770010_CORRESPONDENCE_20171231

NOHTH CAHULINA
Department of Environmental Qual

#'0 Division of Soil and Water Conservation [] Other Agency
Metk' F
All
MDtvtston of Water Quality
t
Routine 0 Complaint O Follow-up of DW ins ection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number'7 !2
Time of Inspection : 6 24 hr. (hh:mm)
© Registered 9 Certified [3 Applied for Permit M Permitted 113 Not Operational I Date Last Operated:
S
t
Farm Name: J �� County :.............
......./,�............................................................................ r.
Owner Name: ............. '.V.
................ ........................................................................ Phone No: ... ,e!........ ..........................................................
FacilityContact: .........' P "�r.., �'G r............... I.......... Title:.................................................................. Phone No:..............,....................................
Mailing Address:..,......z. , �,P/. .,., �!r............ 1. .� .LK. r.........�. . .L.f......................... ..........................
Onsite Representative:....... ,P.`✓��. P ,r..................................................... Integrator: ....... /.47-... ePee ................................
Certified Operator..........,, 4.4c- .0 ....................................
I .............
.......
Operator Certification Number .........................................
Locution of Farm:
C
C
Latitude o& =1 =11 Longitude =• 0° ="
•
D estgn Current Design
Design Current
Current,;,,: � � g
Cupactty aP"gpulAtion"' Poultry Capacity
Populat.io!G li(attte,µ� Capacity Population
❑ Wean to Feeder
❑ Layer
❑Dairy
❑ Feeder to Finish
❑ Non -Layer
„'''
r
�
❑Non -Dairy
❑ Farrow to Wean
M
E �` x
® Farrow to Feeder
ovo
pszj
❑Other
9
Elk
Farrow to FinishTotal
DesignCapaCit „
❑ Gilts_10iri.M�,,
�Tota1�SSLW,
El Boars
s
� .
M�
Number of Lagoons 1 Holdinij,Ponds '
❑Subsurface Drains Present
❑Lagoon Area
❑Spray Field Area
;.
❑ No Liquid Waste Management System
Y &
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes �kNo
2. Is any discharge observed from any part of the operation? ❑ Yes fij�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other L
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4, Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes R) No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 0 No
7125/97
Continued on back

11 ,
Facility Number: r
S. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes 09 No
Structures (Lagoons.11olding Ponds Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3
Identifier:
Freeboard ft ............1.���z..�� ............3 �...................................
{):.........................................................................I....................
10. Is seepage observed from any of the structures?
Structure 4 Structure 5
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9.12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .... ,fj!/� ........ �f
...... 4yfr,Gr+o-e .4......................................................................................
�
ib. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17, Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0•Ndviolkions,o deficiencies.were,noted;durjithis:visit.;You'vuill.recei:ve:no.ftirther
:. ep&OODIWnce ahout�this:visit:•
❑ Yes 1.4 No
Structure 6
....................................
❑ Yes 9 No
❑ Yes §4 No
Yes ❑ No
❑ Yes ® No
❑ Yes 9 No
❑ Yes RNo
❑ Yes .RNo
JR Yes 0 No
❑ Yes a(No
❑ Yes No
❑ Yes No
4 Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
r!✓/%��l,?�ac
W.� ./9•J�v��d,� errc..�,�x�•�/,�..�.¢//�r.c/a✓.r/1�,.�� � _ /,�,.�r%z n
77
Reviewer/Inspector Name
T 1 .�
Reviewer/Inspector Signature:, Date: l
4vAi,

outine O Com taint O Follow-up of DWQ Ins ection O Follow-up of DSWC review O Other
Date`oflaspection
Facility Number '
Time of Inswd6n. I 11tob Use 24 hr. time
Total Time (in hours) Spent onReview
Farm Status:_ �-� s �'� r _ - -- or Inspection {includes travel and processing)
Fans Name. county:
JQ iG hwr.�r SC .._.,..,_
Owner Name: t , . Phone No:
MailingAddress: o�i-..,_T-S..-.-� �%�i`rs� cJ C— .27�
Onsite Representative: Integrator:. a-
Certified Operator, , ,Uw.^e-- Bagk Operator Certification Number: `
L
e
Latitude Longitude 0•�0"
0 Not O erationsl Date Last Operated:
Type of Operation and Design Capacity
Swine" triber• k� = Poul Yr
�. .
Wean to Feeder ❑ I.e a'
- 0 Feeder to Finishjji
❑Non ❑Beef
11 Farrow WC �? �gr!� �v4ypr Gr+ IN
a a�+d t V�q I
JMEdinow- CCd 1 Qoc, sF d i` nuii, q vw.: ,, w w
Fa wt¢oY Other Type of livestock
���
�� �j-�xnP � w;,+4 ,i r4 3'.c '�. �j � � - r�x� � j � •M �,3�'XQ+I�C>
>,, Number of Lagoons 1 Holding Pondrys" 4,x4 i. 0 Subsurface Drains Present"
�F'��',�' I �;� �� a x � �u �'j � ix°„� ��6` ` �,d� x'k*`� �, r'�"'a��tiwn �, �. • k,�rid'�' i ,"4°i, �� �nx': - .x,� �He
❑ Lagoon Area . 0 S ray Field Area
1. Are there any buffers that need maintenancelimprovemeat?
2 Is any discharge observed from any part of the operation? _., . ,
❑ Yes >-PNo
0 Yes, PNo
a. If discharge is observed, was the conveyance man-made? ©Yes WNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify► DWQ) ❑ Yes PU
c. If discharge is observed, what is the estimated flow in gaMnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of per discharge from any part of the operation?'
4. Was there any adverse impacts to the waters of the State other than froth a -discharge?'° _-
S. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenanceirwTmvement?
❑ Yes
;UNo
❑ Yes
P110
❑ Yes
Po
E3 Yes
t3 No

Facility Number:_21-_ L`
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date:2-Ifilflo
Time: .'� : 30
QeDwj In_, Lomation•
Farm Name:, "'tea; Ine-e. sw�, _ County: Qec G VV1GA
Owner Name: ► N A \r i'n eo r \r � % Phone No: f 9Lo % 9 q e —129?
On Site Representative: PEA R,.... Integrator:,&
Mailing Address: 2,sn� 5 r2 "
go �ni__G_ .3 �?3� 221_
Physical Address/Location: y 'Y" I, (#.s f'%n '-0^ X C (� e r 6.er o
_ __ Foss+ io n k�-& l &J�:
Latitude- 35' l _o3 1do Lon 'tude:__'7!1 I y3 199
Qperation Description: (based on design characteristics)
Type of Swine No, of Animals Type of Poultry No. of Animals Type of Cattle No. of Animals
O Sow 0 Layer 0 Dairy
© Nursery 0 Non -Layer ❑ Beef,
O Feeder
Other eo Livestock Farm,._ ('o Numbero Animals: 10S�n _Saws '.2,Z tiers,
Number of Lagoons:—__a(include in the Drawings and Observations the freeboard of each lagoon)
Eacil*lyInspection:
Lagoon
Is lagoon(s) freeboard less than 1 foot + 25 year 24 hour storm storage?:
Is seepage observed from the lagoon?:
Is erosion observed?:
Is any discharge observed?
❑ Man-made ❑ Not Man-made
Cover Crop
Does the facility need more acreage for spraying?:
Does the cover crop need improvement?:
(list the crops which need improvement)
Crop type: 1. mac, ,,f J Be r em A c_ _ Acreage: s v r e l J s
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Is a well located within 100 feet of waste application?
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?'
Yes ❑ No 13
Yes 13 No 0
Yes C! No Q
Yes ❑ No 51
Yes U Noll
Yes ❑ No 14
Yes CI
Nola
Yes Ci
-No Pa
Yes 0
No R
Yes CI
No 3
AOI -- January 17,1"6

