090189_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

type of Visit: (-Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Dunne O Complaint O Follow-up Q Referral O Emergency O Other Q Denied Access
Date of Visit: ! / Q I Arrival Time: /Deeparture Time: ,' a C7 County:
Farm Name: 1 c �r,7��I✓-Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
1-z�•dr---� Region: C�
Facility Contact: ja% Title: _ ��/� f Phone:
Onsite Representative: �l�C sus ;j Integrator:
Certified Operator: ��r'`�� Certification Number: 3�3
Back-up Operator: Certification Number: �-E/Z!'3
Location of Farm: Latitude:
Longitude:
Design Current
Swine Capacity Pop.
T Design 'current
,.
Wet Poultry `l Capacity ;Pop.
I a: R:
Design Current
Cattle Capacity Pop.
airy Cow
Wean to Finish La er
Wean to Feeder vD D
Non -Layer
airy Calf
airy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Des�ga 3Carrent
D ,Poult ;.Ca act l?o
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Farrow to Finish La ers
Gists
Non -La ers
Boars
Pullets
Turkeys
tJther
Turkey Pouets
Other
Other
Irt+Y.uIS'fl'ill�-
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 DW R)
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 0 No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑Yes ❑No DNA ❑NE
❑ Yes ❑ No
❑ Yes J.No
❑ Yes JZ] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

11pacilityNumber: jDate of Ins ection: j
Waste Collection & Treatment
,14. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CS -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 D�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 4No
❑ 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 JNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 2LNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Fq.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phospborus ❑ 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): 137-r�.yr vf%a_ f LJ v r-�3 r-Ij
13. Soil Type(s): ui,•t t-/ !J_1_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3—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 [�]' .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
[RNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
R No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Dd 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. JoLyes o ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[:]Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M-No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E]-No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

i
J.Facility Number: jDateof inspection:
ry 4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes r❑<.
125. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E�J No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [a No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Q No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29_ At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes Va No ❑ NA ❑ N E
❑ Yes RNo O NA ❑ NE
❑ Yes SNo [:]NA [:]NE
❑ Yes L.FO —No ❑ NA ❑ NE
❑ Yes M No
❑ Yes .LNo
❑ Yes tgNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (referjtoLgvestion #) Explain any=YES answersFsnd/or suyr a• Lions or an other ana n "`
i_. - .i n p� ddItlonal I nOinlilendfl y li nil it
Llse dirawings.of Wirt., to;better exptal:n'sity' ations (i�se addrtlonal es as necessa .,
q i
./
die 7Z Gv: T� ✓ G����.rsis
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

Type of Visit: -U Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: p Departure Time: ; DO County: - ,q�� Region:
Farm Name: W4Z49 —� 5-77 i- Ler/MOwner Email:
Owner Name: U) �� �( _ Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator: Sf,S a.•�� Sjyl.;
Title: �pt r*/� Phone:
Location of Farm: Latitude:
Integrator: 9,9
Certification Number: 3.3
Certification Number: 2-9/ 723;
Longitude:
Design Current-
Design Current..s.. Design Current
Swine
Capacity Pop. Vet Poultry
Capacity 1'op .Cattle C•apxcity Pop.
Wean to Finish
Layer
-
can to Feeder Non -La er
Discharges and Stream Impacts
. Is any discharge observed from any part of the operation?
Discharge originated at: ❑Structure ❑Application Field El Other:
a. Was the conveyance man-made?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �] No
[]Yes No
❑ Yes LELNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page
1 of 3 1/4/1015 Continued

'FacilityVacility Number: - Date of Inspection: — f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes Callo ❑ 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): C_J a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes li 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
Callo
❑ 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
T Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q�_No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E[ No
❑ NA
❑ N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
RNo
❑ 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):
13. Soil Type(s): G
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E,No ❑ NA ❑ NE
l5. 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 fallo ❑ NA ❑ NE
acres determination?
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
�g No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
g No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22_ Did the facility fail to install and maintain a rain gauge? ❑ Yes Z No
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5K[-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ONE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 7 - ! = Date of inspection: -3-- r-- 17
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes gNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge 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 [a No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CE�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Q4 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [a No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
[:]Yes ® No
❑ Yes ® No
❑ Yes RLNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Ve"Akkwi
mments (refer�to"gtiestron #) Eapla�n any YES answers and/or any additional recommendations or any other -comments.
. arm r w9 ,.
ings of fac ety to;better,.,e lain�sitaahons ftC additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/inspector Signatui
Page 3 of 3
Phone: 2 `30-!�
Date: 3—'3
21412015

L--' qfS- `f -,-�7,V r6
Type of Visit: (D^C-ompliance Inspection O Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: c7 r7 Departure Time: D County: Xk,&4— Region:
Farm Name: rjf�''~' Owner Email:
Owner Name: /J1T Phone:
Mailing Address:
Physical Address:
Facility Contact: %(/uy�i—��i`'� Title: Phone:
Onsite Representative: C 5 - Integrator: r P-01-4
Certified Operator: r Certification Number:}33
Back-up Operator: �u 5�w� ��jj�-f +`' Certification Number:
Location of Farm:
Latitude:
Longitude:
Desigp
Swine Capacity
Current_. Design Current -_ DesSGuient
Pop. Wet Poultry Capacity Pop. Cattle Capap.
La er Dairy Cow
Wean to Finish
Wean to Feeder la Vjo
Yqvp
-Layer
Dairy Calf
Feeder to Finish
D , P,oultr Ca aci 1'0
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
rj0ther
Turke s
Turkey Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes �o ❑ 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 DWR) ❑ Yes [:]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [-]No
❑ Yes ®No
❑ Yes C& No
❑ NA [] NE
❑ NA [] NE
❑ NA ❑ NE
Page 1 of 3
21412014 Continued

