780037_INSPECTIONS_20171231

NORTH CARCLI NA
Department of Environmental Qual

Type of visit: &7outine
"ance Inspection V Operation Review (> Structure Evaluation U Technical Assistance
Reason for Visit: Q Complaint 0 Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: 7 —[ $ Arrival Time: 4 Departure Time: O County: c OC s UH Region:
�J
Farm Name: 1-014— Se o 1 y tzu s le r Owner Email:
Owner Name: to/4 Sr.a_/y F0 0 S,C Phone:
Mailing Address:
Physical Address:
Facility Contact: Clir t S �3 &,— W k ` Title: Phone:
�
Onsite Renresentntivee lIntegrator• 0 �^ 1 R ' s
Certified Operator.
Back-up Operator: C) 0—,j ti (I
Location of Farm:
Latitude:
Certification Number: 2-
Certification Number: to 0 (3 _t
Longitude:
Sm"
City Pap.
Wean to Finish
Wet Poultry
Layer
egurrent
Capacity
I
Pop.
Cattle
I Dairy Cow
Capacity Pop.
Wean to Feeder
Non -Layer
I
Dairy Calf
Feeder to Finish .g r a. p
Farrow to Wean
Farrow to Feeder
5S ZV
D . Paul
Layers
Ca aci
P,o
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Beef Feeder
Gilts
Non-Layens
Boars
Pullets
Turke s
Turkey Pouets
L jBeef Brood Cow
Other
Other IM 10ther
Discharges and Stream Imnacts
1. is any discharge observed from any part of the operation?
❑ Yes
[ZjK°
[] NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
E&,IgAA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ 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
�o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
0 Yes
E N
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E<O
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 214,12015 Continued

EF ciY Number- - T Date of Inspection:
,Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No Q-N
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier -
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o ❑ 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
FL-I�o ❑ 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
[Z�M ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[n" fro ❑ 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
[D Nts ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes []-Nc ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes t 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): /ila
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [E❑ NA ❑ NE
I5. Does the receiving crop and/or land application site need improvement? [:]Yes E o ❑ NA ❑ NE
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.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes QRo ❑ NA ❑ NE
❑ Yes
[]No ❑ NA
❑ NE
❑ Yes
[EI.Ntf ❑ NA
❑ NE
❑ Yes
❑.Pdo ❑ NA
❑ NE
❑ Yes
Qom_ ❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:)Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes Lr 1`o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes to ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faci ' Number: 7 C( Date of Inspection: T
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
[D_Ah ❑ NA ❑ NE
�❑ NA ❑ NE
❑ Yes M_Ner—� NA ❑ NE
❑ Yes 0<o ❑ NA ❑ NE
❑ Yes [� ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [ZL>itf ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
B_b� NA ❑ NE
M-Ko- ❑ NA ❑ NE
[�'No ❑ NA ❑ NE
2'<o ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
C& f II rc--4 F0'� [2- .3�- ��l sl c4c�, s � � 10-3o- (7
( 710-303-68st
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: ato- q3 3-33 3 �
Date: % ,r
2/4/2015

5 : U c)
MINA a IF esources
Facill.4 imber - O Dt ivision ofLS.oiltand W ate Cationonsery ^
,1
1 , - 0 Oth Agency
Type of Visit: oomm fiance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: E. outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: V Arrival Time: so Departure Time: (a County: Q &-_ Region: RZO
Farm Name: Ltc I'll- � �� 1��5� I Owner Email:
Owner Name: (_uk f�iuS r- _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Cri 41.5— &cA L A di Title:
Onsite Representative: r
Certified Operator: rUGt-Vt YC { "v`L5,e
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: ��,, a
Certification Number: AI
Certification Number:
Longitude:
Lim Design Current R 17esign Currentg
DeIs Curreut
S,wme Capacity Pop. WetnPoaltry Capacity Popp.
Gattl*`g Capacity Pop.
Wean to Finish Layer
DairyCow
Wean to Feeder Non La er
r';r
Dai Calf
Feeder to Finish $ O =
Dai Heifer
Dry Cow
Farrow to Wean Design Current
farrow to Feeder D1?oiultrV Ca acitV:.:_ .Po
Farrow to Finish Layers
Non -Dairy
Beef Stocker
Gilts Non -La ers
Beef Feeder
Beef Brood Cow
Boars Pullets
;_ -- Turkeys
Uther . Turke Puults
F ..
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)
❑ Yes 'No- ❑ NA ❑ NE
❑ Yes ❑ No ❑-t-AV ❑ NE
[:]Yes [:]No I__I KA ❑ 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 [a<A [:]NE
2. Is there evidence of a past discharge from any pan of the operation? ❑ Yes [D'No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ]f No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of'3 21412015 Continued

