090081_INSPECTIONS_20171231

iVVk 5:
Type of Visit: 4EYCo Inspection O Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: A RRooutine O Complaint O Follow-up O Referral O Emereencv O Other O Denied Access !1
Date of Visit: MOO Arrival Time: `fo d Departure Time: County: I4 CV%l Region: F.
Farm Name: 4` + Owner Email:
Owner Name: 9 to 5 Phone:
Mailing Address:
Physical Address:
Facility Contact:
A3 0L^Kee_
Title: $' Phone:
Onsite Representative: ` 4-
Certified Operator: .)p zI ?.,:. 14 1 �C
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
- Design Current
Desigp
Current
Design C►ucrent
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
La er
Da' Cow
Da' Calf
Feeder
Non -La er
Finish
24
3
Da' Heifer
Wean
Design
Current
D Cow
Binish
Feeder
D , P,oul
Ca aci
Po
Non -Dairy
Finish
La ers
Beef Stocker
Non -Layers
Pullets
Turkeys
Beef Feeder
Beef Brood Cow
Other
Turkey Poults
Other r 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[j34
DNA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[ 1� o
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[—,IhTo
❑ 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
[13<o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
l�,
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
;No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection: 2 04
Waste Collection & Treatment
4. Isstorage 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
EdM
❑ 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?
0 Yes
Q-N6
❑ 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
t7 "'o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E3 lqo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
for
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ 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): G (4,J I? i e✓V%'cc. & &- fl
13. Soil Type(s): !2 t 4 !�[ eeIres f o ✓X
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Le o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes Ek<o ❑ NA 0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [R<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
nNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ZLA'o'
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
U�Ko
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
F-J,<o
❑ NA
❑ NE
the appropriate box.
❑WUP [—]Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[—]other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E o
❑ NA
0 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
DNA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: Cf - Date of Inspection: Z ov
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[]-NV—[:] NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[a•fb ❑ 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
[2-Ko- ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[j],Ai'e ❑ 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 GAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [;]_NsL ❑ NA ❑ NE
❑ Yes [3-do' ❑ NA ❑ NE
❑ Yes [Z .Nv-- ❑ NA ❑ NE
❑ Yes Q111o­ ❑ NA ❑ NE
❑ Yes
ElKV
[] NA
❑ NE
❑ Yes
Ef r1 o
❑ NA
❑ NE
❑ Yes
I_' -
❑ NA
❑ NE
Comments (refer #o question #): Eapiarn any YES answers�and/or-any;ad"ditional recommendations or any other. eommentsA;-W, �
Use drawings of facility to better explaimsitruations.(use,•addtttop {,pages`;ms;necessary):'
P4;f I Owl rVe
1
Pt �0 V_ �C 4 , (or ocg-e, -V- 16 re.,­*ct, 9 //
4
g - rV �3
C,,q q(o- 3og - 03 SI
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phonelto-M- 33W
Date: 2. NOV Igo
21412015

Itype or visit: kyuo/mpnance inspecnon v operation xevnew V structure Evaluation C-1 i ecnnicai Assistance
Reason for Visit: ter Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: QGr Arrival Time: 1. Departure Time: / County:
Farm Name: ��f�;5 I- itt`tr'l� 'l Owner Email:
Owner Name: �p �D NLj Phone:
Mailing Address:
Physical Address:
Facility Contact: t 1(,cT, [Jetr�e✓� Title:
T!
Onsite Representative: f
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Region: �t
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
esign
Dal
Current
Design torrent
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
q'44' VVV
Dairy Heifer
Farrow to Wean
Design
Guerin#
Dry Cow
Farrow to Feeder
D . P,oul
Ca aci
P.o
Non -Dairy
Farrow to Finish
I Lavers
Beef Stocker -
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
—.Turkeys
Wither
Turkey Pouits
Other Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [--No ❑ NA ❑ NE
❑ Yes
[:]No
[a -NA
❑ NE
❑Yes
❑No
MNA
❑NE
❑ Yes ❑ No
❑ Yes
❑ Yes No
ETNA [] N E
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: or - 77 1 Date of Ins ection: e-
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
❑ L'� A No
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[] Yes
EJ iVo [] NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E3_bk; — 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
[dam❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[:J� ❑ 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
EO-M [DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
LD °`o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes to ❑ 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): ��(iLJ _ . �-CJ Pk "A
j! �
13. Soil Type(s): - _ A/c, re
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes []'1 to ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [5 Flo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑-No [] NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [� 3 o ❑ NA ❑ NE
❑ Yes [3' 1'lgo ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ I o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
BlZo
❑ 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
[D-No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[31T o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes , No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili • Number: - Rf Date of Inspection: AS CV_
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [E 110 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [RI o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Ea -No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[24to
❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑`1 o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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
EdNo
❑ NA
❑ NE
33_ Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[j No
❑ NA
[] NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
(n No
[] NA
❑ NE
Comments (refer to question # Exolainwany; Y dES�answer : and/or, any additi6nallre6ft mendafions or any other..comments ' t�
Use drawings of facrlrty',to better explamsituahons,.(nse°addifional,pages :as necessary) : r y
c, ,V - 11 ° - 3Bf-1 C V
Reviewer/Inspector Name: 1 1 1 '
Revi ewer/[ nspector Signature:
Page 3of3
Phone: jo,_ 33-- 333
Date: 9S 0 L I r]
21412015