Facili Number; - Date of Inspection:
— G
Waste Collection & Treatment
,. 4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
KNo
❑ 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):7
Observed Freeboard (in): 4299'-
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
[21.No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
allo
❑ 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
[FLNo
❑ 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 [ZNo [DNA ❑ 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
l 2. Crop Type(s):rmf(
13. Soil Type(s): _ K V
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 n No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Z[No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes C No ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes [El 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 [Z 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 IDC No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA [] NE
Page 2 of 3 21412014 Continued

[Facility Number: - Date of Ins ecfion: �-3 ` 1 Q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes D4 No ❑ NA ❑ NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Q No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes � No [] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes (3 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No
[-]Yes ® No
D Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question-.#) Explain any YES answers and/or :any�additional,recommendations or any�othericom
13se:drawings of. facility tabettertezplaim situations (use iiddihonal; pa j e ' necessary).
,s7, w..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: J`33 L
Date:
21412014

w
I
(Type of Visit: Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: QYfo-utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: _ D Departure Time: . O County:1�
Farm Name: W'yInt SK ��-,.t- Sjyrr' i Imo_ _ Owner Email:
Owner Name: ', v �I71 •` Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: / Title: 11-eilpl •'' Phone:
Onsite Representative: Integrator: f Legg "U—
OF
Certified Operator: lz�K Certification Number:
Back-up Operator: f `�4i+�'y Certification Number: g 2 % % 03
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
I JNon-Layer
i) , P,onl
Layers
Non -Layers
Pullets
Turkeys
Turke Poults
Other
I
Ca aci
Ro
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
lBeef Stocker
Beef Feeder
113eef Brood Cow
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes n No [:]NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes [:]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [&No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes [allo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

• Facility Number: - Ds ection: — /
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 ❑ 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 J4 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
[8 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
EK No
D 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
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
n No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ®..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
/lWindow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): / 4-✓ri^S7'j
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes $g No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes G,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
gjNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Rj No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ 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
gNo
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[]Other:
2). Does record keeping need improvement? If yes, check the appropriate box below. Q 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 10 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

• FaciliNumber: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EA No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [?_@ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [—]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
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?
[:]Yes
[&No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes KNo ❑ NA ❑ NE
[—]Yes B No ❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
❑ Yes F1 No
❑ Yes No
❑ Yes .03.DTo
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer pestion #I): Explain any YES -answers and/or any additional recommendations or any :other coptments _' #
nu }
Use drawings: of facility.to better explain situations (use additional pages as necessary):` s
2-4 s 7 7
�7W <2f)1,5-
ReviewerlInspector Name: '� /-r, ---e_ - (S w
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 4;Q 330c7
Date:
21412011

3-31-1
Type of Visit: C;�.CoZutine
nce Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: �13- Arrival Time: ; Ofl Departure Time: ; vv County: Region:��
Farm Name: /I -cf fS14-5 /yr. C: /* -L- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
�c3cg�/y _ ,jm,` Title: ®zlrf af�
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Design
Current
Design Current
Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Finish
Feeder
rFeedder
(%
La er
on -Layer
DairyCow
DairyCalf
o Finish
,k:„`r _:
Dairy Heifer
Farrow to Wean
Farrow to Feeder
=
D , P,oul
Design
Ca aei
Current
P.o . 3
—Dry Cow
Non-Daig
Farrow to Finish
Gilts
Boars
I Layers
Non -Layers
Pullets
Turkeys
I
113eefStocker
IBeef Feeder
Beef Brood Cow
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:
❑ Yes C2 o ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes g3 No [] NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of inspection: — L3 O'z0I
` Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 7
Observed Freeboard (in):-`
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
[:]Yes ELNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
R No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2 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): r9 i/ f
13. Soil Type(s): �<
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [S No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �]t No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® 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 0 Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [,No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [RNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

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

Jet
Type of Visit: ompliance 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: . �3 Arrival Time: ,,0 p Departure Time: �', County: �.� Region:
Farm Name: l A r )C- _514 St yr_ 3yn'-V�k Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: _ f (fi/jy �i�-i�` tT n Title: Phone:
Onsite Representative: _- �Gx.-� Integrator: %i7y'✓,%y� _
Certified Operator: ����..-t�- Certification Number: // 9"3-3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Desl�n CurrenIM
ts
'MesienliMpurrent
Design Current
Swine Capacity Pop.
Wean to Finish
Wet PoultryiiFoiiCapacity Pop.
Layer
Non -La er
Cattle Capacity Pop.
Daig Cow
Wean to Feeder
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D , Moult-: ,
Ca achy io P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turke s
Other
Turke Poults
Other
Other
Discharaes 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 f] 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 [a No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
214,12011 Continued

[Facility Number: q - I Date of inspection:
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
o 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): 7
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CA 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
[D 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
[5No
❑ 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
P3 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): rr�rvr l� �4F'e, rrrf
13. Soil Type(s): ll{?,rLiz
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 �R No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [allo ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
a No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Z No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
[Yj 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 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - /fs jDate of inspection: — 3
'f 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes O No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 40 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes CR.No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes Z] No
❑ Yes .® No
[-]Yes (2 No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
omments (refer to question #) Ezplain'any YES answers and/or any additional recommendations or, any other comments,
11 Use.drawings of facility to better -explain situations (use additional pages as necessary):
Reviewer/Inspector Name:�� LT
Reviewer/Inspector Signature:, —
Phone: 2 2 fp—f33 33�a
Date: v2
21412011
Page 3 of 3

f / rrA 1
Type of Visit: $Compliance inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: alioutine 0 Complaint O Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: g� Arrival Time: U:0 V Departure Time: / Ot7 County: -gk l -• Region:
Farm Name: W%r�j� Owner Email:
Owner Name: �A`�J�1 �G 5"7, e-4 Phone:
Mailing Address:
Physical Address:
Facility Contact: Ul Title: ~4-e/ Phone:
Onsite Representative: integrator: !..
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: % 9g - 3
Certification Number:
Longitude:
Design C*urrent
x n C
- g purrent
1)esi
Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop.
C►attle
Capacity Pop.
Wean to Finish
La er
Dairy Cow
PK,Wean
to Feeder
U1q0V
no v
Layer
Dairy Calf
Feeder to Finish
- "'°""
Dairy Heifer
Farrow to Wean
El ,. Design
C**urrentDry
Cow
Farrow to Feeder
Dry Poulf vCa achy
P.o
Non-Dailry
Farrow to Finish
Beef Stocker
La ers
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
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)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[—]Yes [:]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

