770018_INSPECTIONS_20171231

Rorltine 0 Com "la 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review Q Other
Date of Inspection 3 i f
Facifity Number 77 Titae of Inspection 2 : zv 1 Use 24 hr. time
Farm Status: e Total 71me (in hours) Spent onReview
or inspection (includes travel and processing)
Farm Name: __ CiiR�s ����,� _`i�'•�^�—
Owner Name:
County: /?, c k,1011 1
Phone No:
Malting Address: !�y� /gam - 7GL �i�v f, l�-C .Z �3.7 {�
OnsiteRepresentative: Integrator. �•�,ca� /�'��s
U
Certified Operator. �—. 4 S "1 Operator Certification Number.
Location of Farm:
Latkude Longitude �•�'�"
113 Not Operational Date Last Operated:
Type of Operation and Design Capacity
12 A^,
Swrne.� _ Numberoni� . »''Number= Y Cattia� amber
❑ Wean to Feeder % ❑ Dairy I WHO
.�VMFeeder to Finish zv ❑Non- I3cef
Farrow to Wean ' ���3
f _
-�. Farrow too Feederaa„.:.:xesnx "x
9t Ma'
Farrow to Finish Row
ctc Other Type of Uvesto
„'�• ',u C4➢I�+.� s ��'� �� :: 3` �.wi::3 � aia.� a'S � �'Y t.v1 tr✓, :'.=va.'s.,::,
Q er f{Lagoons./ Holing Ponds / Subsurface Drains Present
'.rFD Lagoon Area Spray Field Area x
I. Are there any buffers that need maintenan ? ❑ Yes A No
2. is any discharge observed from any part of the operation? ❑ Yes O(No
a. If discharge is observed, was the conveyance man-made? ❑ Yes O No
b. if discharge is observed, did it reach Surface Water7 (If yes, notify DWt) ❑ Yes Q 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 F[No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes M10
4. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ONO
5. Does any part of the waste management system (other than lagoons/bolding ponds) require ❑ Yes to No
maintenanc erimprovement?
Confinned on back

6. Is facility not in compliance with any applicable setback criteria?
7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/l/97)?
8. Are them lagoons or storage ponds on site which need to be properly closed?
Structures {Lagoons and/or Holding ponds]
9. Is structural freeboard less than adequate?
Freeboard (ft) n 1 Lagoon 2 Lagoon 3
10. Is seepage observed from any of the structura?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need a zaintenancehmprovement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public bealth or environmental threat, notify DWQ)
13. Do any of the structures lack adquate mark= to identify start and stop pumping levels?
Waste Application
14. Is there physical evidence of over application?
_(1f in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type _ . N� /54 Ai I/ 9 v h � I .✓4a
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the cover crop need improvement?
19. is there a lack of available irrigation equipment?
For_Certified Facilities Onl
20: Does the faciiiry fail to have a try of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal Waste Management Plan in any way?
22. Does record keeping nerd improvement?
23. Does facility require a follow-up visit by same agency?
24. Did R evie,avtr/Inspectgr fail to discuss review/inspection with owner or operator in charge?
❑ Yes , RNo "
❑ Yes P No
❑ Yes RNo
❑ Yes A No
Lagoon 4
❑ Yes )4No
❑ Yes MNo
❑ Yes jXNo
❑ Yes 4(No
❑ Yes kNo
)WYes ,R No
❑ Yes J4 No
t,Yes ❑ No
OkYes ❑ No
❑ Yes�IrNo
❑ Yes ,151 No
❑ Yes ANo
P,Yes ❑ No
❑ Yes 0 No
Comrr:eats (refer to qussilon #) £xplaw any YFS answers andlarsny recommen lions o any"other roizmmenfs.'
s a.. �, Q x .a sti ins
Lise diswngs of fact7sty ro bctterexplatn sttuatrnns' :(use addmonalpaBes
Revlewer/InspectorName_t$FkA
Reviwer/Inspector Signature: Date: % 7

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
ED Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other I
Date of Inspection
Facility Number
Time of Inspection I jj,,tV. 24 hr. (hh:mm)
0 Registered 0 Certified OApplied for Permit A14permitted 10 Not Operational Date Last Operated:.........
FarmNarne: On.5- .. r r `��%1'iO,4.......................................
--- • yt.t'4.•---- .. a...._! .......................... County: ,
Owner Name. ............ ' ..... .i'1� 5. .......................................................... Phone \'o. �f 4...6 5 .-.. Z ZO
Facility Contact: ....(
C l� r� 5............. ."..�t..----------------- Title: ..K. ................. Phone No: ........................--
......
Nlailin Address: 0 (� / // e�
MailingAddress: Y`.....Qka............................................................ ...f I.�'.l ...C......................... 2........1�11. ....
.f-
Onsite Rep resentative:...//11 . r.'.' 5...... n �!. Gt -
S..lti` . ....... t!t- Integrator: t~ .. CLL .............................
Certified Operator:....... . kX..5......... ........... ........q-.14 �.! . Operator Certification Number:........................................
Location of Farm:
Latitude �• �� �« Longitude
�Ctirrent
Population %Poultry m
;,
4 ❑ Layer
❑Non -Layer
❑ Wean to Feeder
Feeder to Finish
Z]
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
a ❑ Boars
v %:Pnniilafinn ('aHla
5. ❑ Other
a
`� � yTotal Destgd Capaci
f
Total SSL1
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -.made?
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes ONo
❑ Yes No ~'
❑ Yes o
Continued on back

Facility Number: '7 — f
8_ Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure
Identifier:
Freeboard (ft): ........... .................
Structure ? Structure 3
l0. Is seepage observed from any of the structures?
Structure 4
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)
❑ Yes VNo
❑ Yes KNO
Structure 5 Structure 6
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 runof entering waters /of the State, notify DWQ)
15. Crop type P.. S c.t'!r .. 15er. t�-� E'................... .......................
..
16. Do the receiving crops diff 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
e
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?
Na violations or deficiencies. were' noted -during this visit.:You will receive no further
correspondence about this visit
f h Fs,, s _C;4- Arn" 4-
tF'e lels are &r-5 6-
(use additional pages as necessarv) ,
t .rrrnt?�
a J ool�C'n eoo�
❑ Yes (<N0
❑ Yes '(�\No
❑ Yes k o
❑ Yes No
❑ Yes No
❑ Yes JNo
❑ Yes KNo
❑ Yes �9(No
❑ Yes ?No
❑ Yes No
❑ Yes P No
❑ Yes 5� No
❑ Yes 0 No
❑ Yes ® No
❑ Yes
7/25197
Reviewer/Inspector Name
Reviewer/Inspector Signature: '/r A , /I'—/ Date:

