090082_INSPECTIONS_20171231

State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Mr. Murphy Smith
19847 N C Highway 1215
Bladenboro, NC 28320
Dear Mr. Smith:
[DEHNR
DIVISION OF WATER QUALITY
May 20, 1997
SUBJECT: Annual Compliance Inspection
Double S Swine Farm
Registration No. 09-82
Blades County
On May 19, 1997, staff from the Fayetteville Regional Office of the Division of Water
Quality inspected the subject swine facility. Please find enclosed a copy of our Compliance
Inspection Report for your information. It is the opinion of this office based on the
information provided and observations made during the inspection that the facility was in
compliance with 15A NCAC 2H, Part.0217 at the time of the inspection. Please refer to the
comments section on the rear of the inspection form for information regarding your facility.
Please be aware that all swine facilities with a liquid waste collection system designed for
a minimum of 250 hogs must have a certified waste management plan on or before December
31, 1997. The district NRCS office, Agriculture Extension office, or the Division of Soil
and Water have specialist available to assist you with upgrading of existing facilities and
certification.
If You have any questions concerning this matter, please call Robert Heath at (910) 486-
1541.
Sincerely,
Robert F. Heath
Environmental Specialist
cc: Operations Branch
Central Files
Audrey Oxendine - FRO DSW
Sam Warren - Bladen Co. NRCS
Wachovia Building, Suite 714, Fayetteville �,� FAX 910-48"707
North Carolina 28301-5�
11 W C An Equal opportunity Affirmative Action Employer
Voice 910-486-1541 50% recycled/ 10% post -consumer paper

r&-Roddm 0 Complaint 0-FoHo= of BM eetlon 0 Foil&= of DSWC revkw 0 OMw
Impeetlon
r�Faclllty Number Daft of
nm of hVection i;-Ia �r Ilse 24 br, a.
farm SWIM TOW Tim On Bonn) SportDARIview
or Inspection (Indodes travel and processing)
Owff Nan=
MAMug Addre= L212
r I= --
OndftRgprftwMdv=-- az
C4rdwopaltor. SA'fo�� 414- Overaw cw�on Number.
K2
rO Not Operational 3 Date Last Cppera�Ded:
Type of Operation and Design Capacity
/j/
"S In;
. . . . . . . . . . .
W Wm t
on to Feeder
DairTy
Feeder
Fee -der to Finish
BCCf
w
Far I -mw�tp Wean
kF
44
*jF4
EME 12 EjMb 13 Odw Type OfLtvedwk
-Z,--a:QN jinbei if Lagoons ''I Subsurface Drains Want
_
Ugoon,=OLm. n- �fw— g7 d Men
1. An 9= any buffen that and M r, 13 Yes XNo
2. Is any ffinhwp observed from my part of the opwv3i=? Yes AND
lf&chwv is observed. was the wavrom MM-OMW Yes ANc
b. If &whwp is observed, did it rcwb Su&= WzW? (If ym notify DWQ) i.7 Yes *No
r- If discharge it observed, what is the estimated flow in pal/min?
dL Does discharge bypass a lagoon eva=? QfM notify DWQ) 13 yes'9NO
3- Is 6= evidence ofpast discharge fim any part of the qpaxd=7 13 Yes ONO
4- Was *= any adverse impaw to the waters of the State other them !roan a &Whop? 13 Yes PrNo
S. Does any pm of the waste management ryzt= (other than kgoonsUlding ponds) 13 Yes P040
Oci q"awment?

a b Muty dot in Compliance Wft arq sppIicsbls Mdh&& tom?
7. Did the facility hill to have a otntiSod opetatar in tegxmxhle charge Cif won atkr 1/11YM
- L An there lggoams or stanW ponds on site which grad no be pmpeeiy clonee
etores UnRos and/ r ljoldft
P. is strurcanai freeboard kss than admpft?
Fs dxm d (flk Roam 1 A%R m 2 Lap= 3
-
10. Is seepage obsavW fi= say ofd a zburmtea?
11. b erasion, or any other threats to the amity of day of the song observed?
12. Do any of the stracun acid
of any of questions 942 was answered yrs, and the situation poems an
imaQediate public health or environmental d att, soWY DWt)
13. Donny of the structwes lack adquete markeas b identify start sad stop paaapiag lovely?
Waste Aovlicatlon
14. is there pbysieal evidence of over application?
-(If in excess of WW, or rwwff entering waters of the State, notify DWty
23. CMP type
16. Do the sctive crops differ with those designated in the Iluiaaal Waste Management Plan?
17. Does the 5ugry lave a lack of adequate aa+eage far land appb atioa?
I S. Does the cover crop new impmVeme nt"?
19. L there a lack of avaiiable irrigation equipment?
Eon Certified Fatuities Only
2Q Does the facility fail to have a copy of the Animal Waste Maaageraeas Plan rcad0y available?
21. Does the facility fag to comply with the Animal Waste Management PLa in ray way?
122. Does r xd keeping naed imgravrmeat?
Does facility require a follow► -up visit by sam apneA
Did Revivwcr/ fast to discan reviowMer or operator in cheap?
0 Ya N'o '
G Yea )q No
]a Ya ANo
13 Yes ,a No
Lagoon 4
© Yes kNo
© Yes *0
❑ Yes P,No
Oyes � No
C) Yes �Nol
13 Yes A No
1:1 Yes *No
fl YesA No
E3 Yes )<No
C1 Yes (] No
13Yes 13No
13 Yes 0 No
xYes IRNo
idYes 13 No
Cwmctft (refer to gw*tkm #): Explain Katy YES smawe�s aadJora�y.r mdations cw any other t pnm�ts
Use dmw' igs'offaraiity.to better elldin situatio�nt. dux additionalpages'as.m Y) ••G:' :=_= =w. t ...
.? 3. f�le..�.-C14V,0%0
ea,,[,�J a.��! ,� �s�of�/�- ,e'_ %rya.-,�or�•��.�L]s'�-r'.s� .v ���.?.
ft
Reviewer/Inspector Name �- ` ""`<-
teviwer/Iospector Signature: 94E2��.
Daft: _, //? / 97

