090183_INSPECTIONS_20171231

NORTH CAHULINA
Department of Environmental Qual

I ype of Visit: UC;ompliance Inspection V Operation Review V Structure Evaluation U Technical Assistance
Reason for Visit: E }routine O Complaint O FoHow-up O Referral O Emergency O Other O Denied Access
Date of Visit: — Arrival Time: O Departure Time: .'DC?County: Region:
Farm Name: fir'` .� `/7-�.y ;,� ; �- Owner Email:
Owner Name:L�. y Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: 1,c41r7 r' Phone:
Onsite Representative: integrator: f .
Certified Operator: Certification Number: /L3Z)7
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
I
Design Current -
.Design
Current
Design Current .
Swine
Capacity Pop ' "' ; WetPoultry;
Capaciity
Pop.
Cattic' Capacity Pap.
Im
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Z2& 7A og
r
Daia Heifer
Farrow to Wean
Design
Currenf
Dg Cow
Farrow to Feeder
„ ,
Dry,,P,ou
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Cl#her
Turkey Poults
Other
Other
Discharees 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 allo ❑ 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 21412015 Continued

Facility Number: - Date of Ins ection:
i Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes `® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 9
Observed Freeboard (in): - �-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes rNo ❑ 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 gt No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4fi were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [No ❑ NA
❑ NI-
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes RNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes X_No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E,No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence/of Wind Drift ❑/Application Outside of Approved Area
I2.Crop Type(s): _25r�'lJlltlV r-1_j
13. Soil Type(s): 2 ; 2— p
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes L&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 [EINo ❑ 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 Q No ❑ NA ❑ NE
[] Yes &jNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Jallo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CANo ❑ 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 JZ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Ins eetion:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Co No
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes S No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
omine
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Inv.
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes JaNo ❑ NA ❑ NE
❑ Yes til-No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
[:]Yes [ANo
❑ Yes �No
❑ Yes FLe_VNo
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
Phone:
Date:
21412015

Type of Visit: Q'Complia,ce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: tE—'Ro%utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: r7 Departure Time: ® County: Region: (�
Farm Name: S; N �r1 l� j A Owner Email:
Owner Name: Ssai S'1 e7�%ZY i y Phone:
Mailing Address:
Physical Address:
Facility Contact:j'ynn /day Title:Phone:
10,
Onsite Representative:Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Desig`n� Current¢ -: Design Current
Swine Capacity Pop.
Vet Poultry
_.
Capacity Popes CattleMCaPacitvmpon.
Ak:
Wean to Finish
Layer
-
Dai Cow
Wean to Feeder
Dairy Calf
Non -La er
Feeder to Finish
_ = Dairy Heifer
iD Cow
Farrow to Wean
Farrow to Feeder
wffclaitpi
D , P�oulact
Po on- airy
Farrow to Finish
La ers
'
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars
Pullets"'
Turkeys
Other
4I
ITurkeyPoults
Other
IMFJOther
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 &jNo ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes D No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
JKLNo
❑ NA
0 NE
❑ Yes
RNo
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[] Yes
❑ No
❑ NA
❑ NE
Structure 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?
0 Yes
allo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
®. No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Z No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®,No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
[RNo
❑ 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?
❑ Yes
ER No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
[] NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements El Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CK No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
i
❑ Yes
Jallo
❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[5jNo
❑ 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 fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
ELNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
® No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes 2 , No
❑ Yes P7-2 No
V3
❑ Yes E No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to..question # : Explain any YES. -answers and/or any additional recommendations or any other comments....w
Use drawings of facility,to better explain situations,(use additionsl,pages,as necessary). I
t&a-!5 1-t1jr 7—o j--r1nou-r—
Gu
Reviewer/Inspector Name:y�'--
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: 3 v 17
21412015

