090176_INSPECTIONS_20171231

NOHTH CAHULiNA
Department of Environmental Qual

V #I
NP Rotktine 0 Complaint 0 Follow-up of DWQ Inspection QFollow uE of DSWC review 0 Other
cility Number Date of Inspection
Fa
I I Time of Inspection. Use 24 hr. time
Farm Status: Total Time (in hours) Spent ouReview
or Inspection (includes travel and processing)
Farm Name:
OwnerName: _L9Z,,1- Phone No:
, 4 I
Mailing Address: C_
Onsite Representative: Jtegmtar- AY.,e"
Certified Operator. Operator Certitleadon Number.
Location of Farm:
Latitude Longitude
de
ft! Not Operatio al Date Last Operated:
Type of Operation and Design Capacity
_. ' x �'., "0". - W4 . , ^ , R . I
4.wv L j'ber.
._0 �Num'PoutUY'.
.. .... 1 "41 MOM_ U1,61 x
re
AN
Wer
Wean to Feeder Dairy
Feeder to Finish k Non- Beef Wo
Effmwx to WSM
F=Ow to F_eeft
M Farrow to Einigh U LAACT JLYPC Or LJVCM=
7
.7
INW"
NIum erN4LI IWlinTg, an
Q Subs
urface Drai
ns Present
Lagoon Area
Field
Area
im
1. Am them any buffers that need maintenarimlimpnwement?
2. Is any discharge observed from any pan of the opmdon?
L If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in pVmin?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ)
3. Is there evidence of past discharge from any part of the opmdon?
4. Was them any adverse kqmwu to the waters of the State other than fiom a discharge?
S. Does any pan of the waste management system (other than lagoons/bolding Ponds) require
maintenancerunprovement?
E3 yes 13 No
El Yes C1 No
13 Yes 0 No
0 Yes (3 No
0 Yes 13 No
13 Yes E3 No
0 yes 13 No
0 Yes C) No
rnwliffuod An AMPA.

6. is fiLcility not in compliance with any applicable niback criteria?
7. Did the facility fail to have a certified operator in respondble charge (tf inspection after 1/l/n?
S. Are there lagoons or storage ponds on site which need to be properly closed?
Structures fL. eMns and/or Holding Ponds)
9. Is structural freeboard less than adequate?
Froeboard (tt): Lagoon I Lagoon 2 Lagoon 3
10. Is seepage observed from my of the structures?
1 I. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintmanceAmprovement?
(If any of questions 9-12 was answered yes, and the situation poses an
Immediate public health or environmental thmt, notify DWQ)
13. Do any of the structures lack adquate markers to idea* start and stop pumping levels?
Waste Ay llcaH
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?
IS. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
Egr fied ac tie
20. Does the facility fail to have a copy of the Amnw Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal Waste Management Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/Inspector fail to discuss review/inspection with owner or operator in charge?
❑ Yes(
No •
❑ Yes
�`) No
❑ Yes
gNo
JI Yes
❑ No
Lagoon 4
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No-
❑ Yes
❑ No
❑ Yes
❑ No
0 Yes
0 No
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0 Yes 0 No
❑ Yes 0 No
❑ Yes ❑ No
Coaihieiits {refer.to questioa #} Explain any YES answers andlorany reconunendadnns or. any other corrmieats.
7 t .ti - ;
Use draiwings of facility ta,better expSain attuatiaa; (use addrt}opal Pages teseceaserj►).`'"�' �...
..Z �• ?CAE W R v e' �iG Gd a�
dd/7� C4.Q�/,�iP�►t-li�i� � �iP�.d /�1 �sf �c.� r�E�E<�,e.E� �¢,�1J/
13
ZZ. 7, ���'/ ! �^— /f cc� ,�.t� .b,�,Fs✓ Go,�/ ��"� �'o -w.d A.vr/ys� r
23, Y �`, �'�/N. tad.✓
Reviewer/Inspector Name
Revlwer4aspector Signature: ,J Date:

10 Rodgue.0 Complaint 0 Follow-ug of DW2 Inspection 0 Follow-up of DSWC review 0 Other
Facility Number 7
Farm Statum.,
Date of Inspection
Time of Inspection Use 24 hr. time
Total Time (in hours) Spent onReview
or Inspection (includes travel and processing)
'Farm Name: ce, r- L", County: ---
04ner Name; Phone No:,,
hWHag Addrus:
Onsite Representative: Integrator. 491el,14 Ae—/4
Certified Operator. Operator Ceitifleadon Number.
Location of Farm.
Latitude Longitude
113 Not Operational I Date Last Operated:
Type of Operation and Design Capacity
Wean to Feeder N A
Dairy
Feeder to FirAsh TZ 77 .,. , R�;. I I M
Beef
I
FormwAy W=
Pe
F=ow to Feeder . . . . . .
14-- W-
LMW— to Finish C3 Other Type of Livestock rpmwy
M:
umber of Lagoons bolding Pon !V3 Subsurface Drains Present
Lagoon AEea jr 10 Spray Field Arlo
1. Are there any buffers that need maintenan improvement? 13 Yes IR No
2. Is any discharge observed from any pail of the operation? 13 Yes JR No
& If discharge is observed, was the conveyance man-made? El Yes XNo
b. If discharge is observed, did it reach Surface water? (If M no* DWQ) E3 Yes e4No
c. If discharge is observed, what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system? Of yes, notify DWQ) ❑ Yes 0
I Is them evidence ofpav discharge fig any part of the operation? ❑ Yes *No
4. Was there any adverse impacts to the waters of the State other than from a discharge? 0 Yes JWNo
S. Does any part of the waste management system (other than lagoons/holding ponds) require
xyes 13 No
maintenzaccorunprovement?