Division of Soil and Water Conservation [3 Other Agency
® Division of Water Quality
10 Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other 1
Date of Inspection
Facility NumberD S' Z
Time of Inspection � 24 hr. (hh:mm)
© Registered 0 Certified 0 Applied for Permit © Permitted 0 Not Operational I Date Last Operated:
FarmName............. D..aeA......5........ eQat~ ..... ............................. County:............ ................................................
r
Owner Name:........... .. Phone No: �r �34� y.0.......................
�...... ...................Y......................_........._.......................
Facility Contact:-----.................................................. Title:............,.. .. Phone No:
Mailing Address: .......... .f9?2/elA-4('oc'2 P? Z41
„... ....
Onsite Representative:..........................................................--••--f------..._....................------.... Integrator:........ 'r�.lf`....
Certified Operator .......... sii,t/....... if... ----................................ Operator Certification Number;......L22Z........... _....
Location of Farm:
Latitude ' 0' 0" Longitude, 0' 0' 0"
iimmral
1. Are there any buffers that need maintenance/improvement? ❑ Yes W No
2. Is any discharge observed from any part of the operation? ❑ Yes P[No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoonstholding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes fQ No
❑ Yes ® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes ® No
IV
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes Ad No
Continued on back

i
Facility Number: —
8. Are there lagoons or storage ponds on site which need to be property closed?
Structures (Lagoons,11oldint? Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes IRNo
❑ Yes XNo
Structure 5 Structure 6
Identifier:
Freeboard (ft):.. Q........ Z, J ...............6..........6..........
........................................................................................................................................ .
10. Is seepage observed from any of the structures? ❑ Yes XNo
I is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 4 No
12. Do any of the structures need maintenance/improvernent? ❑ Yes gNo
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
/K'No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
E&No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type te-............................................. ........... ................. ................................. __................................
.............
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
(UNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
JRNo
18.
Does the receiving crop need improvement?
❑ Yes
No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
.21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
($No
22.
Does record keeping need improvement?
❑ Yes
IN No
For Certified or Permitted Facilities OnIY
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
MNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
QgNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
J& No
0 1eeienofrieNo'violations•ar defciencies.were note&during' this' visit'. You' .w ur
.-:•cyrrespQndeitceaboutthis:visit:•: :.............-.:.� - ... ��.._:.:..._.,.,.:.._......:.� ��_.:.:.
Gornments (rejt`erFtoqueshon} „Explain any YES answers andlor anyreeoutmendaitons or any other cgrnmreutsc���
�. g- �Use drawings of facthtyto bettei explain sttivations. (use addtttonal pages as.nece5sary}
_4tjg .->?re.e YMriaS: .—•x.a Y ..- 'af,i4u^'�.k4z...ezat .:+: .sCi.:..... , �.Y*f.�`.'`a.'..-` .? ,'�R.o >^'°l`H§Zf.'9.."r 'a;i4+'4'^�iZN,S�x�.�eY y.k�nsan
7/25/97
T
.. n
Reviewer/Inspector \amen :4 a��
Reviewer/Inspector Signature: `r Date: / p61F1

0 Division of Soil and Water Conservation ,Operation Review r
Q .. 13 Division of Soil and Water G►nservation Compliance Lispecgoin
ivisian of Water Qua>aty 'Compliance luspection ;:y.w
� w
13 Other Agency Operation Review r _r _ • 3 '_a .= ,.-
Routine O Com laint 0 Follow-up of DWQ inspection 0 follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted © Certified Q Conditionally Certified © Registered JE3 Not O erational Date
j Last Operated:
T1 Farm Name: ....... .m.--b..1.-e...... 5.. Ca' r...................... County: A.f.'.r L.L.r......---............................
Owner Name: ...... �//1 1E'� .l�! , ......�;.............................................. Phone No:............l� Q... z.. �`....-................:.......
Facility Contact: .............. 1ir...�L��..... Title: Phone No:
Mailing Address: ............ .
�Z9 ,r...5......................... x,....NC........ Z0r3Zv
Onsite Representative: ............................................ Integrator: .................. .1.�. r.r.............................. I...........
Certified Operator: .................................................... ............................................................. Operator Certification Number:.........................
Location of Farm:
...................................................................................................................................................... .................. ........... .......................................................... I...----............... .
Latitude • A •6 Longitude • 9 «
Design
Swine ' Capacity
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
;; ❑ Gilts,
❑ Boars
L _ Nuntiber of Lagoons,
Holding Ponds /:Sohd Traps
Current = _- Design -Current. Design
opelation ; Poultry u Capacity :Pooulation _Cattle Capacit.
❑ Layer ❑ Dairy
❑ Non -Layer I I JE] Nan -Dais
❑ Other
Total: Desierf Capadty
- Total SSLW
❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Yj ❑ No Liquid Waste Management System
Discharges & Stream Facts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/thin?
d. Dees discharge bypass a lagoon system? (If ycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (Freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes J No
❑ Yes *To
❑ Yes \ No
❑ Yes No
❑ Yes XNo
❑ Yes fi�No
❑ Yes XNo
Structure 6
Identifier: It
Freeboard (inches): .......3 ........................... ......................... I ......... ....................................
...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 'KNo
seepage, etc.)
3/23/99 Continued on back

Faciliiy Nuniber: oq —.fZ Date of lnsprction
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10_ Are there any buffers that need main ten ance/improvement?
11. Is there evidence of over applic ti n? rr ❑ Excessive Ponding ❑ PAN
12. Crop type yL � l��o� ' CL
13. Do the receiving crops differ with those designate4 in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fait to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21, Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
A61hti6ris:et- deticienc�es mere ngted• jhWing #bis:visit; • Y:oii Will -receive Rio: futtligr
correspondence aharut this :visit.. ......... ... ... ... ....:.:.:.:. :.... .... ... .
❑ Yes KNO
❑ Yes ANo
❑ Yes �10
❑ Yes K No
❑ Yes XNo
❑ Yes JI&o
❑ Yes YNo
❑ Yes X No
(:]Yes KNo
❑ Yes KNo
❑ Yes S<NO
❑ Yes A(No
❑ Yes XNo
[:]Yes 'KNo
❑ Yes 0 No
❑ Yes No
❑ Yes o
❑ Yes fflj�-10
❑ Yes XNo
❑ Yes VNo
FX
❑ Yes jNrNo
Coiiniments(cifer fo .question #) Explain :any YES answers d/or any recommendations or anyotlier continnents"
- w
Use drawings of faciltty�to Bette a iplain srtuatio ` {use`addi4onal pages as necessary)
�6r-M �� 0AW'4la- ;ofecl_
d� deco 4� Cr7S.
ro
Reviewer/Inspector Name__
Reviewer/Inspector Signature: _ W - r Date:
3/23/99