Nov 1y-
I ype of visit: UUompliance Inspection V Operation Keview () Structure Evaluation V 'Technical Assistance I
Reason for Visit: eoufine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: — f (o Arrival Time: Departure Time: 'c County: ,a� Region:
Farm Name: ��.� y, .,;i ;�--�� Owner Email:
Owner Name: ���� �S'�.-�y--�-�7 Phone:
Mailing Address:
Physical Address:
Facility Contact: Q ,`r-, Title: deri1.7 Phone:
Onsite Representative: -`�'_ Integrator:
Certified Operator: f�
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity ' Pop.
Weanto Finish
Design Curren#
Wet Poultry Capacity Pop.
nt
Cattle�NNUM-46-Macity o.
Da' Cow
Da' Calf
airy Heifer
Dry Cow
Layer
Wean to Feeder
III INon-Layer
Feeder to Finish
Farrow to Wean
Design Current
D . $oul Ca aci P,o P.
Farrow to Feeder
Non -Dairy
h
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Turke s
Other Turkey Poults
Beef Brood Cow
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 [f No ❑ NA ❑ NE
[:]Yes [] No ❑ NA ❑ NE
D Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes Q'fio
[:]Yes [D"No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I 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
jffNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[]Yes
Rl' o
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q'NTo
❑ 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
[!J' o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
[DNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:)Yes
R], No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q No
❑ NA
❑ NE
maintenance or improvement?
Waste Agplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
EDNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes❑-
'go
❑ 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): / Za 41, i� r`y- Z eDr`�
_
13. Soil Type(s): a rN s ��l%
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E]-I�o
❑ 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
a'go
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
R3 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
3-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑6 o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [�Jfi o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? []Yes ErNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [}!o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[] NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 214120I4 Continued

Facili Number: - j Date of Inspection:
/L
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[B <o
❑ NA ❑ NE
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
io
❑ 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
[3'flo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
D-lq-o
❑ 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
[�o
❑ 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
[TNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[D 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
[T No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[''-No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
P::Ko
❑ NA
❑ NE
ants (refer to questton,#); Explain any YES;al
as necessarv).
/ .
�fv,2 ij (JftiP��uL�ll's' -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: 27D t3 -TEC)
Date:
21412014
Page 3 of 3

r
1
js—
ivision of Water Resources
Facility NumbeDivision of Soil and Water Conservation
Other Agency
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: O"Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: .'v t) Departure Time: j County: Region: E� c7
Farm Name: �!s'; ,(�� yh; S`i ;;� Owner Email:
Owner Name: Phone:
Sam ,$' .`rr . �� �T Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: fur✓ Phone:
Onsite Representative: Integrator:
Certified Operator: ��.�_ Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
pa
Dairy Heifer
Farrow to Wean
Design
Current
Dr
y Cow
Farrow to Feeder
D . Pont
Ca aci
l;o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
[DNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[—]Yes
[::]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
L.No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[—]Yes
LS No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412014 Continued

Facili Number: - ZkJ I Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CffNo ❑ 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): - f -1.7
Observed Freeboard (in): ���
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® 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 Callo
[:DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes J�FNo
❑ 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 WindDrift❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes S No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ©No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ®, No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(a No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Z[ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
[gNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. [:]Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Callo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑ NA ❑ NE
❑ Weather Code
[:]Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Y [Facility Number: - Date of Inspection: — /s
24. Did the facility fail to calibrate waste application equipment as required by the permit? [-]Yes 03.No
25. is the facility out of compliance with permit conditions related to sludge? if yes, check []Yes 0,No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [—]Yes ®,No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [a No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[gNo
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
RNo
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
Z No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
O No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
BjNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA E] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments {refer to questioo=#) Explain any YES answers and/or:any addfhonal recommendations or any other�comments,°
w- - .-
x .:.
Use drawings of facihty.to better explain situations (use additional pages as necessary)., __.. � _•.;r-
`r,w-,o bay of j! 4'Z i s %;
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

' ivision of Water Quality
Facility Number. ©- fr3 O Division of Soil and Water Conservation
p Other Agency 3 p
i'ype of Visit: omp - nce Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Decried Access
Date of Visit: Arrival Time: ; p Departure Time: f 3 t7 CountyX51 ram— Region: tom'/ 0
Farm Name: ` ,?�/2• ;, .y , 5A ; � _ Owner Email:
Owner Name: ' ,= r Phone:
Mailing Address:
Physical Address:
Faciiity Contact: Tss� U SS.eQ �r/a iy Title: ,1 1n t—,o ` Phone:
Onsite Representative:z�
Certified Operator: -.J'-
Back-up Operator:
Location of Farm:
Latitude:
Integrator: !'I?ar"y/7j rifiW�`
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
" ' Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er I
Dairy Calf
Dairy Heifer
Feeder to Finish
Design Current
D", 1'oult Ca aci P,o .
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Other
Other
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
(4 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
5?-No
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412011 Continued

