090133_INSPECTIONS_20171231

I ype of visit: %:}'Compliance Inspection V Operation Review V Structure Evaluation U Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: C7 Departure Time: County: .,crjvs-`_ Region: jff�L}
Farm Name: j vl Lxf 1-oo t- 1-3 Owner Email:
Owner Name: _�,�, ; f f ; ,� _ 0' t Phone:
Mailing Address:
Physical Address:
Facility Contact: 37117 I �Ixt LaW Title: Prone:
Onsite Representative: ;'—Jd,/d 7 � i }'v-[.��J Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: /
Certification Humber:
Longitude:
J
nt
SwineENNIfflyk
ap
Wet Poultry
@apacity
Pop "
`Cattle. Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
-Layer
DairyCalf
Feeder to Finish
'
DairyHeifer
Farrow to Wean
Design
Currenft
D Cow
Farrow to Feeder
D , P,oul
Ca aci
P,tl
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
t?ther
Turkey Poults
Other
uw��:rn�nrw:
n�uua xwua=.:.n€
@�
Other13
a.rx_��=cee'�urn.mcs
as.d..
i1.Iff�
,. i ..... ..
_Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
tallo
[] NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes F1 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: $.I 1:2L_
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
Q No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
ELNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E,No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes Eg,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7n, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): A_Y/iL 46&
13. Soil Type(s): Cv—P
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
t&No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
MNo
[:]NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18, is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
R_No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes RNo ❑ 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 f-q No [:3 NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 12!rNo 0 NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out ofcompliance with permit conditions related to sludge? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
,Kon-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: L�f �3
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes KNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [, No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 Wo 0 NA ❑ NE
[]Yes C&No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
E�J_No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
fa -No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? KYes
❑ No
❑ NA
❑ NE
a drawings af:facdity (6; beiw. eaplam situations(use additional pages as necessary:
� pre-, SlX� wa� /-� a��o/ w I �f 1� w f` mi l
>� � W • i � 6�Y��r'r'l7�uz'd 1v` t`5L�_ j �-m ���
Reviewer/Inspector Name:
Phone:
Reviewer/inspector Signature:
Page 3 of 3
Date: ID —/` —,;;zd 1?
21412015

t ype of visit. l—mompuance inspection C.l Uperation tteview V Structure r vaivarion V rectimcat Assistance
Reason for Visit: O Routine 0 Complaint ollow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: _ .`po Departure Time: :3p I County: Region:
Farm Name:Owner Email:
Owner Name: : f /; �, }, ,� ; +1 L cz c.c.J Phone:
Mailing Address:
Physical Address:
Facility Contact: / 1 1--tLP-6 Title: Phone:
Onsite Representative: s'�—� Integrator:
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Finish
Wet Poaltry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da Cow
Feeder
Non -La er
Da Calf
Da Heifer
o Finish
o Wean
D , Pouttr,
Layers
Design
Ca aei
Current
Pao
Cow
Non -Dairy
Beef Stocker
to Feeder
to Finish
E
Won -Lavers
Beef Feeder
��A
Pullets
Beef Brood Cow
Turke s
oults
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?
❑ Yes ❑ No ❑ NA 4ZNE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[:]No
0 NA
E]-NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
❑ NA
aNE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: jDate of Inspection:
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
EaNE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
[] NA
MNE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
®--NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
JEK NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
❑ No
❑ NA
[3.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
to No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below_ [:]Yes CK No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):l
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
1210 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
❑ Yes
D No
D NA
JQ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
E-NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
E3 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
❑ No
❑ NA
ONE
the appropriate box.
❑WUP ❑Checklists [:]Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment`' [] Yes ❑ No
❑ NA aNE
❑ Weather Code
❑ Sludge Survey
❑ NA EaNE
❑ NA JaNE
Page 2 of 3 21412015 Continued

FaCiTy Number: - Date of Inspection:
i
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No ❑ NA
WE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No ❑ NA
CZ.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
VNE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No ❑ NA
C2f-NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
❑ NA
aNE
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
�0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31 _ Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
EaNE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
V] No
❑ NA
❑ NE
as necessary):
45 &Ier 7—v /, i>o k a,12 -r-_
O
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-4111 Guns
T i;raX Sd��Y %D �•�r
�,rp�
1f+ ;firrf�� d ;d
j.J ro fl v��r
Reviewer/Inspector Name:(37—
Reviewer/Inspector Signature:
Page 3 of 3
Phne::�
Dv 3y3�fS��
21412015

Type of Visit: QKompliance Inspection O Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: �s%/� Arrival Time: ,'Od I Departure Time: County: Region: O
Farm Name: ; ,,t L a -o FQ r m / —. 3 Owner Email:
Owner Name: _ Jjj : 1 i ,,,,L —k 'i n L a., Phone:
Mailing Address:
Physical Address:
Facility Contact: fti L& Title: Phone:
Onsite Representative: _ ��,� , ,h 21,�/ Integrator:
Certified Operator: Certification Number: 3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current.
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish / D
Farrow to Wean
Farrow to Feeder
_
Wet Poultry
La er
Non -Layer
D , P.oul
Design
CapacityCattle
Design
Ca aci
Current
Current
P.o .
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
IPullets
Beef Broad Cow
Turkeys
Turkey Pouits
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes A7,>3No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes allo
❑ Yes RNo
[:] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 2/4/20I S Continued

lFacility Number: - 1,3, JDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes I. 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)
311, 411)
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑Yes nNo ❑NA ❑NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes 0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes MNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes $g No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes EQNo
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 0 No
[DNA
❑ 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 ❑ 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): J�?-I tj'edl
13. Soil Type(s): ,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Uq No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes ® No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [—]Yes [0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑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
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 4 N
❑ Yes No
❑ Weather Code
El Sludge Survey
o ❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Confinued

Facili Number: JDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]Yes lFYq Y-r No ❑ NA ❑ NE
�25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
14 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?
any
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes `�Z] No ❑ NA ❑ NE
❑ Yes Dg No ❑ NA ❑ NE
[:]Yes �al No ❑ NA ❑ NE
0 Yes ❑ No [D NA ❑ NE
Yes [] No ❑ NA ❑ NE
[:]Yes No
❑ Yes ® No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
grrid v/i�/ 6e—
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Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date:
21412015

Type of Visit: A@Toynipllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Grf routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:—/ ^Arrival Time:
Departure Time: % % •'O
County:
Region: Region: Q
Farm Name: o ' 0 LAI r-Q e'► %_ j � 3
Owner Email:
Owner Name: w _k ) I I a I., / t''\ ... L Ge t cJ Phone:
Mailing Address:
Physical Address:
FacilityContact: i + t-<s _ L_':'LU 7 Title: Q u3 r f Phone:
Onsite Representative: .G o�rr�p� t-� ; „� �ae.l t� Integrator: A"
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Non -Layer
El
Dairy w
lf
Dairy ifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
Design
Current
Farrow to Feeder
D , P,oul
Ca aci
P,a _.
Non -Dairy
Farrow to Finish
Layers
Non -La ers
Pullets
!Turkeys
cker
der
od Cow
Gilts
Boars
Other.
Turkey Poults
Other
Other
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ;5,No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
D NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
[::]No
❑ NA
❑ NE
❑ Yes
E&No
❑ NA
❑ NE
❑ Yes
J.No
[] NA
❑ NE
Page I of 3 21412014 Continued

Facyity Number: -TTJ 113ate of Ins ection:
. Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C�J-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): - 10 — 9
Observed Freeboard (in): . 3 f
5. Arc there any immediate threats to the integrity of any of the structures observed?
❑ Yes
V] 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
jjjNo
❑ 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
MANo
❑ 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
Z 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):��^Cl3�t�b(Gt`
13. Soil Type(s): e
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [S-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [::]Yes CS -No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18_ is there a lack of properly operating waste application equipment?
❑ Yes [, No ❑ NA ❑ NE
❑ Yes 0 No [DNA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. aYes ❑ No
❑ Waste Application MWeekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
E] Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Nu er: - / 3 Date of Ins ection: -/� — ZST
•24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes a No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes CS No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [, No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes CR-No ❑ NA ❑ NE
❑ Yes IgLNo ❑ NA ❑ NE
❑Yes toNo ❑NA ❑NE
❑ Yes C13.No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
CK No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
Jallo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
®No
❑ NA
❑ NE
Comments (refer twquestion #): Explain any YES.:answers and/or any,additional recommendations or anyother..comments:
Use drawings of facIG(y to.6etter. explain situations (use additional,pages as: necessary).
Reviewer/Inspector Name:
Phone: 9/�
Reviewer/Inspector Signature: .e� �.}�� Date: 4 /� `J�r _
Page 3 of 3 21412011

