090115_INSPECTIONS_20171231

A 4L.0 19- c�
Type of Visit: BCommpliance Inspection V Operation Review O Structure Evaluation O Technical Assistance
A
Reason for Visit: �Outine 0 Complaint O Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: 10AC-1
Farm Name: u �`~ u c[ Owner Email:
Owner Name: 4 Phone:
Mailing Address:
Physical Address:
OP 1
o�
Facility Contact: e a Title: Ph/o�n�e:
Onsite Representative: / Integrator: I �l
Certified Operator: 130 n 130V 42uk� Certification Number:
—P
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Region:"i�_"_
�Dn
Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
@attle Capacity Pop.
Wean to Finish
[Layer
Non -La er
airy Cow
Dairy Calf
Wean to Feeder
Feeder to Finish
we9
airy Heifer
Farrow to Wean
Design
Current
Dry Cow
l) P,oul
Ca aci
P,o
Non-Dai
Farrow to Feeder
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Turkeys
Turkey Poults
Beef Brood Cow
"
-Mral
Other: :. _
Other IM
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
E3 ';fA- ❑ NE
E, IA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ErNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ N ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ETNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: 2 - Date of inspection: {f
Waste Collection & Treatment
4-Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
[]'1 Ate-❑ 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
PTN`o­)
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[] Yes
[3`l i�
❑ 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
E` igo
❑ 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
Ea -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
ffNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside ofAcceptable Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
fCrop
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
QfiTo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[] '""
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
D'�lo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ 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 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? []Yes [yNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [3�No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facile Number: jDate of Inspection:
24..Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes LJ go- ❑ NA ❑ NE
2; Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [2-1qo_ ❑ NA ❑ NE
the appropriate box(es) below.
[]Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [,J_NrV— ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
D-Nn--� ❑ 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
❑' ll to ❑ 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
P' Tl� O ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[3-;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
[�' l�o ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�o ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ej_No [] NA
❑ NE
tion
Use draw gs d€ facilfzy' b tte explain situations (use add tiioual-pages as necessary) pndateons an* her co nvents:
o POO s 5'cv C114 ref
r
q CA10 " �0 �-
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone: 910 Y3 X y
Date:
2141OI5

i ype or v isir: V L ompuance iuspeenon v operation review V arrucrure r-valuanon lJ 1 ecomcai assistance
Reason for Visit: C3 Routine 0 Complaint Q Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit:? Arrival Time: _ f 5 Departure Time: County: �� Region: f , l2
Farm Name: U 4 &J'JL(4�f Owner Email:
Owner Name: r ( Phone:
Mailing Address:
Physical Address:
Facility Contact: (304*kly Title: Phone:
r
Onsite Representative: t Integrator: /L
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 17 1
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current'
Capacity Pop.
Wet P©ultry
Design
Capacity
Current
Pop.
! ` , °�
Cattle ��' ���
Desigu Current
Capacity Pop.
airy Cow
Wean to Feeder
D . P°_vltWea
Design
ac'
Current
P,o
airy Calf
Feeder to Finish
—0
Dai Heifer
Farrow to Wean
D Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
La ers
Beef Stocker
Gilts
Boars
NO d Ni
Other
Other
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes s ❑ NA ❑ NE
0 Yes
❑ No
-E:IT1A
❑ NE
[:]Yes
[:]No
�A
❑ NE
❑ Yes ❑ No ❑'NA ❑ NE
[:]Yes []no DNA ❑ NE
[:]Yes P; No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection:
0
Waste Collection & Treatment
4.'Ts storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
D-Na—E] NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
e'1;a`
❑ 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
EJ-Ko
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[J-P�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
CJ ""'
❑ 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): e- � V <-_ -one, o
13. Soil Type(s): wq
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [J'Iio ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [I-N—o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [J'Ilo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[:J- o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Oho
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[2'lVo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3'"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 [3"1Go
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0;rNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:3"No
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility,Number: 1 - jDate of Inspection: V
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [:I o [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes El No ❑ NA ❑ NE
the appropriate box(cs) 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 E�J- o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes a No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes �o ❑ NA ❑ NE
❑ Yes [Et'1Go ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes L] No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
[B'No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes
[E'Ao
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[fNo
❑ NA
❑ NE
Comments (refer,,to question:#): ExpUia a©y-�VIES'answers and/or anyjadditional'recommendations or,any otlrer commeots;�i Y i � € IM
Use drawings.of faciiity #o better explain Mtoation�s (use additional pages as necessary
SeuC_A-*( N a uLy
Cry 67 ro ' b T � N
Reviewer/Inspector Name: DU 1 _ Phone: [ w --L- ,
Reviewer/Inspector Signature: , � J Date: (7
Page 3 of 3 21412015