Facility Number: Date of inspection
Pdor Issue's
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 0264o
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Pio
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 10
roads, building structure, and/or public property) \
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ANo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ko
3123/99

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Z Date of Visit: lJl Time:
O Not Operational Q Below Threshold
® Permitted ® Certified /[3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
h� County: / U��.-� .
Farm Name: ......... J�Gls:.................�' ` h'� .........I''' _... _.
Owner Name:...i.! ........................................... Phone No:
Facility Contact: ....yrd��t. .......r!Y' !. V......... Title: ................. Phone No: ................ _.........
........ .. »
Mailing Address: ...... -.1l..........1..... .. /�/ ..a lA�t•`J�i-ca �'l .............._
Onsite Representative: �. ^'.... !.' . ........................---.............. Integrator:....
Certified Operator: VZ.11Z . Operator Certification Nuuumber: _.,o2
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` " Longitude
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes EjNo
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes JEO No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes A] No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ®No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes WO
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: .................. .
Freeboard (inches):
5/00 Continued on buck

Facility Number: p — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes BiNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes AIo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes PNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? r ❑ Yes RNo
Waste Application
10. Are there any buffers That need maintenance/improvement? ❑ Yes ff No
11. Is there evidence of over application? ❑,Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes P�No
12. Crop type 1f1/116;0r— , .S1- 4116.5r,y e%s",
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes PKNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
Wo
b) Does the facility need a wettable acre determination?
❑ Yes
gNo
c) This facility is pended for a wettable acre determination?
❑ Yes
PkNo
15.
Does the receiving crop need improvement?
❑ Yes
($WNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
19 No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes,
�No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
11
(ie/ WUP, checklists, design, maps, etc.) I'll✓
❑ Yes
®'No
//❑``
19.
Does record keeping need improvement? (ie/ irri atio freeboard, aste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
%No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge,
❑ Yes
ONo
(ie/ freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
In No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
®No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ERNo
0• �iO•�i4rA�i4njs:e� d�fc�eaei� ire h��• �lirtriFtrtg �h#s:v�s�t; • Yoh w��•>reegiye �o #;uthtrr - -
COrres den& tboui this Vlsit.
_Comments {refer ta'gnesEtan f#) Explatn any YES: attswe�ts audlor any recom�endatoas otr arty other cots. a:; .
Use dravvtnga of iacty to 6etter:e$pLain'situatians. {use aditibnal pages asaecessary) rp `R— �'
7, lfi.G Gf1 e."� ,..J.si d�E .5��� ��o� �.�✓�/ G�o.� ,rr� d ,�.:� mvr +
i��
Reviewer/Inspector Name-
Reviewer/Inspector Signature: Date: 5/00

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ® Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes A No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes IM No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes' KNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes (R No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? % Yes ❑ No
Additional; -omments andfor. ra — - -- -- _
w
5100

Date of Visit: r r Arrival Time: '{1 D Departure Time: ,3 ; a County: vL Region:
Farm Name: s lac/'_ Owner Email:
Owner Name: it Phone:
Mailing Address:
Physical Address:
Facility Contact: toUrr�_ ��!7r !'ti Title: ealoe"' Phone:
Onsite Representative: Integrator: r
Certified Operator: Certification Number: p2
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Desigq Current
Design Current
Design C*urrent
Swine Capacity Pop.
Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish
Qa
Dairy Heifer
E
Farrow to Wean
Design Current
Dr, Poultry Ca deity $o
Dry Cow
Farrow to Feeder
Non -Daily
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
- -
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 54 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3
21412011 Continued

Facilit y Number: - Date of Inspection:
.i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes LN No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 fo
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
[&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
MNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
rtm 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
� 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): Cnrrt 6.64/ 4
13. Soil Type(s): i�}X A �/yf
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 R No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [M No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[K 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 []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes r" No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VLNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

I
Facility Number: - Date of Inspection: /
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes I No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [—]Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes ;qNo ❑ NA ❑ NE
❑ Yes ® No
[-]Yes ® No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer t6question #€}: Explain any YES answers and/orany additional recommendationsaor any�oth: comments. ' ';
Use drawings of facili to better explain situatifg, Mg
ons." useailditional; a esasi�ecessa fi ty, P ( P g 1 y)- 4 .IV
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: e �{7/'-2_
Date: � eg — %`per/rZ
21412011

Type of Visit t&t,.ampliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit GHR"o'utine O Complaint O Fallow up Q Referral -O Emergency 0 Other ❑Denied Access
Date of Visit: i vwl L_J Arrival Time: : DO Departure Time: : pO County: hiLT`-� Region: Elzo
Farm Name: /0— Owner Email:
Owner Name: _ u r flf� S Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: z2rlI7Y� Phone No:
Onsite Representative: �iz.�� „ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: Eje 0 ' Q Longitude: = ° 0 ' 0
Design Current Design Current
Design Current
Swine
Capacity Population Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
❑ DairyCalf
E9 Feeder to Finish
y p
❑ DairyHeifer
El Farrow to Wean
Dry ltry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
Non -Layers
❑ Beef Stocker
Gilts
❑ Beef Feeder
ko Boars
❑ Beef Brood Co
Other
❑ Other
Number of Stnsctures:
❑
El Pullets
❑
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
5d No
❑ NA
El NE
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
El No
El NA
[I NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
El NA
El 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)
El Yes
El No
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
No
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[2LNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):`
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® 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
[KNo []NA LINE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
QNo ❑ 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
9LNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
9No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Flo ❑ 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) Curt_ Liz
13. Soil type(s)/�1}�-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
®-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
RNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo ❑ NA ❑ NE
Comments (refer�to question #) E�cplain anyYESanswers and/or any recommendations or any other comirients.
'Use dr'aw�'of=facility to better expla►n sitetatios( se+additional pages as necessary)•
g
Reviewer/Inspector Name Phone: _9/,2 3
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes jo No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 10 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®.No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
CKNo
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
18 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JZ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[9No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(R No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
0 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ 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
ZLNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Rm
❑ NA
❑ NE
Additional Gontments an or Draw1iii
Lc
Page 3 of 3 12128104