C) Runoff Controls from Exterior Lots (RC)
Facility with exterior lots_
Methods to minimize the run off of pollutants from lounging and heavy use areas have been installed as specified
in the plan.
For facilities without exterior lots, no certification is necessary.
Name of Technical Specialist (Please Print):
Affiliation Date Work Completed:
Address (Agency):
Signature:
Phone No.:
D) Application and Handling Equipment Installation (WUP or I)
Check the appropriate block
Q Animal waste application and handling equipment specified in the plan is on site and ready for use;
calibration and adjustment materials have been provided to the owners and are contained as part of the plan.
Animal waste application and handling equipment specified in the plan has not been installed but the owner
has proposed leasing or third party application and has provided a signed contract; equipment specified in
the contract agrees with the requirements of the plan; required buffers can be maintained; calibration and
adjustment guidance have been provided to the owners and are contained as part of the plan.
Cl Conditional approval: Animal waste application and handling equipment specified in the plan has been --
purchased and will be on site and installed by (month/day/year); there is adequate storage'to
hold the waste until the equipment is installed and until the waste can be land applied in accordance with:
the cropping system contained in the plan; and calibration and adjustment guidance have been provided to.
the owners and are contained as part of the plan.
Name of Technical Specialist (Please Print): ew�[ -__0 0"
Address (Agency)=_
Work Completed.: ! l -A5S- chc
lone No.: yiC ' J TZ -
ate: 3 J�12
The following signature block is only to be used when the box for conditional approval in IIh D
above has been checked.
I (we) certify that I (we) have committed to purchase the animal waste application and handling equipment as
specified in my (our) waste management plan and will submit to DEM a verification of delivery and installation
from a Technical Specialist within 15 calendar days following the date specified in the conditional certification. I
(we) realize that failure to submit this verification is a violation of the waste management plan and will subject me
(us) to an enforcement action from DEM.
Na:ne of band Ov ner:
Signature: Date:
Name of Manager (if different from owner):
Signature: Date:
E) Odor Control, Insect Control and Mortalitv Management (SD, SI, WUP, RC or Il
Methods to control odors and insects as specified in the Plan have been installed and are operational. The mortality
management system as specified in the Plan has also been installed and is operational.
Name of Technical Specialist (Please Print):
Affiliation Date Work Completed:
Address (Agency): Phone No.:
Signature: Date:
AWC -- August 1, 1997

r' 0 Division of Soil and_Wate;,Conservation `Opeeahon Review
0 Division of Soil and WaterCon�servatiom _CompLanceUispection ' w - � r {
F
Division of Water Quality :Compliance Inspecti
�� Other Agency Operation Renew -ems �e7 _'` � = .
14D Routine 0 Comellaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:min)
Permitted 0 Certified (3 Conditionally Certified [3 Registered JE3 Not O erational Date Last Operated:
/ r
Farm Name. ............ C! r;5........ ..... County: .l.f.;/1/ .................._. _
I 9/0—
.............. 6; t aka
Owner Name: 0ifC15........._................... .R. !.a! ........................................ Phone No:.................._....._..-----.._........._.........
Facility Contact: ................�.<.J�jrl & .........Y14j .l.'I........... Title: Phone \� o. ....
. /� � r I ..............
Mailing Address: ............. � q ... g�..........!_P...fp......... ..... .........+G� �I t� � ...N. ............................. ...°��...3.
................ /l 3
Onsite Representative: ............ :.CAP.!T yK*13 ........................................ Integrator:................. TL kf. .........
Certified Operator :�t^1S. �f .... ...........YW.j.4.n„_....................... Operator Certification Number:, 6ff ....,,,,,,,.
Location of Farm-
r.....................................................................................................................................................................................•--.-..........jam
Latitude • ° •4 Longitude • ° 44
Design
Swine ....Ca`acit3
❑ Wean to Feeder'
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
��I�umber of-Lagoons=---
HoldnigiPonds / Solid -Traps
Current T Design ;Current, Design. r"Current
Population . Poultry ` Capacity:'1?opulation .';cattle Capacity Population
Non -
Other
Subsurface Drains Present 11❑ Lagoon Area
No Liquid Waste
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
System
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 gaUmin'?
d- Does discharge bypass a lagoon system'? (If yes, notify DWQ)
] Spray Field Area I
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
'� u cL *M Str� � //ucture i~,v-� ,
Identifier: r�f0 J
It
Freeboard (inches): ...........3.1................. .............................
Structure 3 Structure 4
%
t �3 x)
............................................................................. .....
Structure 5
❑ Yes No
❑ Yes ® No
[]Yes [J No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes %No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
3/23199
❑ Yes No
Continued on ck

Facility Number: Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: N,6 viola/ ions.oi- dcf ctenctes -Were noted• O&ifig. this:visit: "it wilveeeeiv(iiti further
ctirareso&ideizce: aba f this 'sit* :. • • : • :.:.:. ..:.• . .:.:.:.: ........
Llse drawings of.facility to better.explatn situations- {use additional pages as necessairy} �.
{{ a_
how 4v 1
-(r;( (evils,
17 �l
t l!
curs5_t�'
� �A °r► 77'1i3•
[weL-cr, irrr-�vt is' ;►tskt
�JA
❑ Yes VNo
❑ Yes No
❑ Yes No
❑ Yes KNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes j No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [f No
❑ Yes P(No
❑ Yes 0 No
❑ Yes 1XNo
j�j Yes ❑ No
L❑l Yes No
❑ Yes No
❑ Yes XNo
❑ Yes ( No
❑ Yes No
❑ Yes No
�h
6 &4 Aks r
,fi
)S �!t [ eSS j , rrv,., v� t7 pFtcr�.l -ib ► <
Reviewer/Inspector Name _ =: �•-Q` AAS
��n,�(
Reviewer/Inspector Signature: Akn_" Date:
3/23/99

if
t; E3 Division of Soil aad-Waeer Conservation-- Operatiii- Review
x Division of Sotl and Water Conservation -:Compliance Inspection =
® Division of Water Quality ,Compliance Inspection 44- }t
x _ El Other Agency, 0 prat] -'Review k f f gf x
0 Routine Q Complaint Q Follow-up of DWQ ins eetion Q Follow -tip or DSWC review Q Other
Facility Number 7 7 8 Date of Inspection
Time of Inspection 124 hr. (hh:mm)
® Permitted [] Certified © Conditionally Certified Q Registered 0 Not O erational Date Last Operated p . ..........................
Farm Name:---••--i,..1-�^�.._r�' `............................ County:......_....:.��v ✓_..
......................... .......... .....................
OwnerName:.......... ..................... lI✓................. ...... Phone No:...(9�4�..................................................................
�J/
Facility Contact:.........—ewlze1.........(.T.'�� _.. ... Title- ................. ....... Phone No....................................
.....G- 7®�. .............................. - ............. ........... Maihn Address. ......................._��al ...t......fOnsite Representative Integrator: r rg �f / � GA..
Certified Operator:...... C �/�........ ✓,........... ��.................................................. Operator Certification Number:..........................................
..... .........
Location of Farm:
A
......................................................................................................................................................................................................................................................................... T
Latitude * 4 C�•4 Longitude • ' 4.
_ .
DesignCrrei n .DDesign Current ent .
atteCCa aci tyPo Population PoulCa acy Population .._.
Capacity Population-',
❑ Wean to Feeder ❑ Layer EO
Dairy
Feeder to Finish 7 9Z b ❑Non -Layer Non -Dairy
❑ Farrow to Wean -
❑ Other
ElFarrow to Feeder
❑ Farrow to Finish _ Total Design, Capacity
- . ❑ Gilts
❑ Boars .--Tota1:SSLW
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 ycs, notify DWQ) ❑ Yes allo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 15 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes NJ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
...................................
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
3/23/99 Continued on back