0
Type of Visit: Q'Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: EN Arrival Time: a a Departure Time: County: Region: {}
Farm Name: L,.uj 6a/'m. /— 3 Owner Email:
Owner Name: f,�J i 1 X %j ; -I Phone:
Mailing Address:
Physical Address:
Facility Contact: 6'1 y 4. LQ Uf/ _ _ Title: ,¢�h r- Phone:
Onsite Representative: :G/1 r L"e Integrator: oflp"' /2" ' _
Certified Operator: �� �jY r,� .7 �,�/ _ Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Curren
Design Current
Design C►urrent
Swine Capacity Pop.
WetkPoltry _' Capacity Pap.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish /1137
Dairy Heifer
Farrow to Wean
�" ; Design Current
Dry Cow
Farrow to Feeder
D*1'oul Ca aci P,o
-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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 M No ❑ NA ❑ NE
❑ Yes
❑ No
C ] NA
❑ NE
❑Yes
❑No
❑NA
ONE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes 0 No ❑ NA 0 NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes � No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes 5�_No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

.[Facility Number: - / Date of Inspection:/ —
Waste Collection & Treatment
-4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
M No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes_
5Q 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
MNo
❑ 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
�jNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[S 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
[2�No
❑ NA
❑ NE
maintenance or improvement?
I I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Ug-No 0 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): 4�_'t
T-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E&No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Pa No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [g 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 Eig-No ❑ NA ❑ NE
Required Records & Documents
19, Did the facility fail to have the 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 [SNo ❑ NA ❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®.No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes LNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 54-No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

•[Facility Number: - Date of Inspection:
/
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Vq No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
(&No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
11 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
04No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes [ANo ❑ NA ❑ NE
❑ Yes E, No ❑ NA ❑ NE
❑ Yes [&No
❑ Yes Cg No
❑ Yes fK[ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question:#): Explain any YES answers and/or any additional recommendations or any other comments: t�.
Use drawings`of facility to better`explain'situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 91P ���
Date: Cyr 1
21412011

It]
I
Type of Visit: �Compce Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �J / Arrival Time: c^y Departure Time: County:: Region:
Farm Name: }}��
�—d[ jst'L- -� � Owner Email:
Owner Name: W , o-, -K l—o "_j Phone:
Mailing Address:
Physical Address:
Facility Contact: L{ f . ;mac..`_ i K z •-e, L,,-f Title: Phone:
Onsite Representative: %�� �; .� LEI Integrator:
Certified Operator:Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Layer
I jNon-Layer
I
Dairy Cow
Dairy Calf
>41feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P.oult .
Ga aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Pouits
Other
other
Discharges and Stream Impacts
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 [R No ❑ NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
[:]Yes
[:]No
❑ NA
❑ 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
❑ NA
❑ NE
❑ Yes
Jallo
[DNA
❑ NE
[:]Yes
�No
❑ NA
❑ NE
Page I of 3
21412011 Continued

Facifi ' Number: - Date of Ins ection: 8'—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ELNo ❑ 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): _ r
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
Uak No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
P&No
[DNA
❑ 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
[allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
I0. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E4No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ER -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [ 1 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): _53e( a' /&/n;
13. Soil Type(s): _ ��e� L,y� I X D
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [R) No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes &) No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes JAMv Y
❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
110 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
m 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
0,No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
& No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZQNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

y
rFamay Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [RNo
• 25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes S No
the appropriate box(es) below.
El Failure to complete annual sludge survey E] 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 RNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ice, No
Other Issues
28. Did the facility fait to properly dispose of dead animals with 24 hours and/or document
[:]Yes Q No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[]Yes El No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes RNo
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes [g No
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes Vt No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes [a No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [ANo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to.'question #i): Explain any YES'answers and/or..any additional recommendations or any other comments.
Use drawings of facility to;hetter explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone.
Date:
21412011

Type of Visit: CrCompfillUce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 EmerQencv 0 Other 0 Denied Access
Date of Visit: rrival Time: Departure Time: !3 !7 County: Region:
Farm Name: Eat,yL. r -3 Owner Email:
Owner Name: /,(J i li ctm _ �'C i� L," L'L/ Phone:
Mailing Address:
Physical Address:
Facility Contact: 1,//; ��; ,,� �.{; n �C1 Title: j2&ln Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Design Current
Capacity Pop.
"Wet Poultry
Design
Capacity
Current
Pop.
Cattle
Design Current
Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Non -Layer
aig Calf
Design current
D . Paul Ca aCi l;o P.
airy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other
Pullets
Beef Brood Caw
Turke s
TurkeyPoults
Other HOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Condnued

.0cility Number: - 133 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): 3 61 _ 3,� -3
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Co No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 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
[a 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
(D No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
g[ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [] Yes [3-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0,No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [Ul No
❑ Yes Z No
❑ Yes [0 No
[:]Yes ® No
❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes fqNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [g No ❑ NA ❑ NE
❑ Yes [!�,No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Fecili Ndmber: - /_3 3 Date of Inspection: r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
t 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge IeveIs 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 1K No ❑ NA ❑ NE
27. Did the facility fait to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 (3 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑Yes C�jNo ❑NA ❑NE
[:]Yes No
[—]Yes No
❑ Yes �No
❑ NA ❑ NE
D NA ❑ NE
❑ NA ❑ NE
Comments (refer to question;#):_Explain any: YES answers and/or any additional; recommendations or: any other comments
Use:drawin s of facili.. to better ex lam°situations use additional a es as.necess .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: J _33V D
Date: Z 62-
21412011
Page 3 of 3

IC
rype of Visit 106<ompliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit 0-90utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: ?Ertro
Farm Name: `+-L Owner Email:
Owner Name: lji `Li �� Phone:
Mailing Address:
Physical Address:
Facility Contact: 42iZ& k1 �� Title: Phone No:
Onsite Representative: 1`G>!�(i---�-c/� Integrator:
Certified Operator: J`�a—u� Operator Certifi ation Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [--o ET
= 1
1 Longitude: = o = ' 0 W
NEDesign Current
Design Current Design Current
Swine Ca act Po elation
Wet Poult � Ca aci `"1'0 elation Cattle Ea aei Po elation
❑ Layer
Wean to Finish
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (Ifyes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
Page I of 3
12128104 Continued

f
Facility Number: 51 — Date of Inspection
` Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / _ / / 1-
Observed Freeboard (in): 5 (0
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 KNo ❑ 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 CaNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
RNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
JXNo
El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Wo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
RNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. CroP type(s)i�AZg�1Ac/
13. Soil type(s) ,a Z /G� b l A O
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
&&No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
f-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
Rio
❑ NA ❑ NE
Reviewer inspector Name �. Phone: D
Reviewer/Inspector Signature: Date:
rage c of j aG/...... ..c

Facility Number: 9: —/3j Date of Inspectionas f
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 RNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E&No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
RNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P9 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
R�No ,
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Lallo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[5,No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
QkNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
QNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9,No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
jgNo
❑ 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? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
CR No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R No
❑ NA
❑ NE
Additionaft oEnmenW.and/ar�Drawings: �> �r ' E� ��¢�A
Page 3 of 3 12128104

I
Type of Visit QKompliance Inspection O operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit OL4'Wutine 0 Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: a a Departure Time: ; / County: ��'` Region:
_41r_= 4=�
Farm Name: 1 \ �l rs �y FarM_ = c _ _ Owner Email:
Owner Name: LJJ 1 k O� vt�` �. La c,�J Phone:
Mailing Address:
Physical Address:
r
Facility Contact: w ► _ i� .1 Title:
Onsite Representative: 15'* c _ Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [� o [� I 0 66 Longitude: 0 ° 0 I = 0
Design CurUn
Swine CapaciPopulation
ty
I Design Current
Wet Poultry G *apacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
I
ai Cow
Wean to Feeder
❑ Non -La er
airy Calf
Feeder to Finish
EM
_
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
ElBeef Feeder
❑ Boars
ElPullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ 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 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
E,No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
NJ No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

ci-
Facility Number. — Date of inspection �U
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �_ r
Observed Freeboard (in): 313 3J7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
Oc/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
� No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Yes
E, No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
IN No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
19 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) Ar_ �
13. Soil type(s) Ce1 Z' Z � a fl
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
[9No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[4 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
JRNo
❑ NA ❑ NE
Reviewer/inspector Name 7 d- - Phone: `j' o' j JJOO
Reviewer/Inspector Signature: Date: Cf D