1
b. D facility not in compliance with any applicable setback criteria? ❑ Yes Na
7. Did the facility fail tohave a certified operator iA reaponaMe charge (if inspection after 1/1/97)? 13 Yes o
S. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes gNo
Struct re { sguns_WWr Ho-IdIy
9. Is structural freeboard less than adequate? �Y 040
Freeboard (ft): L7
1/_ Lagoon 2 Lagoon 3 Lagoon 4
10. Is seepage observed from any of the strucum?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance unprovement?
(If any of questions 9.12 was answered yes, sad the situation poses an
Immediate public health or environmental threat, sally DWQ)
13. Do any of the structures lack adquate markers to identify start and stop pumping levels?
Waste ADAll99tl0rr
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type)?'V ':
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?
I S. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
Er per ifled far ice. On1v
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Amaral Waste Management Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a fallow -up visit by same agency?
24. Did Iteviewerllnspector fail to discuss reviewlinspection with owner or operator in charge?
❑ Yes ,,*No
XY,cs ❑ No
�cs 0 No
❑ Yes XNO
O Yes XNo-
AYes ❑ No
Ayes ❑ No
13 Yes AM
,k Yes ❑ No
❑ Yes WNo
)XYes 13 No
OYes ❑ No
Yes El No
Yes ❑ No
Use dr
Carrimeats (refer,to qute�stion �•• Explain'any �''ES answers aad�oraayQ;r�eaommendations or any pthear torimreat5 .f� , �. ',
w,.. 'I t- 9 L. ..�..n•.x ...,•+ v.T.,,r..�.am....O� �.. aXiLvvF�i?A.�VFR�� r '�•�1��[`.�1' I�5 ice,
FJ S• - )L .f �T ri
-aogin �uf factlt W better lam attuah use add�tra�oal as ae �`� � �� �• �.
��/�+� .t✓ous:��O�4.�`r.,odl .�► !��!.d.J 9•���!/,cse.E .E/,pO.riO� �po�,,..�.y� ,IJv Q
le,zv�.�f COr/JZR far ,6 ✓ �5 �. 4 0� oar 4�� E.S� r
�2r ✓ /t�/y1?/ "/J�/ /JJ��Gigd4lJ� i✓6 3'i'�.5.-4/^/j� A,p
X�
�S �¢GrJij?� coy''/-t ,�e' b,E�-uvA,�s�/.r�i.����,G�,,,L1�,er�.FaeJ•,vo �g�-'�•e
Reviewer/inspector Name ` ' " oV rF` ° i a "" ' ' �* I
Reviwer/Inspector Signature: •�� Date:2&
/,

0 ns Division of Soil and Review
Division of Soil and Water Conse�
rvation ,Com liance Inspection
�I
i
' '
�'
t r' visi
; © on of Water Quality Compliance Inspection
1 _
f OtheP Ageney Qp rBtiOn'.RLView�
Routine O Complaint Q Follow-up of DWQ inspection O Follow -tip of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection . 24 hr. (hh:mm)
Xpermitted © Certifed © Conditionally Certified 13 Registered 13 Not _0`p7r_a_fi_o_n_a11 Date Last Operated:
,4� #l..RP.r1
Farm Name: ....... ..C:.......�i . .......................�`.......,.,......................................... county: ................... ........ ...........
,
1.
Owner Name:................ Pae ................, ar..... .......... Phone No: ............. Z.�r�6.........................
FacilityContact: ............. .W ...,.........................Title:.........,...................................................... Phone No: ......,�`..............1-11.1.....
2FYMailing Address: ........... ......r ..lTt.x" G .....(. Q!,c........................ .......�,r.�arl.�... ........ '.V1. ,...,....... ......... 3.3
Onsite Representative:. ........ ....... Integrator: 1�1..!....1......................................................
Certified Operator:.... &/.e.......... / "' e .� � Operator Certification Number:... ..........13
Location of Farm:
r..... A!" ...... ,/,6eG.,V.�, . .7a, 1e...... C?':...................................................................................................
................. .............................. ............................................................................................................................... ..................... .............................................. ............ I ............. 1
Latitude
Longitude
Design Current
Design
Current
Design Current
.:
Capacity Population
Poultr .,,a ,
Y .
' Ca acit
�, ,.:
1?o ulation Cattle
Capacity Population
❑ Wean to Feeder
'` ❑ Layer
" ❑ Dairy
Wffeeder to Finish Zk 9
: ❑ Non -Layer
"❑ Non -Dairy
`
" ❑ Farrow to Wean
„
❑�.�
Farrow to Feeder
Other ;; ❑
- < ❑ Farrow to Finish
1 3
Total Design Capacity
7�
❑ Gilts
` ❑ Boars
Total'SSLW
I�nitiber of Lagoons i ❑ Subsurface Drains Present ❑ Lagoon Arca ❑Spray Field Area
oldie Fonds /Solid Traps `' ❑ No Liquid Waste Management System
g, 0
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at, ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made'?
h. If discharge is observed, did it reach Water of the State? (II'yes, notify DWQ)
c. If discharge is observed, what is (lie estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes P(No
❑ Yes XNo
❑ Yes _<No
❑ Yes XNo
❑ Yes Pilo
❑ Yes A?No
❑ Yes ZNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
jr
Freeboard(inches): /................................................................................. I.......................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �o
seepage, etc.)
3/23/99 Continued on back

Facility Number: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 99No
Waste Anolication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
XNo
11.
ation? ❑ Excessive Ponding [IPAN
Is there evidence of over apK
❑ Yes
WNo
12,
Croptype r`Wvr{ti ,_
13.
Do the receiving crops differ with those designated in thl ertified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable,acre determination?
❑ Yes
KNo
c) This facility is pended for a wettable acre determination?
❑ Yes
)<No
15.
Does the receiving crop need improvement?
XYes
00
16.
Is there a lack of adequate waste application equipment?
❑ Yes
A No
Reauired Records tit Documents
17,
Fail to have Certificate of Coverage & General Permit.readily available?
[:]Yes
jo No
18.
Dots the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
•j�No
19.
Does retard keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
KNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
22,
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
kNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
R'No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
WNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
UNo
�'Vo yiol'a tQgs'ai d$ticiencwe vore nowi• 000#9 00s:visit; • Y;oo Will t; ec�iye d f>Jl tittrtr
corresQ6 iciei & about. this .visit. .
Comments:{refer lo,questiori ) ;Explain any EYi�✓ `answerq attdltin any recoinmendations,,or,uny oth`er.comtri6 ts,:.�
Use drawings of facihty,to better explain situations (use additional pages as necessary)
d
I _� I
% DrIevvead /� 1 k lwin o wed a-r 46 ,,q 4 owo; d Gh o Gn O
J
berg, Laa- C r�,
&era-ll� 4�^ /tr0 �s
Reviewer/Inspector Name
Reviewer/Inspector Signature:
` :71431l,-11€�
TCLS
Date:
3/23/99

Facility Number: - 17L Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below KYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29, Is the land application spray system intake not located near the liquid surface of the lagoon`? ❑ Yes N0
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
Additional Corn men at or gs , a' ii a
3/23/99