i
Facility Number: 7 Date cil' lusprction
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes N 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? 19 Yes [:]No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes IN No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes >1 No
Waste Anolication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over application? Excessive Ponding ❑ PAN
❑ Yes
No
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
KNo
c) This facility is pended for a wettable acre determination?
❑ Yes
[$No
15.
Does the receiving crop need improvement?
❑ Yes
CgNo
16. Is there a lack of adequate waste application equipment? [ Yes 'ANo
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ 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
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Ej 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?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
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
ONo
0; 10 yioiaiigns o;r• deficiencies were n6ted• dirtying �his;visit: • Vott Will-r' eceiye iiti futi-th&.
correspondence. abauk this visit.
-`:.:v....n..+�-!.•nfn.•4:....,,orl:::n.�l::-.F....l.a,::. ,� V.Ti C .incmarc a.:r�1.�w. n...:�earnr:.:s.o:.rla4vAn�
. ,3—_. _ -
e_drawm of facili to bet#er ex lajin situations use additional a^ es as necessa _ �--
7• Co�✓f1.✓�� >� �S/r� A-f/ Gad/9�R O.✓ ��v �9 -�r�a 2l `
Reviewer/Inspector Name
Reviewer/Inspector Signature - Date:
3/23199

Facility Number Date of Visit: Time:
Q Not Operational Q Below Threshold
ratitted E3 Certified Q Conditionally Certified 13Registered Date Last Operated or Above Threshold:
1�pe
Farm Name: ...C.1161 _....... ysk!.1.....,a rm .................................. County: ...
Owner Name: ....... Ckfa.-I ................................I...a k (.l. .!!6.....-----•........................ Phone No:.......6...SL r 9 Zia .. -----
Facility Contact: ......... &(ak:L .C................................... Title:.............................. .�. Phone No:............... ......
MailingAddress: ......... P...aT$_C ...7.-d 6...........•--•.......................................•-•--........�il�r..W.__.... 33 _
Onsite Representative: ......... ............ .....................---...............................---........... Integrator: -•• --._. 4_C.1! sP f .��_.,� _ _
• a3
Certified Operator:.._.�...................,��,,,,_•. Operator Certification Number:.. 2 9�
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� �u
Design ; Current Design Curent Design Current
5w�ne =
Ca ci 'Po _idatioa PoWtry-. .: Ca a Po ulation Cs a : • Po lion
Wean to Feeder ❑Layer ❑Dairy -
- Feeder to Finish Z a ❑Non -Layer ❑Non -Dairy
Farrow to Wean
- Farrow to Feeder Other
Farrow to Finish Total Des` Ca ci Z a
Giits � Pa.� � _
- Boars Total SSLW
e Drains Present ❑ Lagoon Area Spray Field Area
Nnmber;of Lagoons ❑Subsurfacr
13oldmg Ponds 15olid Traps. ❑ No Liquid Waste Management System f ;
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes
i!io
Discharge originated at: ❑ Lagoon [I Spray Field [I Other
a. Irdischarge 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. Ii'discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [3 Yes q]
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? wSpillway ❑ Yes PkNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................................................... .............
Freeboard (inches): �3
5/00 Continued on b"k

Facility Number: — r Date of Inspection �o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public stealth 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 maintenancelimprovement?
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? ❑ E essive Ponding ❑ PAN ❑ 2X01
raulic/O�verload
12. Crop type SSG rN! t,� . (r ' li : O&tenE
13, Do the receiving crops differ with those a gnated in the Certified Animal to Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
yiplaiigns:oi' dirfejencie were pQted during t� s:visitt You wjl >�eo 4i Rio utther . .
Torre andence. about this visit_ .. ' .. '
❑ Yes KNo
❑ Yes )dNo
❑ Yes No
❑ Yes No
❑ Yes Fd No
❑ Yes g No
❑ Yes jd No
❑ Yes Wo
❑ Yes A No
❑ Yes V'No
❑ Yes fl(No
❑ Yes ( No
❑ Yes No
❑ Yes ;No
❑ Yes Po
❑ Yes No
❑ Yes No
❑ Yes < No
❑ Yes RNo
❑ Yes No
❑ Yes No
❑ Yes 3No
Jse dra 'of facili ta:6etter a situaons. nse"addttronal c� as
_ .. w f3' xPlatn� _ ( n _ m .... pace nary}
a
/w
IlGt.wtbers S / /Q V- /k 4•-e -,c aA.
/ , 12rm /aakS OC Ltlel� Ni41�1JerIfL� �r�lrjer, � '1^DrCIGT '7� 7l
aoa� 1"ecords. 4�s{+c Sa•r��e ��- �,+�� �o�
5SQ e C e7y� �+._. ♦ w �SN 4 t7D �re !�S Lvi E r 9 /`4ffCs.
�r ,a
Reviewer/Inspector Name
Reviewer/Inspector Signature: - Date: 5100

