090185_INSPECTIONS_20171231

NORTH CARDLINA
Department of Environmental Qual

r
Type oI visit: L7[:omptiance inspection V uperatlon Kevlew U structure Evaluation U I eennlc21 Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:j Departure Time: ! c' County: vim.
Farm Name: �Y J f'.'. I cz " Owner Email:
� 1/
Owner Name: �S1 _ �'� r1c� /ri y Phone:
Mailing Address:
Region:e_/�
Physical Address:
Facility Contact: Sr�G ��:/iZl,,Title:Phone:
Onsite Representative: ,'Integrator:i,/<r'/
Certified Operator: S � Certification Number: /6 30 7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
;I)C3igI1
Current
Design C[irretlt
Swine
Capacity Pop.
Wet hPoutt
Capacity
Pop.
ty Pop.
Cattle '' Capacikd
Wean to Finish
Layer
on -Layer
"i
Ni
Dairy Cow
Dairy Calf
Dai Heifer
can to Feeder
,fteder
to Finish
D
Farrow to Wean
__
Design
flu a
Dry Cow
Farrow to Feeder
D Poult :',, ,f 62'eaei
P.o
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
.Y,
OtherJEJ
I Other
;
Discha es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [�JNo [DNA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
[:]Yes [:]No
❑ Yes tNo
[:]Yes F;:,,l No
[] NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

1 Facili Number: - Date of Ins ection:
i Waste Collection & Treatment
` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[0-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
DNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): pZ
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
r'-,Xmo
❑ 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
rM 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 ofthe 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
&LNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[A No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): , A-rmrJu
13. Soil Type(s): ��91� a�j2e,-o
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 64 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes P�_No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes kNo ❑ 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?
Required Records & Documents
❑ Yes R No ❑ NA ❑ NE
[:]Yes �No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
� No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0,No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
RNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking [:]Crop Yield ❑ 120 Minute inspections ❑ Monthly and I" Rainfall Inspections
[:]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[allo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes &No ❑ NA 0 NE
Page 2 of 3 2142015 Continued

�{Facility Number. -1 1 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �g No ❑ NA ❑ NE
r
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 first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
R 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
[�JNo
❑ 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
[A No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[2 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
allo
❑ NA
❑ NE
Comments refer to queS'U0n #) Explain any YES'answersjand/orany additwual recommendations or any�,other comments.`- j
Use drawln{ "Td, g ll, rIa I �.-
:offacility to better ex lain situations' nse addrtina#pages;is necessary
p {
ReviewerAnspector Name:
Reviewer/Inspector Signatur
Phone: 949—_;3'e)_�> 0vL5—t
Date:
21412015
Page 3 of 3

I Ision 0f.V4'ater Resources = .
Facility Number �� - ©Division ofSoil and V1'afer Conervatio.n
O Other Age�icy -
Type of Visit: ompli ce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: D ,� Departure Time: '(% County: a�al/_ Region: �
Farm Name: / y il-4 75,-n� Owner Email:
Owner Name: , La Sj �g /r �r� Phone:
Mailing Address:
Physical Address:
Facility Contact: �,� �Sit��j;�-►.y "/�r•�y Title: f7 Phone:
4117
Onsite Representative: f Integrator:
Certified Operator:Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current
Design Current
Swine Capa ity Pop.
Wet Poultry �CapaeityPop.
Cattle Capacity Pop.
Wean to Finish
iry Cow
Wean to Feeder
Non -La er
iry Calf
Feeder to Finish !
w
Dairy Heifer
Farrow to Wean
Design 'Current
D Cow
Farrow to Feeder
1]ry P,oultr` Cspa ifP.o
Non -Dai
Beef Stocker
Farrow to Finish Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
13eef Brood Cow
Turkeys
Turkey Poults
NJ
Other
Other
Discharges and Stream Impacts
t. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes allo ❑ NA ❑ NE
[:]Yes [:]No [] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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 allo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes J&No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 214120I S Continued

Facili Number: V - I Date of Inspection:
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Z[No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 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
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
M No
❑ NA
❑ NE
waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
g No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ZK 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
S4_No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
J�&No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C!�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 Types): r'/' [U
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [Z No ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes r 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?
Required Records & Documents
❑ Yes (g No ❑ NA ❑ NE
❑ Yes CRNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'
❑ Yes
fR No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
� No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21, Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking []Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[, c�No
❑ NA
0 NE
23_ if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[4 No
❑ NA
❑ NE
Page 2 of'3 21412015 Continued

acili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes �No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes ®No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[] Yes No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes O No
[DNA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 0 No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes Z No
DNA ❑ 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 PS 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 [N 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 CS No
❑ NA ❑ NE
{ zany other comments ;
U e draw ngs of facility to better explain situatiansa{u a addtttonal pages astnecessa yj endatrons or f - ti '
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:��D���S
Date:
21412015