9-64-3 $-/l-z0/0
Type of Visit (r,,C,,,,Yompliance Inspection O operation Review O Structure Evaluation O Technical Assistance
l
Reason for Visit Ro—utine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: . ,35 Departure Time: 0; SO County: 8/4E'4A/ Region: df
Farm Name: bD(4 WC- S _&a —"j Owner Email:
Owner Name: MytRl.0 sm -q' Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: / Phone No:
Onsite Representative: S4cj e-o Integrator: Uld k4L...., e r-b-h1I'1
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E__1 o = ' = u Longitude: = o = . = is
Desigrt Current
Design Current
Design Current
S�vine
Capacity Population
4444 f3 I
Wet Poultty Capacity Population
JE1 Layer I I
ID Non -Layer I
Dry poultry
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
IME10ther
❑ Turkey Poults
❑ Other I
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 to ❑ NA ❑ NE
❑ Yes ❑ No t <NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No L7NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes L` < ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

! V
Facility Number: Q —
Date of Inspection 7-15- /d
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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Z
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 2No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2❑ NA ❑ NE
❑ Yes 2<00 ❑ 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 ITNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El 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 El Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ETNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L!f No [] NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window s°
ow ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Co rAf , LJ Lt4-+ — -y /I
13. Soil type(s) Ala,
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
CTNo ❑ NA ❑ NE
9<0,__0 NA ❑ NE
No ❑ NA ❑ NE
ET'N'o ❑ NA ❑ NE
E No ❑ NA ❑ NE
Comments (refer to -question ##): Explain any As" answers and/or any recomnenions or any other comments.
Use drawings of facility to better explain situations: (use addihotial pages as necessary)
r y
AL
T
Reviewer/Inspector Name ��ke J f_i S ' ;,' Phone: 9/D, f�3. 33oa
Reviewer/Inspector Signature:_2CA4Date: 7-/
12128104 Continued

Facility Number: Q — - Date of Inspection /S- f b
Required Records & Documents ko
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
B o
❑ 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
��
[3 o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B<o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[3<0
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E3 o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
B<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B<o'-❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3' o ❑ 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
__,�
3<o' ❑ 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
��
L7 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
,�,/
L/No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
2No ❑ NA
❑ NE
Additibnal'.Comments a d/,or'Drswut s
Page 3 of 3 12128104

�S�1.tviS 7- 0`7 -- 260ci
Facility Number (� ?
L9-11ivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ompliance 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: �-Zo Arrival Time: . t7D q Departure Time: /(�.' C County: bl q Region:
Farm Name: L) O A b 1 t S. Owner Email:
Owner Name: u V I jzX ! Phone:
Mailing Address:
Physical Address:
I—A0
Facility Contact: S _� Ly` S�'"� �� Title: Phone No:
Onsite Representative: _5;16 G �•� ".1 p- Integrator: �' � k., V"�
Isve
Certified Operator: �f e e� 9 `'r�^ Operator Certification Number: A k!Q 9 929_S_V
Back-up Operator:
Location of Farm:
"'Design . Current
Swine = :Canacity PnnnlaNnn
❑ Wean to Finish
❑ Wean to Feeder
ceder to Finish Zqq 2 1 Z&O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
Back-up Certification Number:
Latitude: = o = 4 Longitude: = o [� l =
Design Current
Wet Poultry Capacity Population
❑ La er F�J
❑ Non -Laver
Dry Poultry
❑ Layer-,
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Facts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
IYes ign Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: EP ` "
x
o 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 [ i-goo ❑ NA ❑ NE
❑ Yes
❑ No
❑'1qA
❑ NE
❑ Yes
❑ No
0-NA
❑ NE
E31 A
❑ NE
❑ Yes
❑ No
❑ Yes
El -go
❑ NA
❑ NE
❑ Yes
ETgo-
❑ NA
❑ NE
12128104 Continued

'[Facility Number: Q - ;?Tj
Date of Inspection S 10 c7
Waste Collection & Treatment ��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes LYNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes E o- ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: #
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
'i
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[E 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
EMo
❑ NA
❑ NE
through a waste management or closure plan'?
1!f 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
2Vo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑Yes
No
❑ NA
❑ NI?
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ff 'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[T No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑` l-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) Cr_7 ► -AJ Q " 14 :7 Zie a-,�
13. Soil type(s)j,�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ell or
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
21qo-
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑'1q0
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
B'lq-o
[]NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[qE] 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,
IV
Reviewer/Inspector Name geve- ve_r' • Phone: WO, T33,� �
Reviewer/Inspector Signature: Date: r-? 0
12128104 Continued

Facility Number: Q 9 — S Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ETNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ W P ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
LT<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 ❑ Wcather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ej`N_o
❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ErNo
❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B<o
❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes UYNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes E N�o [I NA [I NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes <_7 wo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0<
❑ 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
[31 o
❑ 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
ETNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ETNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

En►fare.01 by kR 7-2IA-z00-7
F
10 Wean to Finish
❑ Wean to Feeder
Feeder to Finish 12q4F
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
0 Division of Water Quality
Facility Number ��M
0 Division of Soiland 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
Date of Visit: id ZD �a7 Arrival Time: q./S ,�,� Departure Time: Q County: _1_71&?d N
Farm Name: ��>9 b S Owner Email:
Owner Name: /Vl 1Av p E_4._ >JM4 `fCn Phone:
Mailing Address:
Physical Address:
Facility Contact: AI,21r¢ a..! Title: D.TC_ _ _ Phone No:
Onsite Representativef,:�r /
Certified Operator: yVi�l L f3
Back-up Operator:
Location of Farm:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: A�0
Latitude: = 0 = f E__1 q Longitude: =° 1:1 1 ="
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity. Population Cattle
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ 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.-,
Capacity Pbpulatibii�,.-
El
Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ©�
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [P No ❑ NA ❑ NE
❑ Yes
Number of Structures: ©�
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [P No ❑ NA ❑ NE
❑ Yes
[4 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
ElNA
ElNE
❑ Yes
[P No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: QI - z
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P9 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[,2 No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
[ 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
�j No
❑ NA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[A No
El NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
R 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) GOrAJ. SD c. `APO AI-5
13. Soil type(s) 4-_1('Up4 _.,jCfi A101 atria _ —Nut
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�9 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[jallo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
V] No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
f
Reviewer/] n spector Name GLI V e.I 5 Phone:
Reviewer/inspector Signature: Date: !o -ZO - 2O4 �L-
12128104 Continued