Facili Number: -7 r- Date of inspection: t}
Waste Collection &Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0-No-0 NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
Eff-NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
. o
❑ 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
[7—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
[�FNo
❑ 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 pan of the waste management system other than the waste structures require
❑ Yes
Quo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3'N`o­
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
O 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): 't t"6 3 cs"tcd-de4 SL, D
13. Soil Type(s): Ale
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C3 go
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E3 1�o
❑ 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 []'1q-0 ❑ NA ❑ NE
❑ Yes Ejl�0 ❑ NA ❑ NF-
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components ofthe CAWMP readily available'? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need i provement? If yes, check the appropriate box below. [��s ❑ 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 ErNo
23, If selected, did the facility faii to install and maintain rainbreakers on irrigation equipment? ❑ Yes El"'No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: �' - �`� Date of Inspection %o
24i Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes D-Aler-- ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3-NO ❑ NA ❑ NE
the appropriate box(es) below_
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes []-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes a-lqo- ❑ NA ❑ NE
❑ Yes [! No ❑ NA ❑ NE
❑ Yes E3 tZo ❑ NA ❑ NE
❑ Yes
[t 'N"o
❑ NA
❑ NE
❑ Yes
[3-go-
❑ NA
❑ NE
❑ Yes
CD Nb
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recom endati6ns or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Cd_ T ;- 3L-,8-U 5 r
Reviewer/Inspector Name: � X `l
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7IM3 3— 3s(3
Date: go 6104
21412015

Type of Visit: Q Compliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ! D7L Departure Time: ,3 County: w Region:
Farm Name:Owner Email:
Owner Name: S Phone:
Mailing Address:
Physical Address:
Facility Contact: c zvd /` galas Title: --Z�, /zL_11�/_ Phone:
Onsite Representative: S Integrator:
Certified Operator: J��—r Certification Number: /,�qo13/i
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
_
Design Co.
Design
Current
Design Current
Swine
Capacity Pop.
Wet Pointry
Capaclty
Pop.
Cattle
Capacity Pop.
Wean to Finish
]Layer
Dairy Cow
Wean to Feeder
I
INon-Layer
I
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oul
Ca aci
Po
Non-Da'Iry
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
keys
Other "
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
JR 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 DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
JaNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ja No
❑ NA
❑ NE
of the State other than from a discharge'?
Page 1 of 3 21412014 Continued

[Facility Number: - 3 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
•
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[a No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. es ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN Q'PerAN > 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): e'-4
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�S 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. KYes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ® Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [j No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - 3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check [-]Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes allo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes MNo
Other issues
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
MlNo
❑ 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
EtNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E3.No
❑ NA
❑ NE
Comments (refer to question#)i Explain any YES:answers-.and/orany additional recommendations or" amments �« a
Use drawings of facility ta;better egplam;situatibiii 6se additional pages'arnecessary). w
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
r
Phone:l-
Date: s2:; A 3 ;r�/Z1
21412014

type of Visit: UAfompliance Inspection U uperatton xevIew U btructure Evaluateon U lectmicat Assistance I
Reason for Visit: (34outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: L L yet,sZ f C � Owner Email:
Owner Name: (_„ la_ Fv (-- Phone:
Mailing Address:
Physical Address:
Region:3 )
Facility Contact: n0_1_i co Title: Phone:
Onsite Representative: r/ Integrator: 0(6
Certified Operator: ��✓c� �f`t° Certification Number: /b� /J? f�
Back-up Operator: T Ltz Yjytauil Certification Number: 100(.50 F-
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capaci
Design Current Design Current
HIM Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D , $oul Ca aci P,o
Dry Cow
Non-Da'iry
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Pouits
Beef Brood Cow —
Other
F—FO—ther
Other
Discharees and Stream Imnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Qjs€6— ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:)Yes
[::]No
NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
Q NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
�NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑'IGo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[ETo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - I Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No aN-A- ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in).
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
rtj-Kb
❑ 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
E:�M
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[D— o
❑ 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
1-1 5o
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3<o
❑ 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): �Cv` *Lc l �� 0
13. Soil Type(s): D
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes [;jPdo ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes QNo ❑ 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
[Io
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑"&o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
0 Yes
[D]No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[]No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ['INo 0 NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection k
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑L -No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes O-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 [DAo ❑ 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 u 'V u ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes [!I<o ❑ NA ❑ NE
❑ Yes [�'No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [tj No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative? ❑ Yes 1�No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [—]Yes No ❑ NA ❑ NE
Comments (refer- to question ft Explain any YES-answers=and/or any additional recommendations orany other comments: -
Use drawings of facility to better.explain:sltaations (use additional pages as necessary). -
CZ4 P(00 c(
j�j'Q"j, rU6' / L(
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: l,33 �3
Date:
14/1014