/,
(Type of Visit: ®'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Oloutine O Complaint Q Follow-up ( Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: �� County: (J`QA'l Region:
Farm Name: 44 Sd T T= I C.4 UO 3 Owner Email:
Owner Name: _�� 2,n,,,�1 Phone:
Mailing Address:
Physical Address:
Facility Contact: 6Z�w Title: Phone:
Onsite Representative: r� Integrator: WU r-S
Certified Operator: •15 c ��6C�S Certification Number: 16 F61j
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
za q o o ' `t3 u o Fc-- o (C Jr
Wean to Finish
Design Curren
t
La er
'ut
Cci
o
eS
Dairy Cow
tr
tDesinVU
Ca p ay p.
Pcy
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P,8u1
�„
Ca acr.
P,o
Non-Dalry
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
IN I
Turkeys
Other
"
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 [r o ❑NA ❑NE
0 Yes ❑ No E2 NA ❑ NE
❑ Yes ❑ No Q NA ❑ NE
[]Yes ❑ No
[—]Yes [2'No
❑ Yes 0 No
dNA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Page I of 3 21412011 Continued

Facili Num er: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ET o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �j y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [!fNo ❑ 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 eNo ❑ 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
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yesgt
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[-]Yes ❑.No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ? No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes L21"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): l7 e. ` S Go (.tJLoi-
13. Soil Type(s): Pt`B
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 3,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [D'flo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[214o
❑ 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
[allo
❑ 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_ 0 Yes C?rNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes [TNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes nNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

07
U-7
.--R
jp
C`
c
�
w �

Facility-Numb0+r: - R- I Date of Inspection: %7
24. Did the facility fail to calibrate waste application equipment as required by the permit? b ❑ Yes C No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [DNo ❑ 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 [3IO ❑ 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ❑'No [DNA ❑ NE
[:]Yes [3'No ❑ NA 0 NE
❑ Yes E? No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [�rNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [?I -No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes Eff No ❑ NA ❑ NE
Comments (refer,1 question #)EapWn any YES answers andlor'any additionalrecommendations or any other comments
[Jse;drawings of facility to better explain situad nos ((use additional_`pages as necessary). x
C,a,(Vr r c.✓�_ -- © 6t -I
Sw
11
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 45— 333
Dater
2141201

0 Division of Water Resources
El Division of Soil and Water Conservation
El Outer Agency
Facility Number:
090081 Facility Status:
Active Permit: AWS090081
❑ Denied Access
inpsection Type:
Compliance Inspection
inactive Or Closed Date:
Reason for Visit
Routine
County: Bladen Region:
ty;
Fayetteville
Ye
Date of Visit:
09129/2015 EntryTime: 03.00 pm
Exit Time: 4:00 pm Incident 9
Farm Name:
Joel Robbins Finishers
Owner Email:
Owner:
Joel E Robbins
Phone:
910-876-2551
Mailing Address: 39 Robbins Rd Council NC 29434
Physical Address: 668 Robbins Rd Council NC 28434
Facility Status: E Compliant ❑ Not Compliant Integrator. Murphy -Brown LLC
Location of Farm: Latitude: 34° 30' 35" Longitude: 78' 31' 07"
Take 1713 South 0.74 mile form Lisbon NC and turn left on 1773 Robbins Rd. and go to the dead end and take the private road
off and go approx. 0-25 mile.
Question Areas:
Dischrge 8 Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator, Joel E Robbins Operator Certification Number: 16966
Secondary OIC(s):
On -Site Representative(s): Name Title Phone
24 hour contact name Kathy Barker Phone
On -site representative Kathy Barker Phone
Primary Inspector: Bill Dunlap Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
page: 1

