780052_INSPECTIONS_20171231

3 Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
Av
10 Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Facility Number 5'
Date of Inspection
Time of Inspection I 124hr.(hh:mrn)
D Registered Certified © Applied for Permit © Permitted © Not Operational I Date Last Operated:
Farm Name: ........................... 7;�Ck.......... &.�G.-4. ��3c!t..Z........... wl ..... County:...................... ............----.............
CZY-Owner Name. Phone No. 0 ...........
aci tt opts ct• 'Ti_Cnf.S� a[MC.S Title: ............................................... Phone No:...................................................
Y �[ n h /�/j � q
Mailing Address:........... �..Ts.......I.........X........�..L../........................................ r `.{.ael�.. !!! � ....a_. 3.. . kf........
Onsite Representative:............. 75�!-! ...............fn.c. ✓t .................... Integrator:---....... rites S RnI .....................I......
Certified Operator,-----.......r,------------- pe J 3
.... ..... ...��....------ ``!.G�.�4.�.:1..... O rator Cer#ifica#ion Nttmber:......1..5.....19----.,......
Location of Farm:
Latitude 0a 0' 0" Longitude Q• ' "
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: [I Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
mai ntenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes KNo
❑ Yes ANo
❑ Yes U(No
❑ Yes JANo
/V/R
❑ Yes Jq No
❑ Yes XNo
❑ Yes jR No
❑ Yes jo No
❑ Yes No
❑ Yes No
Continued on hack

Facility Number: — 5�
8- Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.tIoldine fonds, Flush Pits, etc.l
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(ft):............313........................................ ................................... ......
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
. ❑ Yes %No
❑ Yes XNo
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WIMP, or runoff centering waters of the State. notify DWQ)
eC
15. Crop type L,F•••
..... .. MA
.. .. . ............
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
I7. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss reviewhrispection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AW,MP?
25. Were any additional problems noted which cause noncompliance of the Permit:'
El Yes No
❑ Yes No
Yes [xNo
❑ Yes Z No
❑ Yes ;I�No
❑ Yes
No
❑ Yes
No
❑ Yes
XNo
❑ Yes
ANo
❑ Yes
XNo
❑ Yes
JK No
XYes
❑ No
[] No.violations or deficiencies were'note'd-during' this. visit. You.will receive no further
eoeresOiidence about this visit:.:
❑ Yes P(No
❑ Yes A No
❑ Yes ❑ No
Cotnmenits-(refer to question #)": Explain any,Y ES ans"ers and/or atiF"t ecartuneniiations or any other comntents,�"`
:., ..
Use drawings of factlety`to'hetter`explain'situations:;luse"additional pages as necessary}
Kw rA
Uf!°
5"
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: �,,� Date:

- - ---'- . — --
Follow-uv of
' Facility Number 2_ i
of DSWC review O Other
Date of InspectioaIs Z
Time of Inspection 11: 36 Use 24 hr. tinge
Farm Status: --- Ce , _ Total Time (in boon) Spent onReview
Orr Inspection (includes travel and processing)
Farm Name• _ �oRG . MC Lec%^ PQ r County:
Owner Name:. _ �D� n M C L ea m Phone No: c1 /D)L w,0q
Mailing Address: _ZT 1 oX 7? .. �,.... ' �1C rL %V �� , ._. 2836
OnsiteFtepresentative: -S�Lkn M'-LPakx Integrator.
Certified Operator. h n Mc L e o—ru Operator. Cer#fcAtion Number:
Locatiou of Farm:
u
Latitude Longitude
13 Not O emtioual Date Last Operated:
Type of Operation and Design Capacity
.s,� r :7� �
Sprine IVnmber Poultry 'a.....;E. t Number, CatBeTurttber
Wean to Feedet '.
Feeder to FiniEsh Nan- Badrile° " ,
F w to Wean to :,
W F u x . r r.r _...< ! :a' y E' ^� ': M•
Farrow to Finish [] t7ther 7rpe of Livestock
�A f - ` xt t �- '.+.. e. -..... '.'F. >^'g'43G Mom�.-�'�°� ;^s'•^+rr "�„ - z . J„' '°"."'.;'gy ,�' -
t� „'�r ' �s..�• ., �.-:mac r`�e'sr �,%5.. r.�
ber. of Lagoons /Haldmg Po
k � f �� Subsurface Drains Present
Numnds �.,�- ..�,
Lagoon Area Spray Field Area r
I. Are there any buffers that need mramtenaacelnmpmvement?
2. Is any discharge observed from any part of the operation?
S. If discharge is observed, was the conveyance maa-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWiy
e. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Was there any adverse impacts to the waters of the State other than from a discharge?
S. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenancdmpcpraysment?
❑ Yes
1WNo
❑ Yes
ONO
❑ Yes
�No
❑ Yes
E(No
❑ Yes
ONO
L3 Yes
FINo
❑ Yes
IF -No
M Yes
0
�11
Com inded
on back

6. Is facility not is compliance with any applicable setback criteria?
7. Did the facility f a to have a certified operator in respomible charge (if inspection after U1/M?
& Are there lagoons or storage ponds an site which need to be properly closed?
fractures ooas and/ r Holding ponds
9. b structural fteeboard less than adequate?
Fnteboard (8y: I agoon/1 Lagoon 2 Lagoon 3
Z.
10. h seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the struuctm= observed?
12. Do any of the structures need
(If any of quesdods 942 was answered yes, and the situation poses an
Immediate public bealth or environmental threat, notify DWQ)
,13. Do any of the structures lack adquate markers to identify start and stop pumping levels?
Waste An lication
14. Is them physical evidence of over application?
. (If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. crop type .+UN r YA\X & GL ,
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
For Certified Facilities Only
20. Does the facility fail to have a copy of the Amaral Waste Management Plan readily available?
21. Does the iaaty fail to comply with the Animal Waste Management Plan in any way?
22. Does record keeping need impra?
23. Does fatality require a follow-up visit by same agency?
24. Did Revieww/Inspector fail to discuss mviewfmspectson with owner or operator in Charge?
❑ Yes No
E3 Yes No
© Yes No
E3 Yes ;i(No
Lagoon 4
❑ Yes No
❑ Yes RNo
❑ Yes KNo
❑ Yes Atlo
E] Yes gNo-
❑ Yes K*D
0 Yes
13 Yes KNo
❑ Yes P(No
❑ Yes No
❑ Yes No
❑ Yes P�No
13 Yes ANo
❑ Yes ONo
Cammtats (refu to quesnoa #)YEi Tarn airy Y£.S answers endlor nay rmomaareadatrons oz airy ether coimaaeats.'
Use dra;offact�tty to batur arplam.__situasazns iuse-a:�ditro�alpages as necGssasy� $�`��:-"��`"��`�.�.�`� �,,�� ��:�µ .°.
ea, r, s Gid r k'r„q C04 1) S%� W roc a,..,.. e r j 4
Reviewer/Inspector Name
Reviwer/lnspector Signature:
FA
Date: .S zS - 9 7
CC: Diwisiatr of crater Qualityf'Water QrraIkySetdon, FadAry.lssmment Unit 11/14/96

