090100_INSPECTIONS_20171231

.0 Division of Soil and`_Water,Conservati. '.a©peradon
Division of Soil aiid Water.Conservatign �Cornpliance Inspect>fon
Division of Water QualityComplsance Inspection � r
w
Other A x fM g ncy Operatioi>i Review
.. � .':. .. _'�. .. �.— ....'.. , e ... is
Routine Q Com taint 0 Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number pp Date of Inspection
Time of Inspection !dt 24 hr. (hh:mm)
P�ermitted [3 Certified Q Conditionally Certified ❑ Registered [3 Not Operational] Date Last Operated:
Farm Name: .......0 n.....5�.f.*_A .... TIV-L ..F.............. County:.............�:.���!.�'....................................
1
....ti M_-,4� /.......... ....................................
Owner Name: ..... J �0.c,�� �. ...��d.� .. ...��L°4!`�... Phone No: �Y-� ..Z"I ��...�....
Facility Contact: ..... �` - JJ��...��p a l.zzlt.....................Title:....................... ..... Phone No:.....--- *........... .........
.
Mailing Address: ...119.3. Mlew.-l...rl'e5� tel: �©cr.�,,,S1.i..�......�..��r...................... ..28g3V-
Onsite Representative:.......... .................................. ...... Integrator: Jr..:' _..
........................ ...................... FI......................................
J
Certified Operator:,, ram_. i„ Operator Certification Number:.................p...�.�f�..........
l
Location of Farm:
........................................................................ ..................... ...................................... I ........ ............... ................ ................ ....... ........................................
Latitude Longitude • �� �.'
Design
Current.""Design Current :
: Design Current
Sne
„._
, C
atte
n-. C_
Capacity Po p ulation
❑ Wean to Feeder
' ❑ Layer
❑Dairy
---
❑ Feeder to Finish
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
<-
-.. •.
arrow to Feeder rD0
❑Other
❑ Farrow to Finish
=
Total Des�gti'Capacity
00
❑ Gilts
-.
:. ❑ Boars
Tatal.SSLW
Nuliiber of Lagoons
[] Subsurface Drains
Present 110 Lagoon Area
❑ Spray Field Area
HoldingPonds % Sohd'Traps
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
h. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ). ❑ Yes KNo
c- If discharge is observed. what is die estimated flaw in gal/min?
d. Dees discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes qNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes i No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes j�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Freeboard (inches): .......... ................................ .................... .................................... ..... ...................... I....... ................................ ....... I ........ I ...................
..
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ANo
seepage, etc.) ���"'
3/23/99 Continued on back

acility'Number: — Date of Inspection
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
� No
(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 maintenancelimprovement?
❑ Yes
No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
KNo
Waste Application
10,
Are there any buffers that need maintenance/improvement?
❑ Yes
(,No
11.
Is there evidence of over application? ❑ Fxcessive`Ponding El PAN
❑ Yes
Q No
12.
Crop type er Q V / a ae, e_eol!
13.
Do the receiving crops differ with those designat l m 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
1KNO
c) This facility is pended for a wettable acre determination?
❑ Yes
Wo
15.
Does the receiving crop need improvement?
❑ Yes
UNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17,
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
4No
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
KNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
U� No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KNo
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
KNo
(ie/ discharge, freeboard problems, over application}
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
C�No
24.
Does facility require a follow-up visit by same agency?
❑ Ye's
T&'No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P .No
yiolatfioris :oi•• dO fid.6ntR.s -*. 4.rh6ted.. iiOifig this: visit: Yoi} will-i•eed*4e iW further
corresaoridence_ a0uti this visit.. ............... .............. .....
[Ise drawmngs of facility #o better eXplatnsituations (use additional pages as necessary) _ '�_
rCL11"ks g-Od� ed
Good 1Oabk i of <��-�-r�-ids. /
sane o[e�t��s tit Acted-9 I_e-4Lvue,_j e/to+ At, .
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: / 7 `/-
3/23/99

Faciiit�TNumber: — /oo Date of Inspection s
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
kyes
ElNo
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
PNo
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
KNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
O&Y—ps
❑ No
3/23/99

[3Division of Soil and Water Conservation [3 Other Agency -�
`-'Division of Water Quality h °
. .°+.5�", _ ::h`�4'sF .,.x' °g"'°",'.'a= 'y, '3', "'z.-":4"" 'e.: '.,,- a �� Ykc iro3�,b�+w
Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Facility Number O dD
Date of Inspection
Time of Inspection
9•01 24 hr. (hh:mm)
Registered 0 Certified [3 Applied for Permit M Permitted JE3 Not Operational I Date Last Operated:
Farm Name:.......... .... ..................
Owner Name: ..... e,,4eF..1 .�,eJ ,g i! .l �I` 4� •- QitJ
Facility Contact:..•...!C'i4i Title:
.....7................ ...........---.......�. _ �...........
Mailing Address:
Onsite Representative:..-.i14!P
Certified Operator......... err.... 4-Pems.................
Location of Farm:
County: .............J�.?i�?F............ ....... .......................
Phone No: �J �8�.• ������
................................. Phone No:C7.....s/� yl�lyC
.................�.....................�/........................... ..........................
Integrator: ...... /��G�'��! ... j! ze►t�
Operator Certification Number, ..... f4 ,f .........
........................................................... .. .. ........................... ...... .. .......... R.......... ............ ............
Latitude ' ' °' Longitude • 6 "
vestgn
Swime Caipactty�;.Poy�`tiatron
t urgent
%3
Feeder
x,
Finish
Wean
rFarrow
Feeder
Finish
2. ❑ Boars
�16 iK Design ..Ct1
.:Poiiltry Capactty .'Pi►P
�" ❑ Layer
❑ Non -Layer
>;.: ❑ Other
s Tbt
-Design
tCattle ` Capacity-
❑ Dairy
❑ Non -Dairy
Design Capacity A�
Genera
1. Are there any buffers that need maintenance/improvement? ❑ Yes Pq No
2. Is any discharge observed from any part of the operation? ❑ Yes kNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes Wo
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ) ❑ Yes P No
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notifv DWQ) ❑ Yes �(No
3. is there evidence of past discharge from any part of the operation? ❑ Yes �No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes KNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes KNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? Yes ;Fo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97 -

Facility Number: a? — qp
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures lLaeoom.Holding fonds, Flush Pits, etc.
❑ Yes P[No
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes _6 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft): ....................... .................................... ................ ...... .......... .................................. .... .
10. Is seepage observed from any of the structures?
11. is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(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?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type ....... I li—ko �.. �+ Rf .... .....................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities 9nly
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violkionssor. deficiencies:rvere-noted.durin� this:visit. You:will i-eceive-ito-f&ther-
:: correspbbde'ce Aliout this:visit: :
❑ Yes N-No
❑ Yes KNo
KYes ❑ No
❑ Yes KNo
❑ Yes ,9 No
❑ Yes t'No
❑ Yes KNo
❑ Yes IRNo
❑ Yes KNo
❑ Yes XNo
❑ Yes I�No
[KYes ❑ No
❑ Yes �j Io
my es ❑ No
❑ Yes �Pfiio
A �5 fAvfPwlo -
7
Of
Ow Ate"dt
,� .moo<,-�,�.�.�-� �•�, r
ell ate' - '" `
Reviewerllnspector Name
Reviewer/Inspector Signature:
IF
Date:

State of North Carolina
Department of Environment
and Natural Resources RECEIVED
Division of Water Quality
James B. Hunt, Jr., Governor
Wayne McDevitt, Secretary
A. Preston Howard, Jr., P.E.,
Craig Magill / Krista Hansen
Oak Springs, Inc
1193 Allen Priest Rd
Council NC 28434
m i 1 7 1998
Direrf`af "i 1 LE
Dear Craig Magill / Krista Hansen:
June 26, 1998
/ •
NCDENR
NORTH CAROLINA DEPARTMENT OF
ENVIRONMENT AND NATURAL RESOURCES
Subject: Reissuance of Certificate of Coverage
No.AWS090100
Oak Springs, Inc
Swine Waste Collection, Treatment, Storage and
Application System
Bladen County
The Division of Water Quality modified the Swine Waste Operation General Permit originally issued to
this facility on November 10, 1997. In accordance with the issuance of the revised General Permit, we
are forwarding this Certificate of Coverage (COC) to Craig Magill / Krista Hansen, authorizing the
operation of the subject animal waste collection, treatment, storage and land application system in
accordance with General Permit AWG 100000. This approval shall consist of the operation of this
system including, but not limited to, the management of animal waste from the Oak Springs, Inc Farm,
located in Bladen County, with an animal capacity of no greater than 1500 Farrow to Feeder and the
application to land as specified in the Certified Animal Waste Management Plan (CAWMP).
The COC shall be effective from the date of issuance until April 30, 2003, and shall hereby void
COC No AWS090100 dated November 10, 1997. The COC shall hereby incorporate by reference any
specific conditions of the previous COC issued to this facility. The purpose of this COC is to allow
coverage under the revised General Permit. Please review the revised General Permit (enclosed) and pay
particular attention to Condition I1.10 regarding tree removal from lagoon embankments, Condition III.1
regarding inspection frequency of the waste treatment, storage and collection system and Condition 1I1.6
regarding notification requirements for system failures, spills and emergencies. Pursuant to this COC,
you are authorized and required to operate the system in conformity with the conditions and limitations
as specified in the General Permit, the facility's CAWMP, and this COC, with no discharge of wastes to
surface waters. An adequate system for collecting and maintaining the required monitoring data and
operational information must be established for this farm. Any increase in waste production greater than
the certified design capacity or increase in number of stocked animals above the number authorized by
this COC will require a modification to the CAWMP and this COC and shall be completed prior to
actual increase in either wastewater flow or number of animals.
Please be advised that any violation of the terms and conditions specified in this COC, the
General Permit or the CAWMP may result in the revocation of this COC, or penalties in accordance
with NCGS 143-215.6A through 143-215.6C including civil penalties, criminal penalties, and injunctive
relief.
P.O. Box 29535, Raleigh, North Carolina 27626-0535 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycleW 10% post -consumer paper

Certificate of Coverage AWS090100
Oak Springs, Inc
Page 2
Upon notification by the Division of this COC's expiration, you shall apply for its renewal. This
request shall be made within 30 days of notification by the Division.
This COC is not automatically transferable. A name/ownership change application must be
submitted to the DWQ prior to a name change or change in ownership_
If any parts, requirements, or limitations contained in this COC are unacceptable, you have the
right to apply for an individual non -discharge permit by contacting the engineer listed below for
information on this process. Unless such a request is made within 30 days, this COC shall be final and
binding.
The subject farm is located in the Fayetteville Regional Office. The Regional Office Water
Quality Staff may be reached at [phone]. If you need additional information concerning this
COC or the General Permit, please contact J. R. Joshi at [phone] ext. 363.
Sincerel
, 4__
+V A. Preston Howard, Jr., P.E.
cc: (Certificate of Coverage only for all cc's)
Bladen County Health Department
Fayetteville Regional Office, Water Quality Section
Bladen County Soil and Water Conservation District
Permit File

i
❑ Division of Soil and Water Conservation ❑ Other Agency
M Division of Water Quality
19 Routine O Complaint O Follow-up of D«'O inspection O Follow-up of DS%VC: review O Other I
Date of Inspection /! /
Facility Number t� O_ O�
Time of Inspection 1 ".30 24 hr. (hh:mtn)
© Registered ■ Certified ■ Applied for Permit © Permitted JE3 Not Operational Date Last Operated ...........................
FarmName: .......... . ..... . . County: ..... ...........................................
............_..... NIA.. .............................
t /
Owner Nattte:........ a ....... Phone NQ:.((.................................................................
Facility Contact: �%��'1.�,( Title• .. Phone No:
i4lailing Address:......X�r... l/d`......eF. / ..........................
Onsite Representative:..... L � f.... der' I ........................................... Integrator:......MIC O frJ..; ... ........
a ` .
Certified Operator c...... 4f..... �#!,1.................................................. Operator Certification Number:...._.�e 9`r
Latitude �• �4 �« Longitude =• �6 �«
Destga ".CurtraenatDeC1 tgp Current
urrent
�...
latspacitwinea 01atpacrtyPy P
SM. n. n
.W ..,..
r. ,,aa.:pu
�. ❑Wean to Feeder
• Y El Layer ❑ Dairy'
❑ Non -Dairy
,,.
z
�
n;Caoacity
otatSSi,W�
.Numisery of Laguotu f:Holtltng Ponds ' ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
1`
❑ Waste Management System
No Liquid
General
❑ Feeder to FinishNon-Layer
Farrow to Wean
"" �`���'°- ' � °�,•
� Farrow to Feeder
IDOther
❑ Farrow to Finish
~ �" Total Deng
�
❑Gilts
Boars
I. Are there any buffers that need maintenance/improvement?
❑Yes
kNo
2. Is any discharge observed from any part of the operation?
❑Yes
$TNo
Discharge

Facility Number: Oy — /00
a
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (l.aQoons,Nolding Ponds, Flush fits: etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
..........................................................................................................
Freeboard(ft): .. .iLZ'.r.........................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(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?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes )iNo
❑ Yes XNo
Structure 5 Structure 6
l5. Crop type + �I.../t�,e�+(..........................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[3. No.vialtitions or deficiencies. were noted,duritig this:visit. You win. receive. no' ftirther : :
;•:��orresp¢nden�t*abbutthis:visit.•: :�::.-.� -:• •:�.:.:�: - •..... .��.- •. .....•.�.-
❑ Yes �Q No
❑ Yes 09 No
❑ Yes No
❑ Yes E No
J9 Yes ❑ No
❑ Yes KNo
❑ Yes JUNo
Yes ❑ No
❑ Yes WNo
❑ Yes it No
❑.Yes OTNo
O'Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
,22. /cxcc�s.�!,EO/" Y6 .�.E /lC/ �y //O' d�✓,.�r1�C/'� �"� %���f` �Z
7/25197
W r73-
Reviewer/InspectorName.;H v k r. �3T.y� ar;
Reviewer/InspectorSignature: Date:

IF
Type of Visit W Compliance Inspection O Operation Review t7 Lagoon Evaluation
Reason for Visit I Routine 0 Complaint 0 Follow up 0 Emergency Notification Q Other ❑ Denied Access
{ Faciliry lumber dp Datc of isit: FT_ JT 4--T Time: : 3d
110 Not O erational 0 Below Threshnid
Permitted C,rrtified0 C^^Qgditionallr Certified 0 iietiistered Date Last Operated or Above Threshold -
Farm Name: 0-k t 1"er.m-5 _ _ Count-: a1-eru
Owner Name: SCT L i-. C Phone No:
Mailing Address:
Facility Contact: i 3 e— Title:
Onsite Representative: W n e2 Certified Operator: __ a G`L b L&r n
Location of Farm:
Phone No -
Integrator: v n�-! _
Operator Certification Number:
CtSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude ��` �• ��
Design Current Design Current Design Current
Swine Capacity Population, Poultry Ca achy Population Cattle Ca acitV POIDUIROOM
❑ Wean to Feeder 10 Laver ❑ Dairy
❑ Feeder to Finish ❑ Non -Laver F❑ Non -Dairy
❑ Farrow to Wean
Farrow to Feeder Ou Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
P
Discharges 8 Stream Impacts
1. Is any discharge observed from any part of the operation?
Dischar,e 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 obsmed- what is the estimated flow in saUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
Area ILJ Spray Field Area
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Wa5te 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 (inched: o;a
0"3/OI
❑ Yes 0 No
❑ Yes 0 No
❑ Yes QNo
NIA
❑ Yes No
❑ Yes [� No
❑ Yes No
❑ Yes No
Structure 6
Continued

Facility Number: C7 I — /pp
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 ADnlication
❑ Yes rim No
❑ Yes [] No
❑ Yes No
❑ Yes No
❑ Yes No
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
W No
11.
Is there evidence of over application? ❑ Excessive Ponding El PAN ❑ Hydraulic Overload
El Yes
[W No
12.
/
Crop type 6 e r. —/ S r,.,.. I1 9 r uv
rr.
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA WMP)?
❑ Yes
14 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
7 No
b) Does the facility need a wettable acre determination?
❑ Yes
[X No
c) This facility is pended for a wettable acre determination?
❑ Yes
1�No
15.
Does the receiving crop need improvement?
❑ Yes
(A No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
V No
Reouired Records & Document
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes K" 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.) Cl Yes 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 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
QXNo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
W 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
a rt` - — -�-.Sa-, 4 __•�i:•7��01
Camments�(refer�to gnestionP#} Explain any YESkanswers'and/orcny recommendations or anpother°comments."
ate s^ ,�.Use rarugs of facilrtyta betteresituaons ({useraddrtianaf pages as necessary) Field Copy ❑ Final N-r %+- a r% Oc.+ -- NOV. �or #A.c wkeatAW6 Q,7pV;Ca+%bus ►�+-%�C— d 1>R De Ccw.�cr o4- 2OO�.l�'L
Ve�:Ly WUIP ereP�s A-L*cs.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 01- J Continued

•
Facility Number: Date of Inspectinn p3
Odor Issues G
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
o
liquid level of lagoon or storage pond with no agitation`'
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [N No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes do
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
3 ! . 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
O5103101

c
Division of Water Quality
O Division of Soil and Water Conservation
0 Other Agency
Type of Visit O 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 dumber 4 100 Dale of Visit Time:
: 3 28-2002
O lot O erational O Below Threshold
® Pernutted ®Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: -• ............... .
Farm Name: O.A.Sprijitgs................................................................. ........................... Count-v: 0iadell.............................. ................. FRO .............
OwnerName:. .................. - .....-............... ,Ll",.a..l,..C,...........................-.................. Phone No:(9tQj.S9.Q-3.Zb4..........-............................-. .... .. .............
MailingAddress: P.Q.B.9,4.15.4............................................................................................ RoseMIL.IN.C..............................................................
Facility Contact: W311-8.11rixy....................... .........Title: .................... Phone No:...................................................
Onsite Representative: Wa1t.H.ulrmg Integrator: Uurp)ay..k.tll[iUt1y..F r1M................... y.......................................................... ...........
Certified Operator: Vcx7ElAn................................... )31 oYY�1. x....................................... Operator Certification Number: 2.5Z:Z..7.............................
Location of Farm:
9 mi. south of Hwy. 87, right on SR 1714, 1 mi. on left.
® Swine [I Poultry ❑ Cattle El Horse Latitude 34 ' 31 30 °� Longitude 78 ' 29 45
Design Current
Swine Canacitv Ponulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
® Farrow to Feeder
1500
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity population Cattle Ca acity Population
❑ Layer I ❑ Dairy
❑ Non -Layer I I d 1E] Non -Dairy
❑ Other
Total Design Capacity 1,500
Total SSLW 783,000
Number of Lagoons 1 ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds 1 Solid Traps I ❑ No Liquid Waste Management System
Discharzes & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in zalhnin?
d. Dors discharge bypass a lagoon system? ([fyes, notify Dot%Q) ❑ Yes ❑ No
2. Is there evidence of -past discharge from any part of the operation? ❑ Yes ®No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'? ❑ Yes ®i\b
*VVaste Collection &- Treatinent
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Snucture 4 Structure 5 Structure G
Identifier: ... .....,.......................................................
Freeboard (inches): 31
05103101 Continued

t: ac ity Number: 9-100 Date of Inspection 3-28-2002
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?
Yes
®No
(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
®No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation inarkings?
❑ Yes
® No
%Vaste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
®No
1 l .
is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
® No
12.
Crop type Coastal Bermuda (Hay) Small Grain Overseed
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
®No
14.
a) Does the facility lack adequate acreage for land application'?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
® No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Fier aired 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? (iel 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
® No
22.
Fail to notify regional DWQ ofemergency situations as required by General Pernut?
(ie/ discharge, freeboard problems, over application)
❑ Yes
® No
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 AWMP?
❑ Yes
® No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Continents (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): i C]Field Copy ❑ Final Notes
This facility has not yet completed the wetted acres determination.
Well maintained
Reviewer/Inspector name Paul Sherman
Itevie +verllnspectur Signature: Date: 3 a d
O5103101 Continued

Facility Number: 9-100 Date of Inspection 3-28-2002
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
El Yes
El No
liquid level of lagoon or storage pond with no agitation?
2T
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
® No
2&
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
® 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
® No
32_
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Additional Comments and/orDrawings:
AL
FW
05103101

Type of Visit *Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up O Emergency Notification O Other Denied Access
Facility Number jDatei)rvisit: Time:
O Not Operational Q Below Threshold
Permitted ® Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: ...............
I
Farm Name: %✓�.��
...... /.. !........................................................ Count}..._._..._...................................-- ........_....
Owner Name: ,T e' Gf, G. <,,.. Phone No: � ��a 0/ �
J"�........ ......�,�... .�................. ........................
Facility Contact 1 �:�...C..i� k� „......... Title ................................................................ Phone No: ................................. _.................
Mailing Address: /b0 �.4.� ✓ ...........................
Onsite Representative:.....Ct//¢'lT,,,,...Lc.�!d ,r ...........Integrator......f/r4'�!--..,r+.�.......,...........
/.................................
-------
Certified Operator:,,,,,,,,, !P�!>!!-J„_.. .tlal.J.� Operator Certification Number: ,.,,2._Zz7„_,--
.......................
Location of Farm:
Al
❑ Swine 0 Poultry ❑ Cattle ❑ Horse Latitude 44 Longitude ' & i4
Design Current
Swine Canadty Ponulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
/ po
C
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Po ulation
❑ Layer I I ❑ Dairy I I �::].
❑ Non -Layer I I JE1 Non -Dairy
�❑ Other 1 I
Total Design Capacity
Total SSI.W
Number ofLagoon5 / ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holden Ppnds / So6d 'I'ra s ❑ No Liquid Waste Management System
g ii
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Dischar-e oricinated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`? ❑ Yes No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes CKNo
c. If discharge is observed, what is the estimated flow in gal/min"
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes V5No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �'N0
S.Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑�- Yes rNo
01/01/01 Continued