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FALLS -0 au lot
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Mane,
1.411
McLean
1"t
LA
Lill
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Orton LOW A
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Site Requires Immediate Attention:
Facility No. 7 7 —/ z—
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
Time:
Farm Name/Owner: /�l),k vllj
Mailing Address:_ Z50- 3r�iE5 T3� _��1s. ,J,�, z73zs
County: 7�I��.1.ho.✓1� _ _ -
Integrator: Phone:
On Site Representative: vv S Phone: 9lD� zz R7
Physical Address/Location:�n jj.5.3 ' m)16 n✓aezo s, NGneAe w/rW S�14s-1
Type of Operation: Swine _Y_ Poultry Cattle
Design Capacity: 'lae*w - 6A Number of Animals on Site: APPO
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) &e or
Was any seepage observed from the la oon
Is adequate land available for spray? es
Crop(s) being utilized:
No Actual Freeboard: Ft. -` /f Inches
(s)? Yes or&To Was any erosion observed? Yes or(N�o
►r No Is the cover crop adequate? es or No
m
Does the facility meet SCS minimum setback criteria?
200 Feat from Dwellings? 0 or No
100 Feet from Wells? or No es
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or(SP
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orloc If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or(s)
Additional Comments:
Inspector Name
:4s�
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No. 7 Z — z_
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SrM VISITATION RECORD
DATE: 7-4� , 1995
Time:
Farm Name/Owner:�rJX..����-2�
Mailing Address: _,57N 5 7`3.z> 5fzaagj,,A2S_ A.4c..
z,,Y--
01
County:
Integrator: Phone:
On Site Representative: %� Phone:_
Physical Address/Location: 9' ""Ye E M ,uc_ N ,,7X SR 14 sr
Type of Operation: Swine -.Y,- Poultry Cattle
Design Capacity - rha -►J'Av Number of Animals on Site: /vat !
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude• ° ' " Longitude: a f M
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) �e or No Actual Freeboard: Ft. t/9 Inches
Was any seepage observed from the la oon(s)? Yes or&Was any erosion onor
ed? Yes or�
Is adequate land available for spray? es r No Is the cover crop adequate? No
Crop(s) being utilized: -i
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? 0 or No
100 Feet from Wells? es or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or Q�o
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oro If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes ors)
Additional Comments:
4 ,J A Ek,T'i(_a_1_
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

DIVISION 01F .MMIROMCH" AL WAGMURT.
April '13, 1981
tit. 3..8, Charriker
Routed 2, flax 41'A a
811erbe, North, Carolina 28318 ,
SDDJ 1 t
pliant ItmvcdstIsiti.on
' Tar- Utol, fluiac Farm
k1ahmorA County
Dear ' Mr. (hint tkear s .
;his • letter 'is in reference to an investigation made by z Mr.' Waslay S tevvids
of my •atet'f 1ou �A,prll, la; 1981 in ragii4 to your aosipx+eint about odors froe
Tar reel S viva Vats. • Mr. Stevens not with Mr. G'illtam Dunlap'of Tar Heel Svins
Yams nad tar. Wallace Flynt -of, the Uobwos+d Cemnty AgricaLt!.4al Extension
zirav�las a ua Madwe an lrupratioa' of the 1441116y
The Division of Eaviromraeasal .liaraaeg=*at has the responsibility • io adlaia-
i*tear , Ithee. Aalnal p'e*dls t &ogulstion.' This regulation ad4tessraa thee_ method
by whieah the wastewater from an AnIm3l fandlot to"diapooed but does not apply.,
to. odarrs Seamiateed at the feedlot. This oparatiou does use s, s~laseed, .otmresult,k
recirculatiou - typa vaote►irater , tyrentmenv eystem, with partodia land appllc+siiou
of thta wastewrateer. The system In esser 16 ,09tatep of . the -art" and is to cam-
plsance with --the aaulli al feedlot rogulatioa. .
This •agancp 'ilsarl, has the mrasponelbiiLty to assure tbat` air -pollwtion n
**are" are to compliance with the established Vision standards., The
eatesioma. standarrd4 'ware established to achieve and maintain *�Ooifla ambient",.
eNtiruiaxds dealiaed to protact the public health. and welfaemrs. Theme is=rrno
specific air epissiod Ihsiting regalttloia applicable to svtne farasf bowtar,
there "au applicable regulation a hi4h applies to all ©pereationli taut PrddUQe
odorous eeneliistom>rs».. -The mralettsn as stated In the' North Cato it"ahiaistrati►ve ;.
Codes, Title 19 Deoitment of Natural Resoumrce# and Community Development,
Chapter 2, anvirona main Managamint, . Subeahapter' 2 D A# ]Pollatiou Control, kag4tre-
eerests.' subsecilou •.852T .CoutroI and Probibitlen of Odorous Eoisafbas daalarrass
No person' shall cause, suffer, allow; or permit, say plant
acoged. ,in the procrnsiag of aulual„ , alatial; at, vesat4ble xattex>P'
to be opavater d - without employing euttaable m ea sureas 'lar the con .
Carol of odorous =lesions including wet _*crubbeers, inAneratora,
or suah otb er devises as may be, apprrovolt by the Commissicia."
In this case• 946re, from the *wins fare would,iot be covered by this �
regulation, as it appliees.only to process operatioue that prodace''Wosrrs.