`n..
State of North Carolina
Department of Environment,
Health and Natural Resources
Fayetteville Regional Office
James B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
Mr. John H. McLean
Rt. 1, Box 277
Maxton, NC 28364
Dear Mr. McLean:
AIT.-�
C)EHNR
DIVISION OF WATER QUALITY
June 2, 1997
SUBJECT: Annual Compliance Inspection
Jack McLean Farm
Registration No. 78-52
Robeson County
On May 20, 1997, staff from the Fayetteville Regional Office of the Division of Water Quality
inspected the subject swine facility. Please find enclosed a copy of our Compliance Inspection
Report for your information. It is the opinion of this office based on the information provided and
observations made during the inspection that the facility was in compliance with ISA NCAC 2H,
Part.0217 at the time of the inspection. Please refer to the comments section on the rear of the
inspection form for information regarding your facility.
Please be aware that all swine facilities with a liquid waste collection system designed for a
minimum of 250 hogs must have a certified waste management plan on or before December 31,
1997. The district NRCS office, Agrictilture Extension office, or the Division of Soil and Water
have specialist available to assist you with upgrading of existing facilities and certification.
If You have any questions concerning this matter, please call John Hasty at [phone].
cc: Operations Branch
Central Files
Audry Oxendine - FRO DSW
Ed Holland - Robeson Co. NRCS
Sincerely,
/ohnC. Hasty, Jr.
Environmental Specialist
Wachovla Building, Suite 714. Fayetteville maw. FAX [phone]
North Carolina 28301-5043 N� 4 An Equal opportunity Affirmative Action Employer
Voice 910-486-1541 50% recycled/10`;6 post -consumer paper

1, SQA Z7:2 61 C.
-sakn ?"CLecZ.6 how
Daft RepracubtWa MEN"ri
coma Opffamr. Mc Lec.n, 193 Iq
loewdon ofFww.
MCM N rM F -M MEN 2r 7 K
Ell
19 Not Overational J Daft UW Operated:
Type of Operation and Dedp Capactty
Wm to Fftda
Feeder to Finish
4�5Farrow w M�
Earrow ig Finish O&W Type of Livemck
1. An &= any buff=$ that need wumftwm&qmYmDM?
...... ......
Subsurface Drains Pnmmt
13 Yes RNo
Z Is =W &wbwp obscv fmn my pot offt opuadn? 13 yu (fNb
AL lf&sdwv is observed, Was the C=Vqwm moo -rude? E3 Ya F(No
b. 1fdaebarp is cbsav4 did it Tcut Sm*m Waftr? (If YM wtify DWQ) 13 Yes OfNd
r- If &%chvp is observed. what is the enimsted flow in gd&ok?
d. Don discharge bypass a lagocm agm? (IfYM Duffy VWQ) CI Y- ON-
3. Is 6m mda= of pan disc mp ftm my pat of the %matka? Mes FIN*
4. Was there my adverse unpacto to the evatera of the State Others than from a &wbqp? Yes Wo
I Does say pan of the wane mmgancut nvmm (other than bgo=&Uldmg pas&) 13 Yes Flo

r -
* Is Aw ty am in oa Phance with say spplkabk a 62* of OE%? w
D Yee
No
* Did the faeiliry Sd m bra a o wmaid operator in re:pomdbla drape Of hqm4w ubw Mirm
13 Yee
No
L Are then bgooas or storage ponds an site wbicb wed to be p may dosed?
Dyes
No
Rlruet mA at►oons and/or R21fifnt Panda
V. Is sbtechizal 5seebaatd Jews than adequou?
D Yes
P(No
Fieebowd (f AspuoaLmwou 2 Lapooa 3
• lsp = 4
2a ob:Q,►ea aayod�e - _ _--
D Yes
No
11. L wasi mf, or say othier b` t>b , integrity of say off the sdva = obscwd?
D Yes
RN*
11 Do any of the SOUL M aced '
D Yes
XNo
(If any of quesdois 942 was aaswered yes, and the situation poses an
Immediate public health or environmental threat, votVy DWQ)
33. Do say of the stm =uu lack adqu to markets to seat stop pmap&S keels?
D Yee
To
Waste 1l n
14. B them pbysieal evidence of over appEcsti ss?
D Yes
1No-
.(If in eacaa of WMP, or M eamcriag wum of the Stan, notify D�WQ)
M � type .� r mxx Q
X Do the active amps differ with those designated is the Animal Waste Managamw Plan?
p Yes
plD
27. Does the ficiiity have a bck of adequate weags far land spplicstiaa?
D Yea
04b
IL Does the wwo emp need impmv+rnicot?
D Yes
$(No
ig h that a lack of avaflable irrigation equipma t?
D Yes
WNo
Dr Certified Focilitits On1v
2D. Does dm faraMW fail to have a copy of the AWaste Matugemeat Plea reader available?
D Yes
No
31. Does die Sc�ig► fa to eornply witb the Animal Waste Managc=mt Plan is any wayl
D Yes
No
22. Doer rzaaad kcmb* wad b rVuvem O
D Yea
W
23. Does 5celity requim a follaw-up visit by same aV=q?
D Yes
P(No
24. Did Rzvkwabq a w Sea to discuss rzviewhaspxdon with owner or operator iD abarpe?
D Yes
gib
*C*�raaiments ((mf cr�tD gju}eepkm F.acp]aia.tay YES ad/ar dry. isco®mmdatioa4;cr sir' r coermreiits.'
{.:K �T' ;...wl..� f-....�aetVat•:�=. u�..�Wi7li���ag•il,."'r r-^�
cC. e� � : s a.rark `r .. 5 aP � 5+ tj rem ar•�► e rto
RevkwerQnspector Name
ReviwerRasperw Signature:
eG Divtsia), of 1 i'aur Qua!uyf-water QuAniv Sern'ne- FinakV .s......... »-+,
Dam s—zs -97