Facility Number. - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 7_
Observed Freeboard (in): 30
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
5D No
❑ NA
0 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
C& No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E&No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
IS] -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?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes �o 0 NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window/ ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): —a-'!22L4jx
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 g] No ❑ 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?
I S. Is there a lack of properly operating waste application equipment?
❑ Yes Lg No ❑ NA ❑ NE
❑ Yes 29 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2[ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑NA ONE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection. /
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No [DNA ❑ 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.
D 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' [�kNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33, Did the Reviewed]nspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes B No ❑ NA ❑ NE
❑ Yes allo ❑ NA D NE
❑ Yes ® No ❑ NA ❑ NE
❑Yes
C@No
❑NA
❑NE
❑ Yes
[,No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
—% _ (.. q ) P, -._ y , , 3' .: �a� �oments.
Comments refer to question # Ex Ian an -YES answers and/or an adcLttonal recorrimendahons or an of
Use drawings of facility to better.ex lam.s'ituatrons /use additional pages as necessary) �
1p4e. r 145-e- I ft,c NY 40 SLR olV z�- / SM-' V
Reviewer/Inspector Name:
Reviewer/]nspector Signature:
Phone: 2�(?'q3 3-33 c?O
Date:����
21412011
Page 3 of 3

Type of Visit ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 01routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: �Arrival Time: �' Departure Time: : Qt7 County:
Farm Name: Owner Email:
Owner Name:-sr,1'Vy� Phone: _
Mailing Address:
Region:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: _ Svc Integrator: iui'!7
Certified Operator:._ Operator Certification Number: 1919133
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = c = 4 Longitude: = ° = , = u
Design Current
DesignCurrent
=Desig=n,urrent
Sw ineCapaci.YAP opulation
Wet Poultry'Capacty Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
(Wean to Feeder
6DO
OO
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
Dairy Heifer
❑ Farrow to Wean - x
Dry Poultry; - .,.>.P
❑ Dry Cow
❑ Farrow to Feeder `m "' ''''...,
❑ Non -Dairy
❑ Farrow to Finish ❑ La ers
❑ Beef Stocker
❑Gilts ❑Non -La ers
❑ Beef Feeder
❑ Boars ❑ Pullets
❑ Beef Brood Co
El Turke s
Other ❑ Turkey Poults
_
Other ❑Other
Number of S#ruetures:
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 0 No ❑ NA ❑ NE
El Yes
❑No
❑NA
ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
j9No
❑ NA
❑ NE
❑ Yes
V[No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: I—
471
Date of Inspection Y�
Waste Collection & Treatment
n
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r'
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 0 No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
Structure 5 Structure 6
❑ Yes D9.No ❑ 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 19 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IffNo ❑ 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 9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JX No ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. �S Yes o ❑ 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
lay Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �n22ID►40 ln,241 ..:
13. Soil type(s) f: r-no-' Si ✓ it _ _
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes IN No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
59No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
ElNA
ElNE
17. Does the facility lack adequate acreage for land application? ElYes
�t
121 No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes
®-No
❑ NA
❑ NE
Reviewer/Inspector Name � Phone: L233 3TO
Reviewer/Inspector Signature: Date:
,rage-, of J 1L/t3/V4 Uo"Unueu

Facility Number: 7 _;ym Date of Inspection r
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CRNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1 .No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists [I Design El Maps [I Other /�/'
21. Does record keeping need improvement? If yes, check the appropriate box below, es o ❑ NA ElNE
55 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
t3No
❑ NA
❑ NE
❑ Yes
No
[I NA
❑ NE
❑ Yes
r9
INo
❑ NA
❑ NE
❑ Yes
FLNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes M.No 0 NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
[]Yes INo ❑ NA ❑ NE
❑ Yes JRvo ❑ NA ❑ NE
Page 3 of 3 12128104

Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ArrivalTime: ��0 I}cparture'1'ime: t'> t Dl7 County: — Region: .
Farm Name: u Owner Email:
Owner Name: Phone:
Mailing address:
Physical Address:
Facility Contact:
Onsite Represents
Certified Operator
Back-up Operator
✓ Phone No:
Integrator
Operator Certifi ion Number:
Sack -up Certification Number:
Location of Farm: Latitude: ❑O ❑, ❑" Longitude: ❑O =I = a
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
U Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
O ❑Non -La er
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
E]Turkeys
❑ Turkey PouIts
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the coneyance man-made?
Design Current
Cattle Capacity Population
❑
Dai Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: IT]
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 JR No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
WNo
❑ NA
❑ NE,
❑ Yes
HNo
❑ NA
❑ NE
12128104 . Continued

r
Facility Number: —} 1Date of Inspection J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes OZ90 ❑ 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):p
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [?�No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 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 alo ❑ 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 P&No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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 crop 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
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
C , 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
KNo
❑ NA
❑ NE
Comments (refer to questto #): Explain any YES`'answers andlor^an recomrnendaUons organ.. other comments.
Use -drawings of facilitvo b taddit �tier explain situations. (use ion al pages as neeessarSR): -
Reviewer/Inspector Name
Phone:
Reviewer/Inspector Signature:
Date:
12128104 Continued

Facility Number : — Date of InspectionQ—
S
• Re aired Records &.Documents
19. Did the facility fail to have Certificate of.Coverage & Permit readily available?
[:]Yes
JKNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑yes
QNo
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping.need.improvement? If yes, check the appropriate box below.
[:]Yes
JaNc'
❑ NA
❑ NE
❑ Waste Applidation- ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall, ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ ;Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
151 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑`NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge? ;;
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a.phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
14 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
[:3 NA
El 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
J4 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
[:]:Yes
,may
L�.No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No'
❑ NA
❑ NE
Page 3 of 3 12/281W

