620004_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B, Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Andrew McCall, Reglonal Manager
Mr. Bobby Ray Atkins,
Roads End Farm
Route 2, Box 469
Troy, North Carolina
Dear Mr. Atkine:
oft
EDEHNR
DIVISION OF ENVIRONMENTAL MANAGEMENT
Owner
27371
August 28, 1995
SUBJECT: Compliance Inspection
Confined Animal Feedlot Operation
Road End Farm
Near Troy, Montgomery County
on August 22, 1995, an inspection of your confined animal feeding
operation was conducted by staff of the Fayetteville Regional Office. Please
find enclosed a copy of our Compliance Inspection Report for your information.
It is the opinion of this office that this facility is in compliance with 15A
NCAC 2H, Part .0217, and that suitable animal waste management practices are
being followed at this time. Minor erosion problems were noted around the
confinement houses. These areas should be stabilized with suitable ground
cover as soon as possible.
Should you have any questions regarding this matter, feel free to contact
either myself or Mr. Michael Wicker, Regional Water Quality Supervisor, at
[phone].
Sincerely,
Ken Averitte
KLA/ka
cc: Facility Compliance
Wachovia Building, Suite 714, Fayetteville, North Carolina 28301-5043 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled/ 10% post -consumer paper

Site Requires Immediate Attention:
Facility No. 6Z-14
(p Z --T-
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: S - a - - , 1995
Time: Zz 3: 3z
Farm Name/Owner: `B2 E >J �ArR A rn13
Mailing Address: Z �- L' L 7 3 ZI
County:
Integrator: C-A nil Phone: --_5-"25-ie
On Site Representative: 1' 1:a A -r 1c i N Phone: tD -- S 7Z Irs-
Physical Address/1,4Dcation:_4T _ L.L,*9a) �2•4p g Zyy )1?-13 77,,. a r h/rsr�
Type of Operation: Swine V, Poultry Cattle
Design Capacity: Number of Animals on Site: 7/
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude• Longitude:
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)
Was any seepage observed from the
Is adequate land available f r spray?
Crop(s) being utilized:
/d2
or No Actual Freeboard:I'Z*- Ft. Inches
on(s)? Yes o> N�o Was any erosion observed? or No��1J�o�� -
�br No Is the cover crop adequate? 0 or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? (Y�Por No
100 Feet from Wells? es or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or Ia
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue ine: Yes o(s)
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or(V�) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crony? Yes or No .Jor ver Alor
A�� ,A) Ave* (7`rw-
Inspector Name
Z' "4
Signature/
cc: Facility Assessment Unit Use Attachments if Needed.

ALA
�D1VIs""io'n f Water Resources
cEacqef,PNumber
1--[� - O Division of Soil and Water Conservation
Q Other Agency
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit; Arrival Time: Departure Time: County: Region:
Farm Name: �,i. S r1wSe-.- s - Z Owner Email;
�
Owner Name: Rb66 R, Phone:
Mailing Address:
Physical Address:
Facility Contact: 41k;hS Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: _5ma� I�l
Certification Number: 999936
Certification Number:
Longitude:
Current
Design
Design
Current
Design Current
Swine
Capacity _Fop.
Wet Fotiltry
Capacity
Pap.
Cattle all Pop.
weelLa
er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,aultr>
C.a aci
Po
Non -Dairy
Farrow to Finish
La era
Beef Stocker
Gilts
Non -La era
Beef Feeder
Boars
i jBeef Brood Cow
Turke s
Qtit
Turke Poults
Other
I
I
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there, any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes PNo ❑NA ONE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [] No
❑ Yes No
❑ Yes No
W NA ❑ NE
Pa NA ❑ NE
P§NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Page 1 of 3 21412015 Continued