Facili Number: - Date of Inspection: �r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): 9
Observed Freeboard (in): ` r
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
O-No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes ®,No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes JZ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes A No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Ig 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 f2l No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ( No ❑ NA [] NE
❑ Excessive Ponding E] 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�c>~ xLD n /V f r�/-3 t'T -o
13. Soil Type(s): , war .
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ o ❑ 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 [RNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[D Yes
R] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
23No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ 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
(5 No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: ST - Date of Inspection: — G -- / K
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C,No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes JSNo ❑ 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 [ o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes RNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
J2�No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[&No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
M 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
Ul No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No
❑ NA
❑ NE
Comments (refermto, question #): Explain any YES answers and/or any additional recommendations or any other comments r
Use.drawings of faciility to better -explain situation�(use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: g/O-GfJ3 33Oo
Date:
21412011

't
Division of Water Quality ��
Facility Number ®- %�� O DivisiFffin
oil and Waonservation r ��
•0 Othercy
type of visit o pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
teason for Visit: G tcoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: : J iJ County: $�
Farm Name: ,� ; ,. Owner Email:
Owner Name: S •,-fc Phone:
Mailing Address:
Physical Address:
Facility Contact: �s�� S;k4fr-2j Title: ,4P4��� r�
Onsite Representative: Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region: FT*,. D
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
11-ayer
Design
Capacity
Current
Pop.
Design •urrent
WM
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder I
Feeder to Finish x
Farrow to Wean
Farrow to Feeder
Farrow to Finish
INon-Layer
D a P,oul
La ers
I
Design
Ca aei
Current
P,o P.
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Pullets
Turke s
Beef Feeder
Boars
Beef Brood Cow
Other
Other
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
[] Yes
®.Vo
❑ NA
❑ NE
❑ Yes
Lj�No
❑ NA
❑ NE
Page I of 3
21412011 Continued

Facili Number: f5ate of Inspection: / 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V�3,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): —
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
®No
[:]NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 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
to No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes g,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): i!�G�c,P_ �G;?/h Z-emude— /jlysxril!+-rr ldtli r+r
13. Soil Type(s): J'- 0- -.4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
r'A No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[K No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EQ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[!5 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
4!�,No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[A No
❑ 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
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
59 No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

im
Facili Number: - X93 Date of Ins ection: /J
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [32 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Rg No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes CZ No ❑ NA ❑ NE
❑ Yes CH No ❑ NA ❑ NE
[—]Yes [� No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any:; additional recommendations or any other comments
Use drawings pf facility to better explain: situations {use additional pages as necessary). M?`,
Reviewer/Inspector Name: Phone: 1�33--3 Q 0
i
Reviewer/Inspector Signature:
Page 3 of 3
Date: 49 w
21412011

H
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit:
(o-'/ Arrival Time: T t7
Departure Time:
County:
Farm Name
Owner Email:
Owner Name:
�� } ti 2Lr�Y.�`-Y
Phone:
17
Mailing Address:
Physical Address:
Facility Contact: ` Title: _�`jt.� Phone:
Onsite Representative: �°``,L. -_ Integrator:
Certified Operator: 54:14�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Region:
«-_ la a A gn @nrrent Design Current
Desi n Current �' Desi
Swine Capacity Pop. Wet Poultry Opacity Pop. Cattle apAN Pap.
Wean to Finish La er Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder.
4 .k
DryPaultr SCa
Dairy Heifer
Design Current Dry Cow
aei P,o Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
QthNeWrif
Turkey Poults
Other
Other
Discharees and Stream ImDacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [—]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes RNo
❑ Yes ®No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 214,12011 Continued

• Facility Number: - Ds ection: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®. No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 9
5. Are there any inunediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
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 allo ❑ 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 ❑ Evide/nce of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �JlGrllyl�.C`f"� /µ(r✓�j4 %V/i'1 �Cz'SGIi✓ /%3�r:� �1��--x
13_ Soil Type(s): �� '� ^
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ®No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® 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 EL No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [T No
❑ Waste Application ❑ Weekly Freeboard [] Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C,N
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes gLNo ❑ NA ❑ NE
a
` 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
0 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)
❑ Yes
JZ] No
❑ NA
❑ NE
❑ Yes
& No
❑ NA
❑ NE
[:]Yes
E&No
❑ NA
0 NE
[:]Yes CKNo ❑ NA ❑ NE
❑ Yes VS3 No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
�No
❑ NA
❑ NE
No
❑ NA
❑ NE
US -No
❑ NA
❑ NE
Wo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
:-_
Use drawings.of facility to better explain situations (use additional pages as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9/9_y��3�. �D
Date: 32
21412011