Type of Visit: (YCompliance Inspection U Operation Review 0 Structure Evaluation U Technical Assistance
Reason for Visit: (2 koontine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: —/8� (o Arrival Time: {Q' Departure Time: County: - - Region: (�
Farm Name at E22te22, Owner Email:
Owner Name: `� %� Phone:
Mailing Address:
Physical Address:
Facility Contact:. ,�� Title: Phone:
Phone:
Onsite Representative: 5.�� _ Integrator: itrr�_
Certified Operator: Certification Number:
t
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current 111 Design Current
Swine- Capacity Pap. W.et Poultay.. Capacity Pop.
Design
Cattle Capacity
Current
Pop.
Wean to Finish
La er
Da' Cow
Wean to Feeder
Non -La er
Da Calf
Dairy Heifer
Feeder to Finish
Design Current
D : Paul"-:. - Ca aci P,o
Farrow to Wean
Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Pullets
Turke s
Beef Feeder
Boars
I
113eef Brood Cow
othe
Other
urkey Poults
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes Io ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes [:]No
❑NA ONE
❑NA ❑NE
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 IL!J "" ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes J2,Ko ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

1;
Facili Number: Date of Ins ection:
Waste Collection & Treatment
` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
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 'W No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes K No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window []Evidence of Wind 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
�2 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
21 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 P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes V�3 No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - / Date of Inspection: — $ = /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes M No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Co 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 file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [g No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes No
[:]Yes No
❑ Yes W-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
( 9 P Y y bons or any other cainments'.
Uses jdrawm .
omments of tacditye#o�be'ette�r,Eezplarn ituations use add bonaf an �d$drt�o s ernm�menda : 1 J H
Reviewer/Inspector Name:
Phone: 33— 3-3 3a
Reviewer/Inspector Signature: / Date:
r --
Page 3 of 3 21412014

7
� rvi'sioa of Water Resources
Facility Number ®- /jam OO Division of 5ai1 and Water Conservation
•0 Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: - /�5 Arrival Time: . Departure Time: K County: ay�--� Region: �.'
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Z5 a ac_ ff Title: n ,t Phone:
Integrator:
Certification Number:
Onsite Representative:
Certified Operator: sa=&=
Back-up Operator:
Location of Farm:
Latitude:
Certii'ication Number:
Longitude:
Design Current
Design
Current
Design C•nrrent
Swine
Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capacity Pap.
Wean to Finish
D ' Cow
Wean to Feeder
~-J —
"jL:jENon-L:a]yer
I
IDairyCalf
Feeder to Finish
100
jDairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Dr, Paul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
$oars
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?
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 Co No
❑ Yes ®--No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

F'aciliNumber: 7 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in): _y
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
;B-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
C&No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
RNo
❑ 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, andlor 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
ENo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes L&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): J(%B /<
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 12g-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes allo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes 2.No ❑ NA ❑ NE
[:]Yes 2�No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [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 La No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes P No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5aNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[:]Yes
® No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
EQ No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[R No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
®. No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O 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
0 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
UZI No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Eij No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E roo
❑ NA ❑ NE
Comments (refer to question #)"Eiipiarn•any.YES answers and/or any additional,recommendations:or any other comments.^ ter'
Use drawings of facility to: better.explam;sittiations {use additional pages as necessary)., .
Reviewer/Inspector Name:
Phone: 3�vo
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

4
■ ype ui v t5it: ll %.umpuance inspection V vperanon Keview V structure Evamanon Lj i ecnmcai assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: J5W-- Region:
Farm Name -.__�z r nj y /-p�ri�%a r.n� Owner Email:
Owner Name: -51-ri Phone:
Mailing Address:
Physical Address:
Facility Contact: ��Sa j 1 K g� r��--� Title: g2tW ope ro'- Phone:
Onsite Representative: Integrator:
Certified Operator: = Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
@urr 0
Design Current
Swine
Ca aci Po
P ty P•
Wet Poutt .
t7'
Ca act
P t3'
Por-'
P
Cattle Ca aci Po
P ty P-
Wean to Finish
La er
Dairy Cow
Wean to Feeder
- —
Non -La er I
Dairy Calf
Feeder to .Finish
Dairy Heifer
Farrow to Wean
D • P,oul
Design
Ca aci
Ci'rrent
1',0
Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Non -Layers
Beef Feeder
Gilts
Boars
Pullets
Turke s
Beef Brood Cow
Other
Turkey Poults
Other
Other
y
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [-]Yes [:]No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [-]Yes ZI No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [-]Yes 21 No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Confirmed