Division of Soil and Water Conservation [3 Other Agency
® Division of Water Quality
O Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number
Date of Inspection
�09 /7C
Time of Inspection 24 hr. (hh:mm)
Registered E Certified [3 Applied for Permit Cj Permitted [3 Not Opera Date Last Operated:...
Farm Name: ..........P .1x...........1.IY �..........1 r� N1 .. County: ............ .............................................
Owner Name:.......... ............ !�....... ..... Phone No:
FacilityContact: ......... 43g........ �?.l../. ................. Title: .............................................................. Phone No:...................................................
Mailing Address: .......... 6•Z. ... r a ... R f yr............Gr.........eVJ.. (.. �7............. ..........................
Z.
Onsite Representative: .......... </r.......Y...'.... ............................................................. Integrator:....11� p.......f.....................
Certified Operator .......... Z�?E:........ ....-P...:..................... ... Operator Certification Number ;......% �. � �.
Location of Farm:
. .. .. D ..........................................................................................................................................................................................................................
A
S
Latitude Longitude �• �� �s�
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes IR No
2. Is any discharge observed from any part of the operation? ❑ Yes A No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes RNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes PNo
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 P No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ,M'No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require , ❑ Yes No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ;R-No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ,fNo
7/25/97 Continued on back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures (Lagoons,Ilolding Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2
Identifier:
Freeboard(ft):..............P�................ .................. ......
10. Is seepage observed from any of the structures?
Structure 3 Structure 1
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes ANo
XYes . ❑ No
Structure 5 Structure 0
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type 11
,o �i, ', y.. ,,4c<� �w................................................................... .......
16, Do the receiving crops differ with those designated in.the Animal Waste Management Plan (AWM11)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certirted or Permitted Facilities -Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24, Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit'
0 No.violations of deficiencies were noted during this visit..You.will receive no ftirther
correspbndence Aout this.visit:.:
❑ Yes XNo
❑ Yes XNo
`Yes ❑ No
❑ Yes X,No
❑ Yes No
............................. I.- ............
❑ Yes,No
❑ Yes No
Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes XNo
❑ Yes A`No
❑ Yes �KNo
❑ Yes R'No
❑ Yes Wo
Cotniiienti ('refer to question #): Explain any. YES answers and/or`any recommenda[tons or any other cownents.
Use drawings of fucthty to:;better.explain situatiims. (ttsc addition:a2cs as nccessairy) y }
or
ZZc
7/25197
Reviewer/Inspector Name
Reviewer/Inspector Signature:
���
Date: ,�

0
0 Division of Suil•an
Division of Soiin
31�� ®DivlSiyn of Wat
C;er:
<C] ,.. ., Othcrr Agency
... ...
O eratton,Rmeyv I
Compliance inspection
a
�x
y
s
i9p@CilCilt, h}PIP
..?fib
14111iautine O Complaint Q Follow-up_of DWQ inspection Q Fallow -up of I)S`VC review Q Other {
Facility Number 7G Date of Inspection ZQ�d
» �...,...,. ..M. . ,. „ ., »...,.,„ ...,„, 'Time of Inspection ; GO 24 hr. (hh:mm)
© Permitted N Certified [3 Conditionally Certified 13 Registered Q Not Operational I Date Last Operated:
Farm Name: .. 0!11.�.....�.��..�...................... C:c>untv:............. 'f� lhJ................. ................ .......
(...+•
Owner Name: q
. .........��� / d................................................... Phone No: /1.. �..............................................................
FacilityContact: .............DNA........... '........... Title: /...... ................................................... ..,..., Phone iNo....................................................
`e /J ` �" Il k ��. ,......., f� , ..
Mailing Address: c�., -T...,..., I`t',l A :.....................
,,r......,...
Onsite Representative:........................................................................................................... Integrator:..A ....�......................
Certified Operator: •,,,,,,,,,,•iL V.••, ���G .. Operator Certification Number:
Location of Farm:
....................... * .................... * ....................... * .......... * ...................... ........ , ...................... ....... , ......................... ......... - ......
Latitude ���� Longitude �• �' �°
Design
Current ;:, Design Current
Design Cui rctt# '
CapacityPopulatioif
Pou•.
y; P4u
Capacity Po ulatanSwin
❑ Wean to Feeder
❑ Layer ❑ Dairy
Feeder to Finish `7z
"
�� - [] Non -Layer `''° ❑Non Dairy
❑ Farrow to Wean
, .�
❑ Farrow to Feeder
LEIOthe r
❑ Farrow to Finish
#' 7x De Total sign Capacity.
❑ Gilts.
i
❑ Boars
Rµ
TotaE.SSLW
u`..�a.:
Nffibeh
i t 114 'i
JE1 Subsurface Drains Present JFM Lagoon Ai
JE1 Spray Field Area fi
`�
Holding'Pond`s / Solid Traps
{` ❑ No Liquid Waste Management System
Y
Discharges & Stream Im facts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance titan -made'!
h. -If discharge is observed, did it. reach WatL,r of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estitnated flow in gal/min?
d. Does discharge bypass a lagoon system'? (Tf yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes KNo
❑ Yes �E-No
❑ Yes kNo
❑ Yes
C0 No
❑ Yes
0 No
❑ Yes
KN No
❑ Yes *No
Structure I Structure 2 SIrUClure 3 Structure 4 Structure a Structure 6
Identifier: .p
Freeboard (inches): .,.,......-S.l.!/........ I ............. ..... ................,...........................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes PQ No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 0 -- ` Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ;'No
(If any of questions 4-5 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? ❑TYes IZNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes Eg No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes &No
Waste ADMication
10. Are there any buffers that need maintenance/improvement? ❑ Yes eig-No
I.]. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ONO
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ;W No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 15r.No
b) Does the facility need a wettable acre determination? ❑ Yes $ZINo
c) This "facility is pended for a wettable acre determination? ❑ Yes ®'No
15. Does the receiving crop need improvement? Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes 10 No
RequiredRecords & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes P(No
18. Does the facility fail to ve all components of the Certified Animal Waste Management Plan readily available? XNo
GO WUP, checklists esi n aps, etc.) ❑,Yes
19. Does record keeping need improvement? (iel irrigation, frecboard, waste analysis & soil sample reports) Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
ON discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes CR No
ti
24. Does facility require a follow-up visit by same agency? ❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ®'No
TQ yii�l ti¢�s:o� d�fcje' n' 0es 0,4* ittig 0is'visit; •'Yojk AI'teefriye'0ti fu�t�tgr
eorres' orideh& abbot: this visit: .
Comments (refer,to que3shon #) Explarn any YES answers and/a3r�any recommendations orsany other comments._
r 3 r r . _Usedrawn ibf fictltt !to betterexplain situationstuse additiona• apas necessa ry
;..
,a h..ilt nC,S s , 5 - ' !''"'t, _7;t
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 7Z.S 0Md