Permit: AWS090081 Owner - Facility: Joel E Robbins Facility Number: 090081
Inspection Date: 09/29/15 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
Shrine - Feeder to Finish 2,448 1,212
Total Design Capacity: 2,448
Total SSLW: 330,480
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Lagoon
09-81-1
19.00
Lagoon
1
19.00
37,00
page: 2

.
Permit: AWS090081 Owner - Facility : Joel E Robbins Facility Number: 090081
Inspection Date: 09/29/15 Inppection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes
No Na No
1. Is any discharge observed from any part of the operation?
❑
M ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made?
❑
0 ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
M ❑
❑
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 observable adverse impacts or potential adverse impacts to Waters of the
❑
M ❑
❑
State other than from a discharge?
Waste Collection, Storage & Treatment
Yes
No Na No
4. Is storage capacity less than adequate?
❑
■ ❑
❑
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (I.e./ large
❑
M ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
M ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
MEI
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
M ❑
❑
maintenance or improvement?
Waste Application
Yes No Na No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ 0 ❑ ❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑ M ❑ ❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%110 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manureisludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 3

Permit: AWS090081 Owner - Facility : Joel E Robbins Facility Number: 090081
Inspection Date: 09/29/15 lrnpsection Type: Compliance Inspection Reason for Visit: Routine
Waste Application Yes No Na No
Crop Type 1 Coastal Bermuda Grass w/
Rye Overseed
Crop Type 2 Corn, Wheat, Soybeans
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Norfolk
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
0 ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop andlor land application site need improvement?
❑
■ ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
IN ❑
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
■ ❑
❑
18. Is there a lack of properly operating waste application equipment?
❑
0 ❑
❑
Records and Documents
Yes
No Na No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
0 ❑
❑
If yes, check the appropriate box below.
WU P?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
❑E
❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
❑
Stocking?
❑
page: 4

Permit: AWS090081 Owner - Facifity : Joel E Robbins Facility Number: 090081
Inspection Date: 09/29/15 Inpsection Type: Compliance inspection Reason for Visit: Routine
Records and Documents
Yea
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
0 ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
❑
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
0 ❑
❑
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 phosphorous loss assessment (PLAT) certification?
❑
■ ❑
❑
Other Issues
Yes No Na Ne
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
N ❑
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
0 ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
E ❑
❑
If yes, check the appropriate box below.
Application Field
❑
Lagoon 1 Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
E ❑
❑
CAWMP?
33. Did the ReviewerAnspector fail to discuss reviewilnspection with on -site representative?
❑
0 ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
N ❑
❑
page: 5

Type of Visit: Q),Com ' nce Inspection V Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ef Routine O Complaint Q Follow-up C) Referral 0 Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: 1 4
FarmName:� ���5 �Mta- Owner Email:
Owner Name: _� n �n6O �&S Phone:
Mailing Address:
Physical Address:
Facility Contact: KIN .jeit, _ Title: Phone:
Onsite Representative: 6 Integrator: V14 a
Certified Operator: iVi Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design
QW
rent
Curre
Swine Capacity Pop.
P
Wet oultry
Capacity
Pop.
Cattle Captyaci
Pop.
Wean to Finish
I ILayer
Dai Cow
Wean to Feeder
Non -La er
I
Calf
Feeder to Finish(Dairy
Heifer
Farrow to Wean
Qes!
Dry Cow
Farrow to Feeder
Ca aci
P,o
Non -Dairy
Farrow to Finish
I
I
ILayers
Beef Stocker
Gilts
I
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 [B11q_o ❑ NA ❑ NE
[:]Yes ❑ No ❑ NE
[:]Yes [:]No Q-d-A ❑ NE
❑ Yes
❑ No
[�rNA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
bNo
❑ NA
❑ NE
Page I of 3 21412014 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[]yT1�❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No C3-NA—_D NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
3-N-3 ❑ 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
❑.XT--0 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
[3-No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[E '3 o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[n No ❑ NA
❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
L"U "" ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EJ+h6 ❑ 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 CropWindow❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): "� l
13. Soil Type(s): Qrf` �-� ak,
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 F?r I�o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes
LJrNo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [21.NQ ❑ NA ❑ NE
20. Does the facility fail to have a]I components of the CAWMP readily available? If yes, check [:]Yes [� ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [Z[NV ❑ 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 EarNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:.No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili. Number: -CL jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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)
[a'oo ❑ NA ❑ NE
[;�Ko ❑ NA ❑ NE
❑ Yes No
[:]Yes QM
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [` "'o ❑ NA ❑ NE
[]Yes 0'1 fro ❑ NA ❑ NE
❑ Yes �i o ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
Er No ❑ NA ❑ NE
Fa<o�
❑ NA ❑ NE
No ❑ NA ❑ NE
I
Comments (refer to question #t: Explain .any YES answers.;aud/or.any addrtionalsrecommendations or any other comments r I
„...,. _.
Use drawings'.of.facility to better explain situations (use additional pages as necessary). _', s,
Oct, iz
i1- 3r - IL
�1
Reviewer/Inspector Name: V Phone:
Reviewer/Inspector Signature: '!J'r' Date:
Page 3 of 3 2/4/2014