rxr g-9 rScr- /Y' 61)
Type of Visit: 20utine
liance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: jjj[ U(7J Jq Arrival Time: Departure Time:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: 4
Back-up Operator:
Owner Email:
Phone:
County: Region:
/_�:Plb
Phone:
Integrator: A�E _
Certification Number: 16 � U
p
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design ..Curt enf
Design Current
Swine
Capacity " Pup.
Wet Poultry
Capacity :. Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish
_. ' -
DairyHeifer
Farrow to Wean
Farrow to Feeder
D Pout
Design . 'Current
Ea aci _ Po -.,
Cow
Non -Dairy
Farrow to Finish
ILavers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Nil
Turkeys
Other.ti_
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:
❑ Yes A ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No []I.UA, ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [—]Yes ❑ No E3-K7C ❑ 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 �A ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes C] l"o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Q'l�o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

_V -4> 4 CZ -
Facility Number: - Date of Inspection:
oe��
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
� ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ff]' AA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
U5_Na. ❑ 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
[J o ❑ 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
[P-N-o- ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3-Nn ❑ 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
El�go_ ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Io ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[3 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): ej'iK44
13. Soil Type(s): &S
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ®.Pik ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Cg1`u ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes <O ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑Yes ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes WNo ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ZIND
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
<o
❑ 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
[t No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
�o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
TNo
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [D No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [:��o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
❑ Yes
El-Na
❑ NA
❑ NE
❑ Yes
[3-Ivo
❑ NA
❑ NE
❑ Yes
Ig <o
❑ NA
❑ NE
❑ Yes [ wo ❑ NA ❑ NE
❑ Yes L_`i` o ❑ NA ❑ NE
❑ Yes `f-' ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes D'lVo [DNA ❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewfinspection with an on -site representative? ❑ Yes dNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes �No ❑ NA ❑ NE
Comments (refer Wquestion #I): Explain any YES:answers..nndlar any -additional recommendationsior-any�,other comments:: !
Use drawings of facility to better explain situations (use additional pages as necessary).
"jo v--4,,o,- 1v D
s(-C� 5­%-�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 33-
Date: 4�8 V1
21412014

Type of Visit: ZKom 'ante Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Moutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; p Departure Time: County: �jr ��-`, Region:
Farm Name: :D t 1 y (j �t�,5� � Owner Email:
Owner Name: �� y �,(J xy� u �5� Phone:
Mailing Address:
Physical Address:
Facility Contact: srs/ Title: /!'�rcH• �1��C. Phone:
Onsite Representative: �'v _ Integrator: 'W" Z"Ot'm
Certified Operator: Teat W l y kDu p jjAg Certification Number: /41
If 4
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
rrent
!I
Design
Current
Design Current
Swine
!Sfapp:=
Wet Poultry
Gapacrty
P
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Dairy Heifer
Feeder to Finish
(,+'
' _` "'
Farrow to Wean
Design
Cuuent
Dry Cow
D . Point .
I`a aeity
.t
P,o
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
-
Other_
TurkPoults
Other
10ther
Discharges and Stream lmaacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any pan 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 Ej No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [] No ❑ NA ❑ NE
[:]Yes
[—]No
❑ NA
❑ NE
[:]Yes
;&No
❑ NA
❑ NE
[::]Yes
C&No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: 7—
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
i 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): 1'
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CE�No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
C&No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
L&No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
8, 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
[Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
10 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [Pj 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): py�f'iXl�►a /i�c/r%j� /% / �rri f !.[J�� -S Y �- — --
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes S No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes � No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 21 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18, is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
[:]Yes ® No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 54 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other-
2 1. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 5g No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: 1 � % ~ 1
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
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?
Reviewer/Inspector Name
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ®, No ❑ NA ❑ NE
❑ Yes CE�No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes H.No ❑ NA ❑ NE
[:]Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Yt/a� 4i--�— Phone:-3�
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