n
Type of Visit EMompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit B Routine O Complaint O Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: /¢ t Arrival Time: Departure Time: ! D County: Region: ems=
Farm Name: �a Fi - ij A ` rt Owner Email:
Owner Name: Q G —3 nx le %4 r y Phone:
Mailing Address:
Physical Address:
Facility Contact: - �.sSa c �S� •r.��� y Title: 1fkL,0e", Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number: / 1-3D7 _
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: El O E J= u Longitude: 0°= I= u
Design Current
Design Current
Design
Current
Swine
Capacity Population
Wet Poultry
Capacity Ropulation
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑DaiTy Cow
❑ Wean to Feeder
❑ Non -La er
I
Calf
Feeder to Finish
p
Dry Poultry
= .{
k��
❑Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Pullets
❑Beef Feeder
❑ Beef Brood Co
❑ Boars
❑ Turke s
-
❑ Turke Poults
❑ Other
❑Other
Number of Structures:
Dischartres & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
QNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
Q5.TTo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ®No ❑ NA FINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ®-No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes ,K[No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0.No Cl NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [,No ❑ NA ❑ NE
maintenance/improvement? �.
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s)-rr-�..��rr
13. Soil type(s) --p 7p--
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
®No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
t4 No
❑ NA
❑ NE
Reviewer/InspectorName �j Phone:
Reviewer/Inspector Signature: Date: 10 �E71
Page 2 of 3 12128104 Continued

Facility Number: q - IjM 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 ERNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JgNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[9 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
&a 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
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Add itianal,Comaeents,aad/or
Page 3 of 3 12128104

S 9—II-2-0/0
S
Type of Visit (Compliance 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 ❑ Denied Access
/�� County: Region: Date of Visit: Q Arrival Time: ;Q Departure Time: , f7� ty:
Farm Name: -T .1C; Nr S 4 !/IK Owner Email:
Owner Name:--�-�SQC �fiCr 1Cv Phone:
01
Mailing Address:
Physical Address:
Facility Contact: G SIGs -sue Title: �w/V�f� Phone No:
Onsite Representative: J7:ZrQG �i`. %LS�s.e. Integrator: W(I � — 46PW t1✓_
Certified Operator: �TSS4 Operator Certification Number:100,
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = ' = Longitude: = o = ,
Design CurrentPoe—si
apaation
�56_urrent
Wet Poultry C*apacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ Non -Layer
I
I
❑ Dairy Cow
❑ Dairy Calf
❑ Wean to Feeder
Do Feeder to Finish ZQ
1
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
El Layers
❑ Beef Stocker
❑ Gilts
❑Non-La Non -Layers
❑Pullets❑Beef
❑ Turke s
Feeder
Beef Brood Cow
❑ Boars❑
Uther
❑ Other
❑ Turkey Puuets
❑ Other
Number of Structures:
Disebarges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge`?
❑ Yes L9< ❑ NA ❑ NE
❑ Yes
❑ No
❑I1 A_
❑ NE
❑ Yes
❑ No
[9'9A-
❑ NE
LTNA
❑ NE
❑ Yes
❑ No
❑ Yes
O—❑
NA
❑ NE
❑ Yes
Blgo' ❑ NA
❑ NE
Page I of 3 12128104 Continued

Fbcility Number: 4 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Now❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
, �,
1�"No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?: /✓�
v
Designed Freeboard (in): l9
tr
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes
ElE
��
Ko ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ETZ ❑ 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 thre t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes MNo ❑ 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 I" No ❑ NA ❑ NE
maintenance/improvement?
i 1.
Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s)
13.
Soil type(s) Zaa..
14.
_
Do the receiving crops differ from those designated in the CAVVMP? ❑ Yes
El No ❑ NA
_
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
L7 No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
Now❑ NA El NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
1A
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
roLJ NA
❑ NE
Comments (refer�toaqueshon #): Explain any YES answer'sland preany recommendations or any other comments
se drawings of faciEtty to better explain situations (use addittional pages as necma* A
T
Reviewer/inspector Name - e y 5 Phone: /D, f333.3
Reviewer/Inspector Signature: Date: B
IZ128194 4ontinuea