Facility Number: jDate of Inspection:
r �
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KZbNo ❑ NA ❑ NE
a. if yes, is waste level into the structural frceboard? ❑ Yes F] No �5NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �_ Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ArLNo ❑ 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
10 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[?;No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�kNo
❑ NA
❑ NE
maintenance or improvement?
l l . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�6 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): rleC��
13. Soil Type(s): te=�"'J f e
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 1� No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No 0 NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EpNo ❑ 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 1f 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 1� No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1�3 No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: 3
r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check []Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [:]Yes N No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [jj 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? ❑ Yes [p No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [P No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 0 No ❑ NA ❑ NE
Umme refe a Tuestian;# 5Ex �laln4an Y) S answers and/ortAny additional: recotnmendations`or any other comments.
UWdrawinlgs ,a
f:facilitytubetter,fexplaln si`tuattons(use:`additinnil.pages'as necessary}.'
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes [19 No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes (V No ❑ NA ❑ NE
U.lb. Phone: ` (0 q33-;560
Lo Date: 7 Z 1%
2/4/20I'S

• Division of Water Resources
11 Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: # Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Arrival Time: � Departure Time: County: �njRegion:
f
Farm Name: p14 A T %.,1 S I f 2— Owner Email:
Owner Name: De'reck- A/Lc Phone:
Mailing Address:
Physical Address:
Facility Contact: Nhs Title: Phone:
N
Onsite Representative:
u
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder Q
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
Other
D€scharees and Stream ImDacts
Integrator:
Certification Number: 9 ! I J (o
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er EE]
Avon-L;
Pullets
Other
Poults
Design Current
Capacity Pop.
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
I. Is any discharge observed from any part of the operation?
❑ Yes
r5j No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[P NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[�g NA
0 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
No
❑ NA
❑ NE
of the State other than from a discharge?
Page ! of 3 21412015 Continued

i
Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�2 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
Lr
❑ 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
Q3 No
[DNA
❑ 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?
TT
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
f�j No
❑ NA
❑ NE
maintenance or improvement?
T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 0 Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): R5cLtc CPas` -h, Q
13. Soil Type(s): �6V j If
❑ NE
v
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
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?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No [] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes ZNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

i
'Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1�9 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P 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 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes MNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) `F
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
M No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Qg No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ja No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
0 Yes
R] No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Use. drawings''ot facility`to better explain situations (use additional pages as necessary). ati
Qa -� r-e( 010) 6V(- y0g1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
kh�•
Phone:
Date: q 1
21412011

• Division of Water Quality `
Facility Number ®- O Division of Soil and Water Conservation
O Other Agency 11
Type of Visit: 10 Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ® Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ►I •`/b! rho I Arrival Time: Departure Time: County: WWAVRegion: /ego
Farm Name: s G Owner Email:
Owner Name: fle eLk_ Phone:
Mailing Address:
Physical Address:
Facility Contact: k A h Title: Phone:
l�
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
ther
Other
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry . Capacity Pop.
Layers
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes P§ No ❑ NA ❑ NE
❑Yes
❑No
[PNA
❑NE
Ycs
[]No
[P NA
❑ NE
[—]Yes [:]No
❑ Yes [� No
❑ Yes M No
[�NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili iNumber: V5 J4 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: li
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): � 3 4
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
[�g No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
[] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Vg No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
(P 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): C�Gas�a)
13. Soil Type(s): e.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
'n No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
W No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
EP No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�LNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
T No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
P No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[5 No
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [3 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
T
❑ 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
91No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
q No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

i•
Facili Number: 1-- Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes M No
7
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P 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 ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes TT 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? ❑ Yes [5� No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [� No (] NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes J�j No ❑ NA ❑ NE
1Comments (refer to uestion,# ) Explain tiny.YES answers -,and/or any additional recommendations or any other comments:
IJie.drAwIn0idffAclIity tobetter cxplainaltiiatians'(use additional On es necessary):
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
ALr-F 4xrue -PLJ)Q-
.-ql
civ 9io-6241-s'
ReviewerAnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes No
❑ Yes ® No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[]Yes M No [] NA ❑ NE
Phone:
Date: 1 6
21412015