State of North Carolina
Department of Environment,
Health and Natural Resources
,lames B. Hunt, Jr., Governor
Jonathan B. Howes, Secretary
November 13, 1996
John McLean
Jack McLean Farm
Rt I Box 277
Maxton NC 28364
SUBJECT: Operator In Charge Designation
Facility: Jack McLean Farm
Facility ID#: 78-52
Robeson County
Dear Mr. McLean:
Nov 19 1996'
FR'; 1-1 PALCM
RF-t .OFFICE
Senate Bill 1217, An Act to Implement Recommendations of the Blue Ribbon Study
Commission on Agricultural Waste, enacted by the 1996 North Carolina General Assembly,
requires a certified operator for each animal waste management system that serves 250 or more
swine by January 1, 1997. The owner of each animal waste management system must submit a
designation form to the Technical Assistance and Certification Group which designates an
Operator in Charge and is countersigned by the certified operator. The enclosed form must be
submitted by January 1, 1997 for all facilities in operation as of that date. Failure to designate a
certified operator for your animal waste management system is a violation of 15A NCAC 2H
.0224 and may result in the assessment of a civil penalty.
If you have questions concerning operator training or examinations for certification, please
contact your local North Carolina Cooperative Extension Service agent or our office.
Examinations have been offered on an on -going basis in many counties throughout the state for
the past several months and will continue to be offered through December 31, 1996.
Thank you for your cooperation. If you have any questions concerning this requirement please
call Beth Buffington or Barry Huneycutt of our staff at 919n33-0026.
Sincerely,
A. Preston Howard, Jr., P.E., Director
Division of Water Quality
Enclosure
cc: Fayetteville Regional Office
Water Quality Files
P.O. Box 27687, N14CRaleigh, North Carolina 27611-7687 An Equal Opportunity/Affirmative Action Employer
Voice 919-715-4100 500/. recycled/10°/. post -consumer paper

i. N
_Division of Soil and Water, Conservation - Operafion Review = -
t - -
5 Division of 56J1 and ,]'Vater Conservation - Compliance Inspection'
Division of Water Quality -Compliance Inspection k
Other Agency Operation Review: Wu _
Routine O Complaint O Follow -no of DWO inspection O follow-up of DSWC review O Other
Facility Number rJ SZ Date of Inspection L1—LS-qy�
Time of Inspection 0 24 hr. (hh:mm)
Permitted Q Certified [3 Conditionally Certified 0 Registered 0 Not Operational
Date Last Operated:
Farm Name: �/ C ............................... .
ff
J.c _cl\...... M..... L.�.�GLJ!�:...� .%._W__ ............................. County:..._........ "f L�.�{�1'�
Owner Name: �p.f.►` CLOG-- Phone No: ......
-�. . Jr ......._....yj.......... _..M........................ ?-1..-. f1._.........................................
Facility Contact: -,.- �dYl►4 f! l�L"iZ-*' .._........Title:.-.--{, Wh._......�................... Phone No:
.... .. _...................................................
Mailing Address: ....... t•'••bt•c...Ld-1=Q.r h ....l Gi..: ..w2 lr.....l..Y... ........................... G.F3.ii__.1._
OnsiteRepresentative'
._.....G,� ................... r.............................. ................ Integrator:...... ..........................................
Certified Operator: ��G C — Operator Certification Number:
Location of Farm:
....................................................................................................................................................................................................................................................
Latitude �r �4 �=� Longitude ' 4 64
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I Dairy
❑ Non -Layer I Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)? ❑ Yes t
0
Discharge originated at: ❑ Lagoon El Spray Field ❑ Other
a. If discharge is observed, was the conveyance ratan -made'
h. II' discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State
c. if discharge is observed. what is the estiniated flow in oral/inln'
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Identifier:
Freehoard (inches)
Structure I Structure 2 Structure 3 Structure 4 Structure 5
26
❑ Yes oNo
❑ Yes nn No
lr
❑ Yes 9No
❑ Yes 0J 1
[]Yes ANo
❑ Yes gNo
Structure 6
1/6/99 Continued on back

I
Facility Number: '7 — 52 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes AkNo
(If any of questions 4-6 was answered yes, and the situation poses an 11��
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes Po
8. Does any pa►t of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes �fo
9_ Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum "�
liquid level elevation markings? ❑ Yes 4No
Waste Application
10_ Are there any buffers that need maintenance/improvement? [-]Yes �No
11. Is there evidence off over application? (� ElPonding /❑ Nitro en ❑ Yes [ No
12_ Crop type !�'IrYvt .....S...................................\...
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes W No
14_ Does the facility lack wettable acreage for land application? (footprint) ❑ Yes eNo
15_ Does the receiving crop need improvement'? ❑ Yes 4 No
16. Is there a lack of adequate waste application equipment? ❑ Yes kJ No
Renuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes XNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes 4 No
19. Does record keeping need improvement? (ie/ irrii ation, freeboard, waste analysis & soil sample reports) ❑ Yes Iro
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes f No
21. Did the facility fail to have a certified operator in responsible charge? ❑ Yes \ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, frechoard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same ag*ency? ❑ Yes No
No.violations-or deficieride's.were' ri6ted. ddrin, g Ais.visit:. 6u' w'J1'recceive inat ftirthei- .:. -
correspotideh&* about; this ;visit.; ..; ; ; ; ; ; ; ; ; ; ; ; ;
Comments+(refei: to question#): Explain any YES answers and/or -any recommendation or. any other corriinents `. .
Use:dirawin s of facility to better explain situations. use additional pa es as neeessa
Ah*41E 4o-eale n ed,5 7 a be C/rnco.
G 16�d WkiW3 ", Ide-11 'ko' 'Jet k'j.
AL
Reviewer/inspector Name
Reviewer/Inspector Signature:
�S'_A
Date: 2'Z5��1� 11/6/99