Facility Number: — Date of Inspection
Renuired Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [I,.,
Yes � No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ErNo ❑ NA ❑ NE
the appropriate box.
❑ WLTP ❑Checklists ❑Design ❑Maps El Other ,_,.,�
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes L7No ❑ 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
ErNo ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�L91�(oo
L;'No ❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Gllo ❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
D'lVo❑ NA
ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
DX5""❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,_.,
M<0 ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E 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
alN ❑ 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
�,
LYNo ❑ 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
Silo ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
a o U NA
❑ NE
12128104

s
- �1M c �s 1ba1o�
0 Division of Water Quality
[Facility NumberI E �: ' 3 O Division of Soil and Water Conservation
- - 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: 'ras Departure Time: j 7a PM County: Plddfn Region: _ ko
Farm Name: Owner Email:
Owner Name: krlar _ S Phone: Uqk
Mailing Address: n) Is I Mf SQ'i IU __ _ _ _B 10 -Pbero _ pCM
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: HVrOhp w-n
Certified Operator: Lsaac— S Operator Certification Number: tAWA 110307
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [� o [� f = Longitude: = ° u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
JE1 Nan -La et
Dry Poultry
Pullets
Poults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
EFDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
i
Number of Structures:
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
[—]Yes N'No []NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
❑ NE
il Yes WNo ❑ NA ❑ NE
12128104 Continued

Facility Number: Q — i83 Date of Inspection MEMO
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Wo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes &I No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
5a NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25_ Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
52 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
UNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ERNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RrNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
f"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
9 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
'CRNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
sl &d�je- d vole Lrit I a ooc' j In - h iS -'DAM o'I ly
//
�]4r Q�oon hv(i fed f �'o ynus
/
have bew, C DvPr ,
S 1 -1-eak alvk -Flow 140 Mch ba-i i� oto,
3 !,-c9hfreehMd- �o#1 44N of ao®(e ran 'Inio ser e @00 ! u DD h►as 1'ffue C
,ij+ y e&- -w 5'6a*a,,
ntedC a, waii-c- an a [ys,°,r ete Soo., , L O)+ ale raV off- On q 101 1 bg
M1 4ek caflAai Oec- @00
AIrtat cot sam2hay`�h4S 1J Gfl
Foim a,fe (oar 1 bo k 9ocd- 0 Vfra j
12128104

4
Facility Number: — B
Date of Inspection IAIMal
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a_ If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes KNo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑NA El NE
Structure 6
Spillway?:
Designed Freeboard (in): I
Observed Freeboard (in):
AS-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 5jrNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes J;a'No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes NNo ❑ 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 91 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 19 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [_—]Yes tjNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElEvidence of Wind Drift [IApplication Outside of Area
12. Crop type(s) Corny 1vh-eA11S0Xb&h9 bmy"' OAS ._.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
9No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
:g No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
D4 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
CNo
❑ NA
❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name t7'OQn LrhAPhone: /A� 33-3300
Reviewer/Inspector Signature: Date: L a aIDg
12128104 Continued

a
3
Facility No, VQ`�SJ
Farm Name
Owner _
Operator
Back-up
COC
Time In Time Out
Integrator
Site Rep _
No.
No.
Circle: General or NPDES
Date
Design
Current
Design
Current
Wean -Feed
Farrow --Feed
Wean - Finish
Farrow - Finish
Feed -- Finish
Gilts / Boars
Farrow - Wean
Others
FREEBOARD: Design
Sludge Survey '5fo fffhot
Crop Yield
Rain Gauge
h
Soil Test 3Wettable Acres
Weekly Freeboard Daily Rainfall
Spray/Freeboard Drop
Observed 01avJ0,°
Calibration/G / tt&5— A
Waste Transfers
Rain Breaker T T i� a - Pee— aQO-�
PLAT
1-in Inspections
Weather Codes 120 min Inspections
Waste Analysis: 3 t -5-)
Date Nitrogen (N) f �rQ 7 Nitro a (N)
04 o s a. �►a�,Ilc� a l� .
47 —a y�la�lc�
3,0 �11g10-t
Pull/Field + Soil t Crop Pan Window
f ft -xrmo
l