Facility Number: C9 q — S Z Date of Inspection 1v-20-O
' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CiFN0 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[� No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[HNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P1 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
jr.0 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P 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
WNo
❑ 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
WNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
59No
❑ NA
❑ NE
Page 3 of 3 12129104

r�CNIcrj- to k'. Re,Lrs lz/z.5/zeo (,
Facility Number O 9 � $Z
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency.
Type of Visit o Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ®Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: /Z; .i?0 Departure Time: I L)2, 0D County: 81ad enI Region: FP—Q
Farm Name: n A to Fw.—KA _ Owner Email:
Owner Name:1-,Q A 4. S A' �t6— Phone: 910 •
Mailing Address:
Physical Address:
Facility Contact: W t 11j aP,,L E; . Fir -cad Juan( Title: O rC- Phone No: 9/01 (o #19, 4Z/D
Onsite Representative:
Integrator:
Certified Operator: Wllltix"A a._ FirC-CA hA0-t-' Operator Certification Number: zUo2-3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o =' =" Longitude: ❑ ° = I = [.
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
1 ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ 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
❑ Daia Cow
❑ Daia Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
l
i
Number of Structures: =1
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)
1 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 dNo ❑ NA ❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
[X No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[FNo
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
[;j No
❑ NA
❑ NE
12128104 Continued

L
Facility Number:
Date of Inspection9-
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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 32/1
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 14 No
❑ NA ❑ NE
❑ Yes Vf No
❑ NA ❑ NE
Structure 5
Structure 6
❑ NA ❑ NE
❑ Yes V No
❑ Yes [$ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[� No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
r
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
QI No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
WNo ❑ 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 ElEvidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) coi-h!
13. Soil type(s) _ EX /Y OIla — 2il. - Aa
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
dNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
VNo ❑ NA ❑ NE
[,3 No ❑ NA ❑ NE
[$No ❑ NA ❑ NE
[d No ❑ NA ❑ NE
Comments (r'.efer o,questioo:#) .'Ezptain any YES answers and/or any recommendataons or -any other comments
- W-1
Use drawings of facility to better..explain situations. (use additional pagesaas ne'cessary):`
SIu dS G S u,-v �o &IicAdl m N cl Z 7 - zoo (P I
�V Ci �a-Y, Cal�'�ra-�� �«s cam- v/4" e)" 9-Z7-Z0a4,
ReviewerlInspector Name I K i V 1, t.i L (5 I Phone: NIf?) -73 -333 0
Reviewer/Inspector Signature: Date: / Z-7-1 -Z 6 0 47
rage a of i 121-'61oa [ onrrnuea

Facility Number: Q — $Z Date of Inspection lZ -29 -
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [%No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[4 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
j No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[4 No
❑ NA
❑ NE
Other Issues
2$_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[4 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
qNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[RNo
❑ NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EgNo
❑ NA
❑ NE
Additional Comments':and/or'D awings:
Page 3 of 3 12128104

Type of Visit ecompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason far Visit O Routine 0 Complaint Q Follow up ()Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I /0-20-0Arrival Time: Departure Time: County: [FA JfA1 Region: /'WO
Farm Name: ---Do it Wr. s ✓mA Owner Email:
Owner Name: 114141"OLu S&I Phone:
Mailing Address:
Physical Address:
Facility Contact: 51D Ik oy 5ow44 ___ Title:
Onsite Representative,:: rj�'COO ^.f 504., t
Certified Operator: WI/1;oH B 0lted 4061
Back-up Operator:
Location of Farm:
Phone No:
Integrator: ka4, 9f'Ou!/✓
Operator Certification Number: 20020
Back-up Certification Number:
Latitude: o = S =6. Longitude: = ° = 1 ❑ u
Design Current
Design !' °CurrentyDestgn
Current
tion
Wetry Capacity opulation
ae¢;Capacity Population
n to Finish
❑ Laver
❑Dai Cow
n to Feeder
rRe
❑Non -La et
❑Dai Calf
er to Finish Z Z 90::
.�''
❑Dai fleifei
ow to Wean
❑ D Cow
arrow to Feeder
❑ Non -Dairy
❑ La ers
❑ Farrow to Finish
❑ Beef Stocker
�^
-:' El Gilts
ers
-Lys
❑ Beef Feeder
El Boars
El Pullets
❑ Beef Brood Cow
c
❑Turke s
❑ Turkey Poults
�,...,
L=009ther
❑ Other
Number of Structuresg
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
D(No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
0 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
IN 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
A No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
IN No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
® No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

lFacility Number: GJ -S'Z J Date of Inspection /O-ZD'O
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 [X No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):% _
Observed Freeboard (in): r 3 2-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
X 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
X No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
1A 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
(1o' No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[9 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Ovird GtiliCet SDX&,Iv-5
13. Sail type(s) J15
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
CK No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5d No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
❑ Yes
(g No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z No
❑ NA ❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
P�No
❑ NA ❑ NE
Reviewer/Inspector Name �/p j/S b a R Phone: 46970 ^ S
Reviewer/lnspectorSignature: Date: /Q-Z,0 —2OO,j
I L/L4/V9 I.UI/L�Rf1C�L

J
Facility Number: — Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes D(No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 56 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
(9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and iaintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
[4 NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
[31 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
X NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
® NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
DO No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9 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
X 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
[7 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
X No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
X No
❑ NA
❑ NE
"ifiiioii' t'o"ents'andloi Drawingsi 'F i z '- '1
3'Ks�c�c-f�•- aGS�vc-� �:ly r'r✓`.+r�l� £ L�1e� r�Gorclr �
12128104