Type of Visit: (]LWoutine
fiance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: 13 le,4— Region:
Farm Name: D loU4,- 5 p Je- Owner Email:
Owner Name: [ ( Phone:
Mailing Address:
Physical Address:
Facility Contact: t✓ Dul Title: Phone:
Onsite Representative: 1 Integrator: 00
Certified Operator: I
Back-up Operator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
11-
Design Current
�.. _ ,
Design Current
Swine opacity Pop.
Wet Poultry
G�
Capacity' Pop.
... .�
Cattle Capacity Pop.
inish
La er
Da' ,Cow
eeder
Non -La er
Da' Calf
Finishk{;�
Da' Heifer
Wean
Des>ignCurrent
Cow
Feeder
F
I) . P,ouI
Caa i
AP,o
Non -Dairy
Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Other,
Turkey Poults
Other
Other
- -
Dischar¢es and Stream ImDRCt5
1. Is any discharge observed from any part of the operation?
❑ Yes
EJ-N"o—
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[ A
❑ NE
b. Did the discharge Teach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[]INA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
�NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
EfgNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
F No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: jDateof Inspection:
Mt
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�0
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Ca-?M
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
En'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
[ffN"'o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
[3' +llo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2-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
[]'lTo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
[10
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3-f,To ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13_ Soil Type(s): _ (�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Eg-dff ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes ❑ oo 1 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Q ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
❑'�To
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
[fT—No
❑ NA
❑ NE
Rimed Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[::rNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[2no
❑ 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 0 Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E% No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Z No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facility Number: R- Date of Inspection: 0
;4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C9' o ❑ NA [:]NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑Yes ❑ NA ❑ NE o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ea-<o ❑ 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [21 o ❑ NA ❑ NE
❑ Yes C3 No ❑ NA ❑ NE
❑ Yes E3 1Vo ❑ NA ❑ NE
[:]Yes [!fNo ❑ NA ❑ NE
[:]Yes 2 Io
[:]Yes [noNo
❑ Yes %�No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #} Explain any YES answers and/or any additional recommendations or any -other cowmen}ts
Use drawings of facility to better explain situations (use additional pages as necessary).
ze ro 'Pt S PCW.X
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:q33 333
((��
Date: 0 '04,i<J
21412011

fC
(Type of Visit: QCo=Utine
cc Inspection U Operation Review 0 Structure Evaluation O Technical Assistance
_Reason for Visit: 0 Complaint 0 Follow-up ., 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timer Departure Time: f C7 County: VJ f�c.� Region:
Farm Name: L6!uA a/` � Owner Email:
Owner Name: a w 0 Phone:
Mailing Address:
Physical Address: {� p
Facility Contact: Phone:.
Onsite Representative: l� Integrator: O
Certified Operator: r� Certification Number:
Sack -up Operator: I Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
[—]Yes [�'No [] NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No [ ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No C9" }A ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes R3,X6 ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [n"No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

facility 'Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ff <o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[J- L�A
❑ 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
E2,Ko
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes
[T No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�io
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Vo
❑ 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 0 Application
Outside of Approved Area
12. Crop Type(s): _ _ DY U 1` �f G""t
13. Soil Type(s): ! v 0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
WNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[5 1�0
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E]Xo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
a<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
-
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
L.9 o
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3<o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
fNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

IDate of ins ection:
facility Number:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Tl�o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
0'No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
[—]Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
[5 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[—]Yes
0"ko
❑ 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:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Signature:
[:]Yes ffNo ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
[—]Yes [rNo ❑ NA ❑ NE
❑ Yes []'lqo
❑ Yes ffNo
❑ Yes dNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Date: `� NU 1s
2/4/2014
Page 3 of 3

Type of Visit: QPCom lance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: GrRoutine 0 Complaint 0 Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: I Arrival Time:I- I Departure Time: County RegipO
Farm Name: Owner Email:
Owner Name: d Phone;
Mailing Address:
Physical Address:
Facility Contact: V ✓` Title:
Onsite Representative:
Certified Operator: 1(
Phone:
Integrator: 1M j dt 6
Certification Number: 1,7115
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current"_
Design
Current
Design Current
Swine Capacity Pop.
Wet Po�iltry
Capacity
Pop.
Ca[tle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
1 M.
Dairy Heifer
Farrow to Wean
Design
Current
DEX Cow
Farrow to Feeder
DrPoultr
Ca pa
P,o
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
O#her
Turkey Poults
Other
Other
Mow-
Dischar es 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 [3-MU- ❑ NA ❑ NE
❑ Yes
[:]No
�A
❑ NE
❑ Yes
[:)No
[r�Pi-A
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [-]No
❑ Yes EP No
❑ Yes ❑.No
E3- A
❑ NE
❑ NA
❑ NE
[] NA
❑ NE
Page 1 of 3 21412011 Continued