Di-.1sion of Water Quality
Facility Number O Division of Soil and Water Conservation
0 Other Agency
Type of Visit
C,.ompliance Inspection
O Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
�mp
O ioutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: A-rri�val Time: fl Departure Time: �3 0 County: Region:
Farm Name: rl s /a % +'L .� u _ T Owner Email:
Owner Name: -� S ,t C_ -s�� .rr,� Phone:
Mailing Address:
Physical Address:
Facility Contact: =-;?r=_1_ s r- its Lc /a/y Title: Phone No:
AV
Onsite Representative: „5�.,� Integrator: z
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 i [= Longitude: 0 ° [--] , = u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
jID Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation`?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
;4 No
❑ NA
❑ NE
❑ Yes
RNO
❑ NA
❑ NE
12128104 Confinued

Facility Number: — Date of Inspection — —a
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ONo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f
Observed Freeboard (in): v2 10
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JO No
❑ NA
❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
.R 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'?
�R Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 'N No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes tgNo ❑ NA LINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RNo ❑ NA ❑ NE
maintenance/improvement?
] I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XLNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)�� c�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�a No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
E.No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R[No
❑ NA
❑ NE
IComments (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):
WID rill a--;,. ��b.,I, P pA; L - 5
52 rc I .�r Fe3 ewe
L
ertInspector Name l�/� Phone:erlinspector Signature: Date:
12128104 C,ontrnuea

Facility Number: — Date of Inspection l�0
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes WNo ❑ 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 C. 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 E9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes tO No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[$ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[2 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
MNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®,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
J0 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
NNo
❑ NA
❑ NE
Additional Comments and/or
12128104

t' a
Type of Visit EMompliance Inspection (--)Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ,Departure Time: County: ff"n Region:
Farm Name: Si �+� L r-t rs i.5 h i h Owner Email:
Owner Name: Sa. G S i ag L e 7 a Phone:
Mailing Address:
Physical Address:
Facility Contact:&r e_ Si��T Title:
Onsite Representative: f�-
Certified Operator: �—
Back-up Operator:
Location of Farm:
Phone No:
Integrator•
Operator Certification Number: O
Back-up Certification Number:
Latitude: 0 0= 4= w Longitude: 0°= I=
Design Current
Swine Capacity Population Wet PouEtry
Design
Capacity
Current Design Current
Populatiou Cattle Capacity Population
- .
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish p D D-
❑ Farrow to Wean Poultry
❑ Farrow to Feeder "`
❑ Farrow to Finish ❑ Layers
❑ Gilts ❑ Non -Layers
❑ Boars ❑ Pullets
- ❑ Turkeys
Other T El Turkey Pouets
❑Dai Heifer
'' ❑ D Cow
❑Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
su ❑ Beef Brood Cowl
;
Number of Structures: f
=» ip l
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d- Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes JRNo ❑ NA ❑ NE
❑ Yes
IN No
❑ NA
❑ NE
❑ Yes
Eallo
❑ NA
❑ NE
❑NA
❑NE
❑Yes
XNo
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: —%
Date of Inspection
Waste Collection & Treatment
>, 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): Q do
Observed Freeboard (in): C 2 Q
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes P6No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes W No ❑ NA ❑ NE
❑ Yes [9 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes CR No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Z No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 4No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.- ❑ Yes Cq No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop W.,iinndow [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C� rn S 74�G u.-
13. Soil type(s)�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes JRNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? J$ Yes ®No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes N No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes D� No ❑ NA ❑ NE
❑ Yes [9tNo ❑ NA ❑ NE
Reviewer/Inspector Name _ _ `�j-►-� Phone: p— 3
Reviewer/Inspector Signature: Date: / S as G
Page 2 of 3 12128104 Continued

Facility Number: 9+ — Date of Inspection
R Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [RNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E.No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[Q No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
MNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[Sd No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
JKNo
❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
&No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[gNo
❑ 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
B[ 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
ELNo
❑ NA ❑ NE
Page 3 of 3 12128104