Type of Visit IRCompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit aRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 15 hl 0--fl Arrival Time: q�.%,t� r_ Departure Time: 101 4r. County: ! Region: L W
Farm Name: W,7,tn.P � & S'1nk -1 i7liry, Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: � mo SM i Title: Q mlo- Phone No: C
Onsite Representativ11-tmo 0,&0& SM i' _ Integrator: ILL
CertifiedOperator: 1rytt,,�� p Q .SMi� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 6 = N Longitude: = o =1 =
I
UDMgs gn
C>urrent
;£Desigii . ent Design Current
necity
Population
,o: _r
Wet Poultry Capacity Population Cattfe Capacity Population
Wean to Finish
❑ La er
❑ Da' Cow
Wean to Feeder
&
❑ Non -La er
❑ Da Calf
Feeder to Finish
�� Dairyheifer
❑ Farrow to Wean
� ��D Cow
Poultry;<
tzl
❑ Farrow to Feeder
t?i _ +`,,t'. x:- _
❑ Non -Dal
rs❑ Beef Stocker
rONon-La
❑ Farrow to Finish
Gilts
ers ❑Beef Feeder
rs ❑Beef Brood Co
❑ Turke s
❑ Boars
-
Other'
.':
❑ Other
_
0 Turkey Poults
❑ Other Number of Structures:
Dischar es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes EiNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
❑NA
[I NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[?RNo
❑ NA
❑ NE
❑ Yes
E'No
❑ NA
❑ NE
12128104 Continued -

Faculty Number: (OR —) Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
RNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): oZ�
Observed Freeboard (in): 3 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
RNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
�WNo
❑ 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? I -Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes CRNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RNo ❑ NA ❑ NE
maintenance/improvement`?
IL _ Is there evidence ofincorrect 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) 17f'iR7GL��do��[iG[y S
13.
Soil type(s) S
14_
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
tjjNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Cj�No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
I'No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
JR No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment'?
❑ Yes
IRNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Q J '' Phone: [phone]M33
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Q — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropirate box.
❑ WUF El Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ERYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard RWaste Analysis RSoil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Main 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
SaNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[,;�,No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ERNo
❑ 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
2$.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
tR"No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�@ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
E�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
YC No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
MNo
❑ NA
❑ NE
PleGrz iofsoi i .seM 4 m,icA bo-,e, 5 o` s 4^ Ia oct, ivui IS, Cum u;.e o(d-
ho,
7
�1. NO so i ana in rs � aoo8.
14-a s, b - 300q
fE(Culib ,� l 0�id� SI SI,d�rve
t�,- v.S 90 Oder s 3 ra s�
I r I- 0 cro rI e( % � ►�� �a
Pood_ lookiA
Page 3 of 3 12128104

Facility No. ©Q 19q Farm Name Sr11114 Date
Permit COC ✓ OIC_ NPDES (Rainbreaker PLAT Annual Cert)
Pop. Type Design Current
Lagoon
1
2
3
4
5
6
7
Spillway__
Design freeboard
Observed freeboard in
Sludge Survey Date
Ice
Sludge Depth ft & %
Liquid Trt. Zone ft
Calibration
Actual Flow
DesignWidth
Actual Width
f�-------
K 9^-� Q �5
Soil st Date Crop Yield 1 in Inspections
pH Fields Wettable Acres 14"o 120 min Inspections
Lime Needed Weather Codes
Lime Applied �A,r WUP Transfer Sheets
Cu Zn Weekly Freeboard RAIN GAUGE
Needs P Rainf
yvoy 6ty ) I a riT�1" g la/n S40� AA A Oft — ►
Waste Analysis Date—NIMI
Pull/Field
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max Amt
t
a
-se
Verify PHONE NUMBERS an affiliations
Date last WUP FRO $io9 Date last WUP at farm
FRO or Farm Records
Lagoon #
1
Top Dike
Z a ,0
Stop Pump
4-),
Start Pump
G1(Po
L� g�
1( 0
hg D.a
App. Hardware Aae I

Type of Visit JKCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (SV Routine 0 Complaint j8Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: Departure Time: & AH County: 1/1 Region:
Farm Name: My ne-g- Eynon SM rh I"amM Owner Email:
Owner Name: ne 49.j Sm ' _ _ Phone: ` 9
��,�^_41f)
Q�
Mailing Address:
Physical Address:
' Facility Contact: 1NiIY'nlp- SA1 "N Title: o wpi1 ^ - Phone No:
Onsite Representative: 1vQ a- SV Sin # Integrator: M�'�jM1` �rDlrr) y p
Certified Operator: n Ern Operator Certification Number: 1 72-23
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = i ="
Longitude: = e =' 0 "
Swine
4
Olson
-:
Design Current Design Current
-.Capacity
Des' n Current
rg
Cattle
Capacity PO UIR—ton _Wet Poultry Population
Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
Wean to Feeder
4,300o 10 Non -Layer
iry Calf
❑ Feeder to Finish
_
❑ Dairy Heifer
'
Dry Poultry
D Cow
Farrow to Wean
ElFarrow
❑ Farrow to Feeder
s T . _
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
=' ❑Pullets
❑Beef Feeder
❑ Beef Brood Co
❑ Boars
;_..'
11 ! �[]Turkeys
Other
❑ Turkev Pou Its
❑Other
Number of Structures:
❑ Other
Discharzes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ErNo
❑ 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
KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: q
Date of Inspection-y--�.,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure'4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 Wo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes RNo ❑ NA ❑ NE
❑ Yes CgNo ❑ 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? KYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ISNo ❑ 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 CRNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CgNo ❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CRNo ❑ 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 El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types) NIPJ14l bellilyda �ojt//e. CoQi�, Argo ary. JS6 oy
13. Soil type(s) KfA&6 11t Sank A
14. Do the receiving crops differ from those designated in the CAWMP? []Yes RNo ❑ NA ❑.NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 19 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 0 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes R No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment`? ❑ Yes IgNo ❑ NA ❑ NE
Comments.(refer to question #): Explain apy}YES answers and/or any recommendations,or` apypother commen s' �' '
�
Use drawings of facility to better explaan srtuahous. (use additional pages as necessary)i
- _
Reviewer/Ins ector Name a
P Ghn L:r Phone: g►o-433-:�33_t
Reviewer/Inspector Signature: Date: ' ilog
Page 2 of 12128104 Continued