jType of Visit: 0 Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit; I Arrival Time: Departure Time: :fDQw County: �� Region:
Farm Name: 1' '44k 'S / Ymu, I Owner Email:
Owner Name: C . _ /4 i S Phone:
Mailing Address:
Physical Address:
zu
Facility Contact: C17TI k its Title: Phone:
Onsite Representative: N Integrator: W+�
Certified Operator: yl Certification Number: ! 1 J
Back-up Operator:
Location of Farm:
1
Latitude:
Certification Number:
Longitude:
Design
Swine Capacity
Current
Pop.
Design Cur:.rent Design Current
Wet Poultey Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
T 0
Non -Layer Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Design Current Dry Cow
Dr. lA.ouitr. Ca aci P.o Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
Beef Brood Cow
C}thcr
Other
Turke s
Turke Puults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes R No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No C�jNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No 09 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 [3Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
No
❑ NA 0 NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
4 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): SN
5. Are there any immediate threats to the integrity of any of the structures observed?
O Yes
W No
❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes % No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? [ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [K No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes � No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Mn 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 W' dow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
re-9-- N�' )
12. Crop Type(s): 4-P
13. Soil Type(s): �jA�►-s�gy,`�re J
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑Yes QDNo ❑NA ❑NE
❑ Yes Qy 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 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 P No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

a
Facili Number: - Date of Ins ection: 2
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
NA NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes
No
NA NE
the appropriate box(es) below.
Failure to complete annual sludge survey Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
Yes
No
NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Yes
�] No
NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document Yes No [] NA NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? Yes ® No NA NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the Yes (OJ No NA NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. Yes [� No NA NE
El Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes No NA NE
33. Did the Reviewer/]nspector fail to discuss review/inspection with an on -site representative? Yes �]j No NA NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [ No ❑ NA ❑ NE
Comments (refer to 'questlon #): Explain any YES.answers and/or any additional; recommendations or any other comments.
Use drawings: of facili ` to befter ex lain situations;(use.additional pages as necessary).
97s
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 91v— 73-33G0
Date:
214/2 d,4

v
jor z3
40 Division of Water Quality
Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 49 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I i 2 Arrival Time: g® Departure Time: e9� County:0047r.Cm Ef4 Region: �Pa
Farm Name: �.( wl 5 2 Owner Email:
Owner Name: IF10 e7_ - A 4, is Phone:
Mailing Address:
Physical Address:
Facility Contact: _ We c�— &Lhs Title:
Onsite Representative: r I
Certified Operator: f
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Design Current Design Current
Swine. Capacity' Pop. Wet Poultry . Capacity Pop.
Wean to Finish
Wean to Feeder O2200
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -La er
Pullets
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes T No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
NA ❑ NE
�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 M No [3 NA [3 NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection: I y
Ih
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
� No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z I a "
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
IN 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 or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [q No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Fe6c..Q (Vase
13. Soil Type(s): -I le
14. Do the receiving crops diff from those designated in the CAWMP?
❑ Yes
T No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
o] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes]
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[T 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 [n 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 ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: -9 jDate of Inspection: 21
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 09 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes w No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes T 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 Ep No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes 31 No ❑ NA ❑ NE
❑ Yes ®' No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ NA ❑ NE
❑NA ❑NE
❑ NA [] NE
Comments -(refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional. pages as necessary):
Reviewer/lnspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: ��`1 �-33Q)
Date:
21412011

type of visit: W uompliance inspection V operation Review V structure Evaluation V I ecnnical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I Arrival Time: 1 ?9? 0,0U4_Fq Departure Time: i A.•. County:A Region:
Farm Name: �v� A�i�I�►$ G.✓51f�0OwnerEmail:
Owner Name: lJD Phone:
Mailing Address:
Physical Address
Facility Contact: _q4-eV-- A+VkS Title: Phone:
Onsite Representative: .Integrator:
Certified Operator: 0 Certification Number: 18,21? j
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current .
Swine Capacity Pop.
I:. Design Cutr'e�ntW Design Current
Wet Poultry Cris city Pnp. Cattle CapAeity Pop.
La cr DairyCow
Non -La er DairyCalf
Wean to Finish
Wean to Feeder
cO
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Desil;n Current
Dr, P■oultr> Ca aci P.o
Layers
Dai Heifer
D Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Cithcr
Other
Turke s
JTurkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
W No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made`?
❑ Yes
❑ No
[�) NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[] Yes
❑ No
EANA
❑ 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
PNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
fp No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
5d No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: r —q 5 0
No ❑ NA ❑ NE
❑ No [ NA NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard {in}: e
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M No
[] NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[§ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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
�R No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application`? If yes, check the appropriate box below. ❑ Yes [)S 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): �esct� ��tt�e1
13. Soil Type(s): lP
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
[] NE
acres determination?
T
17. Does the facility lack adequate acreage for land application`?
❑ Yes
LP No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[� No
❑ NA
❑ NE
Reaulred Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[V 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 [:A 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 T No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes .E�p No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: i 1
w
+24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [jgNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �j No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility rail 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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
® No
❑ NA
❑ NE
❑ Yes [�JNo ❑ NA ❑ NE
❑ Yes
FNo
❑ NA
❑ NE
❑ Yes
Ej�No
❑ NA
❑ NE
❑ Yes CgNo
❑ Yes 0 No
❑ Yes Npo
1--p
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #):. Explain Any YES answers and/or any additional recommendations or any other.'com.ments.' .
Use drawings', of facility -to better explain situations:(use additional;,0apes as necessary).,...
Reviewer/[nspector Name
Reviewer/Inspector Signature:
Page 3 of 3
/ I,. , r ly
Phone: q1"33,3�m
Date:��-
2/4/2011