FaciliNumber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3-10
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Q�NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
&. 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 ❑ 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
e,'r,
12. Crop Type(s): � K( G r
l l '19*�
13. Soil Type(s): A2fh/,- Dtr-y
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Eno
❑ 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
�1Qo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[]�To
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑Yes �No ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[j No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ED-t10
❑ 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
I:4-11'o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
to
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes []Vo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes S-N-o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q-Wo ❑ 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 0 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [a ' -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:
[:]Yes 631090 ❑ NA ❑ NE
[:]Yes Ea<o ❑ NA ❑ NE
❑ Yes FDI�_o ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[E'Fo
[DNA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
P3"No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
[2No
❑ NA ❑ NE
Comments (refer to question #) Explain any YES answers and/or any additional recommendations or.any,otber comments.
additional
. . ,. .'
iuse�'diawlngs of facility to better ezplain situations::(use additional pages necessary)
'
00 N15 34ycairs
�CCO 4-5 KOAA, zdmej
a
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
PhoiiA —
q,13 47 �
Date: to
21412011

0{ems 6-3
I
(Type of Visit: Q"Comphance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: au ne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 11
Date of Visit: JJD Arrival Time: Departure Time: County: Region:
Farm Name: n Owner Email:
Owner Name: lr Phone:
Mailing Address:
Physical Address:
Facility Contact:
V "
Onsite Representative:
Certified Operator: {
Back-up Operator:
f'
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: L 7�L3�J
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Capacity Pop.
Wet out
Capacity
10
120 am
Pop.
Chttle
Capacity Pop.
rF
inish
7FEedcr
La er
Da' Cow
eeder
on -Layer
Da' Calf
inish
m
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,o_ultr _
Ca aei
P,o .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[—]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[]Yes
[]No
Q i�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
ff NA
❑ NE
C. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[] Yes
0N,o
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 Y
21412011 Continued

Facility Number: IDate of Ins ectio
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[::]Yes
R�F1Qo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
E 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
[fNo
❑ 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
E1. o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[5
❑ 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
t_Ko
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
C940
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Q No
❑ 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 Drift ❑ Application Outside of Approved Area
12. Crop Type(s): d-o"Alk ltr ��44►mot
13. Soil Type(s): 6 or- d t
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M<
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
QV6
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
&, v
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
[A o
❑ NA
❑ NE
Required Records & Documents �,�
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [1[ o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ❑iivo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [-]Maps ❑ Lease Agreements ❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [q"No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E! No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

q
' Facifi Number: - Date of Inspection:_)
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Otherlssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes KKo ❑ NA ❑ NE
❑ Yes [3X55 [] NA ❑ NE
❑ Yes E&do [] NA ❑ NE
❑ Yes ZKo ❑ NA ❑ NE
❑ Yes �To ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. [::]Yes ElKo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes *N
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Ej / o
34. Does the facility require a follow-up visit by the same agency? ❑ Yes � No
Comments (refer to question-ft Explain any YES answers and/or any additional recommendations or any other
Use drewln�s of facilityto better explain 'situations (use additional pages as necessary).
N . �E"S 5 �.�.-O_cv"3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/inspector Name: 1\ Phonelt W
A_
Reviewer/Inspector Signature: Date:Lq
Page 3 of 3 21412011

Type of Visit: omn�pliance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: el routine 0 Complaint Q Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Lid_&_�4z Arrival Time: f7 Departure Time: County: ,nw
Farm Name: JK�/l�„�uxl Owner Email:
Owner Name: Zf - x Phone:
Mailing Address:
Physical Address:
Region:
eKQ-
Facility Contact: )KDrelg, Title: g1V",.;— Phone:
Onsite Representative: _ �'�� Integrator: W'&
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
ti
SKineCapacit}'
Design Current
Pop.
=
Wet Poultry
"Design
Capacity
Current
Pop-
Design Current
C•attle Capacity Pop.
Wean to Finish
Layer
I
ow
Wean to Feeder
Non -La er
I
alf
Heifer
Feeder to Finish
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , l;oultrr :....:Ca
Layers
Non -La ers
_aci
P,o
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Finish
Gilts
Boars
Pullets
I 113eef Brood Cow
_; lit ..
.. Turkeys
Other
T-urkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [,�A 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
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? ([f yes, notify DWQ)
❑ Yes
[] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
R,No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[Z�No
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

' Facility Number: jDate of Ins ection:
Waste Collection & Treatment
{ 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[:]No
❑ NA
[] NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19
Observed Freeboard (in): _?_�_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® 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 ® 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): j5e�MWPIA_
13. Soil Type(s): C ,..- J W 4f5--Z
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CZ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ WE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes �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 CA WMP readily available? If yes, check ❑ Yes [ No ❑ NA [] NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. ® Yes COO
[Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 5 Soil Analysis ❑ Waste Transfers
❑ Rainfal I ❑ 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