Facili Number: - Date of Ins ection:
1 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes MNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in): 1—
Observed Freeboard (in):
Structure 2
❑ NA ❑ NE
❑NA ❑NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
[:]Yes 0 No ❑ NA ❑ NE
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
[2 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the pern it?
❑ 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
M 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 JQ 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): 111 Y rs
13. Soil Type(s): D/6 & A� 4 ar0
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CE�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E, No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 10 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes 19 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes C&No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
MNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Z_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
CO -No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
� N0
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C�[No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Ins ection: 03--
1 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C3:No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes N—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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28.'Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
[A No
0 NA
❑ NE
❑ Yes
CR No
❑ NA
❑ NE
❑ Yes
0,No
❑ NA
❑ NE
❑ Yes �g No ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes Ea No ❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
[:]Yes
0 No
❑ NA
❑ NE
Comments (refer to question.# Explain any YES answers and/or any additional recommendations or any other commentsk
M". 5
Use drawings bf.facility to 6etier explain situations (use additional pages as necessary).
_ _..
Reviewerllnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: % 2 o "K3� __7�JDCD
Date: :5 -- & ;W�
21412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (tine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: � Arrival Time: Departure Time: t County:
Farm Name: A ealv teo"I Owner Email:
Owner Name: _SSG j; /,r ��/ Phone:
1,7
Mailing Address:
Physical Address:
Facility Contact: �%���ira ��ri ��,. �� y Title: �LtJirt+r Phone:
Ousite Representative:
Certified Operator:)
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region: (�
Design Current
Design Current Design C•nrrent
Swine
Capacity Pop.
Wet Poultry --' Capacity Pop. Cattle Capacity Pop.
Wean to Finish
La er Da Cow
Non -La er Da' Calf
Wean to Feeder
~ C' -
Feeder to Finish
S`
DairyHeifer
Farrow to Wean
Farrow to Feeder
Design C_nrrent Cow
OFF, P.oult . Ca gcity ' P,o Non -Dairy
Farrow to Finish
Layers Beef Stocker
Gilts
Non -Layers Beef Feeder
Boars
Pullets Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes CK No ❑ NA ❑ NE
[] Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [&No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection:
i Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
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 C& No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes CK 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 rM No ❑ NA ❑ NE
maintenance or improvement?
i l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 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):/LI v�e��rr� % &rAc�jj,
13. Soil Type(s): nL62&
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 Q No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E, 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?
Required Records & Documents
❑ Yes RNo ❑ NA ❑ NE
❑ Yes 24 No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EQ No
❑ NA ONE
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 I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
2Q No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
PQ No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: _ Date of Inspection: /1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes HjNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge'? If yes, check ❑ Yes g No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey .[:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [g No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [$ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
® No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
P1 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
[LNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[R No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
R No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
;K],No
❑ NA ❑ NE
Comments{refer to question #)::Explain 'any YES answers and/or any additional recommendations or any"other coiiiments���
Use drawings'uf facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:,- ��,��— Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011
.n

(Type of Visit: CrCoce inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
C9"R I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: / Arrival Time: 4 7 Departure Time: County: r­ Region: _(
Farm Name: e-- C 5&nr�Qr Owner Email:
Owner Name: l Phone:
Mailing Address:
Physical Address:
Facility Contact: 47c— `rt /•r Title: .49{,�fy� ro� Phone:
Onsite Representative: �,ti,t�
Certified Operator: fd
Back-up Operator:
Location of Farm:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Vet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pap.
Wean to Finish
La er
Non -La er
D z PLoutt ,
DairyCow
Wean to Feeder w`
Design Current
Ca aci P,o -
DairyCalf
DairyHeifer
Feeder to Finish D
Farrow to Wean
Farrow to Feeder
D Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
QQther
Turke s
urkex Pouets
Other
Other
Discharges and Stream imoactsand 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 [0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
[:]Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - S [Date Ins ection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No D NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® 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?
[a Yes
4a
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑/ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): )P5 G it
13. Soil Type(s): Ll�1C [S'70rg
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 RNo ❑ 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?
Required Records & Documents
❑ Yes MNo ❑ NA ❑ NE
❑ Yes [0-No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Callo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Wo
❑ 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
❑ Rainfali ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
SL No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 9 - Date of Inspection: 3 — to — 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes allo
the appropriate box(es) below.
Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? Yes ®,No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes RNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
�NA NE
NA NE
E]NA [DNE
[] NA [] NE
Yes �,No NA [] NE
Yes [a No NA NE
[] Yes (Q No NA NE
Yes [Z No [] NA 0 NE
Yes
® No
E3NA
NE
Yes
g�[ No
NA
NE
[:]Yes
[-No
❑ NA
[] NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or any other comments a
Use drawings of facility to betterexplain situations (use additional pagesas necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 3�—� _ ;7— 0
21412011