Facility Number: 77 — / 4? Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.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 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?
❑ Yes (No
❑ Yes No
❑ Yes o
❑ Yes
❑ Yes J�No
❑ Yes Ito
❑ Yes ❑ No
j-AOqj0,Rammeats as or raw�ngs._ 4z
Aki
J
S/00

rj
f
11�.�� _._ �.-�r .-s: r =-�'ri :. _W3 ��•'�.r�T_....�..�'�.:.ir..�.;'.rivs.r-F. . .a�« �., _:._ �,�_�-:._,_ -� _�-=--�-3e.-:��j-�-r_ ���-�_ .-..^... .+.. _-_it
Type of Visit Qb Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility lumber Datc of %_isit: 1 b Time: I L '. a3
i 10 Not Operational 0 Below Threshold
O Permitted ❑ Certified Q Conditionally Certified O Registered Date Last Operated or Above Threshold:
Farm !tame: _ C.4%4.-.S n 11 "-1 County:
Owner !tame:
Tailing Address:
Facilit. Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
Phone No:
Phone No:
Integrator:
Operator Certification Number:
IDSwine ❑ Poultry ❑ Cattle ❑ Norse Latitude ' � �= Longitude a •
Design Current Design Current Design Current
Swine Capacity Population Poultry Ca acits Population Cattle Capacity Population
❑ Wean to Feeder ❑ Laver I 1 10 Dairy I
Feeder to Finish ILI Non -Laver I ILI Non -Dairy
❑ Farrow- to Wean
❑ Farrow to Feeder1 ❑Other
ElFarrow to Finish Total Design Capacity
ElGilts
D Boars Total SSLW
I Number of Lagoons 1 I ILI Subsurface Drains Present jILl Lagoon Area ILI Spriv Field Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System
Diseharees & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge ori_inated at: ❑ Lagoon ❑ Sprav 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 eal/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 & Treatment
4. Is storage capacity (freeboard plus storm storage) iess than adequate? ❑ Spillway
Structtu-e I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): _1 G
05103101
❑ Yes I"No
❑ Yes ❑ No
❑ Yes ❑ No
LJ Yes U No
D Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number: ly.— (g Rate of inspection T�
,trees,
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ 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
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
❑ No
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
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 maintenance/improvement?
❑ Yes
❑ No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
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
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ 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
❑ No
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ 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?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
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 A WMP? ❑ Yes ❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Reviewer/inspector Name I
Reviewer/Inspector Signature:
Field Copy U Final Notes
Date:
05103101
Continued

Type of Visit ® Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit ®Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Vj,;it: 3 Time: U `-
Facilit} Number } $
Not O erational Below' Threshold
® Permitted Certified 0 Conditionally- Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: County: C9,"y
Owner Name: C, -, r. S Y n U_ 1 n Phone No: 0
Mailing Address: 2 aX-0 In 1, r-(,atj . C„ a8338
Facility Contact: n Title:
Onsite Representative: ^r,. 4� S !&U t n _
Certified Operator: P 1.- _ Y6 I n
Location of Farm:
Phone No:
Integrator: — cc, r-r-u 1 i 'S
Operator Certification Dumber: --).93 i y
IRSwine ❑ Poultry ❑ Cattle © Horse Latitude ' ' " Longitude ` �•
Design Current Design Current Design Current
Swine CCapacity Ca stir` Population
❑ Wean to Feeder 10 Laver ❑ Dairy
Feeder to Finish [] Non -Laver ❑ Non-Dain>
❑ Farrow to -wean
❑ Farro-w to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons I I ❑ Subsurface Drains Present
Holding Ponds / Solid Traps , ' ❑ No Liquid Waste Manager
Discharges S Stream Impacts
1. Is any discharge observed from an, par, of the operation?
Discharge originated at: ❑ Lagoon ❑ Snrav 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 dischargc from any par of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
WasteCollection 8 Treatment
4_ Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure ? Structure 3 Structure 4 Structure 5
ldentifier:
Freeboard (inches): 5
05IV3101
No
❑ Yes
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
PINo
❑ Yes
151-No
Structure 6
Continued

Time:
® Permitted ® Certified ❑ Conditionally Certified (3 Registered Date Last Operated or Above Threshold:
Farm Name: (, i S ir��AL., 17c rw. County: f ^
Owner Name: �LC�< 1 {.,_d (« Phone No: �rtt I to5.2 - q 14 C _
Bailing Address: P0. D e A Z�R
Facility Contact: _ C L ✓ i .t Y6—a Hr+ Title: Phone No:
OnsiteRepresentative; _q6CL ;g Integrator
Certified Operator: Yct d Lic, Operator Certification Number: !� o i
Location of Farm:
®Swine ❑ Poultry ❑ Cattle ❑ horse Latitude ' 4 0 a Longitude 0 1
Design Current Design , Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Po u}ation
❑'Nean to Feeder P Laver I 1FE—INon-Dairy
Dairy
Feeder to Finish ❑ Non -Laver
❑ Farrow- to "ear
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Dumber of Lagoons ❑ Sul
Holding Ponds I Solid Traps ❑
Discharges & Stream Impacts
1. Is any discharge observed from any pan 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 D WQ)
c. if discharee is observed. what is the estimated flow in sal/min?
d. Does discharge bypass a lagoon system? (If ves. 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 ollmdon & Treatment
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): 3S
05103101
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
El No
❑ Yes
0 No
❑ Yes
� No
Structure 6
Continued

Facility Number: 4g — tk Date of Inspection -i''��'
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �Q 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 Ej 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 M 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 maximum and minimum liquid level
elevation markings? ❑ Yes V1 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 51 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes . W No
12. Croptype
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 (__1 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 EP No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 53 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 0 No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑'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 R No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes El No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes W 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
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments�(refer "ta;queshon #Ij Eigpta�n any YES°answers andlor any recamtnendatrons%or any,,other comments:.
Use drawugs of facility to better explaiw si„tuahons (use dd�tsonal pages. as necessary)+u`*Field Copv El Final Notes b•
Reviewer/Inspector Name E
Reviewer/Inspector Signature:
Date: R (�!�
O5103101 Continued

Facility Number: -I It Date of Inspection1
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.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 fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
3 I . 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?
❑ Yes ❑ No
❑ Yes R No
[I Yes ® No
❑ Yes - IN] No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
O5103101

Type of Visit ® Compliance inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ® Routine 0 Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facilitv dumber Dalc of Visit: 3 0 Time: S d
10 Not Operational 0 Below Threshold
® Permitted ® Certified O iG.&C,onditionaliv Certified 13 Registered Date Last Operated or Above Threshold
Farm Name: —_ CktaS Tku/I FG.rtrvs —_ _ _ Count•: at, ct, no C"a
Owner Name: ____ Ci-lri.j rAd V j,n Phone No: A!; -::)—
Mailing address: 6), ROX 1 .0 • �LSS 3f
Facility Contact: C. K__ �t' �i.t Title: tm i i K Phone No:
Onsite Representative: Un r; -S Y riOLL n integrator:
Certified Operator: �C'a �-+'� Operator Certification Number: ao 3c,
Location of Farm:
®Swine ❑ Poultry 0 Cattle ❑ Morse Latitude ' ° ~ Longitude '
Design Current Design Current Design Current
Swine Capacity Population Poultry Ca acit• Population Cattle Ca acit- Po ulation
Wean to Feeder 10 Laver ❑ Dairy
IN Feeder to Finish ❑ Non -Laver ❑ 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 ❑ La oon Area ' ❑ S rav Feld Area
Holding Ponds / Solid Traps 0 ❑ No Liquid Waste Management System
Dischar-es g Stream Imparts
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 gaUmin?
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 & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure S
Identifier:
Freeboard (inches):
0510.3101
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ;9 No
❑ Yes in No
Structure 6
Continued