Facility Number: — 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 59 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes t4 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[.No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
14 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® 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
q No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/lnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
91 No
❑ NA
- ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
BNo
❑ NA
❑ NE
12128✓04

�.�1''LS 51i3lDR
ac'" i Number ()q T } 133
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint' 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: j, r Arrival Time: , 3 Departure Time: IQ, PCounty: BIA/ Psi Region- Fk7Q
Farm Name: Win Itfw PO/M `#3 _ _ Owner Email:
yn� / l 4-
Owner Name: YY + i 1 ri, FC K111 III w Phone: 137h- 0&5"4 l d 1
Mailing Address:
Physical Address:
Facility Contact: IV �11'1 bu, Title: 41✓e1--,-- Phone No:
Onsite Representative: Integrator:"
Certified Operator: 3 It Operator Certification Number: '
Back-up Operator:
Location of Farm:
Latitude:
Back-up Certification Number:
o Longitude: = o = ` E
DesigNuMPSUP4,01-1—
l 'DesigntGurrent Design Current
Swine Ca aci Wet Poultryr amitpula�hon' Cattle-" Capacity Population
S p�a
El
ElLayer I ❑ Dairy Cow
❑ Non -Layer ❑ DairyCalf
2 ❑ Dairy Heifer
5 Dry Poultry 2
Farrow to Feeder ❑ D Cow
- ElNon-Dai r
❑ Beef Stocker
ZZ,ElBeef Feeder
❑ Beef Brood Co
Other "V41i " Y _
LEI Other XNumbei ofStructures:
Wean to Finish
Wean to Feeder
Feeder to Finish
❑ i`i �
❑ Farrow to Wean
❑
El Farrow to Finish
El Gilts
❑
Boars
Discharges & Stream Impacts
❑ Layers
Discharges & Stream Impacts
❑ Layers
El Non -Layers
El Pullets
1. Is any discharge observed from any part of the operation?
❑Yes
'� No
❑ NA
El NE
• Discharge originated at: El Structure ❑Application Field El 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
El No
❑ NA
El NE
c. What is the estimated volume that reached waters of the State (gallons)'?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
El No
❑ NA
El NE
2. is there evidence of a past discharge from any part of the operation?
❑Yes
�,No
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
RNo
❑ NA
El NE
other than from a discharge?
Page 1 of 3
12128104 ,
Continued

Faclity Number: —1,33 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
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '�C� ��c� 2T_
i
-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes
❑ No ❑ NA ❑ NE
4
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
E�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
15�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
ip No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
q No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) t A n rin 1 jLp,.ti, , .an f
13. Soil type(s) (',, C
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name aAhl .k Phone: 33
Reviewer/inspector Signature: Date: NOV I -A
1212810 it,

• Facility Nuinber:()G[ — Date of Inspection S h Oq
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 ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes N No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge'?
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 U No ❑ NA ❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
ISallo
❑ NA
❑ NE
❑ Yes
ERNo
❑ NA
❑ NE.
❑ Yes
[•No
❑ NA
❑ NE
❑ Yes
❑ No
til-NA
❑ NE
❑ Yes [9 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes IRNo ❑ NA ❑ NE
❑ Yes f�a"No ❑ NA ❑ NE
❑ Yes
YNo
❑ NA
❑ NE
❑ Yes
8 No
❑ NA
❑ NE
:•
Additibnal Comments and/or Drawings: x * :
0(k on bor s fl 1a cam 1�0,� 5-Frod- old hay 1�ft)( on •
cow. ar , r 1 ,Pa-- /
�o�PrI rn �tD✓P �t-c°r 0� �I
�_Td 3f oil
Cnra SS Vod ef I 17 0
-�.b"
ay , I1 nwraaL ca 6rd� aooq 9 o �a�.
e
p-h--ty,o j or na�4 Q 6,-e� hvet) m0i1,'�0► ea,,A, good roc ad 1.
Page 3 of 3 12128104

Facihty No.M -003 Farm Name Kit)16,, t�GYM 1-3 —Date
41
Permit _�COC -' OIC_ NPDES (Rainbreaker PLAT Annual Cert )
Pop.Type
Desi n
Current
�Y
FB Drops
h
Lagoon
1
2
3
4
5
6
7
-
-Spillway
Design freeboard
Observed freeboard in
3
3
Sludge Survey Date
IA
Sludge Depth ft& %
Y
Liquid Trt. Zone ft
,3
, 3
Q
Design Width
W-Oul ff M sH
Soil Test Date llzo Crop Yield J 120 min Inspections
pH Fields 'I. Wettable Acres Weather Codes ✓
Lime Needed WUP �Transfer Sheets
Lime Applied Weekly Freeboard ,, kvo tjv RAIN GAUGE
Cu Zn Rainfall >1" 1 Dead box or incinerator
Needs P Hgb t p aa- 1 in Inspections ✓ V
/ t�;dnt�is0r�or� wMB"
.� ._
Elm•.
._
cmr�s■■
V fy-Pft
Vt�ri ONE NUMB �yRS and affiliations
Date last WUP FRO `) D,j DatdTast WUP at farm flo
FRO or Farm Records �i r4j., r'e.6
Lagoon #
Top Dike
Stop Pump
Start Pump
App. Hardware

Type of Visit WCompliance,inspection '0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 6ftutiiie ' 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �1�^f Arrival Timed'UQ4 Departure Time: ,Q ` stj County: Region:_
Farm Name: WM #`I-3 _ .. _ Owner Email:
ff iP~U Cl-
Owner 1-
Name: W 11 1 Qlst n law Phone: a 43033(rl)
Mailing Address: Po Bois 1 , 7 _ _ D ✓b I A - VC _ _ a�
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative: '
Certified Operator: �I1 QM , t[_A In (a W
Back-up Operator:
Integrator:
Operator Certification Number: AWA 16423
r .
Back-up Certification Number:
Location of farm: Latitude: = o = ` = Longitude: [=o = 6 = i!
-
Swine
Des n Current
ig
Capacity Population
—s'� a
t .-Destgn Current
Wet Poultry, Capacity Population
•
Design Current
Cattle Capacity Population
El Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
on -Layer
❑ Daia Calf
Feeder to Finishr:
q
❑ Daia Heifer
❑ Farrow to Wean
v a
Dry Pon ltry'°
El Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
-Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
s
❑ Turkeys
Outerr
❑ Turkey Poults
,
❑ Other
I
100ther
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
19 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
RNo
❑ NA
❑ NE
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RINo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

#;aaility Number: Oq —()L33 pate of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes &To ❑ 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): 19
Observed Freeboard (in): Ift 3Q L10
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
1,;ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
U 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
N No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
CR 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
1RNo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
UrNo ❑ 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) p Q ' S
13. Soil type(s) C - tp,g '
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CkNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
VKNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
§9 No
❑ NA
❑ NE
I & Is there a lack of properly operating waste application equipment?
❑ Yes
NNo
❑ NA
❑ NE
Reviewer/Inspector Name I up 4n Sch n 1 Phone: —333
Reviewer/Inspector Signature: Date: S
Pnao 7 n( 2 12/2RII)d Continued

[Facility Number: Oq _1_33 Date of Inspection MUM
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [:]Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JRNo ❑ 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 t?No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No RNA ❑ 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
10No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
RNA
❑ NE
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
I'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
''No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P9 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
JRNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Additional _Comments.andLar Drawings n � xt�4'. USS
1S, Borne;4 -eW have, been s fnzj>e& `Gar
Q�-. keee WV'ki on bwe. sf s 0�? 1upoon a . Wo4d ben of - fa)/�7
Sted't�4mvl r� .
14, 1Vosmd(Jrub rvar ItjnW:�h'shi�kThis leap aka
9 � �
Ta� rn6rhs,
WP I I Kee+ -�O'om 4 r e c ones r
Page 3 of 3 12128104