Type of Visit
'nee Inspection
oZUune
Q Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
0 Complaint
O Follow up Q Referral O Emergency
Q Other ❑ Denied Access
Date of Visit: I& I Arrival Time: �fl2 Departure Time: ; fl D County: `� x'r Region:
Farm Name: Owner Email:
Owner Name: _T .5.5 a_G Phone:
Mailing Address:
Physical Address:
Facility Contact: •t �' Title: H re` Phone No:
Onsite Representative: sue"^-�— Integrator: � �9�
Certified Operator: Operator Certification Number: 1 to3 y�
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ o = 1 = u Longitude: 1:1 ° =
Design Current
ity Population
Desigd}Current
r 1r.
Wet PouitryCapacityPopulation
Design Current
Cattle Capacity Pto
Finish
FFe
❑ La er
❑ Dai Cow
to Feeder
`� 0
❑ Non -La er
❑ Dai Calf
r to Finish `D
3T��
Dry Poultry
` '" `
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ La ers
❑Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey1'oults
❑Other
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Beef Brood Co
Number of Structures:
-
Other
❑ Other
Discharges & Stream Impacts
I. 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 69-No ❑ NA ❑ NE
❑Yes
[:]No
❑NA
El NE
[I Yes
El No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
JK No
❑ NA
❑ NE
❑ Yes
CZ 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?
[j Yes
R] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /9'
Observed Freeboard (in): .31
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZR No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
J&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 El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Jglo ❑ 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
0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
5?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) j J a A / c4
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
I.No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
E.No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes
[9.No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
J9 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
E�No
❑ NA
❑ NE
ReviewerA nspector Name I .S' f I Phone: /p-
Reviewer/Inspector Signature: Date: -Z p ,;Zo I
Page 2 of 3 12128104 Continued

Facility Number: — g' Date of Inspection .}70_ 1 j
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IM No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes BNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® 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
® No
❑ NA
Cl NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EANo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E-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
B No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
®No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CgNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E,No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
®.No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit �mpliance 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
Date of Visit: -D��/D Arrival Time: %��s�'^' Departure Time: �, bQ �.a County: 4 �lda'C� Region: �r`C/
Farm Name:— F"'—e"'1-!2, 'FfiaNt.L - Owner Email:
�saG Sifx��t�h Phone: Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: S,2r_ S:vc% .r�., Integrator: 6� z
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 I= u Longitude: ❑° 0 i 0 u
Swine
Design Current
Capacity Population
Wet Poultry
Design Current
Capacity Population
Design
Cattle Capacity
Current
Population
to Finish
❑ La er
❑ Da Cow
to Feeder
Q
❑ Non -La er
❑ Da' Calf
r to Finish
❑ Da' Heifer
w to Wean
❑ D Cow
w to Feeder
❑ Non-Dairyw
to Finish
EBoars
La ers❑
Beef Stocker
❑ Non -La ersPullets❑
Beef Feeder
❑ Beef Brood CoTurke
swl
❑
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes L'7 No ❑ NA ❑ NE
❑ Yes ❑ No E iVA
❑ NE
ElYes ❑ No NA
❑ NE
❑ Yes ❑ No ETNA
❑ NE
❑Yes EK0 El NA
[I NE
❑ Yes 30 ❑ NA
❑ NE
Page] of 3 12128104 Continued

Facility Number: b
Date of Inspection _ol<' IO
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: _ L '� / Las• Z
Spillway?:
Designed Freeboard (in):,v�.wcn+,nr
Observed Freeboard (in): i- 3
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 ,EJ'No ❑ NA ElNE
ElYes L7-No ❑ NA ❑ NE
Structure 5 Structure 6
❑Yes �o [I NA ❑NE
❑ Yes 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 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ffNo ❑ 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 El Yes II'ivo ❑ NA ❑ NE t
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑Ko ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? I f yes, check the appropriate box below. ❑ Yes ljo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ 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) G [3evn- G�,•� �4.�, LO S,
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ET-N-o NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes LTNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q-5-5 ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
C mirtents q )
p y s. _ , .y .Y
(refer to . ueshon # Ex lain an YES,answeirs and/or an ,recommendations or'an other comments.
Use drawings of fad ity.to better explain situations (ns�e;additional„pages as necessary)
Reviewer/ins ector Name 'Phon .
P ► c:..
Reviewer/Inspector Signature: Date: g-Of%2D/D
12128104 Continued

Facility Number: Qg —fig Date of Inspection —oi�—lam
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
ElYes
2<0 ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
LSNa ❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ 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, [I Weather Code
22. Did the facility fail to install and maintain a ram gauge?
❑ Yes
a<0 ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o ❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,E
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
;<o ❑ 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?
El Yes
,T
LTNo ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWM P?
❑ Yes
No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B o ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ffNo ❑ 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
o A
El
33. Does facility require a follow-up visit by same agency?
[I Yes
:!No❑ NA
❑ NE
12128104