i
- - D1vis14A'"�Of Water Qualrty �� � ' -
Facility Number ®- 3 O Division of Soil and'VVater Conservation t
© other Agency
Type of Visit: , _om�pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (! xoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: - / Arrival Time: ' p O Departure Time: ; .3 0 1 County:
Farm Name: ± f 1��,,r1 Zflu L,• f _ Owner Email:
Owner Name: X; 1 1 Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: 9U/y /X�_ .44se Title: AL&W Y Phone:
Onsite Representative: Integrator:
r
Certified Operator: B) Certification Number: /�7 y�7
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
�
'' Des
Current
Desig n Current
Swrne � Capac ty
ultry
Capacity
Pop.
Cattle Capacity Pap.
Wcan to Finish
La er
Non -La er
Dairy Cow
Dairy Calf
Wcan to Feeder
Feeder to Finish
IUD3
Dairy Heifer
Design
Current
Farrow to Wean
Dry Cow
Farrow to Feederachy
P,o
Non-Da'iry
Farrow to Finish
jBeef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
"J"
Turkeys
O#her , ::
Turkey Poults
Other
r
Other
Discharges and Stream ImDaCtS
1. Is any discharge observed from any part of the operation?
❑ Yes
[allo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[] No
❑ NA
❑ NE
2_ Is there evidence of a past discharge from any part of the operation?
❑ Yes
[RNo
❑ NA
❑ NE
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[, No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - 3 Date of Ins ection: (Q *-/
r Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[Z No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 2t
Observed Freeboard (in): 2Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
qNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
� No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes g No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload 0 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):'r`� f©dc��� / Gf) �� �L[/�r-✓ 1S�u�
13. Soil Type(s): Au% L&
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
R No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ffl No
❑ NA
❑ NE
Required_ Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
ELNo
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[No
❑ NA
D NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo
❑ 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 allo
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

Facility Number: - Date of Inspection: — !
' 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes (Z No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®. No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
® No
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
If yes, contact a regional Air Quality representative immediately.
30_ Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[& No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
� No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
� No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
KA No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ONE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other;comments: �;��.-�``.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: r/a
214/2011

of,�Water�Qualify-
.�
Facile Number- �" �" �O D�v�sion of Soil an Wat�erCo
Type of Visit: �mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: �utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: jDD Departure Time: County:��
Farm Name: j�j f ry (,�i f�j sum y� Owner Email:
Owner Name: Billy 4U
41K,a e Phone:
Mailing Address:
Physical Address:
Region: 1 y< 0
Facility Contact: Title: ��,. 5�y�._ Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:�y.��
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude-
Design",.-
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes E.No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [] Yes ❑ No [] NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 21,No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes [&No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: 7- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E?.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): 31
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
Lg 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
Q No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[X 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
04 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 5KNo ❑ 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):n/`��f1�1�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Qq 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 � No ❑ NA ❑ NE
❑ Yes U No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [K No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes W 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 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®.No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [A No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 1�@ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes g No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes P,No ❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 2] No
❑ Yes No
[:]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to -question #):-Explain any YESanswersand/or any additional recomme3ndations.or,::any-other comments
Use drawings of facility to better explain situations (use additional pages as necessary). -`
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