Facility Number: TZE Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or en-vironmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings?
waste .application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraplic Overload
12. CroPt`Pe 6er"'uA-,-_ Si,-,..ei( C11YLA A,S, +Zr—
13. Do the receiving crops differ with those desimated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) this facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit or other Permit readily available?
I & Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP. checklists. design maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation. freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe" discharge, freeboard problems. over application)
23. Did Reviewer,'Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes PNo
❑ Yes qNo
❑ Yes ( No
❑ Yes No
❑ Yes [�fNo
❑ Yes Ep No
❑ Yes E�7No
❑ Yes No
❑ Yes No
❑ Yes ERNo
❑ Yes ONO
❑ Yes MNo
❑ Yes P No
❑ Yes ® No
❑ Yes [gNo
❑ Yes CgNo
❑ Yes No
❑ Yes ® No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
No
No
ONO
(.9 No
Lo No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
.�-A, . :.: w• :..s . �_ •., �:.��..x� L'.�=^ s.: dab ^•' .:.-•" _x
Comments'{i^efer to gnestton :Edam any- at:swers andlot- sty recommen' dams ar �v other eanttne� ._'
Use drawings of fact7ity to better erplatn situahons..(use additional pages as } - —
c Field Copy Final Notes
-�:-,.,ems.--.n.. r»;z,�,.s • .x.+_.:r:�`".:m ;r-t. - a'-- �❑ 1
__.��.77w.�._ Ia:=h�M-r.�,y-:t:?�._�.f
Reviewer/Inspector Name
Reviewer/Inspector Signature: boaDate:
05103101 o 1 Continued

Facility Number: Date of Inspection a 3 0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.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 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?
O5103101
Sd Yes ❑ No
❑ Yes ® No
❑ Yes allo
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No

t- L
Type of Visit ® Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Date of Visit: 0 GZ Time: = dd
Faciliri• Number
Not.Operational 0 Below Threshold
® Permitted ® Certified 0 Condi/tionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: !iCi� A�C�(N i�iQiL.� Count}•: A211:r'4�0--4
Owner Name: /� /��"� Phone No: (?/v 4�r_2 l,92CS
Mailing Address: —
Faciliity Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' " Longitude ' �•
Discbames & 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 CKNo
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 flour in galimin?
d. Does discharge by a lagoon system? (If ves, 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
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
N
❑ Yes ZE�No
❑ Yes )z No
❑ Yes P!No
❑ Yes DKNo
❑ Yes A No
Structure 6
Continued

n
Facility Number: 77 " Af
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage. etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
ti`aste Application
10. Are there any buffers that need maintenance/improvement?
1 I . Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
A
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Repuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes 'XNo
❑ Yes XNo
KYes ❑ No
❑ Yes XNo
❑ Yes XNo
❑ Yes �(No
❑ Yes X No
❑ Yes �gNo
❑ Yes No
El Yes o
❑ Yes i(No
❑ Yes %No
❑ Yes �allo
❑ Yes ;T No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WU� chesPists, design, mgs. etc.) / ❑ Yes PkNo
✓ f/
19. Does record keeping need improvement? (ie/ irriga 'on, freeboard, waste analysis soil sample reports) Yes ❑ No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ,X[NO
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ERNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ENo
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 R) 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.
Casiimeati ,(refei tu;question #) Explata any YES answers sndlnr auy recammendatyons:or. anv other catnmeuts. A
Use tirawtags of iact�tty to better siphon sttatat7otis (use ad�doaal pages as aecesssry) ---
❑ Field
Copv ❑ Final Notes
r: _
ad IA>J7
/ �,� / � � ��.��
�.1 • .c1.�s ,r�r � alizo ,�1 �-
/ `� t�o �� � ,fie /-� ii -��iE� ��'®''`rur!-// G u�i f'�/ram ����f ot��O�Urdd✓'•r
.67&1
Reviewerllnspector Name -
Reviewerllnspector Signature: 7 MRP Date: /4 4
05103101 /
aiC6,
Continued

Facility Number: '7 —/ Date ofinspccti,}n
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below j4 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 allo
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 Q&'No
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 �RNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes B' No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? El Yes X No
Additional"Commettts,and/or Drawings:',: w _...
05103101

G)
0
Michael F. Easley, Governor
William G. Ross Jr., Secretary
North Carolina Department of Environment and Natural Resources
. W. Klimek, P.E. Director
Division'of Water Quality
December 19, 2002
CERTIFIED MAIL
RETURN RECEIPT REQUESTED
CHRIS YAKLIN
PO Box 706
ELLERac NC 28338
Subject: Notice of Violation and Revocation for Nonpayment
Chris Yaklin Farm
Permit Number: AWS770018
Richmond County
Dear Chris Yaklin:
In accordance with North Carolina General Statute 143-215.10G, all animal operations who receive an animal
waste management system permit will be charged in each year of the tern an annual permit fee. Annual permit fees are
billed following the issuance of the permit and then annually thereafter on the anniversary of that date. Your animal waste
management system permit was issued on 9/29/1997.
Your annual permit fee for the period of 9/29/2002 - 9/28/2603 is $300.00. Your payment was due 11/7/2002.
Because this fee was not fully paid within 30 days after being billed, this letter initiates action to revoke the subject permit,
pursuant to 15 NCAC 2H .0205 (c) (4). and G.S. 143-215.1 (b) (3).
Effective 60 days from receipt of this notice, the subject permit is hereby revoked unless the required Annual
Animal Waste Management System Permit fee for your animal operation is received within that time. Operation of an
animal waste management system without a valid permit is a violation of North Carolina General Statute 143-215.1 and is
subject to the assessment of a civil penalty of up to $10,000 per day. Your payment should be sent to:
N.C. Department of Environment and Natural Resources
Division of Water Quality
Budget Office
16I7 Mail Service Center
Raleigh, North Carolina 27699-1617
If you have any questions, please contact Fran McPherson at [phone] ext_ 210.
Sincerely,
Alan W. Mmek, P.E.
cc: Non -Discharge Branch Compliance/Enforcement Unit
Fayetteville Regional Office
Richmond County Health Department
Permit File
1617 Mail Service Center, Raleigh, North Carolina 27699-1617 Telephone [phone] FAX [phone]
An Equal Opportunity Affirmative Action Employer 50% recycled / 10% post -consumer paper