State of North Carolina
Department of Environment,
Health and Natural Resources
James B. Hunt, Jr., Governor
Jonathan B, Howes, Secretary
N.G. Purvis Farms
Tar Heel Swine
2504 Spies Rd
Robbins NC 27325
e��
November 12, 1996
SUBJECT: Operator In Charge Designation
Facility: Tar Heel Swine
Facility ID#: 77-12
Richmond County
Dear Farm Owner:
RECEIVED
NOV 12 1996
FOFA`FcE
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local -North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 91gn33-0026.
Sincerely,
A. Preston Howard, Jr., erector
Division of Water Quality
Enclosure
cc: Fayetteville Regional Office
Water Quality Files
RO. Box 27687, 4 FAX [phone]
Ralelgh, North Carolina 27611-7687 �� An Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 50% recycled/l0% post -consumer paper

r
E
0 Division of Soil and it' Conservati" ;Operatiom.Revie'w
N!'•` ; ivision of Soil and Water Coaaer'Vation-,-'Compliance Inspection
t W13
ivision of Water Quality Compliance inspection
=',i 1" �`' '° a 13
-Other Agency : Operation Review tr R €
r�
Routine O Complaint O Follow-up of DWQ inspection Q Follow -tip of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspecliou ® 24 hr. (hh:mm)
Permitted 13 Certified Conditionally Certified [] Registered 10 Not Operational I Date Last Operated:
........A6e,l /
Farm N:�me �eir ..../ �Zn.se............... County:...........�1,/.0 t'.4.11.G1.........................I............
p................. q// q
OwnerName:......L.�l.:.tti.?..,......../ .n.ilk:S................................................................... Phone No:.....,/.7`.......2Z..<..�........................ ....................
Facility Contact: ......r�l............ llf, gQI'`.....................Title: 2CLStPhone No:...................................................
• F � / f
Mailing Address:.. Q .. s, ,.,. .. o F7 ! !!LS %U... ....................... .' .7.325
Onsite r--�
Representative: �f " Integrator:
Certified Operator:...Q� Operator Certification Number:.......................................
Location of Farm:
.............. ..... ............................. ...................... ..................
Latitude Longitude
e C Curren Design
ti Design Ckrrent
tlltr3Capacity Population AoCt ulatCaacitPoulatoaaaCly„PO `
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish '''; ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑ Other I I'
,i ❑ Farrow to Finish ADO71 ,
Total Design Capacity (�
❑ Gilts.
��f' ❑ Boars ; . '!'i 19' 1i �f ii , l E �TUta1 SSLW
Number of Lagoons • Z ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding'Porilds / Splid'Traps ❑ No Liquid Waste Management System
0
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElLagoon [ISpray Field [IOther
a. If discharge is observed, was the conveyance inan-made'?
b. If discharge is observed, did it reach Water of the State'? (If ycs, notify DWQ)
c, lf' discharge is observed, what is the estimated flow in gal/min'?
d. Does dischargc bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Identifier:
Freeboard (inches)
Pructul-c 1
� K...........
QM.j
Structure-2 Structurc 3
Se�gta"r
31 "
Structure 4 Structure 5
❑ Yes 9 No
❑ Yes 9 iNo
❑ Yes FR No
❑ Yes 9. No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
[]Yes JEJNo
_
Continued on back

(Facility Number: 7% — / Z I Late of Inspection
m
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
ANO
(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
KNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
g.No
\
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
®'No
�'
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
5N0
11. Is there evidence of over application? ❑ Excessive onding ❑ PAN
❑ Yes
0
r
12. Crop type r 12 r u a
13. Do the receiving crops differ with those designated i the Certi zed nimal Waste Management Plan (CAWMP)?
❑ Yes
WNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
VNIO
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
Uf_No
15. Does the receiving crop need improvement?
❑ Yes
ONO
16. Is there'a lack of adequate waste application equipment?
❑ Yes
RNo
Required Records & Documents
17.• Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ONo
18. 'Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
allo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
MNo
20: Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
o
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ro
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Awo
(ie/ discharge, freeboard problems, over application)
❑ Yes
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
4No
24. Does facility require a follow-up visit by same agency?
❑ Yes
090
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONO
�et}cien f*s wore �tpte�. �(ing NsAsit;. ;Y;ojt ),011 teeoiye 4o; fu>�tjtgr; : :16irisb6fideh&ab6id
this visit
11

I
I Facility Number: 7 7 Date of Inspection 40 '
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes PO
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ONo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 0
No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes gNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No

'. i :i E4 '-„ .. d -. ..- i 3 P': i f
@ € is E
Q�D1VA166 OfSoll and Wat r CQnSCC,Vation OpSerytlOn RCV1eWfc`; PE 3 a E€ i (� E
;Division of Soil and Waterl Conservation .Contpl=once Inspectlon
{
gE �tD1VISlon Of,WAter Quality Compllflnce Inspectlon
IE f
f
s �_r , P'„ .1,€ 0ether ! $el]Cyz, bperatlon Review e�4�,...E Yf_ .. " ,.r E< <E ;.. „ '.�. , � , .. ,` f ,���„ . >, ; ., ,
J% Routine Q Complaint O Follow-up of DWQ inspection Q Follow-up of DSNVC review Q Other
Facility Number {, Dot:e. of Inspectlon
Time; or Inspection 24 hr. (hh:mm)
13 Permitted 0 Certified © Conditionally Certified j3 Registered 114 Not Operational Date Last Operated:
Farm Name: / 4.~1......#ee— CountY-
.........................%!I
/..t...
Owner Name: ...S ..a. L".!! Il!.S f'�T�,?�...... Phone No:. ..'rr ! ....-.... I.r.-Ag. l.�C....................
Facility Contact: ............. .tn......� ...t3C�- Title: Phone No: ...................................................
:J �
Mailing Address:..... .............. A$ ... ......... �Pl.�.......... R OfJ�.!i..'�,............. ................ .........��.yy../.�.............
Onsite Representative:......,...... .i.......' Integrator:........... .`. ........r�`% ...... ..... J
Certified Operator:............�� . ............................................
Operator Certification Number:.........................................
Location of Farm:
.......... ............... ........ ................ .................. ..
Latitude 4 46 Longitude • 4 46
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer
JE1 Dairy
❑ Feeder to Finish
❑ Non -Layer
I Non -Dairy
❑ Farrow to Wean
Up Farrow to Feeder
Other
❑ Farrow to Finish I
Total Design Capacity
` 00�
❑ Gilts
rl Boars I
Total SSLW
Number of Lagoons 1E1 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes MI No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance mien -made? ❑ Yes No
b. If discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes No
c. If discharge is observed, what is the estimated Ilow in gal/ruin? . A1A
d. Does discharge bypass a lagoon system? ❑ Yes Vo No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 19 No
3. Were there any adverse impacts to the waters.of the State other than from a discharge? ❑ Yes j No
Waste Collection &'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 • `
ldendfier: pfr
Irceboard (inches): .........:.......... .......... ...... .......... ................... ................................... ............................. ....... .................................... ....................................
1/6/99 Continued on hack