Division of Soil and Water Gonservahon -:Operation Renew
r +� s El. Division of Soil and Watef ConserVattan Co>nptiance Inspectton x' _ � RE
Z Division of Water Qaal�ty Couipltance inspectioQ A °s t z
13 Other Agency, Operation R
.,_.�._r,.,:__...a,�.
10 Routine Q Complaint Q Follow-up of DWQ inspection 0 Follow-up of DSWC: review Q Other
Facility Number Z Date of Inspection
Time of Inspection 24 hr. (hh:mm)
0 Permitted ® Certified 13 Conditionally Certified 0 Registered [] Not O erational Date Last Operated:
Farm Name: ..---.....-- ... County:.........
--..`..........................................................
Owner Name. ............. n �t.................. G �4r......................................... Phone No:.....
Facility Contact: .... -Title:. ........................................
`................:G+�..;l.�...... ..:.. ....................._......... ...•,,,/.... -Phone No:
Mailing address :................ �,7s?-....1(�T.� 11.^. -- ...---...........4:. c�y ...............
f. J
Onsite Representative: Integrator: `.,,.n...�...�/1..... ✓ ..................
...�`� "� ...................
Certified Operator :....... 44 ....../74 .......... —g e—z.......................... Operator Certification tiumber:..........
.... a ...... ................................
Location of Farm:
...........................................................................................................................................................................................---.....--.............................................................
.
Latitude 0 �` �.. Longitude •
Design Current ='
Swine Capacity Potrulation
❑ Wean to Feeder
Feeder to Finish
,2
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design : Current' Design 'Current
Poultry Capacity Population Cattle Capacity Po ulation
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
r
= Total ssLW
�..,fi1Number of Lagoons - #t; ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
Holding Ponds !'Solid Traps M. JE1 No Liquid Waste Management System
Discharge- & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes W'No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. I1•discharge is observed, was the conveyance man-made! ❑ Yes Ce No
h. If discharue is obsm.-ed, did it reach Water of the State? (If ties, notify DWQ) ❑ Yes V No
c. If discharge is observed_ what is the estimated flow in gal/min'?
d. Docs discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes jS No
2_ Is there evidence of past discharge from any part of the operation? ❑ Yes 5a 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 V No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): �.? .................................................................... .................................. ...................................
5- Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IgNo
seepage, etc.)
3/23/99 Continued on back

A
Facility Number: —SZ, I Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
E�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
El No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste ARRlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑/ Excessive Ponding ❑ PAN
❑ Yes
JR(No
12. Crop type-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
FLNo
t
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
ANo
b) Does the facility need a wettable acre determination?
❑ Yes
%No
c) This facility is pended for a wettable acre determination?
❑ Yes
JRNo
15. Does the receiving crop need improvement?
❑ Yes
19wo
16. Is there a lack of adequate waste application equipment?
❑ Yes
CtNo
Required Records & Documents
I7..
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
RNo
18.
'Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
C$No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ERNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
JgNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
IRNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
;RNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
J9 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
J4No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
54 No
1.IQ
yioiaiiggs:o dgf eierteie i re pQte � g �i4s v�s�t� Yoiye o fui<t0 .
- . •correspondence:
abaut: this visit ..............:...:.......:.....:. :
Reviewer/Inspector Name
Reviewer/Inspector Signature Date: y Z[+�

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ;RNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 9 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes XNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes X No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes RNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? X Yes ❑ No
Additional omments an or rawrngs•

Facility Number Date of Visit: Time:
tO Not Operational Q Below Threshold
JKPermitted [3 Certified 13 Conditionally Certified 0 Registered Date Last Operated r ve Threshold:
Farm Name: Q+ .. ! q�- /,'?,7Ai County:..... A _ ............... _...
Owner Name:..��.!�......................... ....... A ZG. . ................................. Phone No: ....._J-�= By&F�-_______�. �..
Facility Contact: .........'IQ. AM-i�r,Al,.............................. ........ Title: ......................�.�..................... Phone No:.........
Mailing Address:....�o �...' „;!.s..-- l "l.��r .1..'.......-...._......... .....7 _.�� C. •....� _— 4
Onsite Representative: .......... ,fT...''S��7C.e,#-............................../......................-----........... Integrator: .................. c;;L,r-, a// .........
Certified Operator:.,,... a--// -* CL Operator Certification Number:....-- —
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • t 46 Longitude • 6 Du
Resign '-Ci�ri^etit
Destgii Current..
gn Cuirextt
.0city Population
a
,
,CaciPo tilatoa . cattle
_ -a Po Lion,-=
- Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
❑ Non -Layer
❑Non -Dairy
Farrow to Wean
Farrow to Feeder
Other
-
_ Farrow to Finish
Total' Design Capadty
❑ Gilts
Boars
ToW SSLW
3x ;Naimber,of Lsgoong ❑ Subsurface Drains Present ©I.agovn Area 10Spray Field Area
dmg Potxis 1 Sohd-Traps.+ _ • ❑ No Liquid Waste Management System r
r�
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ff No
❑ Yes No
❑ Yes o
❑ Yes
❑ Yes
❑ Yes
❑ Yes
Structure 6
Identifier:..................................... ......................
Freeboard (inches):
5100
Continued on back

Facility Number: — Z Date of inspection —�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancerimprovement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Ai2plication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application?
12. Crop type
13. Do the receiving crops differ with those dbfignated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re(Mred Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
o-yiQlai�ipnjs:o�- d�f ciepc�i� wire nQfe� dtjtring tb�s visp� • Your wiii •t�ee�iye too ����r - . .
c6riisp6tid6abatit this visit-.* ............. ' .. .........: ' . I .
GU;Agej 4 rtsw / sa4,y/e 6 /) e.�- per.
y
11" q6&4 /ook; " bet-&.L-_jc�_ .G[d.
F4rm 1'"` lf'e//M ti,AOXAFl,
❑ Yes�No
❑ Yes jl�o
❑ Yes No
❑ Yes No
❑ Yes GQLNo
❑ Yes XNo
❑ Yes ANo
❑ Yes
❑ Yes
❑ Yes K"No
❑ Yes KNo
❑ Yes KNo
❑ Yes ffNo ti
❑ Yes 5(No
❑ Yes P(No
❑ Yes KNo
❑ Yes @(No
❑ Yes k No
❑ Yes FNo
❑ Yes Rollo
❑ Yes NNo
❑ Yes cjw1 o
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: g/pp