Facili Number: - Date of Ins ection: -/
�. 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 to provide documentation of an actively certified operator in charge? ❑ Yes El No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [-]Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
[] NA ❑ NE
]NA ❑NE
❑ NA ❑ NE
[ ] Yes ® No ❑ NA ❑ NE
❑ Yes & No ❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes ZINo
❑ Yes 21 No
[:]Yes [&No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #) Explain any YES answers and/or any.addrtronal recommendations or any other commente r "'
Use drawings of facility to better' explain situations (use additional pages as necessary).,s.w
Reviewer/Inspector Name
�,r✓'t° ( /�``...__ Phone: yid "�C7
Reviewer/Inspector Signature: !y �— Date: �ti
Page 3 of 3 21412011

Type of Visit compliance Inspection Q Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit (94outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:-1 1 Arrival Time: ; l7 Departure Time: County: Region:7�
Farm Name: /Lt V. Owner Email:
Owner Name: Din.. 415 Z42—lra,u)k Phone:
Mailing Address:
Physical Address:
Facility Contact: 12t1-U;6 I Title: _ 49-W n r r Phone No:
Onsite Representative: Integrator:
Certified Operator: �. ��, Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= c [1 . = i. Longitude: = ° 0 I = "
Des' Current
D sigiCurrent
Design Current
Swine ,Capacity Population
Wet Poultry
CapacityPop la on
Cattle Gapaeity Population
El Wean to Finish
❑ La er
❑Dai Cow
El Wean to Feeder
❑Non -La er
❑Dai Calf
® Feeder to Finish J —k
_
❑Dai Heifer
El Farrow to Wean
Dry Poultry«
d°
❑ D Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ La ers
El Beef Stacker
❑ Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
r.: , = ._ .-,, _ �_
❑ Turkeys
Other,"
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharees & 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 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
EN No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
® No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: ± — /),�1 Date of Inspection
s
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
K[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): i9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
tA No
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
19 Yes
IM No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
XLNo
❑ 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
M 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 > l0% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop types) &r/" Z42Z c ' f--e-1
13. Soil type(s) C, G f W &_p
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [9No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
ER 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
JSJ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
E9 No
❑ NA
❑ NE
Cm mentsx(reier t uestjoo;_#) EgplsutJanX. .! an rs and/or any�recommendation s or any other comments.
tUse drawurgs of�facil>ity to betterwexplam situatrons.�(use additionalrypages�asnecessary}•
i'Fk'+1a.Xy} i w1�7�, Tn �#`'Y-=
7, /lam rN a4. L� o?t7n -
►. 3,04L rs J rn k s r 6r-- ofe---e- r/r,j � -At r 0
Reviewer/Inspector Name �C G Phone: , /p-yJ3—T3aa
Reviewer/Inspector Signature: Date: iZG /
Page 2 of 3 12128104 Continued

Facility Number: — J�E Date of Inspection
i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes R[No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes V0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑ Other
21. Does record keeping need improvement? I f yes, check the appropriate box below. Yes C] NA ❑ NE
❑ Waste Application [:]Weekly Freeboard [:]Waste Analysis N 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26, Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection'with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Addhional�Comments,and/or DrawMgsr
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[9No
❑ NA
❑ NE
❑ Yes
RrNo
❑ NA
❑ NE
❑ Yes
l9No
❑ NA
❑ NE
❑ Yes
[KNo
❑ NA
❑ NE
❑ Yes
®,No
❑ NA
❑ NE
❑ Yes
EKNo
❑ NA
❑ NE
❑ Yes [9No ❑ NA ❑ NE
Page 3 of 3 12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ' . �� Arrival Time: ® Departure Time: County: E
Farm Name: D60'LG4_ 3 D/-d eZUtX r4 WL Owner Email:
Owner Name: D ctg2 G� r�� 42s-w- Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: fl r " Title: ('l PA24 t-d- Phone No:
Onsite Representative: Integrator: l7Zcc�rl
Certified Operator: Operator Certification Number: Z ,7
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [� o = ' = Ai Longitude: = ° = 6 0
Design Current
Swine Capacity Population
❑ Wean to Finish
Design C►urrent
VVet Poultry Capacity Population
❑ Layer
Design
C►attle Capacity
❑ Da Cow
C►urrent
Population
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
�Fecder to Finish � S o
❑ DairyHeifer
❑ Farrow to Wean
pry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
El Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
[:]Yes [!�'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
tgNo
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
Page I of
12128104 Continued