w
Type of Visit a Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: [ f Arrival Time:Departure Time: ,�00 rl County:% Region: 1--
Farm Name: �-�%vt 5 r^�-i_ �2 Owner Email:
p y A4-��, sr ..
Owner Name: DDDb�t � Phone:
Mailing Address:
Physical Address: �pJJ
Facility Contact: D rtc_�- A+T" S Title:
If
Onsite Representative:
N
Certifled Operator:
Back-up Operator:
Phone No:
Integrator:/ W101" iyl�L
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = 41 Longitude: = o = f = to
Design C*urrent
Design C►urrent
Design Current
Swine
Capty Population
Wet I t—FtYA Capacity Population
❑ Layer I I
10 Non -Layer I I
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
EA Wean to Finish
El Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non- Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
ElPullets
ElBeef Brood Cowl I
❑ Turke s
Other
❑ TurkeyPouets
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
PNo
ElNA
ElNE
Discharge originated at: ❑ Structure ElApplication Field ❑ Other
R. Was the conveyance man-made?
❑ Yes
❑ No
[P 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
Q�PNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
MNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
4f No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

VwR: `l
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
IM No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
ENo A NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure
6
Identifier: 2_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 �/ f
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
&No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
P No
[]NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
19 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/improvement?
11, is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) LtSec. _ rCrqso_)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? Cl Yes
No
❑ NA
❑ NE
No
❑ NA
❑ NE
No
❑ NA
❑ NE
I No
❑ NA
❑ NE
Ca No
❑ NA
❑ NE
Cnmrrtents7(refer to question #} Explain any YES :answers and/or any recommendations or any other comments
1Us�e7drawlfigs ,of facility to better explain situations. (use additional pages as necessary):
GVd 7 W, , re e"4 V&f t �
Reviewer/Inspector Name Iffi,4110
Reviewer/Inspector Signature:
- -- - - - � Phone: U-
Date: 26
Page 2 of 3 12128104 Continued

RV
Facility Number: 4 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes TNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 15 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 16No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
[:]Yes
155No
[DNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
F%) No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
V1 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
59 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
W 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
P 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
Y—' No
❑ NA
❑ NE
Page 3 of 3 12128104

O Division of Water Quality
Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /O 1 Arrival Time:Departure Time: 0 �(�„ County: fn� 0►'re4, Region:
Farm Name: a2bb7 P0, k kn5 2-- Owner Email:
Owner Name: BObX4 l'f-►�Gfn $ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
u
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = O = g = I{ Longitude: = o = 6 = 1i
0
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
Wean to Feeder t�
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ !ra er
❑ Non -Layer
Dry Poultry.
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ _Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: 1;U
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 1�No ❑ NA ❑ NE
❑ Yes
❑ No
MNA
❑ NE
❑ Yes
❑ No
PNA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
[PNo
❑ NA
❑ NE
❑ Yes
1p No
❑ NA
❑ NE
Page I of 3 12/28/04 Continued