Facility No. v :133 Time In _ Time Out 10 . Date
Farm Name Owner
Owner RIMS Address & Phone Cell Phone
Site Rep Integrator Operator No.
Backup No. BIMS OIC No.
COCIZ Circle: General or NPDES {Rainbreaker PLAT Annual Cert j
Pop. Type Design Current I Pop. Type Design-Design-1 Current Pop. Type Design Current
1
. S 1 "d4e- 4v-'jl.l 1 1.1le 1. -7
Soil Test 3hn)0j' Crop Yield
PH. Fields a/ Lagoon /" _ Rain Gauge
Lime Needed_ Weekly Freeboard
Cu ✓ Zn ✓ Rainfall >1"
Wettable Acres T r/puDK,4pj1 in Inspections
WUP ✓ �l� 1 �tF�►-po�
✓ 120 min Inspections
Transfer Sheets
✓' Spray/FB Drop
- . _ -
Lhl�"�C�
.� ,,�
r�iiii ice■
,,
-
.. _
r�m9."',r1
04Mr�
�rs�
I, -, 7 . / r
Pull/Field Soil Crop Pan Window
Qoy-
185-
- -M
S 1!n hr
max
- ftil=tN6
.ornrnerns

=
ivision of Water Quality y f—a7
Facility Number Q Division of Soil and Water Conservations
O Other Agency
Type of Visit ompliance 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: -fl Arrival Time: /P_ Departure Time: /D 1 D O County: Region:
Farm Name: _ Y1 112eel Fa✓m / 3 Owner Email:
Owner Name: _1��� , Gc �w �z . K+ "� L.s M/ Phone:
Mailing Address:
Physical Address: 1
Facility Contact:T—f Cl �1 �-au1 Title: Phone No:
Onsite Representative: Integrator: =;w,, Jam/ • _
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: o Longitude: = ° 0 6
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
[E]Layer
I. ❑ Non -La et _
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached craters 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 9-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
®, No
❑ NA
❑ NE
❑ Yes
JKNo
❑ NA
❑ NE
12128104 Continued

�acility`lYumber: —��
Date of Inspection
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 19 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in). 3 3S_ 3_
❑ Yes ❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes IN No ❑ NA ❑ NE
❑ Yes 19No ❑ 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 Z No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [:]Yes CKNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes JR No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;K No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CR 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) XhZ3-rr,, ti 10­
13. Soil type(s) `f L Z
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes §4 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
O.Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
ZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
LKNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
RNo
❑ 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):
Reviewer/inspector Name Phone:D-, r L3Zmb
Reviewer/Inspector Signature: Date: D
IL/LO/U�{ I.U/jrLrrMGr/

t
� Facility Number: — Date of Inspection v2'D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes BNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Jallo ❑ 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
N No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
BNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
tZ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CRNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
X 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
Dd No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Q No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerllnspector fait to discuss review/inspection with an on -site representative?
❑ Yes
EgNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JR No
❑ NA
❑ NE
Additional CommentS:and/or DrawiagshL;_ ,'.,41Wi
12128104

Facility Number
33
ivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
Compliance Inspection
0 Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
0911outine O Complaint
O Follow up O Referral O Emergency
Q Other ❑ Denied Access
Date of Visit: 7/,;—v-Y Arrival Time: .' Departure Time: = County: & Region: —F v
Farm Name: t01 I r1 L'A cuJ �ai nn- / fi Owner Email:
Owner Name: l2 Phone:
Mailine Address:
Physical Address:
Facility Contact: _t.j Title: Phone No: /
Onsite Representative: _ Su-+�..c _ _ _ _ Integrator: Pr ,errt. sr i k ,S7i,ee
Certified Operator: Operator Certification Number: 14* OZ23
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 Q = I ❑ u Longitude: = o = 1 =
jx
De5�gn Cnrrentl"
Y8•�..
Design Current" k .{'
DesEgnCurrent
ne,
Ca" aci Po k lu anon Wet Poultry
p ty p ry
Capacity Po' ulation' "Cattle
P ty P
p. t3 p
- Ca aci �t Po Mahon
..
❑
k... - ....,a.,
❑ Layer
�, El Dairy
Wean to Finish
El Wean to r
Feeder
Feeder to Finish �f b �
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
El Boars
❑ Farrow to Wean
Discharges &Stream Impacts
Cow
Dai Calf
Cow
❑
❑ Dai Heifer
El Non-Dai
❑ Beef Stocker
❑ Beef Feeder
El Beef Brood Co
l . Is any discharge observed from any part of the operation? El Yes � No El NA ❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made? El Yes (�..No El NA El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El Yes [RNo El NA El NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) El Yes �,No El NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation`? El Yes �No El NA El NE
3_ ere there any adverse impacts or potential adverse impacts to the Waters of the State El Yes �.No El NA El NE
o her than from a discharge?
Page I of 3 I2/28/04 Continued
Discharges &Stream Impacts
Cow
Dai Calf
Cow
❑
❑ Dai Heifer
El Non-Dai
❑ Beef Stocker
❑ Beef Feeder
El Beef Brood Co
l . Is any discharge observed from any part of the operation? El Yes � No El NA ❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made? El Yes (�..No El NA El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El Yes [RNo El NA El NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) El Yes �,No El NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation`? El Yes �No El NA El NE
3_ ere there any adverse impacts or potential adverse impacts to the Waters of the State El Yes �.No El NA El NE
o her than from a discharge?
Page I of 3 I2/28/04 Continued
l . Is any discharge observed from any part of the operation? El Yes � No El NA ❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made? El Yes (�..No El NA El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El Yes [RNo El NA El NE
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) El Yes �,No El NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation`? El Yes �No El NA El NE
3_ ere there any adverse impacts or potential adverse impacts to the Waters of the State El Yes �.No El NA El NE
o her than from a discharge?
Page I of 3 I2/28/04 Continued

. FacilityNumber: — Date of Inspection F
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[R No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
INNo ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 3
Observed Freeboard (in): % f q (p +
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
0 No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
5§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
CKNo ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
19 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
EgNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
5j No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 01bs ❑ 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) . y� ` hk&y /-rLYa 7 r__ / pyr-rsryol/-if
_
13. Soil type(s) j�p ZZ a.73 `� e)
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? 19 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes Eg No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES�answers:and/or any recommendatrons or ny oth comiiitents? "
.Use drawingrf facility to better explain situat,ons. (use°additional pages as necessary.)=
/5-_ .fie F r!-J,s A)r-e-d 6er47; aFr--7ye Gr'7sj":f
Reviewer/Inspector Name Phone: 77,10— 1 =Z_
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

r
•
Facili Number:
t3' — „3 Date of Inspection B'�/�'-0
' Re u_g ired 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 appropriate box.
❑ W1JP El Checklists ❑Design El Maps ❑ ether
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® 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
E No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
19 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
29 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
ES 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 reviewfinspection with an on -site representative?
❑ Yes
NNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/or Drawings:; ` f: Q "r
Page 3 of 3 12128104

l
(�'6ivision of Water Quality
IFaci[ity Number 13 O Division otSoil and WaterConser ration
ONO tne gency
Type of Visit 46'fompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit- Arrival Time: ! O Departure Time: � County: Region.
Farm Name: i '�_�. rt r1J� m d- 3 owner Email:
Owner Name: I) " u vrL ' K : , Lca_c e , Phone: J,978. 4 `— 91
Mailing Address: D : is D X .i 7 _ ;, � % ": ._ ..—.0 C .._... 3W2`
Physical Address: S5 X
Facility Contact: -f Ln n e-_ _ _ Title: Phone No:
Onsite Representative: .5_x-pn. r
Certified Operator:
Back-up Operator:
Integrator:!_Y`??%uvr� c5%ss?d!�✓�
Operator Certification Number: A% dZ 23
Back-up Certification Number:
Location of Farm: Latitude: =O =1 =n Longitude: =
p a
V�Dgn Current �Destgn' Current Design Currencity' Pap" n�lation Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish ❑ Layer ❑Dai Cow
6Wean to Feeder ❑ Non-Layet ❑Dai Calf
Feeder to Finish`'"' ❑ DairyHeifei
❑ Farrow to Wean El Dry Cow
Dry Poultry
❑ Farrow to Feeder ' ❑ Nan-Dai
❑ Farrow to Finish El Layers
❑ Beef Stocker
' Gilts
ElNon-Layers
El Pullets ❑ Beef Feeder
❑ Boars 10 Beef Brood Co
❑ Turke s
Other's .
�:,.:,`' f .,.,,`'::;; ❑ Turkey Poults
❑ Other ❑ Other Number of Structures: .�
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
1Z No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
KNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
0,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
[S�No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
X No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
® No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