Facility Number: — Date of luspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
0 Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
1KNo
29.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
allo
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
[R'No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
(KNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
41Yes
❑ No
tone gmmen' ' mgs�
,. an, or raw . ,'. :;'�
AJ
3/23/99

(Type of Visit O Compliance Inspection . O Operation Review ® Lagoon Evaluation j
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
t)atk• of Visit: � Time: I - ; D-� Printed on: 10/26/2000
Q Not O erational 0 Below Threshold
13 Permitted E3 Certified [3 Conditionally Certified (3 Registered Date Last Operated or Above Threshold: .........................
4..Q Farm Name:...........�/$r..Zu.vtr........ �......................................................... county: ........ C✓."/`4" G�.tr"-J
.....""......
Owner Name: .... Phone No; ..............D .� ��............................
17 ......,e ����....................................................... P� ).... ........... CJG"
Facility Contact: .....� .....`/r. /! ............... I ...... 'Title:............................................................... . N Phone o....................................................
Pl �
Mailing Address: P o 'o ...^7 ` // 1..'' ,/'✓.J AC. G.'............. ......................................................... ,3.7 / ..........................
....,i... ...
Onsitc Representative:............:�. f1E .......... .... Intcgrator:................. .....................................................
Certified Operator:........... °.. .. '......................................................... Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry []Cattle []Horse Latitude �: �` �`' Longitude �• �� �«
Design Current Design Current Design Current
Swine Capacity population Poultry Capacity Population Cattle Capacity Population
[] Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish aU ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ soars Total SSLW
Number of Lagoons I0 Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
Holding Ponds / Solid Traps JEJ No Liquid Waste Management System
Discharges & ,Stream impactti
1. Is any discharge observed from any part of the operation?
❑ Yes
f'No
Discharge originated at: []Lagoon QSpray Field ❑ Other
a. Il 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
XNo
c. if discharge is observed, what is the estimated flow in gallrrtin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
(fNo
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
(R�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'? ❑ Yes
No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
A Yes
❑ No
SIRIC[ure I St AW[Ure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .......... ..z............................................... ..... ........ ........................... ... .... .......... ...................................................................................
Freeboard (inches
roneiniind
hark
nil

(Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation J
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date ur visiu .3 4� Time:
Q Not Operational Q Below Threshold
■ Permitted ® CeefrtieCertified[3 Conditionally Certified [3 Registered Date Last Operated or
Above Threshold: ................
Farm Name: 4.aAjx/..... .................... County: �......... ,C.�,IRj d .......
OwnerName: ........... 04-ler...................... nre; ................................................ Phone No:. (...I.... Q/................................................................
FacilityContact: .... 1/?/rl.....wx...................... Title: ............................................................... Phone No:....................................................
p
Mailing Address: ....... ,Va2Y. �zfleel'.. e4 C........ tir 7........................................................
Onsite Representative: 4 �� Gil.................................................... Integrator: ..... 47c[A0..........................
Certified Operator: ►' ... T ..��1.. .� ............................. Operator Certification Number:.........................................
......... ..... ........ �..............
Location of Farm:
[]Swine []Poultry []Cattle []Horse Latitude �• �4 44 Longitude a 6 .6
Design Current
Swine CaOacity Ponulation
❑ Wean to Feeder
Feeder to Finish
,sr'72
7 Z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer 1 ❑ Dairy
❑ Non -Layer 1 ❑ Non -Dairy
❑ Other
Total Design Capacity
:Total-SSLW
Nt[mber of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
Hofdmg Ponds /Solid Traps ❑ Na Liquid Waste Management System
Discharges & Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge hypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
01/01/01
�z
❑ Yes U No
❑ Yes §JrNo
[:]Yes SkNo
❑ Yes NNo
❑ Yes )a -No
❑ Yes r5d No
Continued

• Facility Number: © — lje Date of .Inspection Q Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes QNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes JRPNo
(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 OrNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes fljrNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNo
_Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes J'No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ANo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes fl?No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 9No
b) Does the facility need a wettable acre determination? ❑ Yes N No
c) This facility is pended for a wettable acre determination? ❑ Yes XNo
15. Does the receiving crop need improvement? Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes Wo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ Wes, checklists, desi , maps, etc.) [:]Yes A�No
19. Does record keeping need improvement? (iel irrigation, freeboard waste analysis soil sample reports) , Yes ❑ No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ,W No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes tErNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes X No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes Q,xNo
24, Does facility require a follow-up visit by same agency? ❑ Yes V No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
Y� � >ris o dgfjrpt n�ies wire i�4ted iH'E>�g xhis'vjts t; Yoo)0111-teooiYo 00 Mfthor
correspondent e: aboitti this visit
Use rli ar (t fe facil# to better eat lain situations. {use ads -and/or as trecommeitdatlotts or'aay otiticr com enb: , E
y
Comments (refer to 9 tioa #) Expplain eny YES answe ditianal pages as.neCessary), ;
/ 72,
/'nrs���� �''�`f ��"� �.) �AN��Ii �r,h�-f��v+ �i��r��+%/�.✓f
�04
��(� /I�'���.r - �,�L'
ri
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 2 ©/ 5/00

` Facility Number: p � Date of Inspection UzM
Printed on: 1/4/2001
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon?
32. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
33. Do the animals feed storage bins fail to have appropriate cover?
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
,Yes ❑ No
❑ Yes AM
❑ Yes No
❑ Yes No
,M Yes ❑ No
13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
01 /01 /01

r
iVISiOn of Water Resources
Facility Namber � - �� O Division of Soil and Water Canaervatian
Q Other Agency
.66
Type of Visit: Z57ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 42MTo"utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: t}; b O Departure Time: � County: +,rx
Farm Name: Owner Email:
Owner Name: '±- Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: 4� r � � Title: Phone:
Onsite Representative: ��, i+�� Integrator: �lylifiTT�l�
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
t
D�es�ign Current.
Design
Current
Design Current
Inc
Gapa�city Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P.oultr
Ga nei
Pop.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Soars
Pullets
Beef Brood Cow
Turkeys
Other,
ITurkey Po Its
Other
Other
I[FiIW..
tin.Swby.l.miyy.uw WM4pnW3{bpw.wxtl.M lHe.WKe�'iiHWiisiwu%MwnlJiR
NLYw.iWYtlw.c�fH4wwf�6t�w.IFtiiWYVliyuHYx
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)? _
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
❑ No
❑ NA
❑ NE
[]Yes ❑ No
❑ Yes No
❑ Yes RLNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: -Z 7d6, Date of Inspection:
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 I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
E, 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
FjNo
❑ 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
0
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
ED-No
❑ NA
D NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®. No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
N No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes JEJ 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 Drift
❑ Application Outside of Approved Area
/Wind
12. Crop Type(s):
13. Soil TYpe(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes M.No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes SNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [allo
❑ 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 ES -No ❑ NA ❑ NE
❑ Yes S�No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes B—No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below. ❑ Yes 5d,,No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes jS.No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