Type of Visit 4P Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other E3 Denied Access
Facility Number Dale Of Visit- n 0 Time: = D
FONot Operational 0 Below Thresholdj
13 Permitted 13 Certified 13 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
' vA Le
]Farm Name: S —4-curvj F County:
Owner Name: —.51 v,a I e-4v,-.r-v 'Phone No: -- Ito - toile. - ?::2
N-faffing Address: -47-
i --- Zailalr_ SAL&
Facility Contact: TfZ:50-4, "I�T Title: Phone No:
Onsite Representative: ----- Integrator. CAJ--02
Certified Operator: S -s-, hSA Operator Certification Niumber:
Location of Farm:
9LSV,ine [3 Poultry E3 Cattle [3 Horse Latitude 0 " Longitude
aDes"
qW. Currn I
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
JE1 Other I
To1si
PeSW
z
Total SSL
C
Des�
n
Disebarees & Stream hwacts
1. Is any discharge observed from any part of the operation? [I Yes WNo
Discharge originated at: 0 Lagoon 0 Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? El Yes 0 No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
0 Yes 0 No
c. If discharge is observed, what is the estimated flow in gavrnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) 0 Yes 0 No
2- Is there evidence of past discharge from any part of the operation? [:1 Yes Z No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [I Yes WNo
Waste Coffection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? 0 Spillway [:1 Yes KNo
Stru t e 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112103 Cowed

Facility Number: Date of Inspection 1
15. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes JKNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes Eg No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes RNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes R No
elevation markings?
Waste Anvlication
10. Are there any buffers that need maintenanceJimprovement? ❑ Yes ja No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 5jNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type (�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes RNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes M No
b) Does the facility need a wettable acre determination? ❑ Yes [l No
c) This facility is pended for a wettable acre determination? ❑ Yes [R No
15. Does the receiving crop need improvement? ❑ Yes jg No
16. is there a lack of adequate waste application equipment? ❑ Yes ONO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes EKNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes (XNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes CgNo
Air Quality representative immediately.
Feld Copy ❑ Final Notes
Cori%
t357
11.
PMj
FvAeve-- lip'? lb
PA14
d.jVo ,►./lr
Oafs =
sy
H.
PA tJ
�
%j6e►s = KS
kb PA^1
o. % 4K
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
12/12/03 Continued

Facility Number: Date of Inspection i 0
ReQuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes CgNo
22. Does the facility fail to have all corngpents of the Certified Animal Waste Management Plan readily available?
(ie/VVLTPI,"checklis�dessigarfnVKetetc.) ❑Yes KNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo
❑ Waste Applicatioked❑ Freeboa>jK ❑ Waste Anaiysi✓❑ Soil Sampling/
24. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
RNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
25. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑Yes
$� No
27. Did ReviewerAnspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
28. Does facility require a follow-up visit by same agency?
❑ Yes
[ffNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMr
❑ Yes
RNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
R Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
QNo
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
5Kio
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
PENo
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
Rio
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below_
(RYes
❑ No
❑ Stocking Forrk1-_XCrop Yield Form ❑ Rainfa O Inspection After 1" Ram/
❑ 120 Minute InspectiorLe'❑ Annual Certification Fodr--
10 No violations or deficiencies were noted during this visit You will receive no further correspondence about this viidL
wo b4c,. i4, t.� fats • i %zo/oy ,z.,(
s/-j lo q y. L
$ /10 loci 3.3
3S.
; r-ri ���-Ier•� ' �ve+��-s `t"1..��- 4.n-+e.
ass e� a.K ••�� Terms u � �e a.:,.�L.� s (. r - arry r^ warms vd {-
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12112103

t
Type of Visit O Compliance Inspection O Operation Review 40 Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notfcation Q Other ❑ Denied Access
Facility Number Date of Visit: Time: a
Not O erational $eloK• Threshold
0 Permitted O Certified © Conditionally Certified D Registered Date Last Operated or Above Threshold:
Farm Name: e /r!► • /�7 County: 114 P
Owner Name- Q J'h I Phone No: - &I r
Mailing Address: ►cX of h d' PMknef/L
Facility Contact: Title:
Onsite Representative:
Certified Operator: _
Location of Farm:
Phone No:
Integrator: tt T ` A/O w h
Operator Certification Number:
X Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0 " Longitude ' 0 0"
-Design"
Current =
Design Czirrent Design Current
_-Pouitiv
Ca acttv_;Po elation _ Cattle ._ - .Ca achy 'Pa elation
❑ Laver
Dairyx
❑ Non -Laver
r ❑Non -Dairy
❑ Other
a _
_.. - - -
V
TJ.otal Design C07
apaclt _
Total SSL'W
'_ Ntsmber'6f Lagoogs -
I 1 ❑Subsurface Drains Present La oon Area ❑ S rav Field Area
Holding :on ! Sand Traps
a ti w ❑ No Liquid Waste Management System
;Swine:--- - Ca adty-.Po ulatwn._
❑ Wean to Feeder
Feeder to Finish
Q
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
Gilts
❑ Boars
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 man-made?
b- If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify, DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste ection 8 Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1
"r
Freeboard (inches): as/
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure b
05103101 Continued