V y
Facility'Number: 09— i' Date of Inspection O- p—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [X No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Q 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 9 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 MNo ❑ 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
g No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[J Yes
C&No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ONo
❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s)
13. Soil type(s) [;
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
❑ Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
[j Yes
R] No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
§] No
❑ NA ❑ NE
k'-7 &o art Rec7/'�3 9-ma r-s � I
Reviewer/Inspector name ��U — ` Phone: " /— Cat 23
Reviewer/Inspector Signature: Date: / o -- D.S�
I2/28/U4 t ontmued

faciliiy'Nutnber: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CKNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LZ 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 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5� 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
59 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C4 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[K 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
ER 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
W No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
FM No
ElNA
❑ NE
Additional>Coinments and/or Drawings ;�* '� §��'^,rr�,�,
12128104

(Type of Visit • Compliance inspection O Operation Review O Lagoon Evaluation
Reason far Visit Routine O Complaint O Follow up O Emergency Notification O Outer ❑ Denied Access
Facility Number Dale of Visit: lZ 8 0 Time: : B a
Q Not rational O Below Threshold
0 Permitted 0 Certified 0 Conditionally Certified 13 Registered Date -Last Operated or Above Threshold:
Farm Name: ��.. _.. M,15 . �..:.1_ - 3 County: g
Owner Nacre: _ p j i ...tt VtPhone No:.
-Mailing Address....__...._. Z 3�...._._..._W�..._ a61i...1, ,
� Z
Facility Contact: y :: -----Title:
Onsite Representative: ice_ vtig,,,s]
Phone No: _,,,N
Integrator.
Certified Operator. _ W : 1 i AQ . + ✓t Operator Certification. Number. - I. (0 21_ 3 -_-
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' u Longitude • ` "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes WNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b_ If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 5jrNo
3. Were there any adverse impactsllo�r potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes MNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Aio
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:
Freeboard (inches): r
12112103 Continued

Facility Number: 41— Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes P(No
seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑yesio
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes JR No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes R'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes fNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancerimprovement? ❑ Yes ;.No
11. Is there evidence of over application? If yes, check the appropriate box below. Yes ❑ No
❑ Excessive Ponding ❑ PAN 4Nrhydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type C40r.}^( _
gMrp
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes j4No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes RNo
b) Does the facility need a wettable acre determination? ❑ Yes. ®.No
c) This facility is pended for a wettable acre determination? ❑ Yes RNo
15. Does the receiving crop need improvement? ❑ Yes Wo
16. Is there a lack of adequate waste application equipment? ❑ Yes RNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below ❑ yes ❑ No
liquid Ievel of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 9LN0
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes WNo
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 JKNo
Air Quality representative immediately.
Comments (x er to gaestiox�`#) =Explain any YFSaanswtis aad%r any recomm
-6endations orany other comigen - = _:
_ -
:L15e dra►�s of iacity toibetter eacplain sttuadons. (ase additional pages as necessary) _ ❑ Field Copy ❑ Final Notes Y
�..:f=..."A�./M:�!_�r�t.�(�.)Zr-
s.�i S.r�..
2 �• A nv"e--r oar Zt2e `L t i 4eo} t rCi �A-�'f 0+� Q.v L,*s use-
m.„ ty:,s t%'%4e"j 'Of-- e 9 z--t/i k P{eeLr-1e be +o
svr L
w o-'r-1L 14e c e-r f er*— sa,. ti�� cM , rr`4 R c.A- V-._
vo(vwa.. Olt-- LE,e- P
40 ia.� PAS ; s 0.45 ,.� s j,k
�E+- I a DstNG Kspe c_ -tie 'k %kspe.> Ac- %J es+e.&t
ke_ Ke-s +o 6-�" v-iI tr� � , fsK gal we� a c-.-e- . P[ec'r.e_ W%'0. e,
FRevieweir/hispector Name
Reviewer/Inspector Signature:
N
12112103 1 Continued

Facility Number: — 13 j Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 0,,No
22. Does the facility fail to have all com�nents of the Certified Animal Waste Management Plan readily available?
(ie/ hecklist esign'map . etc.) ❑Yes MONo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes WNo
❑ Waste Application ❑ Freeboate ❑ Waste Analyskr ❑ Soil Sampline",
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes %No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes (,No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑
Yes KNo
27. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative? ❑ Yes KNo
28. Does facility require a follow-up visit by same agency? ❑ Yes ?q No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes KNo
N`TPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) KYes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes %No
32_ Did the facility fail to install and maintain a rain gauge? ❑ Yes KNo
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes EgNo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes CR No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ZYes ❑ No
❑ Stocking ForieoCrop Yield Form ❑ Rainfal-❑ Inspection After I" Raitt"
❑ 120 Minute Inspectiowg"11 Annual Certification Forties
1p No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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12112103

State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Mr. William R. Kinlaw
P.O. Box 237
Dublin, NC 28332
Dear Mr. Kinlaw:
E:)EEHNFZ
DIVISION OF WATER QUALITY
May 15, 1997
SUBJECT: Annual Compliance Inspection
Kinlaw Swine Farms
Registration No. 09-163,09-133, 09-158
Bladen Canty
On May 13, 1997, staff from the Fayetteville Regional Office of the Division of Water
Quality inspected the subject swine facilities. Please find enclosed a copy of our Compliance
Inspection Reports for your information. It is the opinion of this office based on the
information provided and observations made during the inspection that the facilities were in
compliance with 15A NCAC 2H, Part.0217 at the time of the inspection. Please refer to the
comments section on the rear of the inspectionforms for information regarding Yarn
facilities.
Please be aware that all swine facilities with a liquid waste collection system designed for
a minimum of 250 hogs must have a certified waste management plan on or before December
31, 1997. The district NRCS office, Agriculture Extension office, or the Division of Soil
and Water have specialist available to assist you with upgrading of existing facilities and
certification.
If You have any questions concerning this matter, please call Robert Heath at (910) 486--
1541.
Sincerely,
Robert F. Heath
Environmental Specialist
cc: Operations Branch
Central Files
Audrey Oxendine - FRO DSW
Sam Warren - Bladen Co. MRCS
Wachovia Building, Sulte 714, Fayetteville FAX 91D-486-0707
North Carolina 28301-5043 NO C An Equal Opportunity Affirmative Action Employer
Voice 910-486-1541 50% recycled/10% post -consumer paper

U*Roddm OConwDint 0FoUow-vpofDW21wpectfon 0 Follow-up qfDSWC review OCMbw
Facility Number j. Date atimpectim
L Time Of luspec&Z, Use U hr. time
F7arm Set C-r-A Total lime (in bourn) Spent anR"fm EZED
or Inspection {includes ftvO and procenbq)
Farimplamr.
Pkme
AbEft Address:.
-i�
Onsite Rqll Pse I tl me: Integratu. ltsw
CArdfied Operator: Operator CmtMeadon Number. 93
Location of Fast:
A
Latitude longitude
Nei Operational Date Lwt Operated:
Type of Operation and Defto Capacity
g m i
-Pon eS wy ikkb
Wean to Feeder
Feeder to finish
Beef
ID I
arrow W Wean
m
Fwmw to Feeder
rl
.-ID.Farrow ig Finisb 13 Other Type of Livemack
~umber afI.agoons g Pandi, —V- 93 Subsurface Drains Pmmt
WMN
I. An 6m any buffer: that need --i _-Vv 13 yes 14 No
2. h any fimbwp obsa%vd ffm my pm of the opcmtkm? El Yes No
& If discharge is dbswwd, was the awv*wm manma&? E3 yes No
b. If &=hwp is dmrv4 did it mach Surface Watm? (1fM notify DWQ) El Yes No
c. If discharge is observed, sim is the estimated flow in gaftin?
d- Does discharge bypass a lagoon system? (if m notify DWQ) 13 Yes ;4No
3. Is &= evidence of past &mbaLW from any pan of the Wermficm? El yes ONO
4. Was iffim gay adverse impacts to the waters of the State other dm from a &wbwp? E3 yes JffNo
S. Does my part of the waste mamgem= system (other &a bgoon%Ujdjg ponds) mqur e 13 Yes AfNo