;3IMS - 1012- 7/10 17Y"-
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: : Arrival Time: i O 0 Departure Time: d pZ' ounty: IW Sri Region: Fq2_ J
Farm Name: Z?1%/tjL(J, 4oks'.—, . Owner Email:
Owner Name: 23) 1�C/Aj, AcyePhone:
Mailing Address: S2�- vi / Nc cW36�
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: Af`i�
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = Longitude: = o [� & = u
Design Current
Design Current Design Current
Swine
Capacity Population
Wet Poultry Capacity Population Catt[e Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
I I
❑ Dairy Heifer
❑ Farrow to Wean
Dry Pou[try ❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ La ers
❑ Farrow to Finish
❑ Beef Stocker
❑ Non -La ers El Beef Feeder
❑ Pullets
El Beef Brood Cowl
❑ Gilts
❑ Boars
❑ Turkeys
Other
❑ Turkey Poults
❑ Other Number of Structures:
❑ 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 �00 NA ❑ NE
❑Yesl
o
9�<
❑NE
❑ Yes
❑ No
0-KA
❑ NE
9� A
❑ NE
❑ Yes
EI
❑ Yes
,Noo
Iigo
❑ NA
❑ NE
❑ Yes
®-?To-
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number: — 037 Date of Inspection c�7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ErNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Stru ture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier.
Spillway?:
Designed Freeboard (in): _19
Observed Freeboard (in):(��
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Pl: o ❑ 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 92 o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CT 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 H<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes E? o ❑ NA ❑ NE
I I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ -PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
155�170
13.
Soil type(s) ur
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
B<o ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Ejl�o ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E N ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ET5o ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
To ❑ NA
❑ NE
Reviewer/Inspector N
Phone:
Date:
Page 2 of 3 Zf"- ' // 12/t8/04 ' Continued

Facility Number: —425J Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes l,d'No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ONo
❑ NA
❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
/
2 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?
El Yes
/❑
E,No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0<
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
�O'NNo
Id No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElE Yes
..
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes BITo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Lt Ao
❑ 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. <o
❑ 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
EK
❑ 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
Zk,' o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ELN&- 3 NA
❑ NE
Page 3 of 3 12128104

Facility Number 7 7
V`Divis-son of Water Quality
0 Division of Soil and Water Conservation
O Other Agency
Type of Visit (9r'i`ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S'0-1`d� Arrival Time: 2 �D0 .s. Departure Time: .00 County: � ��� Region: / o
Farm Name: Ao(zs A,-?Eiat / Owner Email:
Owner Name: 9) �� Abf S2� Phone:
Mailing Address:
Physical Address:
Facility Contact: �k iKaws� Title: (9WNc.V Phone No:
Onsite Representative: Kr- SA-ykw„ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o= t 0 Longitude: = 0 0
Design Current Design Current Design Current I
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish 13520 3s00
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
El Yes BNo El NA El NE
❑ Yes ❑ No E NA
ElNE
El Yes ❑No 3'NA
El NE
❑ Yes ❑ Noo L"I NA
❑ NE
❑ Yes [3' o ❑ NA
❑ NE
❑ Yes ETNo ❑ NA ❑ NE
12128104 Continued

Faciliiv Number: 79 -,37 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
��
1��NNoo
El NA
❑ NE
a. If yes, is waste level into the structural freeboard?
El Yes
[, No
ElNA
El NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): T
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L_I No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
��
B o
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�o
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
El Yes
,��,��
L_f No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ell o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window }❑ Evidence of Wind Drift El Application Outside of Area"�
12. Crop type(s) v iu - 4-J (/�``� Golril/ - 1,j ��1- - doghee-t �sr4!/ 6,a-*Al 414 V�i�Seroi
13. Soil type(s) /V 0 r to
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes DNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,.._, NNo ❑ NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes L4 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes E No El NA ❑ NE
18. Is there a lack of properly operating waste application equipment? El Yes ENo❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name �j� K'�Ve_ j .s Phone: % /Q, �'33.335
Reviewer/Inspector Signature:— Date: -D7-Za0 g
12128104 Continued

Facility Number: 7 $ —3 7 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CI'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes El"No ❑ NA ❑ NE
the appropriate box. ❑ A%P ❑ Checklists ❑ Desig
n ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
El 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 El
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
EJ 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?
❑ Yes
N' o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[? o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LS No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E2"No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dNo
❑ NA
ElNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Yes
El�
�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
[2<o
❑ 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
El Yes
B 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?
El Yes
[3 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
El NE
Comments and/or Drawings:
12128104

RT'/ti5 cam. k�ed 4�c-
a Division of Water Quality
Facility Number 7% O Division of Soil and Water Conservation
Q Other Agency
Type of Visit t tro-mmpllance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit E) Koutine 0 Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of visit: -0-1-06 Arrival Time: Departure d S �,.� Departure Time: ✓� �� .v. County: JQo�oesa.✓ Region:
Farm Name: _ .me__ A Vto _ Owner Email:
Owner Name: �i�ltsQ__ Phone:
Mailing Address: 7 rr BsctN �S urflL C4,4cz Racd/ %IC z936 d?
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: /KctiP �-t gf'7)c�ihi
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = c 0 « Longitude: E__1 ° 0 1 0
11
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La ei
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current'
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Humber of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes F] No ❑ NA ❑ NE
❑ Yes
❑ No
B NNA
❑ NE
❑ Yes
❑ No
L'j NA
❑ NE
LJNA
❑ NE
❑ Yes
❑ No
❑ Yes
❑l No
BA
❑ NE
❑ Yes
,
Lf No
❑ NA
❑ NI
12128104 Continued