Facility Number. 1,?3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
S. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Aonl'ecation
10. Are there any buffers that need maintenancefrmporovement? ❑ Yes ❑ No
I I. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
sC� (truer # YJ�'amv►ss aa�/ or other a__
Tye tirau'mgsa�c~p to ibetter satu:ftiant tiai pages as ❑Fie ❑ Final Notes -
Reviewer r Name
/InspeCto t Tz _xir�� Sf.. W.
Reviewer/Inspector Signature: Date: 9
12412m3 Conrutuaa

Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of inspection
Facility Number
Time of Inspection /: Q 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status, ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
N Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name: .... �1 �%�/t� L,st�_ _ .-. _.. County,----
� / /b d
Land Owner Name: 1,�%-!i �i�� .. . _ .... Phone No:..�, y...
Facility Conetact:........-,�,.,��....�.� •_.. Title: ...._ Phone No: .......
MailingAddress: � .... _. .. _..� ......... _....� .... ................. ........ . ... .... .
�Onsite Representative:..... 3 r _. Integrator: �...� . �
Certified Operator: �. , Operator Certification Number:.�d
Location of Farm:
Latitude C�44 u Longitude • 6 6.
Type of Operation and Design Capacity.'"='r;.�a..;•�aw.�i a
.Sv'hb'sf,4¢x'an2
. UesignCtirren s eS1�T1C elitceae Design CillTent,
Swine A Cattle`
7- ,, a act �x:Po ulationM O�t!3' hCa achy Po Mahon �. Ca aci ` Po ulatton
❑ Wean to Feeder Z
LayerZ ❑
® Feeder to Finish WK Non -Layer A 42 ❑ Non-
- Farrow t0 Wean
...
Farrow to Feeder �77, T0'61-1 sign Caps add
Farrow to Finish
� . �x's�zr A,'.�,�_ �� °" � �.�xt��ez��c�� •.'fin ��?�
❑ Other f z 5a esa �x 4
Number�of Lagooas='I IloldtngPonds / ❑ Subsurface Drains Present
z . � a
�,�� ��� � � y" �� k�`�� `�" �� ,,,� ����` Lagoon Area � ❑Spray Field Area � ���� `l
.
Geperal
1. Are there any buffos that need maintenance/improvement?
2. 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 Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5- Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes X No
❑ Yes ONO
❑ Yes kNo
❑ Yes )kNo
❑ Yes ANo
❑ Yes XNo
❑ Yes KNo
❑ Yes x No
Continued on back

acility Number:
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes kNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes gNo
8. Are there Iagoons or storage ponds on site which need to be properly closed?
❑ Yes O(No
Stoctures ,a o n. and/or Holding P nds
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ YesXNo
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
10. Is seepage observed from any of the structures?
❑ Yes *0
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes O(No
12. Do any of the structures need maintenance/improvement?
kYes [:]No
(if any of questions 9-I2 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 kNo
Waste Application
14. Is there physical evidence of over application?
r
❑ Yes 40
(If in excess of WMP, or runoff entering waters of rite State, notify DWQ)
('
15. Crop type
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes KNo
18. Does the receiving crop need improvement?
❑ Yes XNo
19. Is there a Iack of available waste application equipment?
AYes ❑ No
20. Does facility require a follow-up visit by same agency?
/❑ Yes $(No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ANo
For Certified -Facj ities Onlv
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes ANo
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ANo
24. Does record keeping need improvement?
❑ Yes )KNo
Comments {ri er to°questron.##) Ezplam any YES,answers and/or any recommendations or any other comments:
Use:diawingsJ of facility to better explain situations: (use additional pages as n cessary),tt
—Z /
lz. /.C.� /.-,�c '& 6 -.�. ✓ �.r�,� e,.l ti
!r ,,,,� �.� a,.•dJ,��� �,r„�t ��-.fc y�� s,� ���'-"��-�'� � c%ji.FP
i9, rr,E �yde,�.�f _•�d���.�� .��� .�� %tom-/��d��� o,��-�i�
a
Reviewer/inspectorName<wih . t w� •-r : r° "nNOUN
Reviewer/Inspector Signature: ��� Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97