-Bswts /0-09 -zou9
Division of Water Quality
Facility Number o9 E
O Division of Soil and Water Conservation
- a Other Agency
Type of Visit 015ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 9 : Z/d Departure Time:, SS County:
Farm Name: _ G�y �+rQNC.l, ALV wt Owner Email:
Owner Name: —. �5 Q(.„ SinlSi j _ Phone:
Mailing Address:
Physical Address:
Region: ��0
Facility Contact: —:7SSatG S,W4&jVtti Title: Phone No:
Onsite Representative: SSSriL SfI�/� /t fo ✓ Integrator: /K Lc� P41,V
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: 0 0= I 0 u Longitude: = o=
Design Current Design Current
Capacity Population Wet Poultry Capacity Population.
❑ Layer
st7 ❑ Non -Layer
❑ Wean to Finish
_
Wean to Feeder
Feeder to Finish
S
El Farrow to Wean
El Farrow to Feeder
[I Farrow to Finish
❑ Gilts
El Boars
Other
❑ Other - - -
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
❑ Turkeys
El Turkey Poults
ElOther
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: El Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Currt ni
Cattle Capacity Populi io
[:]Dairy Cow '
El Dairy Calf
El Dairy Heifer
ElD Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
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 0 No ❑ NA ❑ NE
❑ Yes ❑ No 6NA
❑ NE
❑ Yes ❑ No 2 NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes CJ No ❑ NA
<
❑ NE
❑ Yes ❑ NA
❑ NE
12128104 Continued

Facility Number: Q — /gS
Date of Inspection 7-2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,_, NNoo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes B< ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: la2—
Spillway?: a /IZ7
Designed Freeboard (in): ,t7r`p 19
Observed Freeboard (in): 2 Jr'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No A ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed []Yes U FIB O ❑ 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 4 notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes ❑ NA El 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 Lr No ❑ NA ❑ NE
maintenance/improvement?
I I . 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
JDrifl/❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)4�.v.5
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ffNo ❑ NA
l"NNo ❑ NA
O No ❑ NA
XNo ❑ NA
No ❑ NA
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
4 1Yo 30$•1,BS)
Reviewer/Inspector Name ; �; /C tae�[i S Phone: q/O, X-73. 333 y
Reviewer/Inspector Signature: Date: 7—Z �ZC1D
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
12125/U4 [,onnnuea

Facility Number: Og — /gj I Date of Inspection -AIV -041
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WllP El Checklists El Design El Maps El Other*
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Yes L7No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes L1 N El NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes No ❑ NA ❑ NE
❑ Yes �`No,
NA ❑ NE
El Yes
El NE
❑ Yes❑ NA ❑ NE
❑ Yes
Cj`No
ElNA
❑ NE
ElYes
��OEINA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
12128104

Type of Visit OIXornpliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit tOoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: Departure Time: F, a ► q0 County: B 1Q Region: _
Farm Name: U Owner Erna'
qjp - o
Owner Name• S Phone: 101 T72-3122
Mailing Address: 7 77 K 1 Ulltul0?kk- _ _ �n b" a Aga o
Phvsical Address:
Facility Contact: SQ SI Title:
Onsite Representative::
Certified Operator: IvIAd— S�
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: A WA 1068 _
Bach -up Certification Number:
Location of Farm: Latitude: 0 0 = 1 = " Longitude: 0 ° = ' =
r
Dest n.
Current
Design Current
Design Current
Swine z w 'c ac�ty
.Population
Wet Poaltry Capacity Population
Cattle Capacity Population
Finish
❑ La er
❑Dai Cow
Fto
to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish410 LID`s
3
El Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑
El Beef Stocker
N on -L
❑ Non -Layers
❑ Beef Feeder
PGilts
Boars
ts
Pullets
El Beef Brood Co
❑ Turkeys
Other a.
❑ Turkey Pouets
❑ Other
❑Other
Number of Structures:
...
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ 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
ERNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
SIN
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

r
Facility Number: — 10Date of Inspection!�!un t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EgNo ❑ 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): P? -
n f {{
Observed Freeboard (in): :)L(p _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CR No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
JKNo
❑ 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?
JQ Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
EffNo
❑ 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
C'No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Wo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below,
❑ Yes
RNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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)
t6Ure ; gleYM4 . ' S6 ov4-s>ai .
13, Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JKNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
R 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
VrNo
❑ NA ❑ NE
Comments (refer to question #): Explainand YES answers and/or anv recommendahnns or any other comments
�.
Use dravFtpgs'of facility to better explain situations. (use additional pages as necessary)'
Reviewer/Inspector Name l s�lle',.�� Lac Phone: I112 �#33-330
Reviewer/inspector Signature: %44., Date:
Pape 2 of U 12128104 Continued