- - -- Division ofWater :�NHMberE
lity._
Facility l'
�� ; �jDivision ooil anater Conservation
- . Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complainer-Q Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 317 Arrival Time:
^ Departure Time: (� County: ��+' Region: ��
Farm Name: C k r'1 S Leddl�, _rtt ' n— C7 `zQrh Owner Email:
Owner Name: CA,' Phone: E/0) 6S�a 120�
Mailing Address:
Physical Address:
Facility Contact: , Q �!� Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: H Operator Certification Number: "�t398
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =e =, =, Longitude: =° [={ [= «
Design Current
Swine Capacity Population
Wet Poultry
Design Current
Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
El Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
Feeder to Finish 90 �]
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry's
g
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
❑ Non -Layers
El Beef Feeder
❑ l3oars
Pullets
❑ Beef Brood Cowl I
- _
❑Turkc s
Other
❑ Other
❑Turkc Poults
❑ Other
Numher of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
MNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
M NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
P NA
❑ NE
c. What is the estimated volume that reached waters of the State (gal Ions)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
J� NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
[S No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
P9 No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

t
Facility Number: 'I —
Date of Inspection 3 f 8
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 34"
5. Are there any immediate threats to the integrity of any of the structures observed'?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ®No ❑ NA ❑ NE
[]Yes []No O NA ❑ NE
Structure 5 Structure 6
❑ Yes [� No El NA El NE
❑Yes ®No El NA ❑NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes $q No ❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes a] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence ,,of Wind Drift ❑ Application Outside
/o�f�Area
12. Crop type(s) Fe Ca R CP4s4t w), GgA4 &rMu4Q C}taS3 fa4-,-e) �►^ l3+'�i,.yil�r5�.�.
13. Soil type(s) Ckaw4c(Q _Ck4
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 91 No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
Comments (refer to question #): Explain any YE8 answers and/or any recommendations or any other comtnents
y �.
Use drawings of facility to better explain situations (use additional pages as necessary)
Reviewer/Inspector Name I
Phone: !��f33 -33CV
Reviewer/Inspector Signature:
Date: 3/I I L,-"$
Page 2 of 3 1 Z/28/04 Continued

s
1. Facility Number: ' Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes [Z No ❑ 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 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
52 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbrcakers on irrigation equipment?
❑ Yes
09 No
❑ NA
❑ NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
CS Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PO No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[N No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[P No
1�
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El
No
[I 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
ElNA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
I] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[1 No
❑ NA
❑ NE
Additional Comments and/ac:',l?6vwings: -
aS, P leis e Cie 51 ud5e st,,� �4s beer, co t l e{ ed a �. 3/► of r� . `
Cody a S lud5e St �r 0911 rece'1 vied Irk VW& -A P - Pow AA"It- , LV l �
-GwvjtJ c a f 1 4-0 cv+W off c�
�2q. ", J d� -to ��
1Jo �u.h,Ptkg Its ocrt.�red ,��, �n rut,,,�,4,5 sk\c' �aoo7 �
$� ( Sal � es a �v0 rA re ce OF 5a4 r, f-e�- 14
Page 3 of 3 12128104

Division of Water Quality
===Facifitymber r® ) 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 93 Arrival Time: 0 /SCt w1 Departure Time: ��S r7 County: I f"Ot- r Region: AWO-
Farm Name: Uri 5 t4 kir n Fa_ _rvl Owner Email:
C�, `s `Ea k �rrt (9/04 Sa - if a.b.s
Owner Name: Y�l ,, ii tt Phone:
Mailing Address: 22-9 1�1.e41�- fJ C 0kA►f J 3 . Q l c tV G -2833L___ _
Physical Address:
Facility Contact: ClIri, Title: Phone No:
�i Onsite Representative. Integrator: Mt�f?i Ar12tNIa _
u B
Certified Operator: Operator Certification Number: -10:22
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =] a ET
ET
Longitude: 00=1 f 0 u
Design Current
Design Current Design Current
Swine
Capacity Population " Wet Poultry
Capacity Populn Cattle Capacity Population
❑ Wean to Finish
❑ Layer I
791E]
❑ Dairy Cow
❑ Wean to Feeder
1 Non -Layer I
❑ Dairy Calf
Feeder to Finish
Qaw
I �� El Dairy Heifer
❑ Farrow to Wean
�
S xwD ' Poult
❑ Dry Cow
ElFarrow to Feeder
;..
on -Dairy
El Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
�� ❑Non -La Non -Layers
El Beef Feeder
❑ Boars
El", Pullets
' ❑ Beef Brood Co
Other"w
❑ Turkeys
❑ Turkey Pouets I
�a
k
❑ Other
ther
Number'of Struchjres:EE
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
(A 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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
EANA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
§9 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
D9 No
❑ NA
❑ NE
other than from a discharge?
Page I oj3
12128104
Continued

r
j .
Facility Number: —
Date of Inspection a 6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[yNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
9 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
u
Observed Freeboard (in): �}
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?
❑ Yes
Z] No
El NA [:IN I-
S. Do any of the stuctures tack adequate markers as required by the permit?
❑ Yes
10 No
❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
f
Waste A lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
D9 No
❑ NA ❑ NE
maintenance/improvement?
1 l . is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or I 0 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)
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
EP 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.recommendahons or�anyother comments`;
Use drawings of facility to better explain situations. (use additional pages as necessary)
Reviewer/Inspector Name { _.. Phone:
Reviewer/Inspector Signature: Date:

Facility Number: — Date of Inspection
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ti No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JN No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[S No
❑ 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?
IX Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CR No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EUNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[A No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ej 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
R No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional Comments and/ai Drawings:
Nevj Las4c "avvtf PIu 9-)-q-06 is r\A Co rre-4 , Chas m's-xW,
NIr.141 .' n wilt Cor *c+ Coin pta n correG4ej
cunot re s cJ9ry i + -tv DLA) Z .
1
I'\aS Ca+40c4ed flr'ekl "_boor cccl,�(�M� � irrtca bn
EA U4i m'Cvv i.�i t'T*� a C e4, 4 ~� td -Novi vhtieX • C0.11 b ra nor A aa1S
he Jots AW Qer ,+ Co t bps vi3� b�
Page 3 of 3 12128104