Facility Number: 74e - f Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes N0
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
roads, building structure, and/or public property)
29. 1s the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes o
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes o
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? [ Yes ❑ No
5/00

tDiv
-78 SZ
Type of Visit (9 C,,ommppliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit &, outine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 5 O!o '/O Arrival Time: Departure Time: 2 :30 County: Ip46e-Sa111 Region:
Farm Name: Ma.GK Owner Email:
Owner Name:Phone:
,,gg//RX'�N 341
Mailing Address: 1' Z y' g l�-f-. iNO T'r al �'► �Z..ci _ _ _ ,N� A/C z S 34,
Physical Address:
Facility Contact: -} ac-k. e.le_arj Title: Phone No:
Onsite Representative: �o k 4. C rec,_IJ _ Integrator: O rMWAI
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = f = Longitude: = ° = f E__1 "
Swine .
Design current
Capacity Population
Design Current
Wet Poultry Capacity Population Cattle
Desigrt
Capacity
Current
Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
iry Calf
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
2 i0
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
El Farrow to Finish
❑ Pullets
PC]EIGilts
Boars
_
Other :.
❑Turke s
❑ Turkey Poults
❑ Other
❑ Other
Discharpes & Stream Impacts
0
l . Is -any discharge observed from any part of the operation?
El Yes
,_,,
IJ' No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
El No
,.�,,�
L3 A
ElNE
• b_ Did the discharge reach waters of the State? (if yes, notify DWQ)
ElM Yes
❑ No
A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
ElYes
ElB No
A
❑NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
UJINo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
E4<5
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: `% -- SZ Date of Inspection S—dlo
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 2< ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier: --W-- 7e -6-z.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -_3•J�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 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 [1 Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application �
A Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes B<o ❑ NA ❑ NE
maintenance/improvement? No �,�
] 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Lf ❑ 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- Croptype(s) f Gi�rit(- Jw � y � �w.aL� G iN (o►�e�vscr,j) - �i -x�%".V
13- Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
&Ro
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
El-eo
[INA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ NA
[I NE
17. Does the facility lack adequate acreage for land application?
El Yes
,,[---, /No
Lt"�o
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Eql o
❑ NA
❑ NE
Comments (refer to question #): Egplam any YES answers andlor any recammendattons or�anv other comments ;
Use ciraKmgs of facility to better explain srtuataons: (uses addrttonal pages as necessa y) ry
Reviewer/Inspector Name F Ric- / ,✓t S Phone:
Reviewer/Inspector Signature: Date: S-06 -- ZO/O
1 Z1Z61U4 uununuea

Facility Number: -52, Date of Inspection
Required Records & Documents ,_, ,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [I Yes L7No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ETNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps
p El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections El Weather
Code
22_
Did the facility fail to install and maintain a rain gauge?
❑ Yes
B o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,E
L
El NA NA
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
[I Yes
,�1I
L7oo
[INA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Do
ElNA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El8 Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
<0
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
To
❑ 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?
El Yes
/
D 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
L"i'No
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
B o
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
91ro
❑ NA ❑ NE
12128104

t
&IMS d s 15-ZC09 2�
( ivision of Water Quality
Facility Number M
2_��
O Division of Soil and Water ConservationO Other Agency
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
��C,,ommpliance
E)I outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: �}"Z3' Arrival Time: Departure Time: .3•`O �,7 County:
Farm Name: �LGK G�eaN ra'rws Owner Email:
Owner Name: : 0(, N MC I ea"I
Mailing Address:
Phone:
Physical Address:
Facility Contact: Sa►C-K AC.le0ij Title: 6)L.JAJW Phone No:
Onsite Representative: _Eox V, Ak`-ie.,L"t
Certified Operator: �a�K mcle-L'4
Back-up Operator:
Location of Farm:
Region: i-IdD
integrator: Mu t-p4-11
Operator Certification Number: l ?31q
Back-up Certification Number:
Latitude: ❑ e = i ="
Longitude: = o =
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
10 Wean to Finish__ r __
Wean to Feed
er
Feeder to Finish 124 q Ov
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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 Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system'? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Lf No ❑ NA ❑ NE
❑ Yes
❑ No
21NTA
❑ NE
❑ Yes
❑ No
[ NA
❑ NE
a A
❑ NE
❑ Yes
❑ No
❑ Yes
B o
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
12128104 Continued

t t
Facility Number:
Date of Inspection 1 5+--_23-711
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 31NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 40
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q 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 EJ 1vo ❑ 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 Q Ko ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E3<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 ElE Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3 l�o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E -Ko ❑ 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. Croptypes) j3e_rwvi.,-i�- � 7�. 5«...�ii �r.lou •c.� , t.. i.e-V -C-4*v 5'o76e"'5
13. Soil type(s) AjV-r{cl Rai NS
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L��NNoo ElNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E3 o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes B 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 No ❑ NA ❑ NE
J,,G,omments (refer to queshony#y) Explam�any�YES answersand/orany recommendations or any�o#her comments.
.+,syieW+Mw.TH —
Use drawn of factlt Ito better a leans ituanons: use addttionid es as necessa
t133 333i1
Reviewer/Inspector Name R _'_k, Phone:
Reviewer/Inspector Signature: Date: -Z — 2-06 7
Page 2 of 3 12128104 Continued

r �
Facility Number: 7 $ — $Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes u No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes D o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El maps El other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
D Io
❑ NA
❑ NE
[j Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections E] Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
L#, � /No
MTA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[R A
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ETNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
O iA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
El No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E 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
,�,/
E No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Vo
❑ 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
Io
NA
El NE
33.
Does facility require a follow-up visit by same agency?
El
No
❑ NA
❑ NE
Comments and/or
12128104

j3JA4 S t N "C-4 V /0 ZAO, b
Kadlity Number
0115ivision of Water Quality
0 Division of Soil and Water Conservation
O Other Agency��
Type of Visit 0.160mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: '//' O Arrival Time: Departure Time: ]; S%O - County:
Farm Name:•S 4Ck het (e��.! t•.�•� Owner Email:
Owner Name- _� 0 � 1J MC-IC-Q-tJ Phnnv-
Mailing Address:
Robe sv^.f
Region: rib
Physical Address:
Facility Contact: d a-0 M • �'�na� Sn•J Title: /L%�vQS c.r Phone No:
Onsite Representative: Integrator: Af ury" - 'Era LI JN
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o = 4 = Longitude: 0 0 = = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
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; Curr
Cattle Capacity Popuh
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
I
I>
r.
Number of Structures: 1
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 ® No ❑ NA ❑ NE
❑ Yes
[4 No
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
P No
❑ Yes
[4 No
❑ NA
❑ NE
❑ Yes
P] No
❑ NA
❑ NE
12128104 Continued