7 ype of visit: %Mompnance inspection V Operation Keview V Structure Evaluation V Technical Assistance
Reason for Visit: Gr6outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: //)� too I Departure Time: Coun t° --- Region"
Farm Name: = o Owner Email:
Owner Name: �F l�'tli f Phone:
Mailing Address:
Physical Address:
Facility Contact: a- f�s✓1 Title: Phone:
Onsite Representative: fL
1
Certified Operator: c1ZL f L�f �jt (i
Back-up Operator: tj--y4_ L Vo(
Location of Farm:
Latitude:
Integrator: (/"l [✓
Certification Number: / 7 v 6
Certification Number: �7
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Pop.Capacity
Curren#PRE
= Design Current
Pop11
Cow
Wean to Feeder
Non -La er
Calf
Da' Heifer
D Cow
Non -Dairy
Beef Stocker
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
Dry P.oultry Ca a�ity Po
Farrow to Finish
Laye
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
OuterF
Turkeys
TurkeyPoults
10ther
Discharges and Stream Imyacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[];,Ko
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[] No
lLdlKA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[] No
[g KA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[] No
[3 A
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
D�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes
0K—o
❑ NA
❑ NE
of the State other than from a discharge`?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [l]..?<_� ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes D-o❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �y
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes F3 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 mxo ❑ 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 [❑ado` ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes []-Tdo ❑ 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 E11Z ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes [JNo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
�0
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
L:I'I""
❑ NA
❑ NE
acres determination?
l7. Does the facility lack adequate acreage for land application?
❑ Yes
[ o
❑ 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 �o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [:I o ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. [-]Yes io ❑ 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 InspectionsSludge Survey
22. Did the facility fail to install acid maintain a rain gauge? ❑Yes
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Condnued

Facility Number: jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E N_o ❑ NA
❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[]-X'5 ❑ 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
al<oo [] NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
to ❑ NA
❑ NE
Other Issues
2& Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
<o ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
[Z ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
" ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
NNo ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�o ❑ NA
❑ NE
Comments (refer to question ft Explain any YES;answers.and/or any additional recommendations or any,other commentsO
Use drawings of facility to better explain sit©ations.(use'additional pages as necessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�?�_ 4 ql- 91�
Phon4_
Date:
21412011

r
Type of Visit: t�Compl' cc Inspection O Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: . �3 0O Departure Time: 1. County: r., L
Farm Name: ! /0 ii ° ` s T / i ce yrOwner Email:
Owner Name: . G _gn bbj t KS Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: K, 5a lll' lkYs"� Title: Phone:
Onsite Representative: �5� Integrator:
Certified Operator: t/p O Nil r16 Irr� x ken Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
�
8 el
Design' C P rent
g
Capacity *}
�� . I
VA fflIN
lipmop. Wet-Po"ity
Current
g �
Capac Popes
CatEle
Design Gnrrent
Capacity Pop.
Wean to Finish
La er
Non -Layer
D . P,oultr
Layers
Design
Ca achy
-u co
P.o -
Dai Caw
Dai Calf
airyHeifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
()fiber
-
Turkeys
Twke Poults
Other
Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Eq No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2- Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3- Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
S No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - j Date of Ins ection: —/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate`? ❑ Yes [5No ❑ 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): r 9,
Observed Freeboard (in): 131
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
VLNo
❑ 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
Pq-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
JA 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
n No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ IEvidence of Wind Drift ❑/ Application Outside of Approved Area
12. Crop Type(s): , MAJAw Afv ZI-e
13. Soil Type(s): fv 19 d / Ei&
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ®,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ®, No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ffj No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ErNo
❑ NA
❑ NE
Records & Documents
_Required
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�jNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes U!�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 C�3.No ❑ NA ❑ NE
Is 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tite drains exist at the facility? If yes, check the appropriate box below_
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes n-No ❑ NA ❑ NE
❑ Yes CE�No ❑ NA ❑ NE
❑ Yes E^&No ❑ NA ❑ NE
❑ Yes Eg-No DNA ❑ NE
❑ Yes P,No ❑ NA ❑ NE
❑ Yes J!!�No ❑ NA ❑ NE
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes BNo ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Z,No ❑ NA ❑ NE
w ions oq , other com'ments.'� ...
Comments {re er to questmn , .Explain,any YES answers'andlor:any addittonal.r&ommendat n � fi . ill
Use drawings ofi facility., to better explain situations .(use _addettonal pages as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:�1g
21412011