Type of Visit 18 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ORoutine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
D^
Date of Visit: Arrival Time: Departure Time: %1-49R.r+ County: R� rrionaJ Region: r ft
Farm Name: r't S IQ kJ,',) 1 Gzr y Owner Email:
Owner Name: __ r c� 5 ya �� Phone:
Mailing Address: 929 WP-S4- NC IWV 23 /� AJC -739
Physical Address:
Facility Contact: Ckn 0. ik11 Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No: n
Integrator: M� bD y r"W" - Q
Operator Certification Number: aQ 3 10
Back-up Certification Number:
Latitude: o Longitude: = ° u
Design Current
id
Design
Current
Design Current
Swine
Capacity Population
We# Poultry Capacity
Population
Cattle
Capacity Population
LI
7. Iq
ElDai Heifer
Dry Poultry
El Cow
El Farrow to Feeder
El Non -Dairy
❑ La ers
El Beef Stocker
❑ Non -La ers
El Feeder
El Pullets
❑ Beef Brood Co
ElTurkeys
Other
El Turkey Poults
Number of Structures:
❑ Other El Other
❑ Wean to Finish
Feeder to Finish
❑ Farrow to Wean
El Farrow to Finish
't,0 �
PE1Gilts Boars
Discharges &Stream Impacts
1.
❑ Layer El Dairy Cow
Dair Calf
Is any discharge observed from any part of the operation?
❑Yes
� No
El NA
El NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
❑Yes
El No
®NA
El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑Yes
El No
� NA
❑ NE
. c. What is the estimated volume that reached waters of the State (gallons)'?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
El No
®NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑Yes
�](, No
[I NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
N No
El NA
El NE
other than from a discharge'?
Page 1 of
12/28/04
Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[9 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No �@ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): [
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R No ❑ NA FINE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
4o 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?
YJ Yes
WO ❑ 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
0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below_
❑ Yes
® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l 0% or 10 lbs ❑ Total Pbosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ElApplication Outside
of Area
12. Crop type(s)
I E SCU.L l Gre k Pcurrv-L a
13. Soil type(s)
-p . U', r;
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
F?51 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ea 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'a nswers and/or any recommendations ar anyother comments
Use drawings of facility to better explain situations.. (use additional pages as necessary):
1MOW (L"'d5 D,, r��►S�(XQ LA517o►, t,.," lre:�Slae r
Reviewer/[nspector Name Off+- GLY Phone: 3
Reviewer/Inspector Signature: Date: V 7
Page 2 of-9 12128104 Continued

,a
Facility Number: i'7 — ��j Date of inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (4 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 appropirate box.
❑ WUP El Checklists El Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RrNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ MonthIy and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
4 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
X No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
® Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2Q No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
R NA
❑ NE
Other Issues
28_
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Z 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
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
❑ NA
❑ NE
&Ubrak irrr�AA-lo &% 4 5 S�o�
as Poss'bCe C5 rI` r e4 k7
12128104

(Type of Visit: 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance i
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access II
Date of Visit: l Lj I X j l Arrival Time: t Departure Time: County:
Farm Name: VlY1 Owner Email:
Owner Name: 1 a1`-'G!� Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: q
Certified Operator:
Back-up Operator:
Location of Farm:
M
1
ih Title:
Latitude:
4 no nc� Region: 1-12V
Phone:
Integrator: �� j�4i°/Gt
Certification Number: 2agV
Certification Number:
Longitude:
Design Current
Swine Capacity Pop -
d
N gn Current
VVe# Pavttry Capacity Pop. Ca#le
Design
Capacity
Current
Pop.
Wean to Finish
Wean to Feeder
La er
[Non -Layer
a
Dairy Cow
Dairy Calf
Feeder to Finish Q
1'
Desigo Current
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
�u
Other
Other
Turkeys
Turkey Poults
rjOther
aNWdx::3x;iilNku�l!'.iN�:e9d.WY�ln .drIM4..i pYl.-;:..v-1Y:�i"if4�':e4�lY1�MNIRNMeyYgWtl?]fJlpi---.>®i.wi:'iu
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 1 - No ❑ NA ❑ NE
❑ Yes ❑ No NA [] NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ❑ No IKA NA ❑ NE
❑ Yes rp No E NA ❑ NE
❑ Yes [P No [] NA ❑ NE
Page I of 3 21412015 Continued

FaFili Number: Date of Ins ection: /2
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 [�j NA ❑ NE
StrucIe 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
P 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
M 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
�a No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window /❑ Evidence of nd Drift ❑ AA'pplicatia Outside of App oveeed Area
12. CropT e(s):-�Ct.[2 /R� %kG1 GX7GGtH- C> tist !i
YP � ��1. A' f��� i ����
13. Soil Type(s): W'Xq! VWLiGVr:`
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ep No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[4 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
P No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[� No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
fig 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 E� No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FaAity Namber: 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 9No ❑ 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 the 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
F3 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 gnestiod'#� Eapiailn aoyRY S answers.and/orJany ad�it�onalArecommendat:ons or any other comiinents.�'$
Use drew ;,wz.
P ,
ings of facility to better lains"ations use additional. -assneccssary),
Reviewer/Inspector Name:
Reviewed]nspector Signatui
Page 3 of 3
Phone:
Date:
21412015

type or visit: w t_.ompuance inspecnon U tiperanon Kevtew U Ntructure r,vaivarron v iecnmc21 Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I CL Departure Time: 02 :00 rh County: g C - a•✓VlIgoon: FtZp
Farm Name: Ch r►t5 Owner Email:
Owner Name: r1 S $n Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone: /
Onsite Representative: i! Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
,f,
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop,
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Curren#
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P,oul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef 13- Cow
Turke s
OtherIII
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes ❑ No ® NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
0 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 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
T
[P No
❑ NA
C] NE
of the State other than from a discharge?
Page 1 of 3 21412015 Condinued

Facili Number: -I 1Z Date of Inspection: 1 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 NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1P 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
j No
7�
❑ 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
No
❑ NA
❑ NE
maintenance or improvement?
T
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 Ibs. ❑ 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):AqmArr 4W5.Q. a Qri, c c
19,75�
n
st, O
i
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
18. is there a lack of properly operating waste application equipment?
❑ Yes
WT
Lo No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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
[�j 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
5P 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?
0 Yes
[C] No
❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [;5 No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFacility Number: - Date of Inspection: Z
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[9 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
P No
❑ NA ❑ NE
the appropriate box(es) below.
❑ failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[W No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[d No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Comments,(refer.to=hnestion5#)E main anvYES answers ant
Use drawit
Robes t-IQi�lO`P _Dw�
9 1 D -b•9-y -t(oq f (C41)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
aF9
❑ Yes gNo ❑ NA ❑ NE
❑ Yes Fc] No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
[] Yes
Q No
❑ NA
❑ NE
❑ Yes
No No
[] NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
iendations or:any_;ot
Phone: L7io -� 3--3,3
Date: q Lq h 1,
21412015

Type of Visit: ® Compliance Inspection O Operation Review p Structure Evaluation p Technical Assistance I
Reason for Visit: ® Routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: I 1 S I Arrival Time: D Departure Time: County: !9z-dM/Q Region:
Farm Name: �[I// 15 a �r�,.�vt.% Owner Email:
Owner Name: C_-ky 1--ir' ` CL 46 _ Phone:
Mailing Address:
Physical Address:
Facility Contact: "_� l
Gf
Onsite Representative:
Certified Operator:
I
Title: Phone:
Integrator: M tpLU h
Certification Number: Q
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
an toFinish
Design Current
Wet Moultryllcapacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dai Cow
an to Feeder
f
Non -La er
Design Current
D . Paul Ca aci P,o P.
Da' Calf
Da' Heifer
Cow
Non -Dairy
der to Finish
Farrow to Wean
Farrow to Feeder
q 20
'70Q
Farrow to Finish
Gilts
Layers
Beef Stocker
Beef Feeder
Non -Layers
Boars
Other
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes R No ❑ NA ❑ NE
[-]Yes
[] No
NA
❑ NE
[:]Yes
[—]No
j NA
❑ NE
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
Mr No
T
❑ NA
❑ NE
❑ Yes
T No
❑ NA
❑ NE
Page 1 of 3 21412014 Continued