F'acili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ELNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [gNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 2} No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ' ❑ Yes gLNo ❑ NA ❑ NE
Other issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Ig-No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
O—No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
&No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
33. Did the Reviewer/]nspector 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
[3—No
❑ NA
❑ NE
Comments (refer,it[► ryryuestion!# Extnllaini an' E YES answers and/or an , Aditlonali'recommendutions'or'an othwco'mments.
,iuL-!•Eiis Iu�ie.l, lid '..r`I7, I.. yd, tEt rt T.- !:'il. ult'.ia.i4} y.�,!!L 4:{i t..{..., E ;:Ei . ;i; ';'. q ! It i"!r y a !I'; i ! I ,.y t l
:.. -rs
Use drawi' �ofUeili `� toi`better cx lain situatiannsi use addition al'pages-as-'necessa ,-�1, ar
ti.. ( );h
Reviewer/Inspector Name:
Phone: 27 19'
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21*2015

.S r -3 �7
ivislon of Witter Resources
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: p Departure Time: ' tX7 County: .a Region:
Farm Name: .� %' Owner Email:
Owner Name: LU ', Y-r`u ,iG� Phone:
Mailing Address:
Physical Address:
1
Facility Contact: L)i ; �? i~ .�J�'ry ✓Title:Phone:
Onsite Representative: Integrator:
Certified Operator: 1� Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State'? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potentiai adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes F<],No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
r] Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facilit Number: - 7 Date of Inspection:
/
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
5;Yo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(7 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
M No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA]
NE
8. Do any of the structures lack adequate markers as required by the permit?
❑Yes
� No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2 No
❑ NA
❑ NE
maintenance or improvement?
- Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect ]and application? If yes, check the appropriate box below. Yes WNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
®.Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s). — -y'�1�-
13. Soil Type(s): - L10-'e9_­t Zta-
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 allo ❑ 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 [ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes JRNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [&No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [3 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes rV' No
❑ Yes 5KL No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 g f 3 21412015 Continued

LFullity Number: - 171, JDate of Inspection: 171
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail 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
❑ 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?
Jse dru:
'ro 1i0"1 /0(/(-
CAII* 0pc'--C�
Reviewer/Inspector Name:
Reviewer/Inspector Signatuc
d F—
[] Yes
r7' No
❑ NA
❑ NE
[—]Yes
5,No
❑ NA
❑ NE
❑ Yes
[KNo
❑ NA
❑ NE
❑ Yes E. No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes [LNo ❑ NA ❑ NE
❑ Yes M No
[:]Yes ® No
❑ Yes [E�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:/t7`'�d_ 4
Date:
21412015
Page 3 of 3

I G coo
Jff6 ~ 3-/Ki7r6
(Type of Visit: O 7Routine
liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1v Arrival Time: >7 Departure Time: ; 0 County: Region:
Farm Name: U /r �G�•''►'►'u Owner Email:
Owner Name: C i1 rt t"� Y%1��'Phone:
Mailing Address: /
Physical Address: I
Facility Contact: u.", %� _ ,�jz 1-, Title:
Phone:
Onsite Representative: �'�c�-- Integrator: /i(3
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
G
Design Current
Design
Current
Dcaign Current
Swine.
Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
11
INon-Layer
I
EE
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , Poultr.
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
©.thee
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [, No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes © No
❑ Yes [&No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Z No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ELNo ❑ 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
4M 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
�g No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:] Yes
E[No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wct stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
C.No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZO 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): �jKr Vrr� r�
13. Soil Type(s): ��zj-_�Y� Z '4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 12�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 [ Z No D 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 2 No ❑ NA ❑ NE
❑ Yes CS No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes Ca -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
❑ 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 Jallo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Z.No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facility Number: - / 7 b I I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �&No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively.certified operator in charge? [—]Yes [&No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes JZ[No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
5a No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑,No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
allo
❑ 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
RNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Eg No
❑ NA
[] NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
J-No
❑ NA
❑ NE
New ©LUn e,--
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:( L�.�V'
Date: �--/
21412014

atep�"�or�',
. Ag,
PLAN OF ACTION (PoA) FOR HIGH FREEBOARD AT ANIMAL FACILITIES
Facility Number:, - IcF County: 6 L64:40
Facility Name: Too5utneqRtIl AIng
Certified Operator Name: Operator #
1. Current liquid level(s) in inches as measured from the current liquid level in the lagoon to the
lowest point on the top of the dam for lagoons without spillways; and from the current liquid level
in the lagoon to the bottom of the spillway for lagoons with spillways.
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Lagoon Name/Identifier (1D):
Spillway (Yes or No):
Level (inches):
2. Check all applicable items
Liquid level is within the designed structural freeboard elevations of one or more structures. Five
and 30 day Plans of Action are attached. Hydraulic and agronomic balances are within
acceptable ranges.
VLiquid level is within the 25 year 24 hour storm elevations for one or more structures. A 30 day
Plan of Action is attached. Agronomic balance is within acceptable range.
Waste is to be pumped and hauled to off site locations. Volume and PAN content of waste to
pumped and hauled is reflected in section III tables. Included within this plan is a list of the
proposed sites with related facility number(s), number acres and receiving crop information.
Contact and secure approval from the Division of Water Quality priorto transfer of waste
to a site not covered in the facility's certified animal waste management plan.
Operation will be partially or fully depopulated.
- attach a complete schedule with corresponding animal units and dates for depopulation
- if animals are to be moved to another permitted facility, provide facility number, lagoon
freeboard levels and herd population for the receiving facility
3. Earliest possible date to begin land application of waste: I L1/5
I hereby certify that I have reviewed the information listed above and included within the attached Plan
of Action, and to the best of my knowledge and ability, the information is accurate and correct.
Facility
Facility
ner/Manager (print)
nager (signature)
Phone: ctt D — (p of O goq `1
Date: - /2 '" 3 1 - /r-
PoA Cover Page 2121/00