Facility Number: -7
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 2,0
Observed Freeboard (in): 2 /
lil.,..
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [6 No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes Uff No ❑ NA ❑ NE
s
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 P9 No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [IMO 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/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [Z 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 Drill ❑ Application Outside of Area
! i
12. Crop type(s) Sp.�cir/S _s'4T_rMrr;' &&�s _
13. Soil type(s) WO,R L v _ Pa
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
I S. Does the receiving crop and/or land application site need improvement? ❑ Yes
R No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
rO No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
P1 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'? ❑ Yes
(Z No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector flame ea/ d S Phone: 910, V33, 330V
Reviewer/Inspector Signature: zg► Date: 02-- il-Za08
12128104 Continued

. . y
Facility Number: '] $ — S2 Date of Inspection aZ�l�O 8
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [A No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ 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 1" Rain Inspections ❑ Weather Code
22_
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[0 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
[�j No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[P No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[A No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
1� 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
RNo
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency?
❑Yes
n7l No
❑ NA
❑ NE
Comments and/or Drawings:
l2/28/04

q V%
Facility Number g SZ
® Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: '27-07 Arrival Time: Departure Time: dx,°00 .,. County: Ra(--.Z! Region: "CX0
Farm Name: .Y ac_k McAcarJ . Ea► kA Owner Email:
Owner Name: . 0C%,j Mc. ka,+ Phone:
Mailing Address:
Physical Address:
Facility Contact: Jo ,.r el car. Title: Qwt"'V— Phone No:
Onsite Representative: �o� N <<C4 "f Integrator:a�
Certified Operator: Operator Certification Number:
Back-up Operator: r Back-up Certification Number:
Location of Farm: Latitude: = 0 = g 0 a Longitude: = e = d
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
Z
ZZ$O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Design Current
Wet Poultry Capacity Population
❑ La er
❑ Non -La ei
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'?
Cattle
Design Current;;_,
Capacity Popuiatjoq
❑ 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?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[�4 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[9 No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
91 No
❑ NA
❑ NE
12128104 Continued

Facility Number: 7 — SZ Date of Inspection T27- 07
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 [2 No ❑ NA ❑ NE
Structure l 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 NJ No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo ❑ 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
C4 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
0 Yes
R 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
[jj No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[� No
❑ NA
❑ NE
maintenance/improvement?
11, is there evidence of incorrect application'? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 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) So ti �•a,vS . lji 442- I L o vc�ls to } e r3-L 41-d A G ru ss
�Ka� .
Pas�urC- J
13. Soil type(s) NO 8 K, t,-
_
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
[VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]
Yes
19 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[yNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[Z No
❑ NA
❑ NE
IComments (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 r_j k R e- v er 1 S Phone: (910) Y33 -333 0
Reviewerll L nspector Signature: ,2� Date: 3 - Z7 - Z 00 7
12128104 Continued

. L
Facility Number: -7$ —,j Z Date of Inspection 3-27-07
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [)4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [XNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ ❑ Maps
Design
g p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [VNo ❑ 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
[2No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[�l No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[)rNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[2 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
W No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
W No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments andlor Drawings:
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / 31-06Arrival Time: Departure Time: County: R0bf-S011%1 Region: )0' Q
Farm Name: Jam�-&C-K C M iar on, Owner Email:
Owner Name: `\_p_�1 bL—_�_ AAC t eck /V Phone:
Mailing Address: _ 12 4 S? /M t< . M a lcl'ol in P_d. 28 3/0`
Physical Address:
Facility Contact: J 01„ o i 1 � l- e N Title: Q { JN�Y_ ��d�rr Phone No:
Onsite Representative: Integrator: AMuvo T ��AJ
Certified Operator: :_n."_ 4 , M Glet-nJ Operator Certification Number: 0. V 93f 9
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 0 = ' 0" Longitude: 0 ° = ' =
.x r�
OMAN—
Design Current estgn 1 Current
Swine Ca aci PoN�Dpaerty ,Population
❑ Wean to Finish ❑ La er
Design Current
CattleeCapacity Population
WIN 371%.
❑Dai Cow
❑ Wean to Feeder
❑Non -La er
❑Dai Calf
Feeder to Finish
� (a
2.1150
' yip
Dry Pouliry
: '
❑Dai Heifei
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ D Cow
❑ Non -Dairy
❑ La ers
El Beef Stocker
Non -Layers
❑ Beef Feeder
❑ Pullets
IQ Beef Brood Co
e
Other
_ ❑ Turkeys
❑Turke Poults
Number oVStructures:
❑ Other 11 ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[9No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
® No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
[9No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: "] — `Z Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): Q ��
Observed Freeboard (in): 2 6 If
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ff No
❑ NA
❑ NE
through a waste management or closure plan?
1f 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
[A 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
X No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes (9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Ljj1t (( MiN) 5p�,be &nJ__ZCYvh1A-cLo,_ �6_ _
13. Soil type(s) f� 0[� L
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [21 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,0 Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Reviewer/inspector Name f Phone:
Reviewer/inspector Signature: Date: I - 3/ - 20 0 40
12128104 Continued

� 4
Facility Number: -7 g — 5z I Date of inspection -
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes EYNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®No ❑ 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
® 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 properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Addl#:onal Coiiimenfs and/or Draw'ing'si,
12128✓04

(Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 7 $ Z Date of Visit: lU » Time: � oa
Not rational O Below Threshold
M.Permitted Merdfied [3 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Name: T1, C M F , Al -i .eti !` County: 1&,ese.n a ---
Owner Name: _ .. T�1 q ....1 c t e413 . Phone No: 4110 • S2 1 - o f f yf
Mailing Address: __d21 it_ eZ1 • I ae,;'. A !! read _--------- -- -- - x2!�a ?V C_ 3G Y
Fr.ality Contact: ern /11c- Title- Phone No:
Onsite Representative: .-�tri Inc I Ma , ZL u %a;a s o ti--_-• Integrator. CGrrie II �s Fo, a/L �„ c
Certified Operator: r Y-04 h . Al c. L e"" � Operator Certification Number:
Location of Farm: Ra'?dy ��o.•,�s�r,
w
wine ❑ Poultry ❑ Cattle ❑ Norse Latitude �• �' �'� Longitude �• Du
n wt,ames & Stream impets
1. Is any discharge observed from any part of the operation? ❑ Yes E), o
Discharge originated at: ❑ Lagoon ❑ Spray Feld ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes o
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes
ONO
c. If discharge is observed, what is the estimated flow in gal/min? �-
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes L710
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
Structure 1 Structure 2 Structure 3
Identifier:
Structure 4
❑ Yes EfNo
Structure 5 Structure 6
Freeboard (inches): �I.�
121.12103 Continued

Facility Number- 2a — E l
Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 01d 0
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or Yes L�No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes RIZ
S. Does any part of the waste management system other than waste structures require maintenancelunprovement? ❑ Yes u fo
9. Do any stuctures lack adequate, gauged markets with required maximum and minimum liquid level
❑ Yes DIZ,
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 0No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes P,
CO
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
21q ( S o �r3 q Z / ley
12. Crop type % P rn �• �/ �r 3inr, // iir •1.'n OY P r [ r�� iNA F, o� r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAV#'NM)? ❑ Yes ❑-No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes jp].Ai6
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 [�o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes MNo
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 Mi o
Air Quality representative immediately.
Cam trafer to gnes�onr �' YFS' aadlar �' ar shyotlYer rammmts.:
E �1;o 3!r teld Copy 0 Final Notes
�r�ve /V"" TAo
m/osdn /f,'c/l c�rr,'S s ��one nHe ,s fhF
hjronn N6D/i /rE�. 6o,7raCf A"n, ""pr ar/vC� 00
{t ryCtl �o S/orsy �u,^ Lv2a(Cj l rile /7G�. riP%��
T
E
er/IgspectorNameer/Inspector Signature: Date: to -
12112103 Conftnuad

Facility Number: 7 8 Date of Inspection p-
7 sA
Required Records & DocumenU
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [Now
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ielh sts, design , etc.)
❑ Yes
o
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
O-No
❑ Waste Application ❑feeboa:4 ❑ Wastcfu ysis ❑ Sell-
7-23 a.r 14-a0)' :7. 7 10- s 2 0.-536,
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[R'lfo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
El N-O
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
[WO
27. Did Reviewer/Inspector fail to discuss review/mspection with on -site representative?
❑ Yes
QNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
M N
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑4qo'
NPDES Permitted Faeffities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
0-96
3I _ 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 Foam ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
l2/I2/03

of Visit 4V Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: Time: 1 7 �i'
Facility Number 3
Q Not Operational Q Below Threshold
MPermitted [Certified Q Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ...... _. ..
Farm Name: ......_.J 4l ..._......... _ 5012............. ............... ......... ..... County:.! 1744U.Ertl ........ ...._.........
_...._
Owner Name: Tx� n........Ll��:���s ..... __. .... ....... — ../..._..... Phone No: ........_....._. �._..�- - -� . _..�.,� .�. __.
Mailing Address:..,... r2y f� - -... -... ati! �, �i..... _.�.r�,ct�t ------- - aXL2f-A-'.�_-___-...___...__.. --- 2016y..
Facility Contact: ........ ............ ... .............................. Title:.......... .......... ....... ..... ....... _... Phone No: WW _
Onsite Representative: �._ . _ _ - ...... - .............. Integrator .................................
Certified Operator: --- ^•-- -- -� W� _ ...._. ._.� ._------_ Operator Certification Number:
Location of Farm:
MSrwine ❑ poultry ❑ Cattle ❑ Norse Latitude • 4 Du Longitude • 4 «
Discharees & Stream )Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes QNer
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier• i
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑+io
Structure 6
........... I....................... ... ...... ..... .............. ........ ......... ..................... .........._....................... ............ .......
Freeboard (inches): -16
12112103 Continued

Facility ber: 22 -- Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation marldngs?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
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
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ 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 ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
I7. 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 ❑ No
19. Is there any evidence of wind drift during ]and application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
'" —aa�=—r.-µ,me....--•—;._:i,'�=v . ors � -'-"
{14� atRy_BiL�v![S/Crr 2ttY_Y011il COID>RfS..:__
`�i-;.rsc ,.:—�.a
Tlse t�tplaME W__ txops�{{ 'l' $ ❑Field Copy ❑ Final Notes
. ';�-�".�.ice.:.""'�-••i",�'..,_.<.s,��..: .. _..mom :x�,_.<..��,"�'��s�',i.- =-__'`=���R ?... , ���-�:� ::=uri,•:�.�s�-�..
Reviewer/Inspector Name r-:� w1V Qw,•-n•...�,=:rr .a_ st m.;•,r`- ca_. ,�' - -z, `' ^ �_.
ReviewerAnspector Signature: Date:

t 1
IType of Visit C'Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit:-�(0`03 Time:
7 g SZ
Not O erational Q Below Threshold
0 Permitted Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: 3iXCK „MG e-ari RKttg County: _ R0j0E_.g0n1
Owner Name: J 0kri V"ICItw4N Phone No: 10) 521-. 0419/
Mailing Address: )249 1W, Ala-r,g l Road /VfaxAw !VC 2936 q
Facility Contact: 3-mc.y' MC.1Ca1'j —Title: Phone No: 310) S 2 1 —6 we l
Onsite Representative:
Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
0.-1I,ses I Si of SR-l17*aPprtrc.0-2w.t)cs voV44, v i41, s2-1131J
r4o ea-5a tol.f G
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' �° 0� Longitude
Design Current Design Current Design Current.
Swine Capacity Population Poultry Capacitv Population Cattle Capacity Pn ulatian
❑ Wean to Feeder ❑ Layer ❑ Da'
Feeder to Finish 3 �9� ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean - -- ---
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
-Number of Lagoons 0 : ❑ Subsurface Drains Present ❑ Lagoon Area ❑ S ray Field Area
Holding Ponds / So id IEJ No Liquid Waste Management SystemMR
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes Lif No
❑ Yes E N_o
El Yes B No
❑ Yes ETNo
❑ Yes No
❑ Yes No
❑ Yes L'1No
Structure 6
Identifier:
Freeboard (inches): to'
0510.3101 Continued