I-
Type of visit: omp nce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: Q County: � Region: '
Farm Name: I �d J� p % n i 14r," _ Owner Email
a j
Owner Name: UA D ` / Phone:
Mailing Address:
Physical Address:
Facility Contact: ark Title:
Onsite Representative: �
Certified Operator: I! D e 111},lj j t n, f _
Phone:
Integrator: r l
Certification Number: (n fo
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current Design Current
Swine Capacity Pop..,: ';
Wet Pouitry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
FFeeder
Non -Layer
Dai Calf
to Finish
O
6,Dairy
Design. Current .
Heifer
Farrow to can
D Cow
Farrow to Feeder
w� D .. P,oult , C•_a aci P,o
Non -Dairy
Farrow to Finish
La ets
Beef Stocker
Gilts
]Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
mill ..::
Turke s
Other
Turkey Poults
Other
Other
Dischar es and Stream Impact
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes KLNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation'? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes WC No [] NA ❑ NE
of the State other than from a discharge?
Page I of 3
21412011 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[&No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
KNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
CKNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
5� o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
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
M 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
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
® 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 [I 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 I" Rainfall Inspections ❑ Sludge Survey
122. Did the facility fail to install and maintain a rain gauge? [::]Yes [Z No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [ANo ❑ NA ❑ NE
Page 2 of 3 1/412011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [allo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [] 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 [KNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes ® No ❑ NA ❑ NE
[:]Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes Callo ❑ NA ❑ NE
❑ Yes
C. No
❑. NA
❑ NE
❑ Yes
0 No
'[DNA
❑ NE
❑ Yes
®.,No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers -and/or: any additional, recommendations or any other comments , ,a.
Use drawings of_facility to better explaimsituations (use additional.pa�es as-necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: T ��
21412011

bimios /74-L/l0
Type of Visit 4DIEompi
Inspection
O Operation Review 0 Structure Evaluation
O Technical Assistance
Reason for Visit
(DOICoutine Q Complaint
0 Follow up O Referral O Emergency
Q Other ❑ Denied Access
Date of Visit: Arrival Time: % /d Departure Time: j County: Region43:�a_
Farm Name: n45d �t 1D I "S Vt tO % Sk P— Owner Email:
Owner Name: 1 'gob61 ws Phone:
Mailing Address:
Physical Address:
Facility Contact: ,T)Cd �"I" S Title:
Onsite Representative: ke5_40 _T0Lr`Lr_
Certified Operator: %
Toeu �bb1 &is
Back-up Operator:
Location of Farm:
Phone No:
Integrator: K__S
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' [:] Longitude: = o = u
Design Current
Design Current
Design Current
Swine L4 Q* 15 —ac i t:31 Population
Wet I IouIry1 C*apaeity PoPuI it ion
CattleI I I I 10 Mb YV_ —ac i t _VA Population
❑ Wean to Finish
I0 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Nan -La er
❑ Dai Calf
® Feeder to Finish I A ;Z
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
ElNon-La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turke s
Other
❑ Other
❑Turke Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes B<o ❑ NA ❑ NE
❑ Yes
❑ No
2<A
❑ NE
❑ Yes
❑ No
BlA
❑ NE
PTA
❑ NE
❑ Yes
❑ No
❑ Yes
El NA
❑ NE
ElI� Yes
,�
tvo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

li
iL
Facility Nu#nber: 7 9 Date of inspection a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes El"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ' 'No ❑ NA ❑ NE
Struct re Structure 2 Structure 3 Structure 4
Identifier:
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 52[ 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 (Dl'o ❑ 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 ❑-Qo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes UNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Ply o ❑ NA ❑ NE
maintenance or improvement?
Waste Application .,/�
10. Are there any required buffers, setbacks, or compliance alternatives that need [I Yes L'1 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E�<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ 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
24 4o
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
E(NNo
❑ 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
�lo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EJ No
❑ NA
❑ NE
Comments (refer to question #):
Explain any YES answers and/or any recommendations or any other comments.
Use drawings of ��acilitny to better explain situations. (use additiloaa! pages as necessary):
eay 4,_t lam t ,5
zowj
+�UZ & �T�
Reviewer/lnspector Narne
' j .. r Phone: .
Reviewer/inspector Sigi ture:
Date:
Page 2 of 3 iv28/ 4 tontinued