PLAN OF ACTION (PoA) FOR HIGH FREEBOARD AT ANIMAL FACILITIES
30 DAY DRAW DOWN PERIOD
I. TOTAL PAN TO BE LAND APPLIED PER WASTE STRUCTURE
1. Structure Namelidentifier (ID): 1
2. Current liquid volume in 25 yr./24 hr. storm storage & structural freeboard
a. current liquid level according to marker 18.0 inches
b. designed 25 yr./24 hr. storm & structural freeboard 1970]inches
c. line b - line a (inches in red zone) = 1.0 inches
d. top of dike surface area according to design
(area at below structural freeboard elevation) 98350 ftz
e. line c/12 x line d x 7.48 gallonslft3 61305 gallons
3. Projected volume of waste liquid produced during draw down period
f. temporary storage period according to structural design 1 BO days
g. volume of waste produced according to structural design 121058 ft3
h. current herd # F---3-6-7-21 certified herd #1 3672
actual waste produced = current herd # x line g = 121058 ft'
certified herd #
i. volume of wash water according to structural design
j. excess rainfall over evaporation according to design
k. (lines h + i + j) x 7.48 x 30 days/line
4. Total PAN to be land applied during draw down period
I. current waste analysis dated 1 5/26/2015
m. ((lines e + k)/1000) x line I =
REPEAT SECTION I FOR EACH WASTE STRUCTURE ON SITE.
(Click on the next Structure tab shown below)
®ft3
59600 ft3
225220 gallons
1.47 Ibs/1000 gal.
421.2 lbs. PAN
PoA (30 Day) 2/21/00

II. TOTAL POUNDS OF PAN STORED WITHIN STRUCTURAL FREEBOARD AND/OR 25 YR.124
HR. STORM STORAGE ELEVATIONS IN ALL WASTE STRUCTURES FOR FACILITY
1. Structure ID: 1
2. Structure ID:
3. Structure ID:
4. Structure ID:
5. Structure ID:
6. Structure ID:
line m =
421.2 lb PAN
line m =
lb PAN
line m =
lb PAN
line m =
lb PAN
line m =
lb PAN
line m = lb PAN
n.lines 1+2+3+4+5+6= 421.2lbPAN
III. TOTAL PAN BALANCE REMAINING FOR AVAILABLE CROPS DURING 30 DAY DRAW DOWN
PERIOD. DO NOT LIST FIELDS TO WHICH PAN CANNOT BE APPLIED DURING THIS 30 DAY PERIOD.
o. tract #
p. field #
q. crop
r. acres
s., remaining IRR
2 PAN balance
(lb/acre)
L TOTAL PAN
BALANCE FOR
FIELD (Ibs.)
column r x e
u. application window'
T10981
1
overseed
5.51
91.04
501.6
Sept -April
T10981
2
overseed
3.58
86.20
308.E
Se t-A ril
T10981
3
overseed
3.56
86.10
306.5
Sept -April
T10981
4
overseed
3.91
87.40
341.7
Sept -April
T10981
5
overseed
3.68
100.00
358.0
Se t-A ril
T10981
6
overseed
3.30
100.00
330.0
Sept -April
T10981
7
overseed
5.50
77.60
426.8
Sept -April
'State current crop ending application date or next crop application beginning date for available
receiving crops during 30 day draw down period.
v. Total PAN available for all fields (sum of column t) = 2573.3 lb. PAN
IV. FACILITY'S PoA OVERALL PAN BALANCE
w. Total PAN to be land applied (line n from section II) =
x. Crop's remaining PAN balance (line v from section 111) _
y. Overall PAN balance (w - x) =
Will begin pumping as soon as field conditions permit.
421.2 lb. PAN
2673.3 lb. PAN
-2152 lb. PAN
PoA (30 Day) 2/21/00

Itype of visit: weruompifance inspection v Uperanon tcevfew V ntructure Evaivatton V iecnmcaf Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: .' Departure Time: '/6 County:
Farm Name: ril r°y /-a •e'- Owner Email:
Owner Name: k �Lir''l! Phone:
Mailing Address:
Physical Address:
Facility Contact: .�k//� Title: Phone:
Onsite Representative: 17';e /-Wry Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Region: /::�?Zo
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop,
Cattle Capacity Pap.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer
Dairy Calf
Feeder to Finish
aQ0
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,oultr
Ca aci
i'.o
Non-Dai
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 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 Cg No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes ❑ No
[:]Yes [:]No
[—]Yes CRNo
[:]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes 5D No ❑ NA ❑ NE
a: If yes, is waste level into the structural freeboard? [3 Yes ❑ No [DNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): T 19
Observed Freeboard (in): 12
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
,ggNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
SNo
❑ 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
Mt/ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Arc there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [2f No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. Yeso
❑ NA
❑ NE
❑ Excessive Ponding [3 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 st - v r/' '-y
13. Soil Type(s): dn?A Z 42/7 / ZI19/4
14. Do the receiving crops differ from those designated in the CAWMA7
❑Yes � No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable []Yes 21 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes � No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. S Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 , 21412014 Continued

Facili Number: - Date of Inspection: .�Z-- /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CZ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes Eg No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
� No
[DNA
❑ NE
[:]Yes 5�rNo ❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
10 No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
0 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
Qa No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
ER No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers=and/or any; additional„recommendations or: Any other comments ,3
Use ,drawings -of facilityto.better, explai`situatlons., use, additional: Raije"s as"mice'ssary)
0 Aa'04 /2pwn
49
i
sJsr, � Ll�a�r' /b7ar_.��s s ..
Bp .1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: p2 Z►--2�9d/6'
21412014