I
Facility Number: " Date of Inspection .2 O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NlNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
RNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ;V.5,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ONo
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
U No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[bNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P 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 5No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EP 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) 1—Le5 c rte
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
El No
❑ NA
❑ NE
Ai6.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
® No
❑ NA
❑ NE
11'7.
Does the facility lack adequate acreage for land application?
❑ Yes
JE No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment'?
❑ Yes
P No
❑ NA
❑ NE
'Comments (refer to-ques ion #) . Explain any YES:answvers and/or any recommendations or any other comtnen#s
.Use drawtn .offacilit to better.ex lain situations. {use•addtt[onal ;pages as, necessary); '
F rF�'Y r 4I 8'•�'ti � ill � q;s.l � �E r� � �� g'kr � � ac
Reviewer/Inspector Name i �I ,+� a is � Phone: /D 33--13�
M r �� . r,. ��r � x�� ��
Reviewer/Inspector Signature: Litz Date: o L O
Page 2 of 3 12/28/t/4 continuett

Facility Number: — I Date of Inspection !o O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box, ❑ WUP ❑ Checklists ❑.Design ❑ Maps ❑ Other
❑ Yes D§ No ❑ NA ❑ NE
❑ Yes ;] No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
JP No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
§a No
❑ NA
❑ NE
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
IM No
El NA
El NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes N No ❑ NA ❑ NE
❑ Yes 1�4 No ❑ NA ❑ NE
❑ Yes U No ❑ NA ❑ NE
❑ Yes 50 No ❑ NA ❑ NE
❑ Yes
IR No
❑ NA
❑ NE
❑ Yes
09 No
❑ NA
❑ NE
A�"d�rl�tional�Commetits gnd�`lor Drawings �' � � '�,x '� 5 � � a � �
T
Page 3 of 3 12128104

r
III
- -- filDrvisionf WaterQuaity Y
Facility Number +�iDi isiori1f,Soil�and Water"Canservatlon
�,-
'�c a� r
Type of Visit 0 Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S 1 0 Arrival Time: beparture Time: County:
Farm Name: Owner Email:
Owner Name: It I Phone: _
Mailing Address:
Physical Address:
Facility Contact: 00-recV `' r "45 Title:
Onsite Representative: G
Certified Operator: _
Back-up Operator: _
Location of Farm:
Swine
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
'Other
❑ Other
o
Latitude: =
m�Region: Fo
Phone No:
Integrator: &'D —
Operator Certification Number:
Back-up Certification Number:
0 Longitude: = ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
10DO 1 10 Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
:
Discharges & Stream Impacts
1. is any discharge observed from any part of the )peration?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
In
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifer
❑ Qry Cow
❑ Non-DaiEX
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes MNo ElNA ElNE
❑ Yes
❑ No
PNA
❑ NE
❑ Yes
❑ No
C�NA
❑ NE
ftNA
❑ NE
❑ Yes
❑ No
❑ Yes
CZNo
[:1NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. 1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[PNo [INA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ,fig] NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Ito Af
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
;4No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ViNo ❑ 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
PNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'?
❑ Yes
RbNo ❑ 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
�EhNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application_
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Z No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below,
❑ Yes
E,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Ft,�Q �asrQ
13. Soil type(s)
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
bg 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
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[9No
❑ NA
❑ NE
y,.aw PVV-')"4"►4
L
er/Inspector Name �Phone:er/Inspector Signature: Date: ,
Page 2 of 3 12/2"4 Continued

Facility Number: — Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
❑ Yes
�] No
❑ NA
❑ NE
❑ Yes
W-No
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P" 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?
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? (icl discharge, freeboard problems, over application)
32. Did Reviewerllnspector fail to discuss review/inspection with an on -site representative?
❑ Yes bNo ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
6PNo
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes 51No ❑ NA ❑ NE
❑ Yes
1P No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number, a `
f
Division of Water Quality
Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit 40 Compliance Inspection 0 Operation Review 0 structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: i 16 00 Arrival Time: Departure Time: County: M06f lrn Region: EkO
t
Farm Name: ob 4 (fir .4 �-iw- hs N w T - ' Owner Email: 1 r
Owner Name: �ob�O �� �t`_nS Phone: f 1 Ql �Ta--41 �
Mailing Address:
Physical Address: (� n_
Facility Contact: 60b64 (R, 'yt s Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: i'1M
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' = " Longitude: EJ o =' =
Design Current Design Current
Swine Capacity, Population Wet Poultry, Capacity Population
❑ Wean to Finish
® Wean to Feeder ID
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder ,.
❑ Farrow to Finish
s ❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: 1�3
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 N No ❑ NA ❑ NE
❑ Yes
❑ No
In NA
❑ NE
❑ Yes
❑ No
®NA
❑ NE
E9NA
❑ NE
❑ Yes
❑ No
❑ Yes
Z No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
12128104 Continued