Type of Visit • Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: /Z RW y Time:
Not Operational Q Below Threshold
® Permitted ® Certified ©Conditionally Certified [3 ]tegistered Date Last Operated or Above Threshold:
Farm Name: loiN1,61a s Knr nn County: � I -Mae"_ FRQ
Owner Name: y 6., 5-14 , Phone No: i a44 q
Mailing Address: 1 i Lll� - N-C . ,50.3.2a
Facility Contact: /Title: ry�Phone No:
OnsiteRepresentative: �%e,Ol�c.� i+-z^�/� ,_ Integrator: _(%'KIf�t��
Certified Operator:—i��I�6? �e Yr eed�iksi �c / Operator Certification Number: *� O ?3
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑Horse Latitude a u Longitude + 0 0
:Destga ; Current t Da'sign Current x a Design Cnrrent
❑ -acxy LL Po iataaSwine Po�uc;C_`
Wean to Feeder ❑ Laver Dairy T
Feeder to Finish y y Sp ❑Npn-Laver ❑ Nan-Dairy -
`
❑ Farrow to Wean [] Other
❑ Farrow to Feeder _ A r
(] Farrow to Finish =� Total Desigtt CaPsC>Ety
❑ Gilts
❑ Boars - Total SSLW ,
::_ _
- Nnmber.of Lagvoas r ❑ Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
'Holdirig`Ponds'! Sohd'Traps ;- i = ❑ No Li uid Waste Mana ement System
Discharses & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at. ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I�
Freeboard (inches):
:3
05103101
❑ Yes VE No
❑ Yes
❑ No
❑ Yes
❑ No
AVfi4
❑ Yes
❑ No
❑ Yes
No
❑ Yes
No
❑ Yes [4 No
Structure 6
Continued

f
Facility Number:
Date of Inspection 1 O vy
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes (Z No
❑ Yes P No
❑ Yes [�d No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Aunlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes [0 No
11. Is there evidence of over application? ❑ Excessive Ponding ElPAN ❑ Hydraulic Overload ElYes CO No
12. Crop type C. o�aw., /% f S n o6e-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [51 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes M No
b) Does the facility need a wettable acre determination? ❑ Yes M No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? ❑ Yes ® No
16. is there a lack of adequate waste application equipment? ❑ Yes m No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
M No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
[l] No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21, Did the facility fail to have a actively certified operator in charge?
❑ Yes
P No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AN►W?
❑ Yes
Uj No
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Caafi&fc (refer to questiriii #) is:plattt aAy YES_aas ers andforfany reeotnmettdatmns=or anv outer comatents.
Lse drawings of farIl io better e:piainttn saiti6ns�(nse addW na! pages essary as nec) Field Conv ❑ Final Note", t
m :-
1,Cgirj ko uJ4r- rcw
1
Reviewer/Inspector Name q , �a G sa o K Q ao�s-
Reviewer/Inspector Signature: Date:
05103101 _X Continued

r
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ®Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facilih� lumber
Date of Visit: O- -!� Time: b a1 -li-
` I
lro lot Operational Q Below Threshold
Am Permitted 0 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: nO� ij, �e �nr.+._ - County:
Owner Name: Phone No:
Mailing -address:
Facilih Contact: S cve-
4-L Title: Phone No:
Onsite Representative: Integrator:_
Certified Operator: W t � � a m aQ l" r �e�rnaol Operator Certification number:
Location of Farm:
IR Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' z " Longitude ram' �• 0"
Design Current Design Current Design Current
Swine Ca acitv Population Poultry _Ca acity Pa alatioD Cattle Ca aelty Population
❑ Wean to Feeder ❑ Laver E
Dairy
EK]Feeder to Finish ❑ Non -Laver Non -Dairy II II
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boan Total SSLW
Number of Lagoons / ILI Subsurface Drains Present JU Lagoon Area IIJ Sprav Field Area
Holding Ponds / Solid Traps ID No Liquid Wgste Management System
Discharaes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the convevance man-made?
b- if discharge is observed, did it reach Water of the State? (If yes.. notify DWQ)
c. if discharge is observed. what is the estimated flow in eal/min?
d. Does discharge bypass a lagoon system? (If ves, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there anv adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: /
Freeboard (inches): 2711
0510310.1
❑ Yes P No
❑ Yes W No
❑ Yes ❑ No
N/�
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes Qf No
Structure 6
Continued

Facility Number: 0 9 -- g,:;2
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type 1-)1, ram+ Cot , . So
❑ Yes [� No
❑ Yes No
❑ Yes O No
❑ Yes 1� No
❑ Yes No
❑ Yes No
❑ Yes No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
[ No
b) Does the facility need a wettable acre determination?
❑ Yes
[RNo
c) This facility is pended for a wettable acre determination?
❑ Yes
[� No
15. Does the receiving crop need improvement?
❑ Yes
[ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
ZNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
9Q No
20-
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
[ No
(ic/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Cj No
24,
Does facility require a follow-up visit by same agency?
❑ Yes
�] No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[� No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
�otnnaents (t'efer to;grtesttom#) Explsia ;any YES answers<sud/orany tecomntendsdoas ©r any meter rtrnaments;.
: a
Use drawings. of facJity to better eYpla stt¢s6ons {nse addittonalpages as neeessnry) `(� Field Conv ❑ Final Notec
Fr_ c1n,9e reG6"'clQS Cas etL-)4tk r,-,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
0510310I 4 Continued