EQ Routine O ComplaintFollow-upof DWQ inspection Q Follow -LIE of DSWC review 4P Other �I
Facility NumberDate of Inspection LK—J-4901
Time of Inspection 24 hr. (hh:mm)
KPermitted A
Certified [] Conditionally Certified 1] Registered Not O erationa! Date Last Operated:112,
Farm Name: .................... ....L� I. ..�.............�GL i.5...................:.............. County:............. .. t e&n! ........................ .......
OwnerName: ............................ur... .......................� � ............ Phone No:.......................................................... .......
FacilityContact: ................p...................................:.......................... Title: ............................................................... : Phone No:.:.................................................
6 Mailing Address: .............. J...'..Jt,...`.......eA(.`...........-a,3ff �k zovb-e�,�.. ...1 ' ......
Onsite Representative: ..... ........ .......... ............. ................................... Integrator_... �. ,� S
pf, (.:.!....! %... �........ .. ......�'. ....................
Certified Operator:.,,,.,,,..% ..q ! I' [ -r! Operator Certification Number:
Locationof Farm: ........ ............ .....................�. ........................... .......................,..
Latitude
a
Swine Ca aCltyl�PQi�uIBGOn.,,
❑ Wean to Feeder
FeFnish
Aga
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Longitude • 6 66
Design Current`
Poultry Ca paci , Po ulation' Cattle:,.`
❑ Layer ❑ Dair)
❑ Non -Layer ❑ Non-
P r, :..F.
G 0 Other I Ir,
TotalyDesign apa(
Total SSE
sign 1. viz 4� current '
sacsty ' -o lation
r
3�9 z
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑Yes ❑ No
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 stern ? (Il' es, notify DW ) ❑ Yes ❑ No
6 Yp b Y• Y' Y Q.
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes []No
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: j9 l!
Freeboard (inches): ........... I ....... �.............. .................. /
......................................................................... r
5. Are there any immediate threats to th integrity of any f the structyres o servedl? {�e/ trees, severe erosion, o
76 Ch !Th I�i seepage, e4zee",.1,
3/23/99 ��) Co timed on back
of" � i-� ocrrt Crnt in A-e tr�cspli �c�

'.I1 :. f t ,f :rk q1 a -
' I t sion'of Satl and Water Conse p a
" �� `` ;� ` `' rvallon._- O 'eration Rleview
Drviston of Soil "and Water Conservation -Compliance Inspection r
a
# q 1 -� "I( E D1Vl8t0I[ Of Waiter QUAIAty ; Coni[?11anCC I1t5pec, go, `
.�' 1 t{.' lil I I I d r hIA I II'ut I III
Other�,'Nj cy QpeiattoniReviery � l iq-(
10 Routine O Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other j
II�1 I I 1 IIW I Ilh I 111 I III IIII IIYYYIYYIIYIIIWY YA 11114YIIIIW�
Facility Number Date of Inspection
Time or Inspection 24 hr. (hh:mm)
© Permitted [3 Certified l[3 Conditionally Certified ❑ Registered Not O erational Date Last Operated
l..t.. ..�.rl.Q'}�i. `� "i ^ ...... County:
Farm Name: ........................................... ..........................................q............... .......................
OwnerName:........ e.................... ..... f&....a'f................................... Phone No:.......................................................................................
FacilityContact. ....Title• Phone No:
Mailing Address : .......................&�'-
.......................................................................................................................................................... .......................,..
Onsite Representative: ............ :............................................................... Integrator: ................. In-ff............................................
Certified Operator:
Location of Farm:
............................................................. Operator Certification Number:...........
.... .... ........ ....... .............................................................
Latitude ' 6 " Longitude • 6 44
Design I , Current Design Current Design Current
asettPoutionPoultry CaacitPoeltonCCa aci ` Po uiationSwine
❑ Wean to Feeder ❑ Layer ❑ Dairy
;I ❑ Feeder to Finish ❑ Non -Layer 1 1[:] Non -Dairy
❑ Farrow to Wean
�;. ❑ Farrow to Feeder ❑ Other
[]Farrow to Finish Total Design 'Capacity'
❑ Gilts
El Boars Total'$SLW'
�Nuniber,of'Lagoons ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ` ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. II'discharge is observed, did it reach Water of the State? (Ii'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? (I1"yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): ...............
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
5. Are there any imme " to t cats to th inte ity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99 2-1 —
❑ Yes ❑ No
Continued on back

..-a�ry,.,�..�w„err.�.,,'-'..,,,,yF,,,.-....-.......,.-sr.�.-'.w.,y"�1''-�,r:�.^r.A'+^'.>an,.;w wF+,. ,.. .,. "x" ..;_ .'�. „ •• I. h. ..-• ,... .�»..-. .Ta.... >�.•"' ` ��0�
'11",P lap > t h, 0"',,1j '€ 1 11 .. E �,.... _-.z i 1 ' �.;;, re. '_' t_ r,; 3. ,
i ,
Division of Soil=and Water Conservation .Dperation Reviewh
t/ �fES'"(t €il'(:tt#('7r8`?I3&1:tP i7E( ty!(Ed[iE#j'f@( 'ii!rD
jVISIDn�af '011-" ;Water=ConservAtlan Com llancePIns
b ?� ! P [ € 1 E i# .P 3� i I.. �...,Eu: E E =l a.p: - E -€ tip i a.� I •v ,..ESE
6 RE e.y ll�r�`t c3 i:,l,xyE E,. �E[f €fur r;-'• �;y 'r �t.� f,
ail r+, � „� is {'r, Rlviwn of WAter Qlta ity Compliance Inspection "€ do-- .�i, rea �'-
r,eIa��IA �_. ..;,..� .IL'c •:. �,+ i' t• E 1 ,:.i 3�, }( r 1 r
,.��3t�t�4iri�iE ;o i e1 9,Et�t11er��BnCY . uOA@1�it1on7ReV1eW
10 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
A — — I�I�I�I�I I ■
Facility Number Date of Inspection I
Time of Inspection 24 hr. (hh:mm)
© Permitted [3 Certified "!..e
j3 Conditionally Certified (3 Registered Not O erational Date Last Operated:Farm Name: ....... .. r...............1.,..,.,`�,r. ............................... County:................................................................
OwnerName:........ �h�............................I.�.I.6) C.(................................... Phone No:.......................................................................................
Facility Contact: ......Title: Phone No:
MailingAddress: ..........................................................................................................................,............................................................ ..........................
Onsite Representative: Al ( Integrator: /11.{`F
CertifiedOperator: ................................................. ;1 ............................................................. Operator Certification Number:..........................................
Location of Farm: _
............................. :............................................................................................................................................................................. ............................................................ rr
Latitude ������' Longitude
Design Current, Design Current Design "Current
Swine Ca"acl Pb`iilation Poultry Ca acit .Po�`ulation' Cattle " .,;Ca'aci _'`Po'uiation
a; ❑ Wean to Feeder ❑ Layer ❑ Dairy
;:; ❑ Feeder to Finish ❑ Non -Layer I JE] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
[]Farrow to Finish 'TotaID"eMkh Capa:cI y
i ❑ Gilts
❑ Boars Total`SSLW! " `
t ,.�a'1 �.. )IiE }..ij: 3 r•' Alt:.. ,
f ;;, Nuitaber: of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
r�
Ir 6 'i }Holding?Ponds'/, Solld4i p's'', ❑ No Liquid Waste Management System
7 .1
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. II'discharge is observed, did it reach Water of' the Stale? (If yes, notily 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, notily DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Idcnlitier: ,,
Freeboard(inches): ................tG.... .................................... .................................... ...................................
.
5. Are there any imme to th ats to th inte 'ty of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
,,,.,1 seepage, etc.)
3/23/99 �— / r v v Continued on hack