Facility Number: Oq 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 ER 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 RNo ❑ 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 W No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No IR NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�SrNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
10-yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
PRNA
❑ NE
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5d No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
MNo
❑ 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
ER 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
5d 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
E'No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
CgNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
3.O►vni@­ harOffl,'4_ -o MRCS icer bac¢ofv to f ox�i-�gp •
sfrees, 4� Itot'n, +lar nodY;� hp� b ck,
�
q, ifst lo�ool ~F[oK I sect ��, sfvjj, 'N-i sPc&d_
7, D ► �v nod_ m � Gand caper 01 a I I bL,+ ha lfo� C� wa��
N i m prose. l-�hon new hcyh&&e,,
, Vi f l oft L call bra-6 T., December aoog . �
sjv �Svl �� nest da,e If) DOO-7, Vvill issi/e Vov, P6,e.do . ASAO -01
� � 01n 7
L 7`
OrA , Ikrewj
12128104

G
Facility No. ��0� Time In Time Out Date
Farm Name lReate p/G�1 Integrator
Owner Site Rep
Operator
Back-up
COC
No.
No.
Circle: General or NPDES
Design
Current
Design
Current
Wean - Feed
Farrow - Feed
Wean - Finish
Farrow - Finish
Feed -- Finish
Gilts / Boars
Farrow - Wean
Others
FREEBOARD: Design
Sludge Survey to 4,v�Vkdv !L _
Crop Yield 7,$-yf+ � ! �`
Rain Gauge �u� ��
Soil Test
Weekly Freeboard _
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
Wettable Acres _
- Daily Rainfall
120 min Inspections
Date Nitrogen (N)
Observed
Calibration/GPM I
Waste Transfers
Rain Breaker
PLAT
1-in Inspections
Date Nitrogen (N)
9 s -,.3
� aD &) 30
/`b7 1 404-0 So1(LI'j` V-4TW L7 q rV V
u• � -� �l��n4n o

4
0 Division of Water Quality�/ �%✓
Facility Number �"J 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit GrCompliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Q'ifo--utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: —O Arrival Time: ; //3 Departure Time: �P ; 3a County: 11L Region: r�
Farm Name: C' ed 4r�t ch 4e r. - Owner Email:
Owner Name: �� {� S'; ��L /4 /7� Phone:
Mailing Address:
Physical Address: �-
Facility Contact: �' �rctG �,`rs/ �+'y Title:
Onsite Representative:
Certified Operator: - �—
Phone No;
Integrator: �� ✓ �1
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o ❑ , 0 « Longitude: ❑ o E__1 ' = u
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
5-O —� ` ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
El Pullets
ElTurke s
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El Dairy Cow
❑ DairyCalf
❑ DairyHeifei
❑ D Cow
ElNon-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [$ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[RNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12128104 Continued

Facility Number: - S Date of Inspection
r
A
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes Q§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: '4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): /
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes RNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ;KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 54 No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[0 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) _f-e,,C U4&errrt ujaaPJd�r�S���
13.
Soil type(s) _:R &' n 5
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
[allo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
® No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
EgNo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
5a No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
�&No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
I}?I Sin �e % d` �- Surypf' Du vas ?UD S it re ram' k
or
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: - / - p
12128104 Continued

4+ Facility Number: -- tj' Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (Z No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 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 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
fKNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
H No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W 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
R No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
RNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
®No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
91 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
[RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
IgNo
❑ NA
❑ NE
Additional Comments and/or
12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 41 routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / Q Arrival Time: Departure Time: ,� yr County: Region:
Farm Name: ���d��(�/'st�� Q P, Owner Email:
Owner Name: —� �5 a ac jr; Z,Q]at Y Phone:
Mailing Address:
Physical Address:
Facility Contact: _Z ,2QG._ __5�)r19 4 01-7 T Title:
Onsite Representative: 515 �-
Certified Operator: 5Aff:f —
Back-up Operator:
Phone No:
Integrator: ji�
Operator Certification Number: ZZ, T29Z
Back-up Certification Number:
Location of Farm: Latitude: = n 0 I 0 u Longitude: = ° =' 0
urrent Design Current
Wet Poultry Capacity Population
OMNI
Design C•iirrenulation
Cattle Capacity Population
❑ Wean to Finish ❑ La er
B Wean to Feeder 10 Non -La er
_
❑ Dairy Cow
❑ Dairy Calf
Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Dry Cow
ElNon-Dairy
❑ La ers
❑ Farrow to Finish
❑ Beef Stocker
❑ Non -Layers
❑ Gilts
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Boars
El Pullets
❑ Turkeys
Other ❑ Turkey Pouets
❑ Other ❑Other
_
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
U�No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
A 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
DqNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
R No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection t­
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 19 No ❑ NA ❑ NE
the appropriate box. ❑ W UP ❑ Checklists ❑ Design ❑Maps El Other
2 L - Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ES 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 NJ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J4 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[Z No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[KNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
g[ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C:No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® 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
[RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
10 No
❑ NA
❑ NE
Additional;Commentsiand/or Drawings: -
Page 3 of 3 12128104