Facd Number: - Date of Ins ection: 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Z] NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2 Structure 3
i
-2-% 61
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes ® No ❑ NA ❑ NE
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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes rL_-p_jbNo ❑ 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
i] No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
'G] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift Application Outside ofApproved Area
l❑
/
12. Crop Type(s): CQGts 1 1 --`Rl�y�iss 6L . s71ti�./,-�.6Cr��-JC
r f e
soli
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?
0 Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[P 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?
C] Yes
`�' v 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.
T
❑WUP ❑Checklists ❑Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 [ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

facility Number: - Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ® Yes [:]No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ® Yes [] No
the appropriate box(es) below.
® Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fmt 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
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 Reviewer/Inspectar fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
El Yes ®No ❑NA ❑NE
❑ Yes k]C No ❑ NA ❑ NE
❑ Yes
© No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
5] No
❑ NA
❑ NE
Reviewer/Inspector Signature: T14 Date: 1 z146
Page 3 of 3 21412014

(Type of Visit: 0 Compliance Inspection Q 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: rlc.
Arrival Time: Departure Time: 0 ; County: N �Dn/Q
Farm Name_ .It.4 Owner Email:
Owner Name: Ax-f,5 va/e/tkIl Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: Ci wt- 140 fit Title: Phone:
Onsite Representative: K integrator: u" — bry
h Certified Operator: Certification Number: v203 !a
e
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
esign Current
Design
Current
Design Current
pDJ
apacity,. .Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Zp
GTID
Dairy Heifer
Farrow to Wean
Design
Dry Cow
Farrow to Feeder
f) . P.o_ul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
10ther
Discharues 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)?
0 Yes [P No ❑ NA ❑ NE
❑ Yes
❑ No
[�j NA
❑ NE
❑ Yes
❑ No
[SNA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [:]No
❑ Yes '4rn No
[:]Yes q No
NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued I

Facili 'Number: 49 1 Date of Ins ection: "2-
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: 1
41 No ❑ NA ❑ NE
❑ No `t' NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .. V
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q9 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes CP 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 of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): t Gt,PtclGc�a UW1a'f
r >p
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [2 No ❑ NA ❑ NE
❑ 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 f�j No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [� No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ l20 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

1w'acifi Number: - 19w 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 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes CM No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [] Yes ® 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?
33. Did the Reviewer/Inspector fail to discuss rcview/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
efer to:question ft Explain any YES answers andtor any additioi
:6f facility to better explain�situations:{us_e additional pages as ne
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ® No
[:]Yes ® No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Phone:
Date: 7/ 1113
21412011

Type of Visit: • Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: dG 1 Arrival Time: Departure Time: /( County: le jv Region: AQZO
Farm Name.. Chris ti �� �t..�iti, Owner Email:
Owner Name: G`�t S �Ctn _ Phone:
Mailing Address:
Physical Address:
Facility Contact: t .'vY t G. �-f i Title: Phone:
Onsite Representative: Integrator: ►' lulyky�AYQL-,—
Certified Operator: 6! Certification Number: 7,01 g
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current .
Design
Current
Design Current
Swine
.�
Capacity Pop. WetzPoul#ry
y
Capacity
Pap.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
..:: .._ ..
ZU
Da' Heifer
Farrow to Wean
Design
Gnrreat
D Cow
Farrow to Feeder
D . �P,aul# .
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
®No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
fj� NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
4 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
[RNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
-,Gn No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
t�j No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facifi Number: Date of Ins ection: Z
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1'�Rj No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Pq NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: T
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes J�A No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ( No ❑ NA ❑ NE
waste management or closure plan? T
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 E;-g 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 altematives that need ❑ Yes N No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window `❑/ Evidence of Wind Drift ❑ Application Outsi a of Approved Area
12. Crop Type(s): L ' Lei SS rS r%l �. .� r
13. Soil Type(s):
IMF, W)RAM'dw
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
No
❑ NA
[] NE
❑ Yes
No
❑ NA
❑ NE
[]Yes
�g 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 [B 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 §j No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ['A_No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA [3 NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facili Number: I r7-F Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ] No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 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
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
[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
No
❑ NA
❑ NE
Comments (refer to question t Explain any YES answers and/or:any additional recommendations or any other comments.;
r ryL
Use drawinks.of facility to better explain situations (use additional pales as necessary).__`.
h YdJ"Ay __�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: G
21412011

Type of Visit 0 Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 10 Arriv I Time: Departure Time: Q �A w County: M'0 Region: 7"i'4J
Farm Name: s t Owner Email:
Owner Name: I�C, to a t� Phone:
Mailing Address:
Physical Address: �p
Facility Contact: "rt �� 1 41 i" Title: Phone No:
r J /�
Onsite Representative- Integrator: iNllt4q"'-_&VLt)I?
n gn3w
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= o = 6 = Longitude: = 0 0 6 = 6i
s� t00S of Owl'73
Design C*urren#
Swine Capacity Population
Design Curren# Design Current
LruKcFpLcitYLP0PHutins Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
jqzo
❑ Dairy Heifer
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Dry Poultry ❑ Dry Cow
❑ Non-Dai
ers
❑ La El Beef Stocker
❑ Non -Layers
❑Beef Feeder
❑ Pullets
❑ Beef Brood Cowl
❑ Gilts
❑ Boars
❑ Turke s
❑ Turkey Poults
❑Other
Number of Structures:
Other.
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes r No ❑ NA ❑ NE
❑ Yes
❑ No
1�NA
❑ NE
El Yes
❑ No
IPNA
❑ NE
❑ Yes
❑ No
PNA
❑ NE
❑ Yes
[It No
❑ NA
❑ NE
❑ Yes
1�}No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facilify Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
INA [I NE
Stru ure I Structure 2 Structure 3 Structure 4
Structure
5
cture 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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
ElNA ElNE
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? El Yes `� No [I 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 ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Qj No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
09 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Comments (refer t0 question #): Explain any YES answers andlor.any reeommendatigns�orany, other comments .
;Use drawingg of facility to better explain situations (use additional pages as necessary.)"` 4 n�
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Reviewer/inspector Name
Reviewer/Inspector Signature: 4
Page 2 of 3
Phone:
Date:
1
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Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El 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 1`❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'!
❑ Yes
9 No
CPNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
nNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
fS No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
m No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ZI NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
ElNA
❑ 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
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
qNo
❑ NA
❑ NE
Additional Comments ""e Drawings.
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