6. Is facility not in Coumpiiatw With any appticsble Wd** Canaria?
7. Did the facility fat to have a certified operator In rea w=*bk ai'ww (tf in>pectian after 1/l/M7
8. Are these lagoams or storage poz* an site wbieb need to be paopedy clone
L"duM DAeown and/or Holditta l'aadsl
9. Is s�hcdual5raboard less thou sdegnateT .
Freebaasd (a): T aan= I Lagpo* 2 lagoon 3
10. is seepage cbaeved from any of Poe shams?
11. h czasion, or any odwr ftaats to the integrity of any of the muctures obsehved?
12. Do any of the strueam need
mainw—
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWty
13. Do any of the atmcmu lack adquate markets to idat4 start and stop pumping gavels?
Waste Ayallcstion
14. Is thsrs physical evidence of am applitstion?
.(if in excess of VW, or nmoff catering watery of the State, notify DWQ)
15. Crop type .
16. Do the active crops differ with those designated in the Animal Warta Maaagement Plan?
17. Does the facffity have a lack of adequate acreage for land application?
IS. Does the cover crop need impmvet cut?
19. Is there a lack of available i rigation a quipmumi?
or Certified Facilities Qnty
20. Does the bcWW fail to have a copy of the Animal Waste Manageaust Plan readily avaiablc?
21. Does the facility fail to comply with the Aaunsd Waste Man4pm w Plan in way way?
22. Dora record keeping tad =p emmt?
23. Dow facility require a follow W visit by loose agency?
24. Did Reviewesnaspector tail to discuss r+eviewhaspcctsn witb owacr ar aperamr is cbwp?
rj Yea �1No
13 Yea. No
13 Yes PtNo
M Yea PXo
Lagoon 4
D Yes ® No
3 Yes P(No
C3 Yes TZNo
E3 Yes P No
t3 Yes ONO.
❑ Yes JR No
© Yes 0 No
[] Yes ® No
}
❑ Yes $0 No
0 Yes 0 No
E3 Yes J$No
E3 Yes ISM
0 Yes EkNo
O Yes EINo
Cammatts'(rtferW. upon -.;Explain amYYES :ihdiorasry. oasorsuy, coateats:
:... ._,.
LD ...... , snttat�n5 sddifiomdtl
Use cgs of faefiity better explain t i'Rge 'Alm-
/7T,e. ,L�,e��.¢w .✓.�.F� G co.%s c pe.*st rA�•�,,�d�.e��.E�
PW*werlinspector Name
Revl+ wAhspeetor Signature:

State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Mr. William R. Kinlaw
P.O. Box 237
Dublin, NC 28332
Dear Mr. Kinlaw:
kT*TW'J
E)EHNR
DIVISION OF WATER QUALITY
May 15, 1997
SUBJECT: Annual Compliance Inspection
Kudaw Swine Fauns
Registration No. 09-163,09-133, 09-158
Bladen County
On May 13, 1997, staff from the Fayetteville Regional Office of the Division of Water
Quality inspected the subject swine facilities. Please find enclosed a copy of our Compliance
Inspection Reports for your information. It is the opinion of this office based on the
information provided and observations made during the inspection that the facilities were in
compliance with 15A NCAC 2H, Part.0217 at the time of the inspection. Please refer to the
comments section on the rear of the inspection forms for information regarding your
facilities.
Please be aware that all swine facilities with a liquid waste collection system designed for
a minimum of 250 hogs must have a certified waste management plan on or before December
31, 1997. The district NRCS office, Agriculture Extension office, or the Division of Soil
and Water have specialist available to assist you with upgrading of existing facilities and
certification.
If You have any questions concerning this matter, please call Robert Heath at (910) 486-
1541.
Sincerely,
Robert F. Heath
Environmental Specialist
cc: Operations Branch
Central Files
Audrey Oxendine - FRO DSW
Sam Warren - Bladen Co. NRCS
Wachovia Building, Suite 714, Fayetteville N
�AW FAX [phone]
North Carolina 28301-5043 C An Equal Opportunity Affirmative Action Employer
Voice 910-486-1541 50% recycled/ 1 C% post -consumer paper

Rodtine O Co hint O Fotlow-yof DW ecdou O Fottow-n of DSWC revkw O Odw '
FFa MeyN� Q DateotIafpedion
7lme of IaRmcdon F 00Uae 24 hr. time
Farm Seats eTotd 1?me (In bmrs) Span oultewkw
or Inepeedoa (Indades band and piocembe
Farm Nbmta /Ci�✓� �.4,?wr•� ?� �. Comer *v1E .��...,..
p- �i,✓/mow Pf�aoallo�9/D �!! — i� 4lc� �.�.
Mamn Addrras: 45, R33 2. .
pale Represesdv •� a f�`�-.�� .�.
Certified Operator: ��ct�i//rw- ..�_ �I .•�f Operator Crrlideation N=* :
Location of Farm:
u
Longitude [�• �` ��"
83 Not 2urational I Date Lad Operated:
Type of Operation and Design Capacky
..r�,��'�c';�co,?+�f-"'-°'>.� s•)Tt -�w.,/-���„ aN- y�..a i�%e��.��., {y��.xR+�i}a^!4 iM
..hV..,i�t✓���'{-�.J'..�"1 �Yti4.1..YYM'� a%"e-
WiIM
�'K`"Fy ��y� ="'r t3
�e ,w••"' .
Wean t0 Feeder,
_
let!,
Feeder to Finish
'-z z n Nw-Law
Reef
.�
Fawnmuw to
sh 1
,•-. -..>
Q V Wci TYPc of Lh iwdc
'3y''4'T'!�ti'!t.
g
^.::-�.:a?�.R4-� �.'•, r;,-.rc ?J�-F..c ei;'r w"'�.�r:^`,-'s:�'.e.i _.� a�ax. ''�!'• ;+
Y:=+s'ae'x�. i_
WsibeinfLagoomlBolding Pea 5ahstiriaae Drs3ns Present
—XI I.a n Area S Field A:+ea
1. An there mW buffer; that need 13 Yea 14 No
2. b any &mbwp observed firm tiny pas of the off? E3 Yea 0 No
a. If diuharge is obscrw4 was the awn7aum ? 13 Yes ® No
b. ffdiscbwp is ob=v4 did it rcub Surface Wam? (If yes. notify DWQ) Q Yea No
a If discharge is obsernd, what is the estmatrd floor in Phmin?
d. Does discharge bypass a lagoon Mwe n? (if yea, ratify DWQ E3 Yes No
3. Is that evideuoe of past discharge 5om tiny poet of the gwmd a? Q Yes OtNo
4. Was tberc nay adverse bgarts to the waters of the Sate odw than ka a disebwpe? © Yes Mwo
S. Don any part of the wam umagemeat aystcm (other than hgooaa/holding ponds) require 13 Yes AfNo
maintemmer!aupevv�emmt?

1a ftcw9 not m oamplimm *a eery appdicabk sit t T i7 Yes $3 No '
7. Did to hcg9 ho to bsve a cwdW aria r m tapaas k ehagie firm dw t IWM Yes Q No
8. An these ingaans or amnage pools co site wbich need tQ be pa,opmly a cwW L1 Yes PNo
ees
L Sauckuai fr ba v a ku d m adagwc? - 'OyuYes 1po
Freeboard (!tx ao1; Lagoon x Isgoam 3 ls;gooa 4
10. L seepage observed from my of the mmmured Q Yea 10 No
wask m. or my adw ehre m to the hmWity► of sny of the mmum oburvvd?
11 Do eery of the stztmm osed
(if any of questions 9-12 was answered yM and the sitnatbn posy an
immediate public health or eavircumental threat, notify DW()
13. Do say of the lack adquatc markers to identify start and mp pig 1eve la?
warte Anvliest#on
14. L these physical evidame of over app?
.(If in ezaess of'VVMP, err runoff/eutaing wat+ n of&c State, DWQ)
25. Cmq type-�T�-
lb. Do the active craps cWcrwith those designated is the Aar nA Waft Maass== PZam?
17 Does &c Aw ity brave a lack of adegm scresge for had gphcstioa?
1S. Does the carer sap nsad impromicat?
19. b these a bck of avaUble bripScm equi ==O
FQr jQrtified FactlMes, to
20. Does the faulty Sit to have a copy offie Amami Waste Ma mpmew Plaa neaddy mumble?
21. Does the haity W tr ca Wly w3ib the Animral Waste MxmWm w Plain in any avW
22. Dees neao,d keeping nerd
23. Doer fic&W require a faIkw-ap vial by um agate
24. Did Revkvnxlbnpmw fsm to discuss reviewFim:paedoa with owaa or operator in chap?
D Yea
P(No
13 Yea
TJNo
13 Yea
PI No
13 Yes
12 No-
© Yes
ImNo
[3 Yes
19 No
©Yex
JaNo
Q Yes %No
13 Yes PM
D Yu ISNo
D Yes JkNo
0 Yes KNa
CAaunesets (rtfer m quc as : E lvin amY YES ase wrxa eraary hoax: m say
T f 4
Ute,.Of.fa�ityni6etner��.�-'��:>�5��.'�-�,+�:��-.�
�ie. �ibil�OL✓ I✓.i^Ef/s ] (� xa✓.a:�C q�.+Ss, A�I�I�[J�iE'r��
ReviewtOnspector Name
Reviwer/inspeetar signature:
> 11.3I? 7