Facility Number: -7g 37
Date of Inspection D% 4
Waste Collection & Treatment �,/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L`7 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Ef'�A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3.3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P 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
B 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
El NA
El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�B<o
I� No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2 I o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance aitematives that need
❑ Yes
�/
,
L7 No
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
RTo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of AcceptableCrop Window ElEvidence of Wind Drift El Application Outside of Area
12.
Crop type(s) ". dal,.— i0k; s. G • O. COriy ae'4 7~ .SoV .clS 1W.4ur1-d`
13.
Soil type(s) rlclolk
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
2 o
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
LTNo
❑ NA
ElNE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
2 o
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
❑ NA
El NE
18.
is there a lack of properly operating waste application equipment? ❑ Yes
,[Rio
2 o
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
"<L
Reviewerlinspector Name lzc Jvc) /S Phone: 9�4� 5�33.j30�
Reviewer/inspector Signature: Date: 3 — O 7"ZOO�j
12128104 Continued

Facility Number: —37 Date of Inspection 3'07-0
Required Records & Documents
19_ Did the facility fail to have Certificate of Coverage & Permit readily available? El[`f Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes B<o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps
p ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ON ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No ❑ NA
❑ NE
23,
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
io ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1 oo ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
BNo ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EfNo ❑ 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
[!IN. ❑ 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
El Yes
,.,�
BNo ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
[�'NO ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
. To ❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

444E4 e-el 64 z", /1
[Facility Number 7 S 3 7
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: #"23•-67 1 Arrival Time: Z:SO Departure Time: 1� ZS` County: �� �'Sd Region: FiR-O
Farm Name: �` �t�. +-J QQu S <_ rcyr+1 Owner Email:
Owner Name: t{ ��o• Est_ Phone:
Mailing Address:
Physical Address:
Facility Contact: Bt �i,��-o:tit~-� Title: Whtw` Phone No:
Onsite Representative: Integrator: ��+-� f w Q rz",
Certified Operator:
Back-up Operator:
Operator Certification Number -
Back -up Certification Number:
Location of Farm: Latitude: = o = 6 = « Longitude: 0 0 0 ' I= "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
i. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design ':Current `' y.
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any pail of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑Yes
MNo
❑NA
❑NE
[--]Yes
[!FNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
0 No
El Yes
®No
❑NA
El NE
❑ Yes
ERNo
❑ NA
❑ NE
12128104 Continued

Facility Number: -7 — 3 l Date of Inspection i1-z3 _07
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (NNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier;
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ✓�� ��
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [19 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 [RNo ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes (P No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [5fNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi El Application Outside of Area
12. Crop type(s) AS PC.,.,-/f1J/�,��
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E� No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[f No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
UFNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
U No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2fNo
❑ NA
❑ NE
Comments (refer to question f: Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Ric u`2Ve.� Phone: 910. V S3. 3330
Reviewer/Inspector Signature: tq'4 Date: -23 -D i
12128104 Continued

r
Facility Number: -71g - 37 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [B 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 ❑ Checklists ❑ Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[� No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
50 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
[� No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[�j No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to property 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
(FNo
❑ 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
ONo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ENNo
❑ NA
❑ NE
Additional Comments and/or
11/28/04