I
Facility Number:() q —igil Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
UNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check
❑ Yes
C?No
❑ NA
❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑ 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 WCropYield ff 120 Minute Inspections ❑ Monthly and I" Rain
Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Wo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
IONA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit`?
RYes
❑ 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
[INA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ;j�No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
12 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
C'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
EgNo
❑ 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
RNo
❑ NA
❑ NE
(Additional Comments and/or Drawings: [
-7) �� tnS+dj�_ vwj 4f It, iz, �1c-6t4►`fo be Seed6kgffi ­, Ih Pd ,
►vor d aoov-, [VO'e �l- Q0 07 a�2 �+ao ,S�w9�s' •ve
A ais�i bfc,.
o
-� treeho o►�n ��a, ��eao�,,� �,`1?0�' 6 �, �I 'Joel 6vt
I V?r
�, n � � a4� i� o � 30 ours -���, -ftrrt p04 .
Ple4to FF17 Ike- & A -Pie( . ,
Volrk,a.,d s r f �
ca. ± 60 days
r
Not veer coo f yield t &) ho e -Fo• oar dry7.,
12128104

Q q��g�q �S 6q0 P" ° �
1 �/� ✓ &
Facility No. Time In Time Out Date
Farm Name Owner
Owner BIMS Address & Phone Cell Phone
Site lep 11f xL.11Gh integrator Operator No -
Backup No. BIMS OIC aQhn117 5 ,ice' - No. 171--3
COC Circle: <aver5or NPDES ( ainbreaker PLAT Annual Cert )
Pop. Type
Design
Current
Pop. Type Design
Current
Pop. Type
Design
Current
&
• • - - ,►: lam' - •
��------
RO 4- _ L
Soil Test 'A3310?/ 00.1,
120 Inspections
PH Fields goon
S�
p Yield
Rain Gauge
min
Transfer Sheets
Lime Needed
Cu r4DZn
31
Weekly Freeboard
Rainfall >1"
Spray/FB Drop
Wettable Acres
1 in Inspections
CAWMP S16`7tO
WUP �.. 3 0
6 Gad
it ID7-C) 13 --tip �-�y��
L15 4 ZI ""'�
5��CRgMN0
�1OWN
lil
UN W070�
+ •
(L��-=_sue
��
•
w /
Comments

0) r [C `-° 11L-e
t co, j ocnk--c
L.14. b r4W )r-4r4aVa
oc
9W
-
1
HV
o
Q
0 a o
0
r
oc
5e
c
or
cLo
of
'ec
h
�
§C
COut Vlea9.71S
L 4
•sn�
vitoq
AA K'�,
010A
ke-c c-
tf-4
i+
bat b
0
J

Division of Water Quality •ar"' _
[Facility Number O Division of Sail and Water Conservation
M _ - Q Other Agency
Type of Visit
Inspection
O Operation Review O Structure Evaluation
Q Technical Assistance
Reason for Visit
�C,ompliance
elomRoutine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: Arrival Time: POO Departure Time: Lz= County:
Farm Name: 77
ram' Owner Email:
OwnerName: G S / •^— slyJT Phone:
Mailing Address:
Physical Address:
Facility Contact: A"C Title: Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
]Integrator,
IV "00011
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = a= f Longitude: 0 0= r=
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
a fl a� ❑Non-Lay_ei
❑ Wean to Finish
® Wean to Feeder
❑ Feeder to Finish
ElFarrow to Wean
ElFarrow to Feeder
[IFarrow to Finish
El Gilts
ElBoars
Other
❑ Other.
Dry Poultry
ElLayers
❑ Non -Layers
ElPullets
❑ Turkeys
El Turkey Pouits
ElOther
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ❑ 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
❑ Daily Heifer
❑ DEY Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Bcef 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 EgNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
�RNo
❑ NA
❑ NE
❑ Yes
,g No
❑ NA
❑ NE
12128104 Continued

4
.1
S
�r Facility Number: — Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
19-No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ,3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
21 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed
❑ Yes
® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
R No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Wo ❑ 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
54No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CKNo ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below.
ElCg Yes
,mot
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)%,,V-MiLLv. e
13.
Soil type(s) hen -e
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
$aYes
❑ 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
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
ReviewerAnspector Name ZrV Phone:
Reviewer/Inspector Signature: Date: ,__/D` U
1z"ZolVH t-unts""C"

.i
7-7-72
Facility Number: — Date of Inspection F
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 59-No ❑ 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 appropiate 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 EgWaste 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 M No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � No El NA El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
JC No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
DE NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JgNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
09 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
CdNo
❑ 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
p No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E-No
❑ NA
❑ NE
12128104

V
0
Type of Visit (P<o-mpliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit (1outine 0 Complaint 0 Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: * O D County: d Region:
Farm Name: _�.l%a R at6 u_Sa— SJ--i;d �Q ✓ Owner Email:
Owner Name L�— S ; Phone:
Mailing Address:
Physical Address:
Facility Contact: klei4lap _C5�' 1� Title: Phone No:
Onsite Representative. Integrator: I�� _
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Latitude: = 0 = 4
Back-up Certification Number:
Longitude:
=006 =6i
Design Current
Swine Capacity Population Wet Poultry
❑ Wean to Finish ❑ Layer
JA Wean to Feeder 16, goo I z1000 ❑ Non -La er
Design
Capacity
Curren[ Design
Population Cattle Capacity
Current
Population
airy Cow
❑ Da' Calf
❑ Feeder to Finish'
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
,._, El Dairy Heifer
m ❑ D Cow
El Non -Dairy
El Beef Stocker
❑ Beef Feeder
❑Beef Brood Co
Number of Structures:
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Others
.:.:
.
❑ Turkeys
❑ Turkey Poults
❑ Other
❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes CK No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
❑No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
PQ No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
12128104 Continued