Type of Visit IF Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Alp
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other❑ Denied Access
Date of Visit:
—v ime:
Facility Number
C_ondi[tioonally Certified [3Registered
rO Not Operational 0 Below Threshold
Date Last Operated or bove T reshold•
Permitted 0 Certified
Farm Name: h42LA,b
`O
f - 1 cir'wS
County:
Owner Name: ` t' i
�,/ �/
Phone No:: /% z T
Mailing Address:
Facility Contact:
W e r Title:
Phone No:
5,
OnsiteRepresentative:
Integrator:
Certified Operator:
L 0---
Operator Certification Number: 2eJ� 2
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ` " Longitude ' 6 0�
I)estgn Current T Design Current De:
Swine } Capacity Ponulati n Toultry - . Ca ac�ty Population Cattle Ucah
Feeder to Finish
2 177
Non-Laer
❑ Non-Dairy
Wean Farrow to
Other
-
.:
+
Farrow to Feeder
El Farrow
❑ Farrow to Finish
Total Design Capacity"
❑ Gilts
=
❑ Boars
-�' Total'SSM
Nnw
umbfrLagoons
❑Subsurface Drains Present ❑ La oon Area
JEI S ra_y Field Areamuffibli
1
Holding Ponds /SohdTraps
n ._,
❑ No Liquid
Waste Management System
Discharges 8� Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes No
ElYes �J No
❑ Yes W No
❑ Yes
o
El Yes
o
❑ Yes
AN 0
❑ Yes
gNNo
Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: - Y2, Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
�(
elevation markings?
El Yes
EfN.
Waste_ Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
o
11. is there evidence of over applicatio ? ElExcessive onding PAN ElHydraulic Overload
ElYes
rNo
S
12. Crop type d
13. Do the receiving crops differ rth those designated 44 Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
o
Vo
14. a) Does the facility lack adequate acreage for land application?
El Yes
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
o
16. is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
RNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
No
t
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yeso
21. Did the facility fail to have a actively certified operator in charge?
El Yes
fNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
ANo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
P�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
*0
Ila No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer toiquestiou.Aa.,i_iplain any YES answersand/or-anyrecominendations or any other comla'- $s�.Use drawings of facility to,beteaplatn`situations.
addjtional,pages'as necessary):
(use
[] Field Copy ❑ Final Notes
/ 5rol It s tT� G� a)en// 14211ot 4ed
n �
'/J
(�
c,t; rec aYcs,.
�CrZlejl
Reviewer/ins actor Name
P ��-
Reviewer/Inspector Signature: Date: �t
05103101 / Continued

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

,�`
� � `g.
n�
��i � �
V J
� �`�
�.-,
�
O Q
�
.,�
�,
1

Date of Visit: Arrival Time: , Departure Time: /(i.D t7 County: ,,.� `� Region:
Farm Name: � S' r�-� Owner Email:
Owner Name: /7J����y J�ny�5f'l� Phone:
Mailing Address:
Physical Address:
Facility Contact: _V�ve-t_ r` ,%r Title: Phone:
Onsite Representative: Integrator: 11 �M
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current
Design Earrent
Swine Capacity Pop.
Wet Poultry Capacity to
Cattle
Capacity Pop.
Wean to Finish
airy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D . P,oul Ca acit ,.: Po .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
T
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Ljj-flo [] NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Lj-9o'__[j NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑-1<0m[] NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

•[Facility Number: jDate of Ins ection: 3D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E3 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): 1,9'
Observed Freeboard (in):—�
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes ®No DNA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes allo ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [�j 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 D Yes F>-I,No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Callo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes E&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): ZL'aj '�A /; e%1�-_'
13. Soil Type(s): X 14
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes &I 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 ER No ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [Q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®-No ❑ NA [] NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall DStockingD Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
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?
[:]Yes [� No
❑ Yes 1 No
DNA ❑ NE
❑ Weather Code
❑ Sludge Survey
[] NA [] NE
[]NA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of inspection: rl
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EjNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [] Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
if yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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 reviewlinspection 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 [gNo ❑ NA ❑ NE
❑ Yes g No 0 NA ❑ NE
❑Yes ®No ❑NA ❑NE
❑ Yes M No ❑ NA. ❑ NE
❑ Yes k]c No
[—]Yes [-No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments {ref!bto 9 Eton #) Explain any YES a;uswers andloi my additioualirecommendadnos or auy other comments.: i.
Use draviings of facthty tobetterexplain s�iiations(nse additionalpagesas,necessary1,,:
ff p
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
LSI�y� Phone:
' J ,
Date: 3�
21412015

T
Divi-sion of Water Resources
Facility Number - O Division of Soil and Water Conservation
` Q Other Agency
Type of Visit: Compl, 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: ,'(7C7 County: 1 u— Region:'[
Farm Name: AU �FY S �ar rr`_ Owner Email:
Owner Name: A Phone:
Mailing Address:
Physical Address:
Facility Contact: - z-rz--n, Sy1, Title: ~n�---- Phone:
Onsite Representative: Integrator:yyJi
Certified Operator: S'� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
C•a_ttle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish lep
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Po .
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Othe
urkey Poults
Other
FTOther
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 Eallo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [-]No
❑ Yes JELNo
❑ Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z[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): f
Observed Freeboard (in): 32
5. Are there any immediate threats to the integrity of any of the structures observed? D Yes Z, No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 16. No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ,Q 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 f�J_No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7n, 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): erf� /r7
13. Soil Type(s): /
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes .2-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage R Permit readily available?
❑ Yes JZ No
❑ Yes allo
❑ Yes J� No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J�d No
the appropriate box_
❑ W UP ❑ Checklists [:]Design ❑ Maps [:]Lease Agreements ❑ Other:
21. Does record keeping need improvement? if yes, check the appropriate box below_ ❑ Yes Jallo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes M No
23. Ifselected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes Fq_No
❑ NA ❑ NE
❑NA ❑NE
[] NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

IFacWty Number: -,2= I jDate of Ins ection- /7
�i 24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [—]Yes � No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
KLNo
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[—]Yes
No
❑ Application Field D. Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
� No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[]Yes
0 No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Lg� No
Reviewer/Inspector Name:
Reviewer/Inspector Sibmatuz
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 2Zd --imp'--eI.si
Date:
21412015

Type of Visit: CComp nce Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: tine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: o-- (p Arrival Time: p Departure Time: O ; J County: Region: R�
Farm Name _,D j2"L 5 5a frvu Owner Email:
Owner Name: / f� „� ,�-� ,Sin Yl( Phone:
T
Mailing Address:
Physical Address:
Facility Contact: !,'rr,J�„� !'yh;"f Title: Phone:
Onsite Representative:
Certified Operator:
Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design C•ucrent
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Da Cow
Wean to Feeder
HNon-Layff
Da Calf
Feeder to Finish
p�
Da' Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
D . P,oul
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [&No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
[] Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
[:]Yes
[!jNo
❑ 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 21412014 Continued