Facility Number: — /S` Date of Inspection
` Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): /
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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 Z.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes J3 No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ®,No ❑ NA ❑ NE
maintenance/improvement?
1 l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 6No ❑ 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) Grs z��
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes 29 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes U.No ❑ NA ❑ NE
"Commeni4,�(ii.t�r.,to-q-Uesti.on Explain
Llse draw ngs of facility to better explain situations; {use d do al pax s rfte.vrcas necessaiktry) ns or an'yother comments ll
ST 5
Nd��-�' I R.�=`� czrr( v,mk�,j-� 1� ►c����-y UJCoc�r�' �c-�I-t� �rr S/�v-fir
Y �uV
,.. � B�— � - �; � � Phone: —7 3 �'
ec Reviewer/Insptor Name ;"" r �' 3
�:
, .;.. y . n�Y
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — / Date of Inspection LPL
Required Records & Documents file`
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ® Yes LMNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes 9No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 0-Yes LBNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 19 Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
21 No
❑ NA
❑ NE
❑ Yes
E.No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
(E-No
❑ NA
❑ NE
❑ Yes
D9 No
❑ NA
❑ NE
❑ Yes 19 No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes [KNo ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes 91 No ❑ NA ❑ NE
Additional,'Comments andlor Drawings: � �
..
i
Page 3 of 3 12128104

Type of Visit ()-C-ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l� Arrival Time: Departure Time: rya County: Region:
Farm Name: aLLr_ jZ) /-d zqAla x Owner Email:
CIFOwner Name: 12_ 6 nnr, ik0&&x Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 c= i= H Longitude: 00
0 i = 4
r d Dest n Design Current Design Current¢ I gR �� Current
h
Siu Capactty$ Populab n Wet Poultry) Capacity, Populahan Catt[e Capacity Population
PWean to Finish ❑ La er ❑Dai Cow
Wean to Feeder '' ❑ Non -Layer I ❑ Dairy Calf
Feeder to Finish "' �""� ❑ Dairy Heifer
❑ Farrow to Wean El D Cow
Dry Poultry I I
❑ Farrow to FeederNon-Dairy
ElFarrow to Finish El La ers El
Stocker
PE03Bwkr_s
Gilts ❑Non -La Non -Layers
``' El Pullets
❑Beef Feeder
❑ Beef Brood CoAMATurkeys
Other #� �Y`- El Turkey Poults
❑ Other ❑ Other Number of Structures:
Discharges & 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 D WQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Wo
❑ 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?
Page 1 of 3
12128104
Continued

Facility Number: $ — % Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [/$No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier-
Spillway?. -
Designed Freeboard (in): Q/
Observed Freeboard (in): «--`r-
5. Are there any immediate threats to the integrity of any of the structures observed`?
❑ Yes
allo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
(g 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
4 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
5JNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ERNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[9No
❑ 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 Drili ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) Cr G f
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
§4 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[—]
Yes
5No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JKNo
❑ 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):
1�C.. `iX,-, %
iteviewerAnspector Name Phone: g&- f O 0
r -
ReviewerAnspector Signature: Date: x
I iiGW VT I. VIi{I/�NLN

Facility Number: Date of Inspection
Remuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists
❑ 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 dNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CgNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;KNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Jallo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P-No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CgNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
JgNo
❑ 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
§1 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
D ,No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,9 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
15No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Division of Water Quality
Facility Number Q Division of Soil and.Water Conservation d/
Q Other Agency v
Type of Visit t2rCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit &'Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: r% Departure Time: County:— Region:
Farm Name: rr9 T /a Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: J-D
&!Jrmey, Title:
Onsite Representative: S�
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
Ocher
❑ Other
Phone No. -
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0E__1 I El [Y Longitude: 0 0 0� ❑
cd
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkevs
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is anv discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Beef Stocker
❑ Beef Feeder
I,
r ❑ Beef Brood Cow
i. Number of_Structures
b. Did the discharge reach waters ofthe 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?
Page I of 3
�FJ
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
ONE
❑ NA
❑ NE
❑ Yes
❑ No
❑Yes
0No
0. NA
❑NE
❑ Yes
O,No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection a`47
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ 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 RNo ❑ 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 Q No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes W-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 P4-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) C' e by—c=
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NNo
❑ 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?❑ Yes
[KNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
V.,No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
V9LNo
❑ 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): '
Nno 0 I_ f� r-v/` l D v r— Thu,7 c;9-Me�2,,;pi7
Reviewer/inspector Name Phone:
Reviewer/inspector Signature: Date:
12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 64No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. aYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 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
C No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[Z No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ANo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[TNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
51No
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
gNo
❑ NA
❑ NE
Other Issues
2&
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
❑ NE
If yes, contact a regional Air Quality representative immediately
'
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32_
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®,No
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑ Yes
J.No
❑ NA
❑ NE
Comments and/or
12128104