Facility Number: q—
Date of Inspection
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
;,No ❑ NA []NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
Pa No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 07
Observed Freeboard (in): 3�--
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Z 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
[9 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
[9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
K No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
&No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12_ Crop type(s) lftv,W,v I<Ar �
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[A No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
29 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Comments (refer to question ff): Explain any YES answers, and/or, any recommendations or any other+comments.
Use drawings of facilityto better explain situations. (use` additional pages as necessary).: ,_ r
/if , .5;T,'*-1
41J i 143-C a
f7t Mar+ /
Reviewer/Inspector Name T �.-� .-- Phone: 7� 0- — too
Reviewer/Inspector Signature: Date:
ruge L Uf J INLo/vY l.u►su►l"C"

Facility Number: — Date of Inspection
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes CK No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �Z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
El Yes
®No
❑NA
El NE
❑ Yes
21 No
❑ NA
❑ NE
® Yes
❑ No
❑ NA
❑ NE
❑ Yes
($•No
❑ NA
❑ NE
❑ Yes
D� No
❑ NA
❑ NE
❑ Yes
[gNo
❑ NA
❑ NE
❑ Yes
J9 No
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
5� No
❑ NA
❑ NE
❑ Yes
D§ No
❑ NA
❑ NE
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes
5� No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit ® Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: I II : 4=LO Departure Time: County: _&rL^.r
Farm Name: PLk4g NG _�— SkS92AJ .Siu 1" re V w+ Owner Email:
Owner Name: Li aS�tsa r.r S r..; Phone:
7,
Mailing Address:
Physical Address:
Facility Contact: %1cC4�. _TQTa V SArrA Title:
Onsite Representative: _aA
Certified Operator: lJ
Back-up Operator:
Phone No:
]integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 00 = = Longitude: =o
Region: )b"'
`4216dill1i9
Design Current rAh
�
Design Current
,
Design', Current
Swine
Capacity P.opulattonf s Wre�t�Paultry
?-
Capacity Poptulatton'
` CattleY Capacity Population
❑ Wean to Finish
4
rY
F. ❑ Layer
L ❑ Dairy Cow
Wean to Feeder
Non -La et
0 Dairy Calf
❑ Feeder to Finish
��`�``-- -.
-
�x•
�.. ❑Dai Heifer
❑ Farrow to Wean
:y x ,�
�'`
y,
❑ Dry Cow
❑ Farrow to Feeder
1Jry Poultry
❑ Non-Dai
❑ Farrow to Finish
❑ Layers
F ";
;' ❑ Beef Stocker
El Gilts
Non-LayersEl
Beef Feeder
❑ Boars
t.❑
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
_ ] Turkev Poults
❑ Other
El Other
Num#�erpof Structures:
.
Discharses & 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 C9 No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
fid No
❑ Yes
91 No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
12128104 Continued

Facility Number: 0 - 9 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
M No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ Z7 N
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[]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
W 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
E?No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
]A 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
CUNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes U3 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O lbs ❑ `total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drib ❑ Application Outside of Area
12. Crop type(s) 13i tr m t,, de,_ i" "4, 1 A"
13. Soil type(s) Kam„ /a,Js u i U e_
14. Do the receiving drops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes C[ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination i ❑ Yes [gNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Eiiations:�{tiise additio.
❑ Yes ® No
❑ Yes 21 No
❑ NA ❑ NE
El NA El NE
Reviewer/Inspector Name F_ r 1`e,v tY l�s a. �x Phone:
Reviewer/Inspector Signature: Date: /— /i = 4S
12128104 Continued

y 4
Date of Inspection
Facility Number: Qq — j
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 [,VNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 10 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [M NA ❑ NE
24_ Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
JR1 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[V No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[gNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
Vu 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
CM 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
Vw 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
Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
fR No
❑ NA
❑ NE
Addttianai ComnQe �'and/orsDrawiri s "t ���', � � "`" .^ �
s
12128104

Facility Number
r
Name Lj C_
Fann Name a.,,, Fc- y ----
C.O.C. permitted _ on hand Yf
W / i Waste plan ✓ Soil Test PLAT Deep Soil test
Soil type ►•1 !J 5 V� ��- _
Crop types F-�• V%-..- d QI.— & S
II
,r
Designed Freeboard 27 Observed Freeboard
Date I ! — / o
Rain gauge Rain breakers Alm Daily Rainfall
Calibration of spray equipment G.P.M.
Sludge Survey VV Crop Yield 120 minute inspections _
.I- <.
1 i i n. rain inspections Weather code Weekly Freeboard
Waste Transfers / _ Waste Analysis
Pumping time
P g
Waste Analysis % & Month
Comments:
i

0
of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: G .�� Time: v a
Facility Number 4 9 /
Q Not Operational Q Below Threshold
Mermitted ErCertiled [] Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ..
Farm Name: ...... WE 4% `. S!�,� .! _ . S ...c !.. * 7�. ...__._ County:...
Owner Name: aG n Phone No:
--- ._ .........�..-f--...#-... — Imo..
.Madmg Address: Al 0 1 w •• • ;
Facility Contact: Title:Phone No:
Onsite Representative:. Q,��,aSw.: '!�. Integrator:�'1u:�2�1�-��'l�tetd� -------
Certified Operator:_ �e 4►n 5 +» t� , Operator Certification Number: --
Location of Farm:
M Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` " Longitude • ` "
Carr -eat
nnn��linn
JE Wean to Feeder
yob
�: ❑Layer
El Feeder to Finish
=_ ❑ Non -Layer
Farrow to Wean
- _ -' �' _ `1 -
El Farrow to Feeder
Other
Farrow to Finish
-.... ....,. p -TOWNMI
Gilts
Elw
Boars
Discharges & Stream Impac
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a_ If discharge is observed, was the conveyance man-made?
Cal,
-," ❑Nan -Dairy
M-01 6ty
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes [0 No
❑ Yes ❑ No
❑ Yes ❑ No
14/4
❑ Yes ❑ No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [M No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway 06 Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..... ...._..._.
Freeboard (inches):
I2/I2103 Continued