)Gacility�lumber: d p _�(�d
Date of Inspection Z� G
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) Iess than adequate? ❑ Spillway ❑ Yes 91 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..............._...--............. ............................ ... ....
Freeboard(inches):............................................................................ ...........................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 09 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes [KNo
(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 . g No
8. Does any part of the waste management system other than waste structures require maintenance/improvement'?
❑ Yes
(XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
Yes
,,(
2� No
elevation markings?
El
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
XNo
11. Is there evidence/ of over application? ❑ Excessive Ponding ❑ PAN []Hydraulic Overload
❑ Yes
o
12. Crop type
`
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?
CKYes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
,® No
15, Does the receiving crop need improvement?
❑ Yes
�s No
16. Is there a lack of adequate waste application equipment? ❑ Yes RNo,� }}
17. Are rock outcrops present? �-hlg4ljA
18. Is there a water supply well within 250 feet of the sprayfield boundary? ❑ Unknown C Ye�io/"114
❑ On -site ❑ Off -site
Required Records & Documents
19. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
20. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
21. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
22. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
23. Did the facility fail to have a actively certified operator in charge?
24- Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
25. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
26- Does facility require a follow-up visit by same agency?
27. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Odor Issues
28. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
❑ Yes N No
❑ Yes J No
❑ Yes RNo
❑ Yes C'No
❑ Yes 9No
❑ Yes ❑ No Cz)
❑ Yes XNo
❑ Yes XNo
❑ Yes �kvo
XYes ❑ No
29. Are there any dead animals not disposed of properly within 24 hours?
01/01/01
❑ Yes 'UNo
Continued

acility Number: — /dd Date of Inspection 3 d/ Printed on: 1 /9/2001
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 PTNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RNo
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 JM No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes PJ-No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
.- o w omments as or rawings'=
y-�- -- f
�O !!?.a/i✓ �/v � ��i7u7 //mac_ �� �jOr � l.S .aK � d
5/00 !�`� 3 /Zp/a/

f
0 Division of Water Quality
0 Division of Soil and Water. Conservation -
.. O:Qthetr.Agency _.
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: Time' :3 D Printed on: 7/2112000
Facility Number ! 44
Q Not Operational Q Below Threshold
® Permitted [3 Certified E3 Conditionally Certified (] Registered Date Last Operated or Above Threshold: ................
FarmName: .............. .....,.�?rt;lTTf�'�1..��r..��-<............................ County:..........lr zi) tc/x.................................................
OwnerName:....... .................. � (.....,,........................................................................ Phone No:4„p...z///....................._........
FacilityContact: .....,�%� ��....Z" '.....-... ...............I'itle:................................................................ Phone No: ...................................................
oi
Mailing Address: ....... 11FJ.... 1 ..1 r f�..... Grr � it
1 .....---/......... . ... . .�...-.......................
Onsite Representative:..... ! .., ,, .�.... ..................................................... Integrator: ....... ,2 / Kr;7
�+..........................................................................
Certified Operator;,,,,,,,,,,,,W..¢' ...., ltiC� ............................................ Operator Certification Number:,
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �' ��� Longitude
Design Current
Swine CanaeitV Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Soars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I 1 ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSL W
Number of Lagoons 7—/1 JE1 Subsurface Drains Present I ❑ Lag�M�n Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. Udischarge is observed, was the conveyance than -trade?
h. If discharge is ohserved. did it reach Water of the State? (If'yes, no ity DWQ)
c. if discharge is observed. what is the estimated flow in gal/min?
d. Dees discharge bypass a lagoon system? (If yes, nojiiy DWQ)
❑ Yes N No
❑ Yes U-No
❑ Yes f$No
❑ Yes RNo
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 M No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l S[rlhaure 2 Structure 3
Identifier............ -2'�. y.........................---..................................-........
❑ Spillway ❑ Yes 1KNo
Structure 4 Structure 5 Structure 6
Freeboard (inches):
5100 Continued on back

kacilityNumber: d — Gb Date of Inspection Printed on: 7/21/2000
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? ❑ Yes No
(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? RYes ❑ 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 ADUlication
10. Are there any buffers that need maintenance/improvement'? ❑ Yes X No
l . Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes IV, No
12. Crop type
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 ONO
b) Does the facility need a wettable acre determination? ❑ Yes ONO
c) This facility is pended for a wettable acre determination? ❑ Yes No
15, Does the receiving crop need improvement'? ❑ Yes PS'No
16. Is there a lack of adequate waste application equipment? ❑ YesANo
Required Records & Documents
17. Fail to hav crtificatc of Coverage & General Permit readily available'? ❑ Yes XfNo
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 report ❑ 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 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 14 No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes jj� No
24. Does facility require a follow-up visit by same agency'? ❑ Yes IN No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 'ANo
E3; �vV 'violaiigris:ojr dtflciendt,5 were h6ted... during Ns'visit.' • Y..oir will •receive do fu th ,e
Torres ori�eirce: at�otit this :visit.:::::::: :: : : :: ::::::: .:::::::::: :: : :
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):
,L�h� ,�/�i,%•fib/ ,lt� ,�•-,rc � or�� — �� c. —,� cT�; �.�i -7-�
Reviewer/Inspector Name
Reviewer/Inspector Signature: �� �f�� Date: �'f/ 5100

L9
I Facility Number: al: Date of Inspection Printed on: 7/21/2000
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below RYes ❑ 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 RNo
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 J�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 allo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes RNo
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Ryes ❑ No
5100

W
Type of Visit Co7outine
nce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Beason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L—`TArrival Time: _A 9-f Departure Time: County: r-w Region:
Farm Name: ©�' J_; fl Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representa
Certified Operatoi
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = ❑ Longitude: = o = 1 ❑ 1.
Design
Swine Capacity
Current
Population Wet Poultry
Design
Capacity
Current Design
Population Cattle Capacity
C►urrent
Population
❑ Wean to Finish
10 Layer I
❑ Dairy Cow
❑ Wean to Feeder
Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean
arrow to Feeder
1,5VO
Dry Pc►ultry
❑ Layers
❑ Non -Layers
El Pullets
❑Turke s
❑ Turke • Poults
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑Beef Feeder
❑ Beef Brood Cow
UEher
Number of Structures:
❑ Other
10 Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
� No
El 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. Docs 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
I No
❑ NA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — 90 Date of Inspection O�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EN No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [SNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 50 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'? [I Yes R] No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12_ Crop type(s) P7 �Qe l I4e-J
13_ Soil type(s) (�%y
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ul No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
M No
[I NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Comments ('refer to question #) Explain any YES answers and/or any.:.recommendattons or any:othcr comments
Use drawings of facility to better explain situations. (use additional pages as ry necessa)
Reviewer/Inspector Name /��'v~P '', Phone: ->OQ
Reviewerhnspector Signature: Date: '_;Z Oc��
ruge Z uj .7 jzlzalujr iissnuea