Type of Visit Qfornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0-lioutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Zl�' Region: D
Farm Name: ��3 n_d fzz" Y. �ulOwner Email:
" OT %
Owner Name: _ .1 qy a= le -a ux Phone:
Mailing Address:
Physical Address:
Facility Contact: . ! l 0 u !V , ! o t r-a MSc Title:
Onsite Representative:_ —
Certified Operator: . 5a,
Back-up Operator:
Phone No:
Integrator: �e.g'-'04
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 ❑ f =" Longitude: = ° = 6. = N
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle C►►opacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
El
❑ Non -La er
El Dairy Calf
ElDai Heifer
Dry Poultry
El Dry Cow
ElNon-Dai
❑ Layers
ElBeef Stocker
Non -Layers
ElN
El Beef Feeder
❑ Pullets
Nets
El Beef Brood Co
-
ElTurke s
Other
❑
❑ TurkeyPoults
❑ Other
Humber of Structures:
Other
Wean to Feeder
Feeder to Finish
Farrow to Wean
El Farrow to Feeder
Discharees &Stream Impacts
1. Is any discharge observed from any part of the operation?
1
❑Yes
� No
❑
ElNA NE
Discharge originated at: El Structure [I Application Field El Other
a. Was the conveyance man-made?
El Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[-I Yes
9I No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
W No
❑ NA
❑ NE
other than from a discharge?
Page 1 of
I2/28/04
Continued
k•i

Facility Number: — Date of Inspection %- D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 19
❑ Yes [3No ❑ NA ❑ NE
❑ Yes Cff No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 29 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 BNo ❑ 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 [9No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4- Does any part of the waste management system other than the waste structures require ❑ Yes R1 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?
I t . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13, Soil type(s) -C 5e Z 1,0"a
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo ❑ NA ❑ NE
V, No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
KNo ❑ NA ❑ NE
'.Comments (refer to question #): Explain any YESanswers and/or any recommendations or any other comments
bx,r„
Use drawings of facility to better explain situations$ (use additional pages as,netessary)
_11'
Reviewer/inspector Name f Phone: �3
Reviewer/Inspector Signature: Date: D
Page 2 of 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
1 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 14 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ,0 Yes JNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard �3 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (le/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
IN No
❑ NA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
I,�'No
❑ NA
❑ NE
®Yes
El No
El NA
El NE
❑ Yes
9-No
❑ NA
❑ NE
❑ Yes
59 No
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
[gNo
❑ NA
❑ NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
`Q No
❑ NA
❑ NE
k'"ddihoual'Camments.and/or Drawings
p`11 I+Uhw.. pui' Illf'rla ��irtRxis�
�fr�� q�.+r- ��r�s
f�i(w',
C C�
O`ZJT
rzr28104

J
Type of Visit QMompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: �,`� a County: I4 Region:
Farm Name: �` r-crLkK �a►'✓�� _ Owner Email:
Owner Name: f 0,9(ZA �� /u Y, Phone:
jr
Mailing Address:
Physical Address: /
Facility Contact: D4 VJ— f) !'Df r- -14X Title:
Onsite Representative: ��—
Certified Operator:"�-
Back-up Operator:
Phone No:
Integrator: ern
Operator Certification Number: Z,
Back-up Certification Number:
Location of Farm: Latitude: = o = I = u Longitude: = o = + =
_
Swine
- .Design Current
Capacity Population
Net Poultry
Design .. Current
@apacity Population
Design Current
Cattle Capacity Population
❑ We;to Finish
❑ Layer
I
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer I
I
❑ Dairy Calf
ceder to Finish
❑ Dairy Heifer
❑ D Cow
Farrow to Wean
pry Poultry
❑ Farrow to Feeder
-
El Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
Non -Layers ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
fth
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
V 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
[allo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[--]Yes
J-No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection 17-
.w' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [9No ❑ NA [_]NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 9No ❑ 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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[4 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
J@ No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
g No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
J'No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
g No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) d�rrML[Qa l'd5`1�K�t_ / �7/lJ
13. Soil type(s)AV (1-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
K 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
CR No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or auy,bther comments:
r s.:
Use drawings of facility to better explain situations. (use additional pages as necessary):
r l off= -
Reviewer/inspectorName ri`- Phone: g/(Yy33 ��—
Reviewer/Inspector Signature: Date: 7—
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection �69
r Required Records &.Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes JONo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 19 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [9'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® 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
JZ] No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
94 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Up 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
UgNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
WNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Additional`Comments and/or Drawings:
Page 3 of 3 12128104

f
a Division of Water Qualit
.acility_.Number ((� �" 115 O Division of Soil and Water Conservation
0 Other Al•ency
Type of Visit ®Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: III -Of 05 Arrival Time: S}30 Departure'I'inse: �� Counh ��4 c[<—/ Region-, ��2LJ
Farm Name: �0_111e — 0u.& -M j .. Owner Email:
Owner Name: D,Q.t�l MLP- t x Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: Do J
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: �y, [.5JN
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 0 1 Longitude: ❑ o❑.
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
1 ❑ La er
❑ Non -La es
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
L100
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La yers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. is any discharge observed from any part of the operation'?
Dischame originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system'? (Ifyes, 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 0 No ❑ NA ❑ NE
❑ Yes
19 No
❑ NA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
X No
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
U No
❑ NA
❑ NE
12128104 Continued