• {
Facility Number:
Date of Inspection
Waste Collection & Treatment
` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ANo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
RNo
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J9
5. Are there any immediate threats to the integrity of any of the structures observed?
[:1 Yes
R] No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Z No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® 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
ERNo
❑ 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) -r_tmuiilncyy��%Q
13. Soil type(s) Qr� Z�'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
NNo
❑ NA ❑ NE
15. Does the receiving crop andlor land application site need improvement?
❑ Yes
5d No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
9 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Lallo
❑ NA ❑ NE
rCommen:6 (r`efer to question #): Explain any YES answers andlor any recommendations or any other�comments
Use drawings of facility to better explain situations. (useadditional,pages as necessary):
;tea
i T N ,� �la��►-t
C� . 1�1 t�,G $F
Reviewer/Inspector Name I Phone: 4�7/0 - 3.30(�>
Reviewer/Inspector Signature: Date: S° (d
rage 16 u) -3 I Z11601 4 a.usssnaea

E
Type of Visit gCoompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (D Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �� �� Arrival Time: 1 �S �✓f Departure Time: ? �S County: Region:
Farm'Name: r ld �7RQM Owner Email:
Owner Name: y4L o Phone:
Mailing Address: IrZ2L L pJ d �. 10
Physical Address: 5A A t__
Facility Contact: �`. Ate- ` Nq C fka-N Title: Q!LJ >:]�_ _ Phone No: I /1>-& /fr
OnsiteRepresentative: ` 4 Integrator: 00A.4 _ y5r�!t� Cam_
Certified Operator: �r �!k Operator Certification Number:
Back-up Operator: '1i4k L �74� Back-up Certification Number:
Location of Farm: Latitude: [= o Longitude: = ° E
S" ine
Design Current Design Current
Capacity Population . Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
ZD(�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
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 KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
ONE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
12128104 Continued

r
Facility Number: 0 ef— 5 Date of Inspection iZ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes A 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 A No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes kNo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
k�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
XNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
X,No
❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
XNo
❑ NA
❑-NE
Gouuments (refer to question #} yExplaua
AeR,
Use drawings of facility to betFer"eaplam
any 7GESanswers and/or anecommendations or any other comments,
.. �,� s ..: em s..
sitteations,{use ad"di#lonal�Pagesast nary
Reviewer/Inspector Name
Uj ' ? t ' Phone: Als`t
Reviewer/Inspector Signature:
Dater 23�OS
V 12128104 Continued

1 Facility Number: — Date of Inspection
Reed Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes KNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
)KNE
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
XNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
gNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
XNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ 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
XNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Additianal C&rnments�andlor Drnwings:
12/2&04

of Visit 4D Compliance Inspection O operation Review O lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number �� of Visit: Time: g? 3 a_
O Not Operational Q Below Threshold
Permitted UtCertified Q Conditionally Cetifi
rred [3 Registered Date Last Operated or Above Threshold:
Farm Name. �':�... b c .. -
_W...... ^ _ -- - - - - County:
onn : �--
Owner Name: � SS�u S � � � Phone No:
? tUmg Address:
Facility Contact: ,.- iC �Ittle• Phone No:
Onsite Representative: - LS,S..t 1 sr. I - Integrator: -'
Certified Operator:- 2�1S eAm ..5E Operator Certification Number.
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • u Longitude • d
J.Desi =-Cnent
Swine _ Caicrtv.-:Penalatien
Wean to Feeder
-t5b
Feeder to Finish
O
3
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Disc arFes & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes &No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ yes ❑ No
c_ If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ®'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes FINo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Wo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I S}" -U �
Freeboard (inches): of vi
12112103 Continued

Facility Number: Date of Inspection I o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IR No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes nNo
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 maintenancefunprovement? ❑ Yes ®.No
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes RNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
Waste Application
10_ Are there any buffers that need maintenancelrmprovement? ❑ Yes RtNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes W_No
❑ Excessive Pending ❑ 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 (CAWWP ❑ Yes RNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Z No
b) Does the facility need a wettable acm determination? ❑ Yes IgNo
c) This facility is pended for a wettable acre determination? ❑ Yes ®No
15. Does the receiving crop need improvement? ❑ Yes [Z No
16. Is there a lack of adequate waste application equipment? ❑ Yes H No
Odor /sues
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 RNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ERNo
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 JdNo
Air Quality representative immediately.
❑ Feld Copy ❑ Final Notes
-4_ Pf co-5 e— w aw d.et.ux -�� w-ceo-S a ro v.,A d-e. Se-c.-4� k&CA00 w
aA- 'tOVC- C ar l '� r-s+
Reviewer/Ynspector Name
ReviewerAW Spector Signature:
cz v% J e.K i eAA-C e .
Date:
71 /77M2