Facility Number: — Date of Inspection
Recuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [Z No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [A No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RLNo ❑ 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 Cade
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
ERNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
R1 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
& No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

ivision of Water Quality
iFacili4y Number Division of Soil and Water Conservation
r
f Visit Compliance Inspection Qperation Review Structure Evaluation Technical Assistance
n for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �/Trrival Time: Departure Time: County: Region: '
Farm Name: _ &O -K y /`" r-,;, j Owner Email:
Owner Name: U—CT- l k G Phone:
Mailing Address:
Physical Address:
` t�2/
Facility Contact: 1 Title: Phone No ,
Onsite Representative: Sd Integrator:yJ/r.1
�/J G �
Certified Operator: # Operator Certification Number: g .
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = 0 d 0 „ Longitude: = ° = I 0 u
a-
Design Current
Swine?nCapacty Population
Wet Poultry
Layer
-
Design Current
CapaciiyPopula�tion
Design Current
Cattle Capacity Population
El Dairy
❑ Wean to Finish
❑
❑ La ers
❑ Non -La ers
❑ Pullets
❑
❑
❑
Pauits Other
Discharges & Stream Impacts
Cow
Heifer
Beef Feeder
❑ '
El D Cow
❑ Non -Dairy
El Beef Stocker
❑
El Beef Brood Co
1. Is any discharge observed from any part of the operation? ❑ Yes [9 No ❑ NA El NE
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes El No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) El Yes [I No ❑ 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) ❑ Yes El No El NA El NE
2. Is there evidence of a past discharge from any part of the operation? El Yes KNo ❑ NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes W No ❑ NA El NE
other than from a discharge?
12128104 Continued
Discharges & Stream Impacts
Cow
Heifer
Beef Feeder
❑ '
El D Cow
❑ Non -Dairy
El Beef Stocker
❑
El Beef Brood Co
1. Is any discharge observed from any part of the operation? ❑ Yes [9 No ❑ NA El NE
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes El No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) El Yes [I No ❑ 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) ❑ Yes El No El NA El NE
2. Is there evidence of a past discharge from any part of the operation? El Yes KNo ❑ NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes W No ❑ NA El NE
other than from a discharge?
12128104 Continued
1. Is any discharge observed from any part of the operation? ❑ Yes [9 No ❑ NA El NE
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes El No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ) El Yes [I No ❑ 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) ❑ Yes El No El NA El NE
2. Is there evidence of a past discharge from any part of the operation? El Yes KNo ❑ NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes W No ❑ NA El NE
other than from a discharge?
12128104 Continued

iFacility nuAQ0 Date of Inspection 7
` Waste Collection & Treatment
r 4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N 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): g
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
[K 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
[K No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® 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 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside
of Area
12. Crop type(s)�/'jjjLC4tat ��`�•
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CA 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 acre determination? El Yes
[allo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
WNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(A 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):
T
Reviewer/Inspector Name Phone:
Reviewer/inspector Signature: Date:
12128104 Continued

F
Facility Number: — Date of Inspection 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes (K No ❑ NA ❑ NE
the appropiate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[0 No
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JK No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
5d No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EgNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C&No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
10No
❑ 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
R No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
@?No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerlInspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit Q�Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 41fo-utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �6��t76 Arrival Time: 167.`3 B7 Departure Time: „3 County: '_+'L Region: ic-RQ
Farm Name:y Q -�.�r % n S Owner Email:
Owner Name: G L C Phone:
Mailing Address:
Physical Address:
Facility Contact: rah r 3S Ae2g; -Title:
Onsite Representative:
Certified Operator: 4e /1
Back-up Operator:
Phone No:
Integrator:Cl9sr
Operator Certification Number: /yqCS�i0;z?
Back-up Certification Number:
Location of Farm: Latitude: = e = ' = Longitude: E=1 ° = "
Design Current
Design coe�rreut
Design Current
Swine
C►opacity population
Wet Poultry
.seg
Capacity Population
C•attie Capacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ Dai Heifer
❑ Cow
❑ Farrow to Wean Dry Poultry '�
® Farrow to Feeder
00
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
Non -La ersElBeef
Feeder
PE]Boars
❑Pullets
❑ Beef Brood Co
- - -
❑ Turkeys
Other
<'
❑ Turkey Poults
❑ Other
❑ Other
Number of St - cKi es:
;,� •��xr�;c�.:
- - =:;cry
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
29 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
4 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
X 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
K No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
QNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
0 No
❑ NA
❑ NE
other than from a discharge`?
Page 1 of 3
12128104
Continued

•
Fac►itty Number: — �a
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
JR No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): t 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[4 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
MNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
" No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > Io% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) `(%a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CE No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
RYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[Z No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
El No
❑ NA
❑ NE
Comments (refer to. question #): Explain any YES. answers and/or any recommendations or,any other�comments ,�T. `�
Use drawings offacility to better explain situations. (use:addttional `pages as necessary) ;�t,r
/S �wu r �J�rk;��'t- j�ccv�j�j�,�,-r��t-rlrll�a�at•
Reviewer/Inspector Name Phone: 2Z.333
Reviewer/Inspector Signature: Date: �—%�

• Facility Number: —J
— �� Date of Inspection
` Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes &No ❑ NA ❑ NE
the appropriate box. ❑ WLJp ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 9No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Wo.
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
C4No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
R No
❑ NA
❑ NE
33,
Does facility require a follow-up visit by same agency?
❑ Yes
1KNo
❑ NA
❑ NE
Additional Comiiients and/or Drawings:.
AL
Hi
Page 3 of 3 12128104

Type of Visit f$'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: I Departure Time: , County: �_ Region:
Farm Name: t OL " 5ef-; IL ._ Owner Email:
Owner Name: IJ G 1__ ` G- Phone:7Z D
Mailing Address: i> !� ��. %�`9 / 1 aS7 ,, /T�� Ale -
Physical Address:
Facility Contact: 4&cd Title: Phone No:--
Onsite Representative: Integrator: �/4f"Q24e 252aj^ -____.
Certified Operator: :/ ��~L- Operator Certification Number: / a
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 ='
= Longitude: 0 ° = I =
Design Current
��
Design Current° :a
D
C+apacity Population
WetPoultry _
lattime
Capacity Populat�orCpty Population
❑ Wean to Finish
❑ La er
-; ❑ DairyCow
❑ Wean to Feeder
❑Non -La et
❑ DairyCalf
❑ Feeder to Finish
"" ❑ DairyFleifei
❑ Farrow to Wean
Dry Poultrys
❑ D Cow
Farrow to Feeder /,�D a Q
` "`. ❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
Non -Layers
- �; ❑ Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
----
❑ Turke s
Other
❑ Turkey Poults
"k
❑ Other
❑ Other
r �Ni m�ber ofStructures: �®
m
Discharges & Stream Impacts
. Is any discharge observed from any part of the operation?
❑ Yes
5d No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
[qNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
XNo
❑ 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
KNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
®,No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
J,No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — �Q Date of Inspection —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes CKNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): C
a
Observed Freeboard (in): c3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
R 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
C&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
W No
❑ NA ❑ NE
8. Do any of the stuctures 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
MNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
KNo
❑ NA ❑ NE
mai ntenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[K 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 Drifl ❑ Application Outside of Area
12. Crop type(s) �e%/N wde_!
13. Soil type(s)
v
14. Do the receiving crops differ from those designated in the CAVR P?
❑ Yes
®.No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ER Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'![—]
Yes
ED No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Reviewer/inspector Name �L:',�
.. t Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

•Facility Number: fld Date of Inspection 0— ra
Reouired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 5�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C9 No ❑ NA ❑ NE
the appropirate box. ❑ wUp ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rain Inspections ❑ Weather Cade
22. Did the facility fail to install and maintain a rain gauge? El Yes JM No El NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ' ❑ Yes P No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
2T
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
WNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(,R 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
(9No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems. over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
CZNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
❑ NA
❑ NE
Additional Commentsxandlor`.DrawEngs s y
12128104