Facility Number: 7 - .9- Date of inspection 1.7
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, Cl Yes U�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 1KNo
(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`? ' AlYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? s[No
Waste Application
10, Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen ❑ Yes No
ti
12. Crop type ..............................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes X No
14.
Does the facility lack wettahle acreage for land application? (footprint)
❑ Yes
Al No
15.
Does the receiving crop need improvement'! AWC C% MP S �7 f afAeO
❑ Yes
No
16,
r /
Is
No
there a lack of adequate waste application equipment?
❑ Yes
Ixe
Uired ItelUrdS & I)oetmrentti -
17.
Fail to have Certificate of Coverage & General Permit readily available? , f 6e rev+$le
❑ Yes
No
18.
Does the facility !'ail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WIlP, checklists, design, maps, etc.)
❑ Yes
ArNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
.9 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a certified operator in responsible charge`?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(XNo
(ie/discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
WNo
24,
Does facility require a follow-up visit by same agency?
❑ Yes
#No
N.o.viaiations'o' deikiencies:were naeid' daringA' lsi :visit:.'You,zrilfrecceive na further.' '
.. • eorrespaidei��e' about: this ;visit.: ' ..... .......... ... .
Comments,(refei•: to question:#): Explain any YES answers and/or any, recommet
66 drawings' of facility to better explain situations. (use additional pages as nece
Y, AW � �mv►a 2 C .U✓�o °�''� Lrt,g.e/�o lv ''t
.5Z -
A"
r
`{ Alv1 S
zi
rM
t or any,other, comments ".I. � , t ., �
}
z, ftWV;4:4"- _#W " 'L
LAaa �.
- +UW a
Reviewer/Inspector Name
Reviewer/inspector Signature: Date:-7-,2-6'- X7 11/6/99

(Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation I
for Visit O Routine O Complaint O Follow up O Emergency Notification • Other ❑ Denied Access
Facility Number Date of Visit: l e O Time: L�El
O Not Operational O Below Threshooid
0 Permitted © Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ...-........... ._.......
Farm Name: ..... ....:: r.....!�.! a ...... .s we'_..Ce...».......».»................................ County:.........! .!! i:i i ».......».....»_._.......
OwnerName : .... ........................................ ... ......... .»........... ................ .......»........ 'Phone No: _._..................
MailingAddress: ....»........... _ .... _._..._»..»» _........_ ....:..........».»»........... »».........».»._»...
FacilityContact• ............................ ................... »._._»...........Title:... ...... .»....».»..........».. Phone No:
Onsite Representative: .............. . . . . .. . ... ».. »........._ ............... » ......_.... Integrator:.»_.» ».».».»............»»........ ............. ..........
_ .».»........
Certified Operator: ._........ ...» ....... .................. »..».. »..»»... _._.....»» »........................ Operator Certification Number.--.....__.. . . . .... . ... . ........
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude ' 4 66 Longitude e 6 «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: ........»..». ll--...._._ _ Z.... 4 �.41..._.»._»_.......»..........._.............».».»».».» .....». ».» .._.... ».»..»...». ».»_..._..» ....»...
Freeboard (inches): »» tD
12112103 Continued

Faciii Number: --t --- i, Z Date of Inspection 0r
a
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
S. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c)'This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Lssues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional (] Yes ❑ No
Air Quality representative immediately.
mck- W+ m1r.
Reviewerffiispector Name
Reviewer/Inspector Signature:
12112103
❑ Field
v; 1 ao,
Date:
Final Notes
Cowed

z
Date of Visit; Q Time:
Facility• Number
10 Not O eratinnal 8eloa' hreshold
® Permitted 0 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Thresbolri:
Farm ?dame: _ . 1f � � . Ptht'U'%s F[nrk,,W County: ba=tAf- t�
Owner Dame: t fr— t e ( �ii,�;... Phone No:
Mailing Address: 2_"� O '4, i Cs fzt ce d 21-3 zl�—_
Facility Contact: To n u rYln a re Title: Phone No:
Onsite Representative: _ I t a + tM(>aC-0, Integrator: j 10 -- L D
Certified Operator: G+rs P�!'r' Operator Certification Number: 2b3 eq
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 6 Dµ Longitude •
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle Ca acity Population
❑ Wean to Feeder
10 Laver
I
1
1[:]
Dairy-
❑ Feeder to Finish
IEJ Non -Layer
I
1
10
Non -Dairy
❑ Farrow to Wean
Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons J � Subsurface Drains Present
'Holding Ponds / Solid Traps ^' ❑ No Liquid Waste Manager
Dischar2es & Stream Imaacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & IrgalMent
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): air
05103101
Spray Field Area
El Yes ®No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes R 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 P No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes P 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 No
YX
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
}Vast nnilcation
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12, Crop type 9tr"'" ,J. kvl, (4-r-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [9 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes ® No
Rewired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
UNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
[>_jNo
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
0 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
( No
22,
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
B No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
R No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
QNo
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comm nts (refer `to questl6n #) 3iExpluin any YiJS',answers an'dlnr,any recomncotlation`s" or any>other comments." '
�Uac;drawings�of facility to be�tte� expflaln alt atinns (use additl6nal`pagcs as necessary),El Field Copy ❑ FinalsNotes
4—
Reviewer/Ins ector Name
p �. l." �1 A, x:t�$. �f✓�, rill`:. .nia3'..
Reviewer/inspector Signature: Date: b
05103101 ca Continued

Facility Number: — 12 Date of Inspection
Odor 15r,,;U U
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, Arc there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. 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 fans) noted? (i.c. 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? .
Additional Comments and/or Drawings:
❑ Yes (13 No
❑ Yes P No
❑ Yes Q,No
❑ Yes 1� No
❑ Yes No
❑ Yes No
❑ Yes [ No
05103101

u
f
r
Facility' lumber �}"� ! Date of Visit' Time:
FO Not O er tional 0 Below Threshold
C1 Permitted © Certified O Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: _ /f, G , i�LIN,C.S 1^t,-y County: l2 i r,I, j Fl o
Owner .Name: _T(,i,r', , e e�St J 2 _ Phone No: O
Mailing Address: 2404 Sair^ t2Daef o
Facility Contact: a Title: Phone No:
Onsite Representative: ia H A4,1 A le_ Integrator: L'r- V) t .0
Certified Operator: IS Ulf e.rr Operator Certification Dumber:
Location of Farm:
N Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 4 0 u Longitude • 4 .6
Design Current
Swine rnnarity Pnnulatinn
❑ Wean to Feeder.
❑ Feeder to Finish
❑ Farrow to Wean
® Farrow to Feeder
t o�
❑ Farrow to Finish
❑ Gilts
❑ Soars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laver ❑ Dairy
❑ Non -Laver ❑Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of liagoons I A' ;I❑ ' II❑ Subsurface Drains PresentLagoon Area I❑ Spray Field Area I
,.Holding Ponds / Solid Traps No Liquid Waste Management System
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes qNo
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made? El Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c, If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'. (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes FBI No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: . — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Wlilte Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes RNo
❑ Yes �] No
❑ Yes P No
❑ Yes ® No
Cl Yes ® No
❑ Yes ® No
11, Is there evidence of over application? ❑ Excessive Pondmg ❑ PAN ❑ Hydraulic Overload ❑ Yes C�Lddo
12. Crop type e, (`ran u d- hFj oT
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes ® No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 12 No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes WNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes IN No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [3 No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes P No
22. Fail to notify regional DWQ oremergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ® No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes E4 No
24. Does facility require a follow-up visit by same agency? ❑ Yes O No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes LE�No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit,
lerdrawiti�s of'fat ility to betq.tet.'eioluiipsltuutlons: (use dddiational�ges 5s"rnecessary) i° ' ❑ Field Copy ❑Final Notes
cor
Reviewer/Inspector Name w g:
Reviewer/inspector Signature: Date: D
05103101 Continued