4tS72_*S uAhkve-W 60 Rim. & —"V — Ga o /
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O'Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: $-07-07 Arrival Time: Departure Time: �.';ZO County: �+aQ a ^! Region: FCC?
Farm Name: C!C_ I O.AJ FaV- kAS Owner Email:
Owner Name: 0.l e- Nip.. v- Phone:
Mailing Address:
Physical Address:
Facility Contact: K x4k4 bLkci +J Title: *7--e4. Spe_r. Phone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = [= d =61 Longitude: 0 o = ` =
Design Current
Design Current
Design
C►urrent
Swine Capacity Population
Wet Poultry Capacity Population
Cattle 'opacity
Population
❑ Wean to Finish I
1
11:1 Layer
❑ Dairy Cow
❑ Wean to Feeder I
I
1 10 Non -Layer
I
I
❑ Dairy Calf
Feederto Finish 13672 1 1
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El Dry Cow
El Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
El Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[g 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
[3No
❑ 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
0 No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[N No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
® No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 0 -- `'7 (o Date of Inspection $-07 -0-1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): i q
Observed Freeboard (in): 661 It
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [N No ❑ NA ❑ NE
❑ Yes 19 No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes N No ❑ NA ❑ NE
❑ Yes [3No ❑ 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 [2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [XNo ❑ 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) je,,.k u a c _ C Grni L) Gru"ry i'0, S
13. Soil type(s) � (;,bA NhA
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
ENNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
C9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
®No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other, comments a '
Use drawings of facility to better explain situations. (use additional. pages as necessary):
Reviewer/inspector Name �.ic. `rev �, �S w Phone: 910, %33.3-'300
Reviewer/Inspector Signature: Date: A — O 7- Z-V b7
Page 2 of 3 12128104 Continued

Facility Number: O q -j7 Date of inspection 5-07-01
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 [21No ❑ 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 0 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
21 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9 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
R No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ 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
9 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
,® No
❑ NA
❑ NE
General Permit? (ie/ discharge, Freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
JM No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency? -
❑ Yes
,® No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

E
Facility'Number
Type of Visit &'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 4YEmergency 0 Other ❑ Denied Access
Date OMvit: ,,2 l!� 1 Arrival •1'imc; - (�' Departure Time: County: Renion: FF_Q
Farm Name: C-o n Owner Entail:
Owner Name: J Jr �-� /� ti+' e' Phone: -7�
Jklailing Address: f-� •� �wy� Ij C.,. 4 7Z-,7
Physical[ Address:
havility Contact: Dee I -e fil r' y e' 1'iCle: r Jd Y'� PlumeNo:
Onsite itepra:sentaative: Tr rLn _ f f t AOL Jt�/ r!/i G Integrator: /7? U f
or
C;crtified Operator: ,L a I -I _ _ '_�J r'% Operator f..:ertifit:arion Nuanber:
Biwk-up Operator:
L'ocartiou of harm:
Swine
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finisl
Boars
Other
❑ Other
Back-up Certification dumber:
Latitude: =o =' = Longitude: =0=1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
Other
Poults
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Dahy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of -Structures-.
Discl�es & Stream fin -pacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure 21 Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters ofthe State? (ifves, notify DWQ)
c. What is the estimated voluow 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?
YYes ❑ No ❑ NA ❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
Pq NE
❑ NA
❑ NE
[� Yes
❑ No
❑ Yes
❑ No
❑ NA
DK NE
❑ Yes
❑ No
❑ NA
X NE
12128104 Continued

Facility Number: — w
Date of Inspection
Waste Collection & Trerttment
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
Structrn e l Structure 2 Structure ? Structure 4 Structtin� 5 Su•ucture G
Identifier:__ -
Spillway?:
1-ksigned Freehoird (in): 1 1
Ohserved Freeboard (in): rg
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CgNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-sitc which are not properly addressed and/or managed ❑ Yes DI 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? Z Yes ❑ No ❑ NA ❑ NE
ti
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA KNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. RYes ElNo ❑ NA AEA_
N Excessive Ponding %I Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13, Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
EJ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
lK4 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[]
Yes
❑ No
❑ NA
NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
NE
18: Is there a lack of properly operating waste application equipment?
.Yes
❑ No
❑ NA
r H &'
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):
``iL'.�'.�'CY7r•�y�'jet•"c'L�{��";.4�•.^�^�i�..�:i-�•6,�irf��+''•'! rt�it;;`��;;�YJPt-y{ �-�.'Y/r'�'ti C�},f'i.:r•i�,']�by �1:i-�,i�,•�✓mil
,/
�
(_.
'I jflC •�Y'v y i••�I 'Il f�,1�11 P... �� y...Yi r L!� µl. _
1.-I J/'' /`
i 1 r y ';�. i t - �'G VL rr•.r; iJ'Jr���.^� dG �"..�t• a'l j'd7r' j;-�>�^ t i t'.% b
T1 'i Y.'•'L_. Vic: �, �lY,� ��,, :f'. 1'-`i •�{%�, l�r f%��.., r;'J �:,�I-'7., i`t- I ;.1 [.'.\C°t-".35i�: c'_ f� f:'�-�r-�; `",� �- i' 1Gs-ii, r"� s`—Yam/--x'i�
�
'�_ ', � �`" �rc(
„� /""..•LYE,, �� : , r - ,�.. � rYL` .:t� r�. }'Yr' rY ���� � � � .rat' ��.
tfi:-z ,i.
Reviewer/Inspector Name �YLJ�. (=,�-r.�t� �q- Phone:
Reviewer/inspector Signature:"'" "/ Date: ,� —%—z,
121,78104 Continued

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 ❑ No ❑ NA �&NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ZNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
E4 NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
EINE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
Z NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
(a,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
Z 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
I�NEE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
®'Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[allo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
P Yes
❑ No
❑ NA
❑ NE
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