Facility Number: — Date of Inspection d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 12190 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes gjllqo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate ;box be Yes Ito ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysisoil Analysis [:]Waste Transfers ❑ Annual Certification
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes 2<o ❑ NA ❑ NE
❑ Yes
(i'&o
❑ NA
❑ NE
❑ Yes
05o
ElNA
ElNE
ElYes
Ull!o
❑ NA
❑ NE
❑ Yes
PrNo
ElNA
ElNE
ElYes
M"N' o
❑ NA
❑ NE
❑ Yes 91-4o ❑ NA ❑ NE
❑ Yes ('No ❑ NA ❑ NE
❑ Yes
Ey No
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes L NVNo
El NA El NE
El Yes ❑ NA ❑ NE
Additional Comments and/or D *i►ri ". .,
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit ('Comp 'ante Inspection 0 Operation Review O 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: l0-/9LO Arri,rral Time: �� p0 r� Departure Time: Z: Q�' w County: 15� �� Region:
Farm Name: _3o � rho le to r',1 S Ey i" ,L cr S Owner Email:
Owner Name: DCl R06W" S Phone:
Mailing Address:
Physical Address:
Facility Contact: _ KC`14k `3 b !�A54 Af Title: ��� � Ore Phone No:
Onsitc Representative:
"'7 baui4 J Integrator: Aglk /215 9rd-'_f N
�ioriv s
Certified Operator: �� O �' �' Operator Certification Number: 14w'# l6 96
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = & =is Longitude: 0 ° = ' = w
n
Desiga Current Desig]II
Current Design Curren#
Swine
Capacity Population R'et Poultry Capacity
Fopulation Cat#le Capacity Population
❑Dai Cow
❑ Wean to Finish
❑ La er
❑ can to Feeder
❑ Non -La er
❑ Dai Calf
Feeder to Finish
'g
❑ Dairy Heifer
El Farrow
to Wean
to Feeder
Gilts
❑ Boars
Discharees &Stream ImpaCt5
Discharees &Stream ImpaCt5
I. is any discharge observed from any part of the operation?
El Yes
�.J
Lj No
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field ❑Other
a. Was the conveyance man-made?
El Yes
❑ No
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
ElNo
,B"NA
CTNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑Yes
❑ No�NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
[�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
9-<o
❑ NA
❑ NE
other than from a discharge?
12/18/04
Continued

. -\
Facility Number: — gj
Date of Inspection /O-I
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?
❑ NA ❑ NE
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Lam- /
Spillway?: AID
N
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ETNo ❑ 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?
❑ Yes [J"NNo
❑ Yes E No
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? ElYes E hrNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes Cl No ❑ NA ❑ NE
11.
Is there evidence of incorrect application? If yes, check the appropriate box below- ❑ Yes
L1No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence ofWind Drift ❑ Application Outside of Area
12.
//Window
Crop type(s)
y
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
�
E NNo ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
IT No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
NNo ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
�E
L7 No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
[ Na ❑ NA
❑ NE
Comments referhto uestion # ; Ex lain an YES answers and/or1n recoutmeudaisons:or an other comments.
Use drawings of facriity to better explain sttuahons(use addttaotial pages as necessary]
_ 4
"G d 6
Reviewer/Inspector Name l Phone: eta- 3 3—
Reviewer/inspector Signature: Date: 10 —0 2M
Il/28104 Continued

Facility Number: O — g/ Date of Inspection FV__/T__6fl
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 appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps
g ❑Other
❑ Yes L' I No ❑ NA ❑ NE
❑ Yes L7 No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ 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?
ElYes
L5"No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElIJ Yes
,B'NNo
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VN
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LJ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B 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
CTN.
❑ 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
L3 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[3 No
❑ NA
❑ NE
12129104