Facili Number: - Date of Ins ectiow. p—/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ff�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): r _
Observed Freeboard (in):(�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0,No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Fzi No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:)Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
QNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[5"o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
DNo
❑ 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): !" W�+r / Sl/JT'v-•zs
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
O No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
O 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
[jjNo
❑ 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 [SNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [g No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes )EJ No
[]NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

y Facility Number: - Date of Inspection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [RNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Z No
rtA No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes lCi.
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
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
EA No
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
NLNo
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
allo
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW"?
❑ Yes
Z .No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ErNo
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E�No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ff)Explain any -YES answers audlor;any additional recommendations or any other comments. '
Use drawings of facility to better explain°situations"(use additions p-ages:'as.necessary).
T Q hQ LU: s :✓per/ 6 �'"``� G� �' `L
Reviewer/Inspector Name: Phone: %a /b
Reviewer/Inspector Signature: Date: ! 33-330 0
Page 3 of 3 21412014

i ype 01 v Isn: �ampuaoce inspecnou v vperauvo meview V arrucrure r vaivanan V i ecanecai Assrsrance
Reason for Visit: outine 0 Complaint 0 Follow-up Q Referral Q Emergency 0 Other Q Denied Access
Date of Visit: I/S" Arrival Time: Departure Time: f } o County:
Farm Name: T)rg.t, ltl �S` ,,•r,.,� _ Owner Email:
Owner Name: /%%u�,n ��,�y,; Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:Phone:
Onsite Representative: _ 5fafirl Integrator: `Z $
Region: r'F—�L7
Certified Operator: �,�,.� Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design
Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
I INon-Layer
I
alf
Feeder to Finish
airy Heifer
Farrow to Wean
Desi
U. a
Dry Cow
Farrow to Feeder
Dr. , Roul.
Ca aei
P,e
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
r1l3cef
Brood Cow
Turkeys
Other -
Turkey Poults
10ther
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 [a No ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
[:]Yes [:]No
❑ Yes E&No
❑ Yes � No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P5-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L?!�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 23-No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4fi were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Ca,,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E� 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 [4 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 E�LNo
[DNA
❑ 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 0 Application Outside of Approved Area
L❑
12. Crop Type(s): 4�!lnr Z
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EqNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 54 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Eg-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [S No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [LNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes �o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes NlNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

]FacilityNumber: - Date of Inspection: J
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P�-No
' 25. Is the facility out of compliance with permit conditions related to sludge? 1f yes, check ❑ Yes �No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [—]Yes 021,No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [a No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [ANo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[—]Yes SNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes [Z-No
❑ Yes [ o
❑ Yes ,�lo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments s -:
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

IType of Visit: 4Ef Cliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Qrlroutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access IJ
Date of Visit: Ip LJ Arrival Time: 1 10,' J 4 I Departure Time: / a County: Region: T/>'O
Farm Name: S )P5Q/' R'L► Owner Email:
Owner Name: , Phone:
Mailing Address:
Physical Address:
Facility Contact: c�f� i V7'L Title: �%� Phone:
Onsite Representative: Integrator:
Certified Operator: �r'Gc,e_ Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current�Desgn Current
Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
_
Cattle Capacity Pop.
Wean
La er
airy Cow
Wean
on -Layer
airy Calf
Feeder
Dairy Heifer
Farrow
IF
Design _ Current
D Cow
Farrow
D . I;outtry
Ca achy_,_ Po
Non-Da'Farrow
Beef Stocker
Layers
Gilts
Boars
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
r
rther
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
[]Yes
ONo
❑ 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
JE�No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

'[Facility Number: - Date of Inspection: — D—
Waste Collection & Treatment
` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? 0 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 [2 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ( No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes O—No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance a]tematives that need ❑ Yes allo
❑ NA
❑ NE
maintenance or improvement?
I l _ Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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): /::I,- Y,A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes ® No ❑ NA ❑ NE
❑ Yes LR No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Eg 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
H No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbrcakers on irrigation equipment?
❑ Yes
Q No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Eacili Number: q - I I Date of Inspection*
— /
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[S 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
[5�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Z No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
1E�No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
K No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
g 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
[g No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss 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
0 No
❑ NA
❑ NE
Comments (refer to..question # Explain any YES answers and/or any additional recommendations or any other comments =*�
Use drawings of facility to better explain situations (use additional pages as necessary). a�TM
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
33--33 010
Phone:
Date: 42 ` U
21412011

Type of Visit: O Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: O; 3 o County: Region: �D
Farm Name: P!%uz/e S
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: /�jp a e` Phone:
Onsite Representative: Integrator: l•�v`
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
� `Design Current
ne Capacity Pop.
-
Wet Poultry
Layer
RNon-LaYCT
Design _ Current
Capacity Pop.
esient Dgn Curr
Cattle Capacity Pop.
Dairy Cow
Wean to Finish
Wean to Feeder
Dairy Calf
Feeder to Finish
"
Dai Heifer
Farrow to Wean
Design _Current
Cow
Farrow to Feeder
I7 . Poul
Ca aci = Pop.
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
13oars
IPullets
Beef Brood Cow
r
Turkeys
Other
Turkey Poults
Other
Other
Dischar,=es and Stream Impacts
1. Is any discharge observed from any part of the operation?
[] Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify 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
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

IFacihty Number: jDate of Inspection: .ro2L —
S Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
RM 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): 1—
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
Co No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4fi were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
� No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
I' No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[g 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 ® 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): 1°ec�i� 1r�/
13. Soil Type(s): _� �( f��/ V, 4,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Qg 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 R] 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 WNo ❑ NA ❑ NE
❑ 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 [gNo ❑ 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 2�[ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes R No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JZ No
❑NA ONE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: a
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes g[ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes
Ej No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes [A No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes JZ] No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ® No
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ® No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ® No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary). ,
Reviewer/Inspector Name: �5 Arrl"--. c•-j�.►-�
Reviewer/Inspector Signature:
Page 3 of 3 j"y�� .T-o S �� , ,ot rr ` �v••'� cor
Phone: gip-�f33 ^33ao
Date: oZ G —;2,9 1�3
21412011