FacilityNamber: — /B Date of Inspection
Rewired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes )KNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ Yes ELNo
23. Does record keeping need improvement? If yes, check the ropriate box below. [I Yes 0,No
❑ Waste ApplicatioV❑ FreeboarVO Waste Analysir❑ Soil SamplinV---
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes %No
25_ Did the facility fail to have a actively certified operator in charge? ❑ Yes SLNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes JHNo
27. Did ReviewedInspector fail to discuss reviewimspection with on -site representative? ❑ Yes 19 No
28. Does facility require a follow-up visit by same agency? ❑ Yes O No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP7 ❑ Yes C&No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes %No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
12112103

5
1
DSWC Animas _Feedlot Operation Revlew ar3
a s. � -, ,- ,: � �� der<-,z�s -•;»,,,� � _^,�vsE�'�..,x, - a ,�,^4^ ""`"`"`�a� � - � -„ '- .
5.v'JZ
_ � DWQ Animal Feedlot O
Vera t16n,,Site Inspection
4
• Routine ' Q Complaint O Follow-up of DWQ inspection O Follow-up of DSNVC review O Other
Facility Number
Date of Inspection
O
Time of Inspection 24 hr. (hb:mm)
Total Time (in fraction of pants
FarmStatus. ❑Registered ❑Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
VCertified ❑ Permitted or Inspection includes travel andprocessing)
ONO Operational Date Last Operated:
Farm Name: County: ��'_. ..... ..
Land Owner Name;. .... .... _..... _.......... Phone No: s!�_ .... _ .... .........� _
Facility Conetact:... /. ,eG�� f Title: ......... _/.. _ .... .. _ Phone Flo:...._.__
Mailing Address: 7... ,fSdCr._. ,�Q� ..1.._.d �... �.
Int a#or:
Onsite Representative:. ..G••,,... ..... egr .............. _ ...... _....._.... __.....
�"-� _ .
Certified Operator: !�" . .. Operator Certification Number:
Location of Farm: x-.
:..... �.._�.... ..... ..... __ ..� _......... ...... _.-- __... _... ........................... .._....._ _ aQ
Latitude 0 4 Du Longitude • 4 I�G
Type of Operation and Design Capacity
: �� : au CDa aci r, P.o maxu, ls�t*hiozn 'nf Po�u.ltr-ymvs�z Ca aci +„P,�o ii.,�lxatt,aan ,�,.,y x CatR'tle r.snCen;
esgCrr0e5gICOrlent a^igl3zr: r'�t
SWine §4,
wC` Pa ulatioaa
n�
Z
iff Wean to Feeder S-b ` RNon-Lavex
" ❑ D
Feeder to Finish „y. ❑ Non-Dairy
r Farrow to Wean s `' a
Farrow to Feeder TotaF.Di ign Capacity, "k` k
Farrow to Finish
❑ Other
"�'�W..'� s` ...--n^xf;'a. ,�--!eT.+�t4, � t .. �,. 3zn< �s >-.:<Y=.,....`q,.,'+�.�.. •��-.�3 �#-,. :hY..� 3'F6xs �,�.#.>.. '� MS",3'. .+.,�- ,y}�ry.,.
��Nnmber of LagaansI�Holdiag�Poads Z ❑ Subsurface Drains Present
10 Lagoon Area ;; 10 Spray Field Area
Hera
1. Are there any buffers that treed maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes . 4o
b. If discharge is observed, did it reach Surface Water`? (If yes, notify DWQ) ❑ Yes KNo
c. If discharge is observed, what is the estimated flow in gal/inin?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ yes JkNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes )kNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes �$'No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes /ZNo
4/30/97 maintenancelimprovement? Continued on back

uprillty Number ..0.. —..
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ANo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes )kNo
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes )KNo
St�uctnres {Lagoons and/or Holdin0 Po�dsl
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 'IWo
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
10. Is seepage observed from any of the structures? ❑ Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes XNo
12. Do any of the structures need maintenance/improvement? kYes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? IWYes ❑ No
Waste Application
< `
14. Is there physical evidence of over application? ❑ Yes 0 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ) �.
15. Crop type .............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes KNo
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes Ko
18. Does the receiving crop need improvement? ❑ Yes WO
19. Is there a lack of available waste application equipment? ❑ Yes ANo
20. Does facility require a follow-up visit by same agency? ❑ Yes ANo
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes 4lo
For-CertifiRd Facilities
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 N No
24. Does record keeping need improvement? ❑ Yes Wo
Comments (refer to gaeshon �Ezplain any YES answers and/or.'any;.recommeudahons'or any other comments
Use drawings of facility to better explain situations: (use add�honal pages as necessary) r '
Reviewer/Inspector Name
Reviewer/inspector Signature: Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97