E.sl_/erect 6j RR 7—Z# —zoo?
M
® Division of Water Quality
Facility Number (j 9 g 1 Q Division of Soil and Water Conservation
_
0 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
10
Date of Visit: Arrival Time: Z : IO Departure Time: 3:OD County: �c���/ Region:
Farm Name: Mac : Re 6 Laj s Fi ej , la e t­ Owner Email:
Owner Name: Mr_ i R. ,106'NS Phone:
Mailing Address:
Physical Address:
Facility Contact: woe_ ( P_o(o10t ^J S Title: Phone No:
Onsite Representative: K a+&y Du5 cz N _ Integrator: uvpti ti
Certified Operator: 7-e e- Rokio ix, S Operator Certification Number: /b 176 &
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= o = 4 0 Longitude: = ° = i 0
di
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
0 Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design 0
Cattle Capacity. Pop
❑
Da Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
D Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 [Z No ❑ NA ❑ NE
❑ Yes
3 No
❑ NA
❑ NE
❑ Yes
[FNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[d No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
12128104 Continued

Facility Number: 0 — g
Date of Inspection -12 - O 1
i Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes QXNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): i
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q1 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
1f any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 09 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 0 No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area j, s f-v A„•�Ndr �, t
� 12. Crop type(s) j3P.,! I �n.. _C2ey
13. Soil type(s) N A FJ
I4. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes [ No
17. Does the facility lack adequate acreage for land application? ❑ Yes [RNo
18. Is there a lack of properly operating waste application equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
Reviewer/inspector Name C_k S Phone: 410, q33. 3330
Reviewer/Inspector Signature: Date: 7-/Z - 2oo7
I2/28/U4 Continued

Facility Number: 0 9 — Q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [$No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3 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
[:YNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Cl 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
a No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[9 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[5� No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3 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
[2 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
[�g 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
❑1No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit
Compliance Inspection
Q Operation Review Q Structure Evaluation
0 Technical Assistance
Reason for Visit
outine Q Complaint
0 Follow up 0 Referral Q Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time 77. aDeparture Time: 7l County: t�
Farm Name: ��r O Lb � t7 C
c r t P'i6k &Ls Owner Email:
Owner Name: E D A I : hS Phone:
Mailing Address:
Region: 1fk__D
Physical Address: 1 )) !!
Facility Contact: !U r L zh h+ -1 S Title: Phone No:
OnsiteRepresentative: 0"' Integrator: v✓04
Certified Operator: ��rL1D't Operator Certification Number: 16
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = ' E__1 " Longitude: 0 ° = , 0 "
DesignM�=-Hrren
=Dgn Current
Design Current
Swine C*apacity Population
Wet Poultry Cap city Population
Cattle Capacity Population
❑Dai Cow
❑ Wean to Finish
❑ Layer
❑ Wean to Feeder
❑ Non -La er
❑Dai Calf
Feeder to Finish D�
❑ DairyHeifer
s ❑ Farrow to Wean
D on
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cowl
❑ Turkeys
.
Other
❑ Turkey Pouets 1
.<,.,
❑ Other
❑ Other
�F .
eiures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
91 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
8 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (I f yes, notify DWQ)
❑ Yes
R 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
C.No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
9LNo
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

Facility Number: — 0 Date of Inspection '04o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 5 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
f0 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ yes
JKNo
❑ 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
C3 Yes
❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
fR No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
P.No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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) �_—/"»'I U U r 0__5r_enj
13. Soil type(s) Q
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(A 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
J9 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[9 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA ❑ NE
'Comments (refer to question ft Explain any YES answers and/or any recorn,modations or any other comments.,r `-k
Use. drawings of facility to better explain situations (use additional pages as necessary): .
Reviewer/Inspector Name _— Yt/ �-�� —^—� Phone:
Reviewer/Inspector Signature: Date: g � —� (0
1-4 Cffj

Facility Number: — $ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ffi�N0 ❑ 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 El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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
10 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
j No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
MNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
SNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IN 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
JK 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
KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
BNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RINo
❑ NA
❑ NE
Addittonal Comments and/oi'jrgDrawings �._. :,..::U�
Page 3 of 3 12128104