Facility Number: 09 — 1 I
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ 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?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type 'ffe' r.a0L iia... _Z SC
0-0
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14, a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes U No
❑ Yes [P No
❑ Yes W No
❑ Yes [3+No
❑ Yes [)_� No
❑ Yes [19 No
❑ Yes [2No
❑ Yes [j No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes EX No
❑ Yes [� No
❑ Yes W No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
Yes
❑ Yes
[� Yes
❑ Yes
® No
QjNo
[� No
® No
❑ No
® No
❑ No
M No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Camteetts (refer to questiar #) Eitatn any YES answers and/or any �ommeadaits or snv other comments.
Use drawttegs of faciltty tabetter eplatn sttnattons :(ase ailiitttonal pagesas necessary) Field ('ot�v
pal Notes i
j] F :
iP 44
/TecoraQs :hd;"tom laq oev Jtoj hcc,A lsR. -roLc- S+b E b.. s 4-o.,T e"
�p*:1 Z004. Na na-4`.i1G�1io� +n nwc_ W►r. S>^.: +4 ,<���c.. 1.,4
A r. Nl O V w .11 bc, 1 s s to c� L � ex vqm :..:...
C r'1 W �► `tl b�: w i.4+� .Q ,,�� -C +w o a" *.f.
hL, L S
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
.3
05103101 Continued

or
0 Division of Soil and Water Conservation ❑ Other Agency
'Division of Water Quality
Ll Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection (?:` 24 hr. (hh:mm)
0 Registered E Certified © Applied for Permit © Permitted JE3 Not Operational I Date Last Operated:
Farr) Name:...... ,p�iX. i . ! . f'...O,t��~....... County:.......... ..... .................. .......................
Owner Name:..... w ,r%f,,l/�'r .. •� i�C...... . Phone No: /D . ...��Z ......................
Facility Contact: ......-��/ !Ti . �-,r,C...............•. Title: ........................................................Phone No .........
Mailing Address: ..... �,.r%�.....�....,./�!�T.. L�!�.?..lt!...�..r.....!ZQ �rI ....---
......... .....
Onsite Representative:....... �✓� �ih� n
�- ----------------------�..---........'..................................... Integratrir:.......��S..,P..�...L���/�r!1
-.��..- }.
Certified Operator........ !-,??� ...... !,,•-- �i�l.T•^'................................ Operator Certification Number: ..........................
Location of Farm:
..................._..............................................-............... ... .............................. .... F ..-•--
.....?e .. f�...-s...�r�C..—A.. � .-.............................. ............
Latitude • ' L__ 1
1 Longitude • 6 96
w'Sr�n Current Design Current ; Deslgn rCurrent
Swine, -Capacity ;'Popuilation„Pnnitry , Capacity Population Cattle � . uCapacrty Populatton
.
y [� Dairy ..:..
ean to Feeder Od Gap ❑ La er
;Z 1:.
rEDIEFeeder to Finish ❑Non -Layer . ❑Non-DairyFarrow to Wean$ Ks max.
❑ Farrow to Feeder ID Other
k - ElFarrow to Finish ry - ¢y Total Design Capactty :;
❑ Gilts M:
KTotal�SSLW -
r4x ❑ BOars $ M _
h
�,Number of La-i*& PHoldip Ponds f' ❑ Subsurface Drains Present ❑ L ❑ S eld Area Lagoon Pray Fr Area
;�_ ��a�, ff . � ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement? ❑ 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 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/rnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes WNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes V No
5- Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ANo
maintenancelimprovement?
b. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes J4 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes kNo
7/25/97

Facility Number:O — f
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ITNo
Structures (Lagoons.Holdine Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 09 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:
Freeboard(ft): 3'3...............................................................................................................................................
........................................................................
10. Is seepage observed from any of the structures?
❑ Yes
ID No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
KNo
' 12. Do any of the structures need maintenance/improvement?
Yes
❑ 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?
❑ Yes
XNo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
j[ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ....�t.,1?. k��i�7..�lhef��1--.-................_..................._...................._._........-...................-..............
..............�......_._....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
IT Does the facility have a lack of adequate acreage for land application?
❑ Yes
JqNo
18. Does the receiving crop need improvement?
❑ Yes
1XNo
19. Is there a lack of available waste application equipment?
❑ Yes
,No
20. Does facility require a follow-up visit by same agency?
❑ Yes
KNo
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
WO
22. Does record keeping need improvement?
❑ Yes
,KNo
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
NJ No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
RNo
pi•No.vio'latioins•vr. deficiencies:were;noted;during' this,- visit -.You.v411recei'Ve_no:firther_
.: COfresputidence about -this:visit:• : .. :
_S�X 4W+ Ar- cam/ fAdCC r
7/25/97
Reviewer/fnspector Name
Reviewer/Inspector Signature: Date: f�Z %�

[3 Division of Soil and Water Conservation 13other Agency
H Division of Water Quality
19 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Dale of Inspection
Facility Number O Time of Inspection 24 hr. (hh:mm)
13 Registered ® Certified [3 Applied for Permit 13 Permitted 113 Not p erakit:naf Date Last Operated:
Farm Name: A .✓.d i .s�.,fiL � � County:e..................................................
t
Owner Name: ............................. Phone No: g/C3 ......... .......... Z
Facility Contact: ...................................... ...... Title: ...... Phone No:
Mailing Address: .....,Gs1�Ff� f -t ,.......�4 y......./ t T .�Y.. ,Z yl----•.................
.
Onsite Representative: .............. Integrator: ........
J�!�4�✓^�5...4f'!�.---
Certified Operator:.................................................. ............................................................. Operator Certification Number*........................... ......
Location of Farm:
• _.�...........................................................................................................................................................................................................................................
i
.... FAK r, ,. ........ ..... ................... ...............
Latitude ' 06 « Longitude ' 6 "
x � Des'gn ,; �,C rrrt
Wean to Feeder
f
dd
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
r_ pesjgn�:' <Curi=ent "' 06sign Cutrrent""
Poult
ry a: Capacity Population v Cattlek CapacttyPopolahon
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non-Dairy
❑Other x ` .
E ` Total Design Capacity =y
w4;k Total' SSLW
Subsurface Drains Present �10 Lagoon Area i❑ Spray Field Area
No Liquid Waste Management System�w„ A,,A
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes (WNo
2. Is any discharge observed from any part of the operation? ❑ Yes UNo
Discharge originated at: '❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes UNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes C97No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes Wio
3. Is there evidence of past discharge from any part of the operation? ❑ Yes RNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes Wo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes Wo
mai ntenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes VNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes L)FNo
7/25/97

Facility Number: of
8. Are there lagoons or storage ponds on site which need to be properly closed?
tructures (Lavoons.Holding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Identifier:
Freeboard (ft): ...........!3.........
Structure 2 Structure 3
10. Is seepage observed from any of the structures?
❑ Yes KNo
❑ Yes 10 No
Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
❑ Yes P No
❑ Yes )?�No
,R Yes ❑ No
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes [VNo
Waste Application
14. Is there physical evidence of over application? ❑ Yes IQ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type e W. ....4�tt>....................... - ............. ............................................... ....... ........ -................................. ..............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes tO No
17. Does the facility have,a lack of adequate acreage for land application?
❑ Yes
J�J No
18. Does the receiving crop need improvement?
❑ Yes
W No
19. Is there a lack of available waste application equipment?
❑ Yes
P No
20. Does facility require a follow-up visit by same agency?
❑ Yes
P9 No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
W No
22. Does record keeping need improvement?
❑ Yes
BI No
For Certified or Permitted Facilities Onl
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
RNo
0. No.violatioits:or' deficiencies.werenoted.ing this:visit. You:will recei�to_hirihei
O&Ospandepce dbout -this. visit.-',., :. :: : :. :..: .
7/25/97
Reviewer/Inspector
Name
Reviewer/Inspector Signature: Date: f1-2fj?Y __

0 Routine O Complaint O Follow-ug of Dn ins ection O Follow-up of DSWC review O Other
Date of Inspection Zfl97
Facility Number O Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review. l�
❑ Certified ❑ Permitted I or Inspection includes travel andprocessing)
❑��N)jot Operational . Date Last Operated: ..........
Farm Name: — (�'i� _>F�1 / 3 ice: � �i�.?.�- _... ._ County: .... . �J��'� _ .............--- —.......
Land Owner Name: !C r.� Stx� GSA... ._....� Phone No:
Facility Conetact: _ .."''' �S!J"�T't _ ... _ _______ Title: �^ Phone No-
Mailing Address: _ /2 O/ !ti rL' T �C7�9%4 !V l`�� ...... ....
Onsite Representative: 1�.r� G�'�:! ._ ... �...w. Integrator: _ &!- ✓ 1.e�glG ✓t1.
Certified Operator. !'`�� /, /�%}� _/� ., Operator Certification Number:�// of
Location of Farm: ,b/,G %Z/% silk f� ^� ,�x�' ,a it , rs,��S ,/
Latitude ��0 4 Longitude �' C�& u
Type of Operation and Design Capacity
Design Ct1ITCnt " ^g"a � � YieSlgn" '�Cu PC nt ;� �c e as y Design Current'
SW1Rek: y x a&y °Poll Az 40: �� CatUi✓%r° 5.,$X
elation ,- u _ _ Ca aci Po "ulatsoe'
"` Wean to Feeder d6
❑ Feeder to Finish
Dairy
Farrow to Wean �' � ��
Farrow to Feeder�Tot Destgn,Cap t3',��
Farrow to Finish w �. 718 '
'r
Numb r of Leo n ;/��Ha d g PoridsN Subsurface Drains Present411
4.
w
❑ Lagoon Area Spray Field Area
❑ Non-I.a er
❑Non -Da
ne
1. Are there any buffers that need maintenance/improvement7
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon [I Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water'? (If yes, notify DWQ)
e. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes )V No
❑ Yes 8kN0
❑ Yes �No
❑ Yes A No
❑ Yes
No
r
❑ Yes
No
a
❑ Yes
❑ Yes
ewo
/VNo
Continued on back

Facility Number: ... 0I.— —...L
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures an ons andlor-Holding Pondsl
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structui
�f } Structure 2 Structure 3 Structure 4
_ .' �+t�/..... _......... ..... ... ......... ...........
_.
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes RNo
❑ Yes XNo
❑ Yes NNo
❑ Yes ONO
Structure 5 Structure 6
❑ Yes tKNo
❑ Yes � No
Kyes
❑ No
❑ Yes 3XNo
Waste Application
14. Is there physical evidence of over application? ❑ Yes krNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type _� [ ...... _.... _.. _ ...__... __. ._ .................... _...._ .......... .. .
I6. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a Iack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
ForCertified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
ations or any<otbe
Reviewer/Inspector Name W, m .Im
Reviewer/Inspector Signature: Date:
❑ Yes KNo
❑ Yes JSNo
Yes b No
Yes ❑ No
❑ Yes )ONO
❑ Yes )X(No
❑ Yes k
❑ YesNo
K,Yes ❑ No
0
y2-
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97