Facility Number Date of Visit: Tune: O: S'D
Q Not Operational Q Below Threshold
ermitted [3 Certified E3 Conditionally Certified Q Registered Date -Last Operated or Above Threshold:
Farm Name: County: 'RAR44----eR�_.
Owner Name: 7�_ L_ L� _ Phone No:. --- - ��l �� s2.8Y - 1 `1''1---------
Mailing Address: P• 0. QOX '�s`l_ Rom x;`�f �. G Zj?!j!
Facility Contact: .. la -1-A dl a rx Title: .
Onsite Representative: a/ - r_„ r.. zQ,'cl L - - 9.&d 4A AC
Certified Operator. T �! id -leak &,.ee:i
Location of Farm:
Phone No:
Integrator: v r1 ------------- ---- -
Operator Certification Number: _.. .2,!a /O
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �' �" Longitude
Discha es & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [314(o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [<o
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ yeSp
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 9NO
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Q Wo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Ergo -
Waste Collection & Treatment _��
4. Is storage capacity (f -ceboard plus storm storage) less than adequate? ElSpillway ElL7 Yes No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ....._._. _
Freeboard (inches): 3 1 �'
12112103 Continued

FaciU; Nahnber: Gy
Date of Inspection lO'?
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 thorough 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 maintenancerunprovement?
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 maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
❑ Yes Gii1b,
❑ Yes Q-Ko
❑ Yes Ego
❑ Yes nlqo-
❑ Yes 014o
❑ Yes 01%6
❑ Yes BVo
12. Crop type &IMy4la- (na"., - ---
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Q-No'
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑-No
❑ Yes MNo
❑ Yes ❑ No
❑ Yes pairs
❑ Yes P_K01_
❑ Yes
ago -
Final Notes
Reviewer+u spectOr Namez_ ,h. ,�.,�a_.�.:...�.,«...MIX,
;. I
ReviewerAkopector Signature: 12& is B . ra,��r' — Date: /O a do cJ
LI✓Uffll t.onunuea

Fality 1'6umber: p 0 Date of Inspection o • �`
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
gillo
22. Does the acility fail to h!vSA components of the Certified Animal Waste Management Plan readily available?
❑Yes
OrJYMP, chefkfists, dpifn, p4s, etc.)
❑
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
gN
❑ Waste�kppliestiea ❑ FFaebow+ ❑ Wnft mnIysis ❑ S�—
? ?,0 '7-19 7',Q G » > 3.0 $-.7.9,V Y-�y- 'rl
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
U-No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
g}No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
[:]Yes
g-No
27. Did Reviewerftspector fail to discuss reviewImspection with on -site representative?
❑ Yes
❑-No
28. Does facility require a follow-up visit by same agency?
❑ Y�
o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
QWo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑-o
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
QW0
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
O-No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
e'No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
Ql!do
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ -FMM ❑
❑ Annual Certification Form
12/12(03

IType of Visit: ® Compliance Inspection O Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: D p0 County: Region:
Farm Name: Owner Email:
Owner Name: '04�� J 8W�q� wC Phone:
Mailing Address:
Physical Address:
Facility Contact: �}P.t�q n e Title: Phone:
Onsite Representative: y Integrator: wN
Certified Operator: I F0 A, Certification Number: 9Z
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current- Design Cprrent�
Swine Capacity Pop Wet Irery Capacity Pop
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Finish
1. H
ILayer
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
- Design Current
D . P,oul Ca a_ci Po ..
Dairy Heifer
Farrow to Wean
Farrow to Feeder
p
Dry Cow
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turkeys
Turkey Poults
Other
Other
Discharees 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
[] No
❑ Yes
L No
❑ Yes
[�j No
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility umber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No W NA ❑ NE
Struc7c 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
T
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[�c No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [F3 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 Approved Area
12. Crop Type(s): C')_ o ove�
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 1 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
! No
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
TT®]
❑ 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.
T
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. [—]Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes FA No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ® No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes q] No ❑ NA D NE
Other Issues T
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:)Yes P No
❑ Yes q No
❑ Yes ® No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [4 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [ p No DNA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes `1 No ❑ NA ❑ NE
Comments (refer to question #)• Explain any YES answers `and/or'any additional recommendations or any other comments g
Use; drawings of.facility to better explain situations (use additional; pages as'necessary). Ni
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: toe--lb�2/ tv
Date:
21412011

Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ; 3 Departure Time: 1 J ; o O 1 County: Region: )9:5iZ D
Farm Name: f
IV
Owner Name: C_
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: 41&tW }�jWjyJBasS Title: Phone:
Onsite Representative: r Integrator:✓
Certified Operator: I/��s�r� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Cattle
Design Gurreat
Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
}� Farrow to Wean
Farrow to Feeder
Farrow to Finish
La er
Dairy Cow
on -Layer
Dairy Calf
Q
Design C►urrent
Dr, P,aultry C►.a act P.o
La ers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Co...
Outer
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Ej No 0 NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [:]No [DNA ❑ 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 J0 No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - D e] Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5g-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): Igi
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�,No
❑ NA
D 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
O No
❑ NA
[:]NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
ONE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2g 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): / r(
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes B No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes R7 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [a 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 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 [a No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - D Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [gNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check aYes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes EZ No ❑ NA ❑ NE
❑ Yes Eallo ❑ NA ❑ NE
❑ Yes 54 No ❑ NA ❑ NE
[:]Yes
® No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
[Z-No
❑ NA
❑ NE
Comments (refer to question #j: Explain any YES answers and/or any additional recommendations or any�other comments . '.. -
Use;draKtin�s of.facilitV..to bettertiexplain situations (nse additional pages as necessary).
S/"/ h aS �Jrc�n- /`�s�r�D✓ �� GUcL%�Y / V i" J[%t'G�JS10VY14
ter`` U-4,4
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:�`3���
Date: , p —J
21412011

ono Water. altty
FFactlity`Numbec Q Drvisiati of Soft aud,Water Caiusetrvation�
_.
.. ... � Otlaet Agenaey -
Type of Visit
ompliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Vieft
outine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Dented Access
Dalc of Visit. [ ram Arrival Time: ; a eparture Time: to ; County: �' Region:
Farm Name: 0a K �,noe[i n S _ Owner Email:
Owner Name: L L C Phone:
Mailing :Address:
Physical Address:
Facility Contact: r7f r' S Title:
Onsite Representative: 6 _'
Certified Operator: a7)�J/;'M
6
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
U Feeder to Finish
91 Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
Phone No
Integrator V V
Operator Certificanon Number:
Back-up Certification Number:
Latitude: ❑6 ❑` ❑u Longitude-.
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -Layer
Dry Poultry
Pullets
0
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dal � Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number, f Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
IN-1
❑ Yes ([No ❑ NA ❑ NE
❑ Yes ❑ No ❑,NA NE
I
❑ Yes ❑ No ❑ NA NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes QNo ❑ NA ❑ NE
❑ Yes Arlo ❑ NA ❑ NE
12128104 Continued

m
Facility Number: — pa
Date of Inspection D` O
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 I Structure 2 Structure ? Stnicture 4
Identifier:
Spillway?:
Resigned Freeboard (in):
Observed Freeboard (iny _
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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 Q No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure Structure 6
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes ,�Q 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 i�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes UZ No L^i 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 Eg-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �4No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes (9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ HydrauIic 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 Drifl ❑ Application Outside of Area
12. Crop type(s) 1=e Z
13. Soil type(s) Zy Z vim
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LK No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C!No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑ Yes
EZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ gNo
❑ 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):
T
Reviewer/Inspector Name 22= Phone:
Reviewer/Inspector Signature: Date: f Lai D
12ab/U4 c.onanuea