- ® Division of Water Quality
Facility Number g R Q Div ion of Soil and Water Conservation
Other Agency
Type of Visit 40 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: 1L Arrival Time: = 30 Departure Time: County: 4) e-Ls Region:
Farm Name: C. Owner Email:
Owner Name: _pp�rrrr� Phone:
Mailing Address: 2_1 � �bb� � 5 � � . C_0tMG" t _ _N � _ 2 8 q3 y
Physical Address:
Facility Contact: Title: Phone No:
OnsiteRepresentative: , _"`�-��+ �{{ rciei...� _____ Integrator: mop ,"
Certified Operator: e +� l Qo b� i tw S Operator Certification Number: 6 6
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [ ----- 10
= d = 6, Longitude: = o = I ❑ "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
` ❑ Layer
❑Non -Layer
Other
❑ Other — - ---
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'?
Design Current
Cattle Capacity. Population
❑ DainLCow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
_51i
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
0.NA
❑ NE
❑ Yes
❑ No
RNA
❑ NE
Z NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
�&No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: - —1r
Spillway?: VtO
Designed Freeboard (in):
Observed Freeboard (in): -ZiZ -
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes LgNo ❑ NA ❑ NE
❑ Yes ❑ No [RNA ❑ NE
Structure 5 Structure 6
❑ Yes KNo ❑ NA ❑ NE
❑ Yes [K No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes RNo ❑ 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 EqNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Wo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [&No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) Ma a A �
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes J� No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 9 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes In,NO ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 2 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes C&No ❑ NA ❑ NE
Reviewer/Inspector Name f �, Phone:
Reviewer/Inspector Signature: Date: !Z O
12128104 Continued

Facility Number: — 8 Date of Inspection IhI I� V
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps ❑ ether
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ElNo ❑ 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
[5'NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
J�J 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
E No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[� No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EINo
❑ 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
EgNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[`jNo
❑ NA
❑ NE
Adtional Commentsamdlor,Drswings.,a �, -, w �T
12128104

Type of Visit O Compliance Inspection O Operation Review O lagoon Evaluabon
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: // " / 9 d Y Time: � •' JS
Facility ?Number 8
Not rational Q Below Threshold
® Permitted ® Certified 0 Conditionally Cerdfied Q Registered Date -Last Operated or Above Threshold:
Farm Name: County: 1 a d1c r� F l� O
Owner Name: Iss i,. P,; 101Z2i0s-.--------- _ Phone No:
Mailing Address: o? 9 7 6 i u c R eat C n" nr c: l 1J C.
Facility Contact: ..... Title: _ . Phone No:
Onsite Representative: _ _ - a,",, Q a_ ._ _, . Integrator. 1nr1 „� _ ► n w j
Certified Operator. o Cr C, 6; Operator Certification Number: y I G 9 G G
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 Du Longitude �• � Du
Discha es &Stream
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated au ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reacts 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 q No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 10 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes gj No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Frecboard (inches): 3 3"
12112M3 Continued

acility, Number: 9 =< /
Date of inspection ////p/o
5. Are there any immediate threats to the integrity of any of the structures observed? Cie/ 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 throat, notify DWQ)
7. Do any of the structures need maintenanceftmprovement?
S. Does any part of the waste management system other than waste structures require maintenanceftmprovement?
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 maintensmm/i nprovement?
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
❑ Yes © No
❑ Yes M No
❑ Yes © No
❑ Yes No
❑ Yes No
❑ Yes [P No
❑ Yes Q No
12. Crop type J- ^-I.Lrds� Z-5 a ti 6.,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes J 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?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
❑ Yes ® No
❑ Yes No
❑ Yes [1 No
Odor issues
IT Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes EP 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 ER 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.
-R'����
CommmtS (set`#' tri :#)'E�Iam � Y]�S aas�rRs 9adlar arty � 0�',ierAf�att�el:C.w �
der _. id.x y'.i:�' m"' ^x r�J�., 4''°°')i.'`-.F-''ss.�- u`. sd€,2i'-`�� - } -3s .ar�F•. ..=- -y"i- T� ..:..,'w.a:,:.x,..l.:.ux ^�_,:.d
Ilse draws' #tf 1beCtct at>Ratc.u�e as
._...�.._. _. � �9.��_�, ?.;�_. �-m�..�.�_.�.,,,...e.�.,_ _�.1_.�'Y � ®Feld Corn+ ❑Final Notes �`
Reviewerliaspector Name j
Reviewer/inspector Signature:
Date: /f //y / d
12/I2103 Continued

Facility Number: (1 — Date of Inspection !! n
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [9 No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ® No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ril No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ® No
25. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ® No
27. Did Reviewer/Inspector fail to discuss review/inspection 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 oftbe Certified AWMP? ❑ Yes ?J No
N'PUES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes 09 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