:
12112103 L Cowed

Facility Number: 6t ^ Date of Inspection---�---t
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
22. Does the fatality fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27. Did ReviewerAnspector fail to discuss reviewfmspection with on -site representative?
❑ Yes
❑ No
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1 " Rain
❑ 120 Minute inspections ❑ Annual Certification Form
12112103

Type of Visit a Compliance Inspection O Operation Review O Lagoon Evaluation "
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: it 0 Time: 1 /0 : 00
.. - .. 0 Not rational Q Below Threshold
® Permitted P1 Certified ❑ Conditionally CertMed Registered Date-I.ast Operated or Aboove� Threshold:
Farm Name: County: --
Owner Name: � �. g l Phone No: 410 — �. 5 ' `l8 Lj S
Mailing Address: fo 53 C> 1 dC `T�-a % � . CA�1t-�e,.� r - l�-C-_ - 28`4 $
Facility Contact: . _• �! {{ T-itle: Phone No:
Onsite Representative: >'�.I b � Integrator.-_ f�
Certified Operator. Qo 6 ,.. 1 Operator Certification Number.
Location of Farm:
NimEber a l4:agotlns
-° t
za
Discharges & Stream Imincts
1_ Is any discharge observed from any part of the operation?
❑ Yes
qNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
U�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
WNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
RNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
i.......`...__
Structure 5
Identifier: �..+ .......... .........�.... _.__....... �.._....._..
_,
..
Freeboard (inches): .Z
12112103
Confin ed

Facility Number: Date of Inspection t l
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes (.No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑yes RNo
plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes KNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes RNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes PfNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenanceftmprovement? ❑ Yes ,Q No
l 1. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes .LNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Ea No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes &No
b) Does the facility need a wettable acre determination? ❑ Yes J,No
c) This facility is pended for a wettable acre determination? ❑ Yes gNo
15. Does the receiving crop need improvement? ❑ Yes RNo
16. Is there a lack of adequate waste application equipment? ❑ Yes QNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes JNo
I9. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes E}No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes I.No
Air Quality representative immediately.
❑ Final Notes
Pievse_ v►to-
Ac %S
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5aa L i QC
J� yro..�� S 0 1�tQ_
W+[
a (o 1 e— -Vo
Reviewer/inspector Name 'I`i .. -'
Reviewer/Inspector Signature: Date. I (L &Y
12112103 / Continued

Facility Number: — '�� Date of Inspection 11 1 Z
Required 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?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Applicatiqv""O Freeboah(❑ Waste AnalysVO Soil SampIinko"
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 Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
N'PDES 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 ❑ Rainfiai ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes Wo
❑ Yes D(No
❑ Yes RNo
❑ Yes IRNo
❑ Yes LKNo
❑ Yes &No
❑ Yes 19 No
❑ Yes [X�No
❑ Yes SENo
❑ Yes WO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103