Facility Number: —1Da Date of inspection
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 EgNo ❑ NA ❑ NE
the appropriate box. ❑ W UP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[2 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
V[No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[gNo
❑ 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
E.No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Q No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®.No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[l No
❑ NA
❑ NE
12178104

r'
a. c
Division of Water QualityT7
Facility Number 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 fa'koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /� Arrival Time: �� Departure Time: � County: ��/'� fti Region:'�J1
Farm Name: i 1�1� i r - I ► ,6-5 Owner Email:
Owner Name:A G� ____- Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representati
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certificatio Number:
Back-up Certification Number: / , / C
Latitude: = o = i = Longitude: [= ° = 4 0
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other
❑ Other
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
.;
Design Current;°
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy 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 ,5No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
aNNo
❑ NA
❑ NE
❑ Yes
V -No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P§:No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Al
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes &No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 09,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 ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes R No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes &No ❑ 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 Drifi ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
BNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
ERLNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
U—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): J
Reviewer/inspector Name Phone: �� t
Reviewer/Inspector Signature: Date: ,
A% 12128104 Continued

r �
• Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Z,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Wo ❑ NA ❑ NE
the appropiate box. ❑ wup ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;..No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes &No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E[No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
a No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
/RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
qNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Jq No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®•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
[5No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewerlinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RLNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
U-Uo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

to Division of Water Quality
Farilisty Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review tructure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 4fOther ❑ Denied Access
Date of Visit: 3 s Arrival Time: i �� Departure Time: [ [ County: Region:
Farm Name: t Owner Email:
Owner Name: __ L�G� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: I Integrator: rh — E
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ 6 = « Longitude: 0 ° = 4 = 4i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I ! ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke 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-
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heife)
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ 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 4 No ❑ NA ❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑ Yes
❑ No
OaNA
❑ NE
RNA
❑ NE
❑ Yes
❑ No
❑ Yes
J] No
❑ NA
❑ NE
❑ Yes
❑ No
WNA
❑ NE
12128104 Continued

Facility Number:-10J Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes X No ❑ NA ❑ NE
❑ Yes �fNo ❑ NA ❑ NE
Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�1 No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No ❑ NA
NE
X
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
❑ No ❑ NA
NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No ❑ NA
NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA
WE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No ❑ NA
NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No ❑ NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No ❑ NA
NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No ❑ NA
(� NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No ❑ NA
P 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):
V c to b 1 � cic-
T
Reviewer/]nspector Name WE ZI IPhone:
Reviewer/inspector Signature: Date: S
12128104 - Continued

- Facility Number-9— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA W NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ONE
the appropirate 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
01 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
0 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ No
❑ NA
ONE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
[9 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
XNE
26.
Did the facility fail to have an actively certified operator in charge?
El yes
ElNo
ElNA
[} NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
( NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ 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 gNE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ❑ No ❑ NA 0 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA (9-NE
12/28/04

i.. v �-... - .• - ... •.1. - wi.�C.[+iY'..• .N �..5�.�: w,r. -Af'f �'+-.ws.:�•s:. '"�.��f:'"FY.i v+.:..ti�-..... -� ..,. xr-� - �.-r-aa�,. �._.. -. � .—.. � ..�. .. r ..-. � -- .- - .. - .. ,.. __
. -, -!�
F431ity Number OD
* Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 951structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Other ❑ Denied Access
Date of Visit- 3 Q Arrival Time: i Departure Time: i i County: a Region:
Farm Name: Y Owner Email:
Owner Name: �� i �G _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
,Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: ❑ o ❑ & = Longitude: = ° 0 I = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ La ers
❑ 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 . CurrentG
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: ELI
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 [4 No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
N NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
Aj No
❑ NA
❑ NE
❑ Yes
[--]No
WNA
❑ NE
12128104 Continued

-. ;.� ... ..-...--.-- mom,.; -,._ R.,. -_. .. .. . ._.... -. j.. .y ,..F. � . Nx :-T:•'F" n -. - < ._..i � •. .. -n. - r,^'x• • s... t' '
Facilit, Number: QFk Date of Inspection
.,WasteTollection & 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 C!3'No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
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
❑ No ❑ NA n1 NE
maintenance or improvement?
X
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No ❑ NA NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
❑ 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 Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14- Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
( NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
❑ NA
NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
14 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
P 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):
IF s e Z_b ca�j_ C �u j- .
Reviewer/Inspector Name 'S Phone:
Reviewer/Inspector Signature: Date: LQ
f L/4V/VY 4+V+su++uc[r

f
�� `,.}�� i •..!'-:.r .:✓'. - � � _ .-.. c .� -. -.-_ _• _. � +. ... .. `F r- _ � „ .. .. --.- � � � ter--_ _• .._r � . r
Facil!!SNumber:q _ _ Date of Inspection cn
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA JZI NE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check ❑ Yes ❑ No ❑ NA M NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
0 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
LL] NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
® NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
(9 NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
[11 NE
27_ Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA 6 NE
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [:]No
❑ NA M NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes ❑ No
❑ NA ® NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ❑ No
❑ NA Q NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes ❑ No
❑ NA tR NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ❑ No
❑ NA C&NE
E
12128104

Division of Water Resources
Facitity Number - Q Q O Division ai Sol! and Water Eonservation
© Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up Q Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: r Departure Time: /. County:
Farm Name: <0k d --+ Owner Email:�
Owner Name: 01A � / l�-� Phone:
Mailing Address:
Physical Address:
Facility Contact: C,1P.t.,.p g ?n" Title:
Onsite Representative:
Certified Operator: /q, `Ox.6
4��
Back-up Operator:
Location of Farm:
AA9& Region: j�-0
Phone:
Integrator: E=4441
Certification Number:
Certification Number:
Latitude: Longitude:
.gin, -
Design Cnrrent
Design
Current
Design Current
SwineC•apacity Pop.
VVet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
D A P,Qulfr -
Design
Ca act
Current
P,o
Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes
❑ No
❑ Yes
No
❑ Yes
No
rMNA ❑NE
❑ NA ❑ NE
❑NA ❑NE
i
Page I of 3 214/20I5 Continued

Facili umber: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
R9 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[7l NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: !/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[P No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
W No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[P No
❑ NA
[] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[P 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 g(Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): a
13. Soil Type(s):
14. Do the receiving crops Yjffer 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
[� No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records Documents
_&
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[21 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E!� No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis []Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [� No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214120I5 Continued

IFacHity Number: jDate of inspection: yzz
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[P No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[5 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
T No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[� No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
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
[P No
❑ NA
❑ NE
Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P33. No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[0 No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/]nspector Signature:
Page 3 of 3
Phone:
Date:
21412015

Type of Visit: a Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 10 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other/ 0 Denied Access
Date of Visit: / Arrival Time: dQ Departure Time: r County: B!Q n Region:
Farm Name: l'% �> t� Owner Email:
Owner Name: Phone:
l
Mailing Address:
Physical Address:
Facility Contact: (V4W {=L4t e7le6" Title: Phone:
L! d -r a
Onsite Representative: Integrator:-J��h?r A L°i-
f/% L.
Certified Operator: % f ' d1Qe f Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design C*urrent Design Cnrrent
Swine Capacity Pop. Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Da' Cow
Wean to Feeder
Non -La er
Design Current
D , P,oul Ca aci P,o .
Da' Calf
Feeder to Finish
Farrow to Wean
Dai Heifer
D Cow
Farrow to Feeder
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Layers
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Putlets
Turkeys
Other - �:.�_;._ Turke Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes � No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
NA ❑ NE
�] NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ® NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes © No J❑� NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes 7i No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 214,12015 Continued