Facility Number: D 9 — ! 15 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ®No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
�A
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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 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
CR No
❑ NA
❑ NE
Additional Comiii6 tm"r1Drawings:
:.,01 NUANN �
I2128104

Facility Number: 09-1/5 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ® No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): !�
Observed Freeboard (in): 2.4
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 00 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
J@ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
(R No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
99 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 Drift ElApplication Outside of
Area
12. Crop type(s) 439r'M UCLI /6 QSAik P_
13. Soil type(s) �, W
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[5No
❑ 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
[)4 No
❑ NA ❑ NE
3:
Reviewer/Inspector Name ,` e V� j ''` Phone: 9l0 $(o /S /
Reviewer/Inspector Signature: Date: — OS
12128104 Continued

a., -- - - -
Facility Number 0 S�
Name _ �>oiss r e-a ti
Farm Name 0,4 ,6 4
C.O.C. 9 0 f 1permltted
Waste plan oil Test
Soil type C e &
Date v q -- D
74— /
on hand
PLAT Deep Soil test
Crop types Oe4- s,, ,-- d a- 4 r_ c-- ES 4 t/
ri
Designed Freeboard Observed Freeboard
Rain gauge Rain breakers ✓ Daily Rainfall
Calibration of spray equipment �` ,�� G.P.M.
Sludge Survey Crop Yield 120 minute inspections
l in. rain inspections Weather code Weekly Freeboard
Waste Transfers Waste Analysis
Pumping time
Waste Analysis % & Month
Comments:

MI
(Type of Visit 0 Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number IDatearvisit: -/' 6 Tuue: l.? ►'� S
0 Not Operationall Q Below Threshold
permitted 13Certified D Condiitionally Certified 13Registered DateLast Operated or Above Threshold:
Farm Name: �G�r� __ it �C �k _ �Gur �— .''�' ...__ County
Owner Name: _ . _ _ ��G� Ira,i .�. d!�oje g _ . .. _ .. Phone No:
Mailing Address: _ �Il� Scy c fia,n e C!4 w A jf M 4r EJ� f�i fvs..M IV C � 8
Facility Contact: OorWeay iC Title:._....... Phone No: _
Onsite Representative:
Integrator: .. _ ..
Certified Operator-_ , 400 -- - . Qa �_ _ Operator Certification Number:
Location of Farm:
W
[a'Slwine ❑ Poultry ❑ Cattle ❑ Horse Latitude • &A Longitude ' �' Du
Discharges & StreamImpa
1. Is any discharge observed from any part of the operation? ❑ Yes Blgo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a_ If discharge is observed, was the conveyance man-made'? ❑ Yes aSo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes CT10
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 M'Rd-
2. Is there evidence of past discharge from any part of the operation? ❑ Yes a o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Q190
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Elfio
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: —W
Freeboard (inches): 02 a`
121I2103 Continued

Facility Number: q —/!�� Date of Inspection 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes e.KO'
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑yes EMIG
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 maintenancePimprovement? ❑ Yes [rNo
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes B<0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [31qo
elevation markings?
Waste Aonlication
10. Are there any buffers that need maintenance improvement? ❑ Yes E31�o
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ yes E3No
❑ Excessive Po , nnding ❑ PAN [I Hydraulic OqO verload ❑ Frozen Ground [I Copper and/or Zinc
12. Crop type /jC/a S.a a //--
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes M-M-
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
I6. is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Q-116
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes B'No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes Leo
. Air Quality representative immediately.
- � �.n..>_;_ ...,rem r,..:.... �----� < r- �---Y>.�.-� :..:,ys- •sir � r��"-=-'-�:� .��':� -ram
Oti+lfef toYlQ7' aIIy C� a1�j►�OiOIS 'A -
- ....
aT3scwtrags of fty M better splam s�luaboaes. {� Peas }' teld Copy ❑Final Noes
AL
P�edse I�ICIi/li�ri+ 4rQiS �CPUer O„ /I`t�OUrj '��• N't, ��►p/!r✓x .S/ �t�Y,
S p r ,'n J p a /0 JzPo P leao d s%o evy
U 5 n< e-41( r G(
Hw
Reviewer r Name �S x z;. i w wA
Reviewer/Inspector Signature: AhA Date:
12112103 Continued