I
Facility Number: a
Date of Inspection I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 1-4 5-$
❑ Yes No
❑ Yes ❑ No
Structure 5
El NA ❑NE
®NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 390 3 .P.1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
MNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
P 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
IP No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[]Yes
I&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
JA No
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�INo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �INo ❑ 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 Drifl [IApplication Outside of Area
12. Crop type(s) Fi5ct,i.,'t? (PQS4L*e_)
13. Soil type(s)��ujle
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes lVo ❑ NA Cl NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 4 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes ZjNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of property operating waste application equipment'?
❑ Yes No
❑ Yes No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
God Fb m , jFCCe.16
El NA ❑NE
❑ NA ❑ NE
L
er/Inspector Name Phone: N10) y�--Z53cu
wer/Inspector Signature: Date: r6 08
12128104 Continued

t
� + r
Facility Number: 6� — Date of inspection 1 oe
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C9 No ❑ NA ❑ NE
the appropirate box. ❑ WDP ❑ Checklists ❑ Design ElMaps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 10 No ❑ NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;9 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
n No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
DO No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
S No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the,time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
tO 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
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JR No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: AA : �6 Departure Time: s rr1 County: rn m Region:
Ij
Farm Name: �b `` � lq"I`'�L'nS ~tA6i(�a-vt 1 # Owner Email: ,I
Owner Name: 60bYyu R A + Ki f)-$ Phone; OJOJ S7-a
Mailing Address: 5b5 A:± -Ins NUrij art rJC 273 i 1
Physical Address: ,, ��qq
Facility Contact: hh�Y` r_ V � A+k4 S Title: Phone No:
Onsite Representative: UepPC�— kw nS _ Integrator: Mom'
Certified Operator: Aawns Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = O = I = Longitude: = ° = & =
ii
Design Current
1?esign Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Pap�ulton
Cattle Capacity Population
❑ Wean to Finish I =
❑ Layer
❑ Dairy Cow
® Wean to Feeder 71O QOO 1
❑ Non -Layer I I
Daia Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -La ers
❑Beef Feeder
PE113oars
El Pullets
❑ Beef Brood Cowl I
❑ Turke s
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'? ❑ Yes KNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? []Yes []No ENA ❑ 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 EINA ❑ NE
2. Is there evidence of a past discharge from any part of the operation'? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes i;3.No ❑ NA ❑ NE
other than from a discharge?
Page l of 3 12128104 Continued

Facility Number: Date of Inspection 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
PQ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
X NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Loa I "
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 or�ll 34
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[!PNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0 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
[PNo
❑ NA
❑ NE
S. 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)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 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) Re CL CPas-ku
13. Soil type(s) C�V i j le
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 9No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes fP No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA ❑ NE
PgNo ❑NA ONE
[ANo ❑ NA ❑ NE
1�_; ­­", 1 11., 11 .. ­:' '.z - .-I :."� �'. I I — . I ... . . 1 1. . I., - !� -' " - 1 .41, '?'�a,
Comments (refer to question #) Explain any YES answers and/or any recommendations or any other. comments
A
Ui61fawings of facility to better explain iituations.'(use additional pages as necessaiyAll
)i
GO'Dd Farm .
Reviewer/Inspector Name r I?hane ff/0 433r33�
Reviewer/Inspector Signature: Date:
I u9C UJ 141461 -0 "AtnuCu