State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Mr. William R. Kinlaw
P.O. Box 237
Dublin, NC 28332
Dear Mr. Kinlaw:
IDEHNR
DIVISION OF WATER QUALITY
May 15, 1997
SUBJECT: Annual Compliance Inspection
Kinlaw Swine Farms
Registration No. 09-163,09-133, 09-158
Bladen County
On May 13, 1997, staff from the Fayetteville Regional Office of the Division of Water
Quality inspected the subject swine facilities. Please find enclosed a copy of our Compliance
Inspection Reports for your information. It is the opinion of this office based on the
information provided and observations made during the inspection that the facilities were in
compliance with 15A NCAC 2H, Part.0217 at the time of the inspection. Please refer to the
comments section on the rear_ of the inspection forms for information regarding your
facilities.
Please be aware that all swine facilities with a liquid waste collection system designed for
a minimum of 250 hogs must have a certified waste management plan on or before December
31, 1997. The district NRCS office, Agriculture Extension office, or the Division of Soil
and Water have specialist available to assist you with upgrading of existing facilities and
certification.
If You have any questions concerning this mattes-, please call Robert Heath at (910) 486-
1541.
Sincerely,
Robert F. Heath
Environmental Specialist
cc: Operations Branch
Central Files
Audrey Oxendine - FRO DSW
Sam Warren - Bladen Co. NRCS
Wachovia Building, Suite 714, Fayetteville W_ FAX [phone]
North Carolina 28301-5043 N%q 14 C An Equal Opportunity Affirmative Action Employer
Voice 910-486-1541 50% recycled/10% post -consumer paper

Fadlity N=*Wj. -
Tbw of Impeedm ro Use 11 Lr. tlme
Farm Stag Total flme (to boon) Span onReriew
liar Inspection (Iodades Iza and processing)
F'asmName: l ,.Liw �` Cotmty: ..Taa zamou)
Owatr Nartte: �i �l . Z %; ^.:^. ,— -- Pbone No: ld 6 — D
Mailing Address: .3 7 •r6�i�.J L� 2�.2 _
Ondit Repro � 1�• .� >rore�,�or; la r� .... R .f
C.arti$ed Op m or: •1e:� �/ ��•�•w _ 0pu*w CmMcafim Nambe r: /VX
Loestioa of Farm:
Ide Longldsde �• �� C�«
IB Not 2crational Dade ]ta:t Operated:
Type of Operation and Dedge Capacity
wean to FeederDairy
Feeder to Finisb
show to w '. _ •• - -
�`. Y l } dt�� .[C.ie• -RAi ram:.:
mM to Feeder
FwrowtoPinisb � , z�13 Odw Type of .�
.p
"Naniber of L .00 i J-HCming�P s' `"� Snb:nrfwx Drains Presest
Area . " ` S rs Field Area
I. Are that nay bu$'em that teed msitsttnmoelaaprovtuxt?
2. h any &wbwp observed from any part of else operafim?
a. If &wbwp is observed. was the cmveymec n mameft?
b. If dis lwp is obstsv4 did it narh Swfu* Wail (Ifyyes notify DWiy
c. If &%chop is observed, wbe is the gxft flow in gamnin?
& Does discharge bypass a lagoon wwn? (Ifym notify DWQ)
3. Is that evidence ofpast discharge from say part of the opersfin?
4. Was there any adverse impacts to the waters of the State other than fmm a diwbmv?
S. Don any pant of the waste mm egamem system (other d m legoonvUlding ponds) mqui me
j] Ya
®No `
13 Yes
Yes
®No .
13 Yes
PNo
0 Ya No
©Yes No '
©Yes No
13 Yes No .�

6L b SdMy Mt m oatxepiianoe whh any appliable 06M* a wis?
t] Yes 10 No
7. Did the &=IW M 16 bave a ardfied opaame in TeRMWIft dwp {tf aft >E/ ffm
M Ya ODb .
i. An 6cre lagoons or storage pool: an sift svhM need to be paoWly dosed?
rl No No
IMMEOas
9 b Mvcaaal 5+eebatrd bm an a&gnw?
13 Yes 13 No
fivebaaxd ( iagoag�! Lagoon 2 Isom 3
Upon 4
10. L saepsge observed Am my oftbs masmat7
O Yes In No
I I. b exasioa, os atty olba threats to the iity of nay of tbt ttwcwxes observed?
' L7 Ya 19No
12. Do any of thr z need _ '
13yes it No
(if any of questions 9-12 was anrered yeas and the sltnatbn poses an
immediate public health or esvb=ne*W threat, vottfy DWQ
13. Do my of the sancom lack edgnate marinas m identify stsxt and stop pumping bw h?
D Yes JoNo
Wane Atlniieatloe
14. b then pbysiW evideare of over apphcadon?
13 Yes MNo
Of is exress of WMP, or nmof` M=img warn of the State, aatify DWQ)
11 crop type
16. Do the active sops differ with thou designated in the Animal Waft Mauagec tat Plan?
© Yes JI No
17. Does the facility haves a lack of adequate acreage for land apphadn?
13 Yes 0 No
18. Does the cover cvM need iavprovcmftO
Yes 13 Na
19. 7s $= a lack of available br4ptioa Vie+
O Yes O No
r reified Facil
20. Does the facWW fail to have a stogy ofthe AninW waste Afeaagrmeoi Plan =40y avagshle?
p Yea JE No
21. Dons the bcMW fag W cam* with the Ani W Watts MMLBMM Plata in nay w►ol
No
22. Does =ord keeping need mgwvetmen*
Y D No
23. Does faaIty require a follow -asp van by same gVwcy?
Q Yes 01 No
24. Did Rr4cwcdhwpccw fag m disaysc u n aitb owner or opemmr in tie?
13 Yea )I No
Comm {refs w'questioa t17:.,Fxplaia nay YES and/or y.reca raeadatzM or anycther r r.
Use,drgm8s of faC�! am ibetfef eplam srtuaao�s, �u:e s�ditio>nlpaSssoyj- "''ti , r-=' r�
� -mod ���.-J � �� ,�-✓�� r
,ems
Revkwerll ovecmr Name � ;.- . 7.� �/srl • M �'r � x++r.?y ,w V i.. r df '.���1r��41"�::`J�:j
'MwerAlospeaw Signature:

State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Mr. William R. Kinlaw
P.O. Box 237
Dublin, NC 28332
Dear Mr. Kinlaw:
ffl?W'A
E3F=HP4FZ
DIVISION OF WATER QUALITY
May 15, 1997
SUBJECT: Annual Compliance Inspection
Kinlaw Swine Farms
Registration No. 09-163,09-133, 09-158
Bladen County
On May 13, 1997, staff from the Fayetteville Regional Office of the Division of Water
Quality inspected the subject swine facilities. Please find enclosed a copy of our Compliance
Inspection Reports for your information. It is the opinion of this office based on the
information provided and observations made during the inspection that the facilities were in
compliance with 15A NCAC 2H, Part.0217 at the time of the inspection. Please refer to the
comments section on the rear of the inspection forms for information regarding your
facilities.
Please be aware that all swine facilities with a liquid waste collection system designed for
a minimum of 250 hogs must have a certified waste management plan on or before December
31, 1997. The district NRCS office, Agriculture Extension office, or the Division of Soil
and Water have specialist available to assist you with upgrading of existing facilities and
certification.
If You have any questions concerning this matter, please call Robert Heath at (910) 48fr
1541.
Sincerely,
Robert F. Heath
Environmental Specialist
cc: Operations Branch
Central Files
Audrey Oxendine - FRO DSW
Sam Warren - Bladen Co. NRCS
Wachovia Building, Suite 714. Fayetteville ��`- FAX [phone]
83
North Carolina 201-5043 1� C An Equal Opportunity Affirmative Action Employer
Voice 910-486-1541 50% recycled/10% post -consumer paper