Jr ..
Facility Dumber: T-F— I Date of Inspection
Odor IUM
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?
29. Is there any evidence of wind drift during land application? (ix. 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.)
3 l , 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?
05103101
❑ Yes [:]No
❑ Yes [0 No
❑ Yes ERNo
❑ Yes RNo
❑ Yes No
❑ Yes No
❑ Yes ❑ No

Facility Number Date Of Visit: Time:
10 Not O erational IQ Below Threshold
*Permitted ® Certified [3Conditionally Certified 0 Registered Date Last Operated or Abovq Threshold:
Farm Name: Zlli<lr✓/E County: ;�c�wco.►i�
Owner Name: .��/J �/� Phone No:
Mailing Address: Z�' O %V C Zr"" f JC6.0� i /ta���-JET,
Facility Contact: AW0O.tif- Title: Phone No:
A07-
Onsite Representative: �,/O~ Integrator: �•.C✓�-�l
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ IlorseLatitude 0 0• �u Longitude 0
'z i' ail 1 �! (Design- Currentii` r €��' �� ` ; f DeSl Current Design Current - '
`ECa acih�'' 'Po ulation� Potilt ry Ca acitv`,' Po'"ulatiori: -Cantle , Ca" xcitr Po 'ulation
Wean to Feeder,' ❑ Layer I ai
❑Feeder to Finish h . [] Non -Layer I JoNan-Dairy i I
❑ Farrow to Wean I ; ❑ .; ;
Farrow to Feeder 6O (,' Other
ElFarrow to Finish );
Tafal Design Capacity
❑ Gilts
El Boars Total Ss LW
Number.;of Lagoons .'; Subsurface Drains Present ❑ Lagoon Area Spray Field Area '
F ,
Woldin!Ponds /'Solid Traps „ ❑ No Liquid Waste Management Svstem
Disgharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c, If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Coligetion & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: p
Freeboard (inches): ___,P'
❑ Yes RNo
❑ Yes CKNo
❑ Yes 9 No
❑ Yes ® No
❑ Yes No
[I Yes PRNo
❑ Yes to No
Structure b
05103101 J� Continued

Facility Number: '72 — l Z.
Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any pan of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? - ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type---
❑ Yes tZN0
❑ Yes N No
❑ Yes ONo
❑ Yes �9No
❑ Yes M No
❑ Yes ®No
❑ Yes 0 No
13. Do the receiving crops differ wlth those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ,k No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
' No
b) Does the facility need a wettable acre determination?
❑ Yes
91 No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
IS.
Does the receiving crop need improvement?
❑ Yes
No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18.
DOCEA11L facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(i checsts, design, ma;, etc.)
r� Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis azsample reports
❑ Yes
,W No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
;RNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
RNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
)
P-No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Co nments (reQ: ques#ion #) Rxpiain any,;YES'ansKcrs andlorr,Snyirero>rninendations or aay other�co�msnents;
, "mo
�Uso drarvings offar`ility to better,eaplain °situations .(usc nrlditioasl pages�as uecessary) ;
Field Conv ❑ Final Notes
„_it E �W' 6 f a,E „k o sF
,.E trig, .lY rrst re.i - EE..f � : iiki�e 15r 4 FF, S:{. f>s.✓ .[ ..fy-.ry - {Iu1- iil. F'1 . F € .�i�. g..
�S'. Gr�l,�/�i���•7 a�.r..� �,�� ��.� ,�.��,,//,dam .,,�
og
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: / 4Z
cow

Facility Number: 7 — /Z Date of Inspection / D
dor 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.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
24. 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?
NYes ❑ No
❑ Yes Q No
[:]Yes ,® No
❑ Yes .R No
❑ Yes KNo
❑ Yes allo
Oyes ❑ No
1
Additional Comments and/or Drawings:,,,;, .
1 /. (.Tr�� .�i �, ��s Lr�if� �•.� 3�� y� G iF�Wit..tr��) Ae,
J
05103101

of Visit IV Compliance Inspection O Operation Review O Lagoon Evaluation
IReason for Visit PkRoutine Q Complaint O Follow up O Emergency Notification O Other
❑ Denied Access
Date of Visit: 3" _ � Time:3
Facility Number Z. C/
Not Operational O Below Threshold
Permitted © Certified, P Conditionally Certified © Registered Date Last Operated Above Threshol .........................
Farm Name: 11..J.'11.�'..de
..L.. e. County:....... .G. ?.4 ............................
Owner Name:..... N..L`!........... ..! t��s.... 1�'1 .............................. Phone No:...........1... .Z.Z..g.yl ...............................
Facility Contact:......1P.........................Title:.................
.......... Phone No ...........
MailingAddress:......................................................................................................................
Onsite Representative: l ,_, ......•........... ...............•„
7Certified Operator: ram•.................................... p ,..................................... `�
Location of Farm:
Integrator:.......
Operator Certification Number:........
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 « Longitude • C 46
Design Current Design Current Design Current
Swine Ca acit Po tilation Poultry capacity Population Cattle Capacity Population
❑ Wean to Feeder Fj
Layer ❑ Dairy
❑ Feeder to Finish Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder Q ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total, .SS
Number'of Lagoons
:.;s•,
❑Subsurface Drains Present
❑ Lagonn Area
❑ Spray Field Area :•;
_ „;
4 `:
f
Holding Ponds id Tra s
-
No Liquid Waste Management System
Discharees & Stream Im acts
I. Is any discharge observed from any part of the operation? ❑ Yes P(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`? El Yes No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [] Yes [(No
c. if discharge. is observed, what is the estimated flaw in gal/min? ]1//\\
d, Does discharge bypass a lagoon system? (,If yes, notify DWQ) ❑ Yes INo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes � No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes R' Io-
01/01/01 Continued

r
Facility Number: 7' -Z /?,
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes gNo
Stry9jure 1 Struct7 2 Structure 3 Swucture 4 Structure 5 Structure 6
Identifier:......L..3...............................7.....r................ .... ..................... ........... ........................ I.... .............. I....................
Freeboard{inches}: ......... .............. ........y..............................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes J�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes �io
(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 4No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes gNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ffNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessi Pondin PA Hydraulic Overload ❑ Yes �(No
12. Crop type ,
13.
Do the receiving crops differ with those designatdin the Certified �mal Wadste Management Plan (CAWMP)7
El Yes
o
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
o
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15.
Does the receiving crop need improvement?
❑ Yes
o
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
4:7-G2
0
l is there a_water upply-iw4U-within�SQ=fc ❑ems
o
❑ On -site ❑ Off -site
Reguired
Records & Documents
19.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
20.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
o
21.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
22.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
23.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
24.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
25.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ro
26.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
(No
Odor Issues
28.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
'No
liquid level of lagoon or storage pond with no agitation?
29.
Arc there any dead animals not disposed of properly within 24 hours?
❑ Yes
F>LNo
01/01/01
Continued