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Pallo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropriate box, ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ANo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes q9 No ❑ NA ❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[P No
❑ NA
❑ NE
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[P No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead an within 24 hours and/or document
❑ Yes
M No
El 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
Eff 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
i] 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
jiNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ENo
❑ NA
❑ NE
AAditi.orial Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Q'G-ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: i t7 d Departure Time: jall,�— I County: /&9!j r,122t2Z Region:
Farm Name: `i'I(C in c &LW4Y Owner Email:
Owner (Same:Phone:
Mailing Address:
Physical Address:
Facility Contact: /1 i-2n _ tC i h.s Title: Phone No:
Onsite Representative: SL_ -
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Integrator: �A!Zfr;�"`'
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o❑,❑ Longitude: 0 0 0 i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
j ❑ Layer
1 JE1 Non-i a er
U Farrow to Feeder j
❑ Farrow to Finish i
❑ Gilts
❑Boars ---- - --- -- --- - J
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design - Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifet
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
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)?
Number of Structures: ®a
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [& No ❑ NA ❑ NE
❑ Yes
5q No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
El Yes
14No
❑NA
[:I NE
❑ Yes
2 No
❑ NA
❑ NE
12128104 Continued

+ ,Y
Facility Number: &4 — 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 1�jNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ,S —e
Spillway?: &9
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
9 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
allo
❑ 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
L& No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
QNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
&No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s) e- _ of-7', r y
13. Soil type(s) � 1' IL &—t
v
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EQ 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
[0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
[2 No
❑ NA
❑ NE
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: 6,,4 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [Z No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. EQ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [3 Monthly and 1" Rain inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[0 No
❑ NA
❑ NI
25. Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
Q No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
5& No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
21 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[N No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
W 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
(4 No
❑ NA
❑ ND
If yes, contact a regional Air Quality representative immediately
3 L
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
W No
❑ NA
❑ NE
(3) _T74 e-r-,aX / �, 9,1, P— -e
12128104

11
Date of Visit: Time: I b
FacilinNumber
Not O erationaE Below Threshold
® Permitted ® Certified 0 Conditionallh• Certified ❑ Registered Date Last Operated or Above Threshold.
Farm Name: c!` County:
Owner Name:i ., s Phone No: f D
A9ailingAddress:{C Q min.c]_t��r�« to AfgC,-.- ?�-
Facility Contact: Title: Phone No:
Onsite Representative: {)e+`Q6k_. ,Ail-L[ /\. integrator: ag I I I
Certified Operator: .4 4", C Operator Certification Number:
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0° " Longitude ' �• �-
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle Ca acitv Population
® Wean to Feeder
I
❑ Laver
I
I
❑ Dairy
❑ Feeder to Finish
JEJ Non -Laver
I
I
JE3 Non -Dairy
Farrow to Wean
❑ Other
El Farrow to Feeder
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons © . ❑ Subsurface Drains Present
Holding Poads 1 Solid Traps ❑ No Liquid Waste Managen
Discharges S Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lazoon ❑ Sorav Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is obsen•ed, did it reach Water of the State? (If yes, norif}, DWQ)
c. if discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Cp1Igcf}gg & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? R5,§pillwav
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: i:�IpW. 1 Cm-„n .2.
Freeboard (inches):�-
05/03/01
El Yes EENo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes [Q No
Structure 6
Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes ( No
seepage, etc.)
6. Are there structures on -site which arc not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes �!] No
{If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes � No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes MNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes Wo
Waste Application
10, Are there any buffers that need maintenance/improvement? ❑ Yes [5jNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes V No
12. Crop hype j- �'
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reguired Rgcords & 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 design2
21. Did the facility fail to have a actively certified operator in charge2
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 1�9LNo
❑ Yes �No
❑ Yes ® No
❑ Yes 0 No
❑ Yes RNo
❑ Yes [I�No
❑ Yes ® No
❑ Yes [91'No
❑ Yes ®1No
❑ Yes ® No
❑ Yes No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments �xwc3•:
(� ,q�d stionakit>Ex�lln any"YESanswefrsAt%il/rantrecornmendaton,argany other co�mius.
uatlnns!�!(use+additional pages tis,necessary) i;,n Field Copv ❑Final Notes
Use drawings of tacit€ty to better expla€n sitvJ,d
�di k��l �r n#J� t lY�
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 3
05103101 Continued

Facility Number: (,ram — 4o bate of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.c, residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29, is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
iAd.ditional Coini ients and/or Drawings:;
05103101
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes 50 No
❑ Yes ® No
❑ Yes No
❑ Yes ❑ No

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