Facility Number: jDate of Inspection.! rf/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure i
Identifier: L-
Spillway?:
Structure 2 Structure 3 Structure 4 Structure 5
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
99 No ❑ NA ❑ NE
❑ No � 6 NA ❑ NE
Structe
❑ NE
0 NA
❑ Yes
("No
❑ Yes
F No
❑ NA
❑ NE
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 No ❑ NA [] NE
maintenance or improvement? 91
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes PNo
❑ 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 ro Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop yPT e(s) : Aga,�.
13. Soil Type(s): Gt
14. Do the receiving crop differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[] NA ❑ NE
Page 2 of 3 21412015 Continued

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 &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 Q5 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Pg No
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
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 ❑ 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
op
At
_20�� � �^K odC��".sC�
C41 's toe -4 e-
tz� 'A' "Z' ' L'7
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
❑ NA ❑ NE
❑ NA [] NE
❑NA ONE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ONE
❑NA ❑NE
Phone: q
Date: 6 ��
21412015

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: • Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: //: County: ,B
Farm Name: 5" ri A S SBL�J yy) _ Owner Email:
Owner Name: �V4 St,) );�� aC Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: it
Certified Operator: a,tit-'ac L2!_Lx1
Back-up Operator:
Location of Farm:
Title: Phone:
Latitude:
Integrator: *A4 fit
Certification Number:
Certification Number:
Longitude:
Region:
Demos
p@urreut
Design
Current
Design o , ent
Swine^ .
^*i
xCapacty
,Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
EDai
Dairy Calf
Feeder to Finish
Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P,oul
Ca aci
1p,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other-
F,
�,�
Turkeys
Turkey Poults
Other
101 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other_
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Q No 0 NA ❑ NE
❑ Yes
❑ No
$3 NA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
[:]No
❑ Yes
No
P
❑ Yes
f!q No
NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q1 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 46 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 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 M 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): L GQ
13. Soil Type(s): V"
14. Do the receiving crops dA er from those designated in the CAWMP?
❑ Yes
T No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q4 No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[P No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑ Check] ists ❑Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
V
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
191 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
43 No
❑ NA
❑ NE
Page 2 of 3
21412015 Coadnaed

Facifi 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 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?
cents (refer;to question: EaI
�awingi`or&iiHty to better. xj
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes It*
No
❑ Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
❑NA - ❑NE
❑ Yes �}j , No ❑ NA ❑ NE
❑ Yes [P No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes T® No
❑ Yes T No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Phone: LID r ` of - Sft
Date: g i /.%
21412015

type of visit: w tomptiance inspection V uperanon tceview V Ntructure Evatuatton V i ecttnicat Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I b1 Arrival Time: D r �k. Departure Time: : County:
Farm Name: S , S'p Owner Email:
Owner Name: �� � � L" C' % UJ RL.vn LL C Phone:
Mailing Address:
Physical Address:
Region: F400_
Facility Contact: (344,110 Upki n P 64 Title: Phone:
Onsitc Representative: Integrator: LAtw
n
Certified Operator: � _ �i Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
gn CISNe
!11
Design CurrenCcity
Pop.
h
Wet Poultry
Pop.
Ca#ile
Capacity Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
I TOR,
le,75Design
Current
Cow
Farrow to Feeder
D . P,oul
Ca aei
Po
Non -Daily
Farrow to Finish
113eef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other �_
Turkey Poults
Other
Other
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Dq No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
0 No
NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes No
❑ Yes No
I1�! NA
`❑�
❑ NE
NA
❑ NE
❑NA
❑NE
Page 1 of 3 21412014 Continued

)E<acili 'Number: 61 - Date of Ins ectior
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[54 No
❑ NA
❑ NE
a_ if yes, is waste level into the structural freeboard?
[:]Yes
❑ No
W NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�N
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
[R 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
P0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
`P No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
9. Does any part of the waste management system other than the waste structures require
[:]Yes
[�] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[M No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[2 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 I ype(s): L44M Y K M
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?
❑ Yes
CDNo
❑ NA
0 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
PNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
M No
[DNA
❑ 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
[;5 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard [] Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
P No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[$ No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Fdcility Number: jDate 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 No
the appropriate box(es) below. r
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? O Yes [,g No
Other Issues
28. Did the facility fail to property 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? ❑ 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 No ❑ NA ❑ NE
Comments: (refer to question #): Explain any YES answers andtor._any_-additional recommendations:or:any,other comments:
Use drawines of facility to better explain situations (use additional pages as necessarv).
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes M No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 00 No ❑ NA ❑ NE
❑ Yes J�j No ❑ NA 0 NE
Phone: V—Y33 -33co
Date: Lz sl
2 412014'

I ype of visit: W Uomptiance inspection U Operation Review U structure Evaluation U l ectinical Assistance I
Reason for Visit: * Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1 S / Arrival Time: D v. Departure Time: County:
Farm Name: ©Q k �Prr�4 719
+p/ Owner Email:
Owner Name: OQL��'sw..►. CLC Phone:
Mailing Address:
Physical Address:
Region: )WO
Facility Contact: (moo /armeQ�„ Title: Phone:
Onsite Representative: rJ Integrator: �.
Certified Operator: of Certification Number: less Iq
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Design Enrrent
Swine " " Oapacity Pop. Wet Poultry C►apacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
i
Dry Cow
Farrow to Feeder
D . ,l',oul Ca aci P,o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Puuets
Other
Other
Dischart=_es and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [C No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [p NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [] No ER 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 (9 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 [Z5 No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

i
Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E� No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
0 NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
�! H
Observed Freeboard (in): r/o
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
P 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
fg 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
EA No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
1P
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[k] 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): i ge 6�tss /t ip, �' 5-6�9
(
13. Soil Type(s): "aYV M
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ERNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
fQ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
[$ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
(53 No
❑ NA
E] 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 [�j No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 0 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 oj3
21412011 Continued

Facili Number: Date of Inspection: S 4
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes Eg No
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes tA 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 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 �4 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes E�T No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes (2 No
❑ Yes ® No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or .any additi6"1l recommendiitiohs or, any other comments`
Use drawings of facility to better explain situations. {use additional pages as necessary). �.��_ „ , ,5 � {'�,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: -' �j
21412011

Site Requires Immediate Attention: _2.,�6._
Facility No. 69'—t00
DIVISION OF ENVIRONMENTAL MANAGEMENT
4 ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: / , 1995 Me —
Time: p
Farm Name/Owner: 0.4
Mailing Address: / i Vic-•-� J y 3 -
County:_
Integrator:_ J-t1 Phone:
On Site Representative: p Phone:
Physical AddresVLocation
Type of Operation: Swine Poultry Cattle
Design Capacity: ^ T,� 3 "*,9 Number of Animals on Site: /tea _Saar _ �•� � u,,�
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° ' " Longitude:,_.,. ° "
Circle Yes or No
Does the Animal Waste Lagoon h TUr
ufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately l Foot + 7 inches) No A Freeboard: .3 Ft. _Inches
Was any seepage observed from the
Is adequate land available for spray`
Crop(s) being utilized:
)? Yes or 10 ''v as any erosion ob ed? Yes or No
No Is the cover crop adequate? e c r No
Does the facility meet SCS minimum setback criteria? 200 Feet from DwelIin s? ke, No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue.Line Stream? Yes or(9
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or 1�
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or 49 If Yes, Please Explain.
Does the facility maintain adequate waste management r s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop). Ye or No
Additional Comments:
- &
Inspector NzWe
A ?V4
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

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