Dirisio4 of Water Quality
lFacility Number �� $ 3 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: O%0 Arrival Time: Z; 00 ,in Departure Time: County: RO -C16.1— Region:
Farm Name: �� Owner Email:
Owner Name: RO u P . _ Phone:
Mailing Address:
Physical Address:
Facility Contact: J �G'�r[ Title: LJN Phone No:
Onsite Representative: JJ Integrator: 111a'o Z K"J rj
Certified Operator: R'.11. -it1� _ �cy=S e, Operator Certification Number: Ay.4 2 7 q5-
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
13,52-01
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: [= o [= , [= « Longitude: F-1 o =1' = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Laver
Dry Poultry
Non-L
Pullets
LI Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
—
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes EYNo ❑ NA ❑ NE
❑ Yes
UrNo
❑ NA
❑ NE
❑ Yes
NNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
(gNo
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: 75-37 Date of Inspection 3-07 -D
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? El Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z is
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
" No
El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
Di 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
CA No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[9 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
WNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types} Se
Koslel, #Q':'
13. Soil type(s) ZVQ
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q?No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determi
nation' ❑ Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(0 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA ❑ NE
Reviewer/Inspector Name � c /��/,' r✓ e.ls Phone: (47/0Ap iSV /
Reviewer/Inspector Signature: Date: -3 -0 ,-x -Zad (p
12129104 Continued

Facility Number: 7 S -37 Date of Inspection 3-07-0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M 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 ❑ Checklists ❑ Design
g El Maps ❑Other
21. Does record keeping need improvement'? If yes, check the appropriate box below. ❑ Yes W No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
t9 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
[KNo
❑ NA
❑ NE
❑ Yes
[A No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑Yes
J�jNo
❑NA
El NE
❑ Yes
®No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
Add itional'C6Fnrnenfs and/ror Drawings:
12128104

Facility Number P 3 % Date of Visit: /� ��/c Tune:/ e .s
Q Not erational Q Below Threshold
13 Permitted 19 Certtiifieldl ❑ Conditionally Certified 13 Registered Date -Last Operated or Above Threshold:
Farm Name: _R u AAC- ---- -_ ^— County:. ��1 L ,� 0 G_.. _ it' `~•
Owner Name- Jy_;_1, 4_�_ W _ i' u. s 'Phone No:
� V' r %.— van
?Mailing Address: - , `' 4. n s �:_,__ l 1 C 1,_K-r "t, �s
,7 ,.y,AV_:_�Le - N G
Facility Contact: . _ Title:._
Onsite Representative: Q1,4 a c, s c
Certified Operator:
Location of Farm: i3 I i ,t L._? P.1 S
Phone No:
Integrator: 1 • ` L& v-j2k W - Q e L &j O ----
Operator Certification Number:, -�_'7..
[Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • Du Longitude •
Dise6mnes & Stream hum
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 dischar�ge is observed, did it reach Water of the State? (If yes, notify DWQ) [3 Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min? ,41
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes © No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure l Structure 2
Identifier.
Freeboard (inches): !
12112/Q3
Structure 3 Structure 4 Structure 5 Structure 6
Continued

Facility ,Number: W — 37 1 Date of Inspection �v c-
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/unprovement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctuues lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste APDlication
10. Are there any buffers that need maintenance./improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type a4lo- i%W /J`*+ 4% If Gr•0.i.j
❑ Yes No
❑ Yes M No
❑ Yes ® No
❑ Yes E] No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
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 P No
b) Does the facility need a wettable acre determination? ❑ Yes © No
c) This facility is pended for a wettable acre determination? ❑ Yes r&J No
15. Does the receiving crop need improvement? to Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ® No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ® No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes M No
19_ Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 6 No
Air Quality representative immediately.
Field Copy ❑ Final Notes
rq� i ►1 t�� �-,
c .�:� �r : c.�t.1Z '� s
b�.�'t.,..: -•'j
-f a l-. y � � S i �c,•,�
Ct.;• r�^� �-F. �.or_ -rri3
:,n n.a'ce.) k.jra
'F, ear �.-L dw
��75.f
"��`��� Zt +'tiC �'•'
[[��
rG>1a '-��i 1-F
(1CGc�C..37,
1 C 4; .a C L W+ ✓ L
5
[--� C G'• c: G+ h , .w a I
�, r e 1.ti
" ,t\
t 44 �, }
ReviewerAnspector Name ,
ReviewerAmspector Signature:
Date: /642 C
12/12/03
Coed

Fariiitt Number. 7 - 3 % Date of Inspection
Reauired Records & Documents
2I . Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
22. 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
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes a] No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, hwboard problems, over application) ❑ Yes ® No
27. Did Reviewer/Inspector fail to discuss reviewimspection with on -site representative? ❑ Yes No
28. Does facility require a follow-up visit by same agency? ❑ Yes No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes QJ No
INMES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) 0 Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ® No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ® No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After 1" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
I2/I2103