Facility Number:
Date of Inspection
30. is there any evidence of wind drift during land application? (ix, residue on neighboring vegetation_, asphalt,
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon?
32. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
33. Do the animals feed storage bins fail to have appropriate cover?
Printed on: 1/4/2001
❑ Yes
�No
❑ Yes
Iro
❑ Yes
FNo
❑ Yes
[�(No
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Oyes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
!
Reviewer/Ins ector Name = '�""
e "mi ' `�s+3C:'
F Mal
Reviewer/Inspector Signature: a e Date: /4 ,
01/01/01

f 3II
Divi'sio" of Water Resources —
Facflity Number `7 - � � Division of Soil and Water Conserva�Ion
Q Other Agency �
Type of Visit: ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: li Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: D9•/ Departure Time: 1 County: 4rp'a2-64Region: ie-t�b
Farm Name: �LL.� -5i"Ov Owner Email:
Owner Name: /Ili &Lt41-0 �S Phone:
Mailing Address:
Physical Address:
Facility Contact: �i�.j Aa/ 7 e Title:
y
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Phone:
I'15a 1964'V%4'�
Certification Number:
Certification Number:
Longitude:
Design Current
Design Current111111
Design Current
Swine Capacity Pop, Wet Poultry Capacity Pap.
Cattle Capacity Pop.
Wean to Finish I ILayer I
Dairy Cow
Wean to Feeder
I
jNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Zv-FIDE
ign Current
Dry Cow
Farrow to Feeder
Dr. P,ault , C:a act P.a
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
113eef Brood Cow
Boars Pullets
Turkeys
Other Turkey Poults
OtherFTOther
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes F No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No 2 NA ❑ NE
[:]Yes [:]No
❑ Yes 9 No
❑Yes 1%FAINo
NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facill Adumber: - Z Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No O NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? []Yes t 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? 0 �
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 [��o ❑ 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? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding [3Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Accee�ptable Crop Window ❑ EvideF14)
of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s): t . W � �L}v— ,- , �y`' ' i
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?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the 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.
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes 1�No
❑ NA
❑ NE
❑ Yes
T No
❑ NA
❑ NE
❑ Yes
No
❑ NA
[] NE
❑ Yes
No
❑ NA
❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes /Y 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
Pa,&,e 2 of 3 21412015 Continued

acili Number: 7- Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below. 1
❑ 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 RNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
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
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
1
® No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
7
1� No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
R No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
❑NA ❑NE
❑NA
❑NE
❑ NA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Phone: ,/ p�►
Date:
2/4/201.5\

.0"
(Type of Visit: ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: ® Routine 0 Complaint 0 Follow-up O Referral O Emergenev 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time;to,County: j1?Q'✓d Region:
Farm Name: M4 Owner Email:
Owner Name: AllY Phone:
Mailing Address:
Physical Address:
Facility Contact: �� .� r'� - Title: Phone:
Onsite Representative: Integrator: 42i'--PGA-` 022
Certified Operator: Certification Number. -
Back -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
esi�g�n
esignrrent
ineED
apacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
to Finish
Layer
Dai Cow
to Feeder
Non -La er
Dai Calf
r to Finish
Dai Heifer
to Wean
r
Design
Current
D Cow
to Feeder
Dr, P,oultr.
Ca acit
P,o .
Non -Dairy
to Finish
La ers
Beef Stocker
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes P No ❑ NA ❑ NE
[:]Yes [:]No NA ❑ NE
[—]Yes [:]No NA ❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) [:]Yes ❑ No F2] 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 I of 3 21412011 Continued

dFacili Number: rj - 2 Date of Inspection: ,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
pa NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
0 NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
[] NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
[:]NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
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/ 0 Evidence of Wind ,Drriftt J ❑ Application Outside of Approved Area
12. Crop Type(s):68�l�._ dam' V'''�S S� �`'r "V�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes T No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [F] No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �B 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
T
❑ 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 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�q No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

,, Facil Number: - Date of Inspection: -7
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 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes [!� No
❑ Yes E� No
❑NA ❑NE
❑ NA ❑ NE
Phone:
Date: 0 4:z
21412015

(Type of Visit: ® Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: V Routine O Complaint O Follow-up O Referral O Emergencv O Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Arrival Time: Departure Time: 0� County: Region: g
lL� Owner Email:
J
Phone:
Physical Address: . A
Facility Contact:Title: Phone:
Onsite Representative: y Integrator: NLG PACs
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Deslgn
CurrentM
rent
Design Current
Swine Capacity
Pop.
Wet Pouitry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Design Current
DairyHeifer
Farrow to Wean
D Cow
Farrow to Feeder
pr, P■oulh,
Ga aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
U.ther
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? ..
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes �No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes] No
❑ Yes No
NA ❑ NE
�NA ❑NE
NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facill Number: jDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes �q No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 91 NA ❑ NE
Struct re I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes JE� 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
[A No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
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 o Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s): C�GLt�
q vy,
13. Soil Type(s): a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
91
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
SP
❑ 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 150
No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No
the appropriate box.
❑ Wi1P ❑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 Ey No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: IDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
kA No
❑ NA ❑ NE
25, is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
E�? No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
�§ No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
EP 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
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
Lp No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
ifT 9
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: X T
21412015

for Visit: 9 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: DQ: O Departure Time: County:
Farm Name: _ � 1,w— 5Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: u
Certified Operator: 4
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: AJO- PP-41)
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Design
Current
Design
Current
Swine Capacity Pop,
Wet Poultry
Capacity
Pop.
Cattle
Capacity
Pop.
Wean to Finish
Layer
E]
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
"VILayers
Design
C►urrent
D Cow
Farrow to Feeder
Itr�
C•.a acit
P.o
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
ers
Beef Feeder
Boars
Beef Brood Cow
Other
TurkeyPoults
Other I IOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: r
a. Was the conveyance man-made? ❑ Yes ❑ No ® NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
® NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: 7 i - Z Date of Inspection: Z
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
29 NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �� k
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
5D 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
YJ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
JP
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes W 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 C�ropQWi-ndow ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s): c a Sr CA, -, ) , _S:'
13. Soil Type(s): M
14. Do the receiving crops iffer 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?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
TT
❑ 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 qD 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
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
[]NA ❑NE
21412014 Continued

Facili Number: ? -12= jDate of Inspection:
2.4. 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 F9 No
the appropriate box(cs) 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? [3 Yes E]p No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes `� No
❑NA []NE
❑NA ❑NE
❑ NA ❑ NE
❑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
[;j No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes]
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
entscdriivinEsof,facilitvtoxtietterezulain=situations(use$dditioiialpaeeaasgetcessarvl.a..
F
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: L?
21412014