Roiddoe O Co hint O Follow-up of DWQ Imection O Follow-up of DSWC review O Other
FacIDty !Number v Dote of Inspection i
Time of Impecdw • oa use U hr. there
Farm Stains+ �= fiG� Total T me On bowrs) Spent onRed w
or Insp"don (indedes travel and procenhi l
Farm Names--
Owiter Name: —Phone No: �lz<�i-
MaDing Address: C� � r 3 7,L '41c "._7
On:ite Represevhdm ., a� _B,& - &frgrsmr
{
cam" Operator. �,//„ �.../. .. Operator Cerd�nNumber. _/<;' p3
Location of Firm:
.! _W_ 1! u
Latitude �•L��`C�" Longitude U•U`�`
0 Not 2arzoonal Doh Last Operate:
Type of Operation and Dedgo Capacity
f S�rcuxt�..�r r �+y3� :xr:� � . :•xt �*r - ` �" . ��#� *»�l,a. � .�. er' '?�'1i ",�,�� -' - ''�'"`�` �d's.�sT
`` ne;w�luber fY.amber' i+s x _ ,'
Weaa to Feeder Umrip
Feeder to Finish
Farrow to Wean ...'a
4 !'�
F+
F F' h :� OthstType of%.iestocic f
-. a .2:i '.' :.S � ).. .,...-.,�.r:• yr'--..'-� .v� "i-4;5+. ff! "� .fy. ¢s�: r: WN,
" 111amber of I.igoans Holding Pon`di�
Sabsurfare Drains present
Lagoon Area = S ray Field Area
I. Are that any buffos that reed maintmaamraWovemew?
2- h aay.diw Y observed from any part of to ope:mroa?
& If disc*wp is observC4 Was the convey== man-MRW
b. If discharge is observed, did it reach Su*=W&W7 (Uyes. notifyDWQ)
e. If discharge is observed, what is the estitoated flow in ga1/min?
d. Does discharge bypass a UV= system? (If yes, notify DWQ)
3. Is these evidence of past discharge from any part of the opesaticn?
4. Was there any adverse impacts to the waters of the State other than from a discharge?
S. Does any part of the waste management system (other than lagoonsUlding ponds) require
. maiatenaaor!�grovemeat7
13 Yea ® No
D Yes ® Ni
❑ Yes ® No
a Yes PrNo
Q Yes
No
13 Yes
No
❑ Yes
No
Yes
No .p

6. Is bcay not in compliance Wi9b nay applicable a e=* eaiteria?
7. Did the Airy £nl to have a ceoffied operator in ragoadibb doge Cif mgwctiou after InJI 7)?
- & Are thee lagoons or storage ponds on site Vbieb mood to be properly rlca W
SMLW—res a saooias andlor Hold
9. Is struchual 5teeboard less eban adequate?
Fnzbm d (It): d agovnl Lagoon 2 lagoon 3
10. L seepage observed from say of tie stroct x=?
11. Is erosion, or nay other threats to the integrity of any of the onwomm observed?
12. Do any of the stmemm need
(If any of questions 9-12 was answered yes, and the situation poses an
Immediate public health or environmental threat, wAffy DWt)
13. Do any of the sauctures lack adgoate marker: to identify start and stop pumping levels?
Baste A - Plieation
14. Is there physical evide n of ova apphcadw?
.(If in excess of WW, or r►m4E' mtzriong waters of the State, actify DWi)
15. Crop type _ C.W-/ ....
16. Do the active a mps differ With those designated in the Animal Waste Management Plan?
17. Does the facility have a lath of adequate acreage for land application?
Is. Does the cover crop new bnpmvcmmt?
19. Is there a lack of available irrigation equipment?
br!Certified Fac Uiti" Onh
20. Dees the fed'-ity fail to have a Loopy of the Animal Waste Management Plan readily availWe?
21. Does the f cility fail to cow* udth the Animal Waste Man gcmcnt Pbm in nay wo?
22. Does record keepmg need zvmvemcul?
23. Does fadhty requare a ibllow-W visit by same agency?
24. Did Rmcwer&spe= far? to &s=u reviewrinspection with owner or operator in chap?
13 yesi No •
Yes kNo
Yes PINo
13 Yea p No
Upon 4
E3 Yes JO No
13 Yes 13 No
13 Yes A No
13 Yea 10 No
0 Yes M No-
E3 Yes JM No
13 Yes M No
XYw QNo
E3 Yes 0 No
Q Yes JO No
(XiDKNo
Q No
© Yes M No
t] Yes JS No
Coairaeats (rrfermquestioa �• • Expb� any YES aaswe� and/ar�y,reco�meo�`oi aay,caher. ;� �-
i]se,dras�+mgs of facility to >letscr a plsin.sicu o i e sdditiEs PaSa as;
3,�.�
Nil �,✓,�cii S�vL/j �� 7/3_3 , �°J�
L ff�...r� ' .�-I� ,.r��' C� ,,�,ttie.���4 9�C.+st v.✓O/ s, Ho
Reviewer/lnspee wr Name
'eviwedlmpeetor Sig aftm. Dart;
.s/i3/f7

tacauy NW?,ber--jZL-jL2
Division of Environmental Management
O Sf -I 3 3
Animal Feedlot Operations Site Visitation Record 0 -�
Date: RLILUO
Information;Genergl f7
Farm Name: � n i a w Fiic-sk,
owner Name: AL 11ciVAaw , _ .. _ _ thane Na• gb 2 33
On Site Representative:,, 26 r�� _ -Integrator: u ��
Marling Address: r . Q e zc 3'?
DAJA
Physical Address/Location: N G - SR IS5
Latitude: l� I Longitude.:
QgerationDescrIptl�ji (based on design characterisks)
Hof Swine No. of Animals * PouLo y No. of Ammals
f Mi malt
No. o
0 Layer 0 Dairy
O Ntasay O Nor -Lager O Beef
0 Faadm
Other7ype of LN"tock 1VWnber of Animals: 3
Number of Lagoons: 3 (iaciude in the Drawings and Observations the freeboard of each lagoon)
Facility I� 'en:
Lagoon
_
Is lagoon(s) freeboard less than I�foot + 25 year 24 hour storm storage?:
Yes 0
NCO
Is seepage observed from the lagoon?:
Yes 0
No M
Is erosion observed?:
Yes 0
No?q
Is any discharge observed?
Yes 0
NO 0
O Man-made 0 Not Uan-+made
Cover Crop
Does the facility need more acreage for spraying?:
Yes 0
NqIq
Does the cover crop need improvement?:
YesX .
No O
( lire the crops which need bVrovaww)
Crop type- _�5 &ctt!s „ Ate: .
Setback Cfriterfa
r
Is a dwelling located within 200 feet of waste application?
Yes 0
-No)l
• Is a weU located within IOO feet of waste application?
Yes 0
; 40F
Is animal waste stockpiled within 100 feet of USGS BNe Line Stream?
Yes O
No
'Is animal waste laird applied of spray irrigated within 25 feet of Blue Line Stream?
Yes 0.
N612
AOI — January 1?.199d
_ _ _ .�.
• .. ,r-

Mauiten�tt
Does the facility maintenance need improvement?
Is there evidence of past discharge from any part of the operation?
Does record keeping need improvement?
t. Did the facility fail to have a copy of the Animal Waste Management Plan on site?
Explain any Yes
dv% C
Yes 0 NoPb
Yes ❑ Ncp%
Yes 0 No�Sk
Yea 0 Np!B,
Signs e: Date:
rG Facility Asseipu sr UA& Use AtMr &nau jrNee&d
p rraawinp or QbservatioMe
� Z �
A ��$ � q CcuJ Sv.r►� q Ca.as o �
4- 4 1 vc", ,
O'C'Or-I
S c ue re— \e { J o m-e,
= P(ghs 100 $nod -
•
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AOI — SanUM7 27,19%