Facility Number: —/ir Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ,a
22. Does the ility f ' to have all c nents of the Certified Animal Waste Management Plan readily available?
(ie/ , ch i'sts, d ig s, etc.) ❑Yes �o
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O-NO
❑ Waste Application Qjxcebowd ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [-Cu
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes EPTC
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
27. Did Reviewer/Inspector fail to discuss reviewhnspection with on -site representative? ❑ Yes ❑ 6
28. Does facility require a follow-up visit by same agency? [:]Yes 04o
29. Were any additional, problems noted which cause noncompliance of the Certified AWMP? ❑ Yes Oiqb-
NMES Pernutted Facilities
34- Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes lfo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33- Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Site Requires Immediate Attention: �-f!ya_
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
Z ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: 2'
Farm Name/Owner: ,L7o r
Mailing Address:
County: 41�—
Integrator: AUoft Phone:
On Site Represent;;6 : Phone:
Physical Address/Location: f4k.-
Type of Operation: Swine � Poultry Cattle
Design Capacity: t Number of Animals on Site:� -
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: «
Circle Yes or No
Does the Animal Waste Lagoon h sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) ye or No Acnial Freeboard:. Ii' Ft. _Inches
Was any seepage observed from the lagoon(s)? `Yes; oras any erosion observed? Yes o No
Is adequate land available for spray'.) Yes o� r No
Crop� rs) being utilized: (w-
Does the facility meet SCS minimum setback criteria?
Is the cover crop adequate? Yes or No
200 Feet from Dwellings? Ark or No
100 Feet from Wells? e oo
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or o
Is animal waste discharged into water of the state by man-made ditch, flushing system,_ or other
similar man-made devices? Yes or e­ If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? 119or No
Additional Comments:
— — Ak�
Inspector Name
e: �/ 4 0?!
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

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State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Andrew McCall, Regional Manager
�EHNR
DIVISION OF ENVIRONMENTAL MANAGEMENT
water Quality Section
September 18, 1995
Mr. Doug Bordeaux
Rt. 2, Box 740
Elizabethtown, N.C. 28337
SUB.TBCT: Complaint Investigation
Animal Feedlot Operation Inspection
Doug Bordeaux Swine Farm #1
Facility No. 9-115
Bladen County
Dear Mr. Bordeaux:
On September 15, 1995 the Fayetteville Regional Office of the
Division of Environmental Management conducted an inspected of your
animal operation and lagoon as part of a complaint investigation.
The anonymous complaint alleged that insufficient freeboard was
being maintained in the waste 'lagoon as well as excessive foul
odors were reported. The brief inspection of the above facility
revealed "No" observable deficiencies and the area surveyed was in
the opinion of the inspector to be free of excessive odors.
As part of the inspection a freeboard determination was made
of the lagoon. The freeboard at the time of the inspection appeared
to be a least three (3) feet. As you may already know, freeboard in
each lagoon must be maintained atone foot plus sufficient capacity
to hold a 25 year 24 hour storm event or a total of approximately
nineteen (19) inches (in this case freeboard represents the level
of the lagoon liquid in relation to the lowest possible discharge
point.)
If you have questions regarding this matter, please do not
hesitate to contact me at [phone].
4sincerel
Paul E. Rawls
Environmental Specialist
cc: Murphy Family Farms, Inc.
Dianne Williams Wilburn, DEM Facility Assessment Unit
Wachovia Building. Suite 714, Fayetteville, North Carolina 28301-5043 Telephone [phone] FAX 910-48"707
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

.r
Farm M
county:_j
Integrator:
On Site Ro
Physical A
Site Requires Immediate Attention: ti°
Facility No. 4-,ss
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VI.STTATION RECORD
Type of Operation: Swine _x-
Design Capacity:
DEM Certification Number:
DATE: 9 -If , 1995
Tune: 1:2, _
Phone:&an 2_ -2&41.
Poultry Cattle
Number of Animals on Site:
ACE DEM Certification Number: ACNEW
Latitude: Longitude: -
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Q or No Actual Freeboard: '1 3 Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No (seepage Was
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No Not Evaluated'
Crop(s) being utilized: (Spray Field or cover crop was not evaluated) ^
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? du5) or No
100 Feet from Wells? or No
* Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? ' Yes or No*
* Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or-dther
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No(Waste management records were not
Additional Comments:
This wa a vebrief inppection. a more thorough inspection will conducted in the Juture.
Please contact%TEM should any condition arise that poses a danger to surface waters_.
* This farm was not located on a USGS TOPO map to determine ?Blue Line" status.
If you have questions concerning this report _please do not hesitate to .contact the inspector
at [phone]. Please contact the inspector if the above information is incorrect.
Inspector Nam Signature
cc: Facility Assessment Unit Use Attachments if Needed.