Type of Visit: 0 Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ® Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1'3 Arrival Time: / .302.E Departure Time: County: Region: C
Farm Name: Gc-✓t�ZQ. Owner Email:
Owner Name: �l-� ��� Fa-C 'tA S-•G Phone:
Mailing Address:
Physical Address:
Facility Contact: !�� -p Title:
t-�
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
t,
Latitude:
Phone:
Integrator: 0 G_- (' s
Certification Number:
Certification Number:
Longitude:
Swine
inish
4WGilts
Design Current Design Current
Capacity Pop. Wet Plultmnyclapacity
Design Current
le Capacity Pop.
Dai Cow
eeder
ENon-LaXer
Dairy Calf
Dai Heifer
Finish
Wean
Design C►urrent
r P,pultr. Ca aci P.o
Layers
D Cow
Feeder
Finish
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
1H'1T'11
Non -Layers
Boars
ullets
Other
Other
urkev s
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?
3t Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes JE� No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
[:]Yes Ej�No
[:]Yes �No
NA ❑ NE
�NA ❑NE
NA
❑ NE
❑NA
❑NE
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ 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: 2—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) r
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
V 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
P No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
�No
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 Wi Drift [] Application Outside of Approved Area
T
12. Cropyre{s) S
: LTA
13. Soil Type(s): f
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
4
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
O No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P 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 El Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes q No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ZNo
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Faeili umber: - C jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No [DNA ❑ 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
1P
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
'Comments (refer to question #): Explain any YES answers and/or any additional recommendations or anyother.coinments.,.,
Use drawings of facility to better ex lain situations (use additional ages
I
Reviewer/inspector Name:
Phone; `l o 3 3.30
Reviewer/Inspector Signature:
Date; 4:5C/13
Page 3 of 3
21412011

i ype of v ism w uompitance inspection tv uperanon meview v brrucrure Evaivation V i eenmcai Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: /:?1fb Departure Time: �/ • County: BN�% Region: JW
Farm Name: Q,t�`t�`YX�( sw. Owner Email:
Owner Name: 4 /`w"✓'*7' Phone:
Mailing Address:
Physical Address:
Facility Contact: �+,—� i��� Title: Phone:
Onsite Representative: H Integrator:
Certified Operator: k1 Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Current
Design
Current
Design Current
Swine
Capacity
Pop.
V4'et Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer
I
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
2p
%v
Design
Current
Dry Cow
Farrow to Feeder
Dr Poultry
Ca acit
Po P.
Non-DaITY
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes F] No ❑ NA ❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No [%4 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 Q No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

i
FacilityNumber: 'I. - Z 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
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? []Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 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
[P 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)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
[DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): A
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[I No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EP No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[53 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
M No
[DNA
❑ 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.
TT
❑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
No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facilit Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [-]Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [] No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [::]Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
M 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
[11 No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
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
jP 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
No
❑ NA ❑ NE
Comments (refer to question #}: Explain any YES answers and/or any additionalrecommendations orany other,cominents.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: (6 6vt fV L
Reviewer/Inspector Signature:
Page 3 of 3
Phone: —1 ,(,g �
Date: 6
21412011

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 0 Denied Access
Date of Visit: 15 Arrival Time: Departure Time: p(�/w,� County:
Farm Name: LA4 _5" �Q� Owner Email:
Owner Name: AQ� "'"SAC 1 - Phone:
Mailing Address:
Region: z
Physical Address:
Facility Contact: (4n ►y t0 Title: Phone:
Onsite Representative: Integrator: N G Pt�als
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
ae Cff_D__8C1t_VjEP.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I INon-Layer
I
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
20
Design
Gurrent
Dry Cow
Farrow to Feeder
Dr,. P,nultr>
Ca H.
Po ..
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
F713ecf Brood Cow
Turkeys
©_they
_Turkey Poults
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
2!�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
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

L
Facility Number: - Date of Inspection: 5 jLf I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 19 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): --c_
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.) 03
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 Al2plication
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 [:ZbNo ❑ 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 [3 Evidence of Wind Drift ❑ Application Outside of Approved Area
pt- 12. Crop Type(s): I ,r u4A 6ZaS5 rk�
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?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes � No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes IR No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes � No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No
and report mortality rates that were higher than normal? 1P
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [�'No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 1� No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑NA ❑NE
[�NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
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 [ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �T No ❑ NA ❑ NE
FUs�e
ments (refer to question #) Expliiin any YES answers and/or any additional recommendations or any other comments`
drawings of facility to better explain situations (use additional pales as necessary)..
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: I to--j -3 30D
Date: S
fq / ,,
21412011

• Division of Water Quality
Facility Number I - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: O Compliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: 4WRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access II
Date of Visit: /� l Arrival Time: LEI Departure Time: Q .' County:
Farm Name: ����jjq„r"�f''��L S(,D Owner Email:
Owner Name: jr— iP[.� 5 �(� cz Phone:
Mailing Address:
Physical Address:
RLCffMOJ
Facility Contact: dq Title: Phone:
Onsite Representative: Integrator: li.{'t�
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Nan -La er
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
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)? _
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?
Longitude:
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
❑ Yes ❑ No
[]Yes []No
❑ Yes C!oNo
❑ Yes [I No
NA ❑ NE
NA t❑ NE
NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facill ' Number: - 7- Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
No ❑ NA ❑ NE
❑ No ?r_'3 NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J /
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EP 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 I 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) T'
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift ❑ Application
Outside of Approved
Area
,
12. Crop Type(s): &_l
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
IS. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Re aired 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 V Rainfall Inspections []Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

lFachii7y Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ®No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes T❑ No [§NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes AM
{ j No ❑ NA ❑ NE
❑ Yes V No ❑ NA ❑ NE
❑ Yes Qg No ❑ NA ❑ NE
❑ Yes F1 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or -any other comments
�. a
Uw drawings of facility to better explain situations (use additional pages as necessary).:
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: r lb,33_ -m
Date: 0.4—/f
21412011

1�
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4§ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: F County: *amowy Region: 0030
Farm Name: �1 &_dJ //� Owner Email:
Owner Name: /w �W� s� + Phone:
Mailing Address:
Physical Address:
Facility Contact: 1r.4" Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: 11167 L ✓� f
Operator Certification Number:
Back-up Certification Number:
Latitude: Longitude.
Design Current Design C►urgent Design Current
Swine g FpKc, t-
yj Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish 10 Layer I I ❑ Dairy Cow
❑ Wean to Feeder
1110 Non -Layer
❑ Dai Calf
❑ Feeder to Finish
❑ Dairy Heifer
Farrow to Wean 2-6 Dry Poultry
❑ D Cow
El Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑Non -Layers
Beef Fee
❑ der
❑ Pullets
❑ Boars
❑ Beef Brood Cow
❑ Turkeys
Other ❑ Turkey Pouets
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes '1 No ❑ NA ❑ NE
❑ Yes
❑ No
CMNA
❑ NE
❑ Yes
❑ No
�3 NA
❑ NE
CI'JNA
❑ NE
❑ Yes
❑ No
❑ Yes
qplo
❑ NA
❑ NE
❑ Yes
BNo
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CjN0 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No .P NA ❑ NE
Struck re I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: o-Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a 17';Z4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes FNo ❑ 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 [P 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 15 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 5§No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu., Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ dence of Wind Drift ElApplication Outside of Area
12. Crop type(s) &mL4d
13. Soil type(s) lrinL4_1l 1q
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations,'or.any other. comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
r
Reviewer/Inspector Name phone; -3�0
Reviewer/Inspector Signature: Date: Z
Paine 2 of 3 12128/04 Continued

Facility Number: — Date of inspection 0
Required Records & Documents l
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Wo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CpNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Eb'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
U No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
M No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
jShNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
nNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
E$No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
5No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ 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
�jNo
❑ 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
C�No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit (Tompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit WRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 3 f Arrival Time. Departure Time: i County: PIChMNk Region: '�
Farm Name: lk Neel swme Owner Email:
Owner Name: �� P✓i'S F-7aeir Phone:
Mailing Address:
Physical Address:
Facility Contact: M re- Title: Phone No: aq.S''1 6-157
Onsite Representative: Integrator: Vito wviS
Certified Operator: 15*vf✓ Operator Certification Number: g o3 n
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = e = s = Longitude: = ° 0 i = _0
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La cr
�' ❑ Non -La et
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: a
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ 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 CgNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
12128104 Continued

Facility Number:M —d�� Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes 5'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6,
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 19 7a4-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
RNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
-Yes
❑ 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
[5 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
❑ NA ❑ NE
maintenance/improvement?
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
C'No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
, f
12. Crop type(s) .OaJja I &MALda1--
L
13. Soil type(s) \VCA — C"h&_S
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®'No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
BYes
a No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
Yes
['No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA ❑ NE
Comments (refer to question ##): 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):
A
Reviewer/Inspector Name MAk, SCj4lV6 IEe_ Phone O(0 OD
Reviewer/Inspector Signature: Date: Q
v 12128104 Continued

Facility Number: — Q Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes ®No ❑ NA [)NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. 0 Yes UffNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking 25 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
JRNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
® NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
NjYes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ff No
❑ NA
❑ NE
27.
,Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
C9NA
❑ 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
® 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
ERNo
❑ 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
ff 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
FNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
q No
❑ NA
❑ NE
Additional Comments and/or, Drawings:
7. PIP rc. cL,+ s roll +ree r 4 b,,. a) k"de e I b
)5, Mush- lyre_ 5 fta,
se a-
s�- mvIch ba^,!�seotr 0niaro,, j nea��'I- hOLj ,
o?�, �ore(or'dS ke an ha Cam'¢,
a3, boo$ El-d e- �L�.eVC7 - M
Np w+n e�o� l�la'�d . VO n�'PdPd s ra ldr hQ� aJ� C av��,
Page 3 of 3 12128104

Facility No. 01 Farm Name `f� WPf SWIG Date E31 lo
Permit COC OIC R*fOe)+PA-ry NPDES {Rainbreaker PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
-Sludge Survey Date
Sludge Depth ft& %
Liquid Trt. Zone ft
Soil Test Date ZkON Crop Yield
pH Fields yam_ Wettable Acres
Lime Needed z-z1))_', WUP
Lime Applied Weekly Freeboard
Cu ✓ Zn ✓ Rainfall >1"
Needs P 1 in Inspections
120 min Inspections
Weather Codes ✓
Transfer Sheets_
RAIN GAUGE
Dead box or incinerator
�5.
Pull/Field
Soil
Crop
RYE
PAN
Window
Max Rate
Max.,Amt
hQ C410,
N,91-se
s?
4!
Verify PHONE NUMBERS and affiliations -
Date last WUP FRO Date last WUP at farm
FRO or Farm Records - J
Z -Ou f k �(fe1 �' I k 14��
Lagoon # 7
Top Dike
Stop Pump
Start Pump
App. Hardware
L,

i
Facility Number Q
VDiivision of Water Quality
0 Division of Soil and Water Conservation
O Other Agency
Type of Visit ,Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other [:1 Denied Access
Date of Visit: Arrival Time: �� Departure Time: [�= County: Q✓l� Region:
I I I
Farm Name:
Owner Email:
Owner Name: 1 V �3t r V i 1 n S Phone:
Mailing Address:
Physical Address:
Facility Contact: !_ b r] lr Z, Title: Phone No:'71 ,NS 7 c0 75
Onsitc Representative! �f) n LA Mm Y- Integrator: r— U ✓ _
Certified Operator: 5 Operator Certification Number:�.�
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = o = i Longitude: = ° = A
Design Current Design Current
Swine Capacity Population . Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
ElFeeder to Finish
Farrow to Wean I ZOS ( ZOa
arrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Met
❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure [IApplication Field ElOther
a. Was the conveyance man-made?
Design Current
Capacity Population
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure [IApplication Field ElOther
a. Was the conveyance man-made?
Design Current
Capacity Population
ry
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 V,No ❑ NA ❑ NE
❑ Yes
❑ No
�NA
❑ NE
❑ Yes
❑ No
W NA
❑ NE
❑ Yes
❑ No
19 NA
❑ NE
❑ Yes
0 No
El NA
El NE
❑ Yes
No
F
❑ NA
❑ NE
12128104 Continued

I
N_mber: ��_ —_ � � Date of Inspection
�tYFacility u
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No Cl NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes NbNo Cl NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: I a^'
Spillway?:
Designed Freeboard (in): 101
Observed Freeboard (in): "5) Lf +
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes [ 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? Xyes ❑ 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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes ANo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) WG s
WA - Cam:
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
)qNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�tNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name CH9LISTWE &A Wr k Phone: /0 0
Reviewer/Inspector Signature: Date: E zU
12128104 Continued

L
Facility Number: I Date of Inspection Zp
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 Wo ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �N. ❑ 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
�jj No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
�iA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;jNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
TejNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss asscssment (PLAT) certification?
❑ Yes
❑ No
JXNA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;kNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
MNo
[INA
❑ NE
and report the mortality rates that were higher than normal?
Yk
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
ElNA
ElNE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (icl 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
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
ku-s-4 u-v -1tu mms" c9L "t,4 y a-i roL4 m I U--2-
- due + '% z m% .
&k9'6
N" - 0? s 0 i 1 /1KUJCA
OTO-co ` 50 ; 14-- S +- t os s : I� Unq
-- W,0 �116wtl ; n
12128104

Facility No. f -7 Time In9 30 Time Out
Farm Name Integrator
Owner Site Rep.
Operator -- 7-- _ No.
Back-up No.
COC
Circle: General or
NPDES
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
—
Gilts / Boars
Farrow —Wean
Others
FREEBO esign
Sludge Survey
Crop Yield—~
Rain Gauge 1\!-'
Soil Test ' Wettable Acres
Weekly Freeboard
Spray/Freeboard Drop
Weather Codes
Waste Analysis:
L� Daily Rainfall ��
120 min Inspection
Observed 31
Calibration/GPM DQ.
Waste Transfers—
Rain Break��
PLAT ^ ,,
1-in Inspections
Date Nitrogen (N) Date Nitrogen (N)
F a V Z <, 5 "L� Z, . k�'
Pull/Field Soil Crop Pan Window
1