Facility Number: —jg — $Z.
Date of Inspection - 43
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(]If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes LYNo
❑ Yes Io
❑ Yes EE No
❑ Yes 2<1
❑ Yes E 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
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[I No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer,,to}geiestionAi#} �tlt+E�zpiain any YES�sweilacid/o a y rec©mmendalions or any other comments.
Use�drawings of faeiirtytobetteraezplam stti�ations ,{use additlonal pages as necessary). ❑Field Copy ❑Final Notes
Reviewer/]nspector Name
Reviewer/inspector Signature: Date:
05103101 Continued

L.,
Date of Visit: 22 ~p 'ime: a
Facility Number % S�
Not O erational 0 Below Threshold
pf-Permitted O Certified [3 Conditional]v Certified © Registered Date Last Operated A hove Threshold:
Farm Name: _ �aGk C ecr►'. /S County:
Owner Name: 4 "_ / " ` C � eea- L, 7 Phone No:
Mailing address: 1 „Ina r r � [ _ 4 . !�!i'f, &Gi4�"
Facility Contact: �e J>7 e , „ Title: Phone No: r�
Onsite Representative: �Integrator:
Certified Operator: �1 a ��- )4jCZea-W Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 00 " Longitude 0
`..:Design:`. _ Cei
-Swine Canatity Poid�
❑ Wean to Feeder
I
Feeder to Finish
I Z Yf6
EJ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of "gootss ❑ Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
:Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation`'
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed. was the conveyance man-made?
b. if discharge is observed. did it reach Water of the State? (If yes. notify DWQ)
c. if discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes. notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillwav
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
ldentifier;
Freeboard (inchcs): 2
OS/03/Ol
❑ Yes 14 No
[--]Yes <No
❑ Yes P�`No
❑ Yes
KNo
❑ Yes
4No
❑ Yes
I�No
❑ Yes
Structure 6
Continued

Facility Number: IF — y
Date of Inspection -z -o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any pan of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
«`aste Anylication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type VA Qa d e /JP e--944 ,-4- ri 6L k
13. Do the receiving crops diffe with those designated in Certified Animal Waste Management an (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes KNO
❑ Yes XNo
❑ Yes ;KNo
❑ Yes KNo
❑ Yes AlNo
❑ Yes KNo
❑ Yes 34-LNo
❑ Yes gNo
❑ Yes WN0
[:]Yes ONO
❑ Yes 2�`No
❑ Yes:c,
0
❑ Yes
❑ Yes *0
❑ Yes E(No
❑ Yes R�rNo
❑ Yes 4No
❑ Yes qNo
❑ Yes dNo
❑ Yes RN 0
❑ Yes 9No
❑ Yes Z�No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
..
Comatents (refer to question #) Explain any YES, swers-andfor any recowntendik ar aov athcr'comments.
_..
Use drawings of facdlity ta. bet#er eiplatn situations. (use addtteonal ;Ws as arressary) ❑ Field C'onv Final Notes ter,
10bks qdov,- wallAlfa �. .�- e cl .
A m rseed S!
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: '-' —a
05103101 61 /
Continued

Date of Visit: Time:
Facility -Number
10 Not O erationa[ 0 Bellow Threshold
Permitted M Certified 0 Conditionally Certified 0 Retiistered Date Last Operated or Above Threshold
Farm Name: _ _ �CtCL t•►rle +,tea �.. t-c�r.�. County: a r. F2 Q
Owner Name: J C 11 n 1Me. Le &W1 Phone No 0
h#aping Address: 1 %�� l�h� . IM Mr j C&
Facility Contact. -3 o yAc-LAA. Title: Phone No:
Onsite Representative: Jf o I., r. Mc L. a s, n Integrator: C od, no i (�S
Certified Operator: 'r. k" _ _ „ Mc- L--e=f� r, _ Operator Certification Number: 183 I R
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° : Longitude `
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle Ca acit• Population
❑ Wean to Feeder
❑ Laver I
I
I
JE1 Dairy
Feeder to Finish
ILI Non -Laver I
A
❑ Non -Da in
❑ Farrow• to Wean
❑ Farrow to Feeder
❑ Other
❑ Fatrow, to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons 171 Subsurface Drains Present La oon Area V S rav Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management Svstem
Discharses & Stream lmpaMs
1. Is anv discharge observed from any part of the operation?
Dischar_e originated at: ❑ Lagoon ❑ Svray Field ❑ Other
a. If discharge is obsen ed, was the conveyance man-made?
b. If discharge is obsen-ed, did it reach k ater of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in galimin?
d_ Does discharge bypass a lagoon system? (If yes. notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
%Va5te Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure ? Structure 3 Structure 4 Structure 5
Identifiier:
Freeboard (inches):
05103101
❑ Yes allo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
[ No
❑ Yes
No
❑ Yes 10 No
Structure 6
Continued

Facility Number: 'N — �b
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type d Pd-rh ...r� c C r.�G.�Q ('C "x n Q S- 1.3 i"o e — . r. trs r . 6 c- G r.
❑ Yes [ No
❑ Yes No
❑ Yes Q No
❑ Yes No
❑ Yes No
❑ Yes �9 No
❑ Yes [9 No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 29 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
§] No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
99 No
Reguired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
PNo
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc_)
❑ Yes
R No
19_
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
El Yes
91 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
U] No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
;0 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
El Yes
V No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ZINo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[$ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comozents (refer to.question { „Explain any YES iinswers_and/or any recommetn�dahons o any other cu�ments � .
UseYilraRvtgs of facility to better explain srtuattons: (use additional pages as necessary)sx El Field Copy ELF nal Notes
reco (6. �, L b ke-J 44
t.$) 4.i 1L Z S G w\,Yo �e Be �a-c c (r-,S
H
Reviewer/Inspector Name l #;
Reviewer/Inspector Signature: Date: 63
05103101 Continued

Facility Number: — Date of Inspection
Printed on: 5/4/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon'?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes Jj No
❑ Yes ( No
❑ Yes ® No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes ❑ No
05103101

F II— E�11lIAPIiYF�� _ � IfP!>®N __-_.w=•4`�"'t-11i°p`i®7�`i'�w.��•_'���tl]Iltll®13i1t7: ''EINI�JImiL.�.�!YY�fiaC.;iENY�
Type of Visit: (D'Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: outine 0 Complaint O Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: (� 1 Arrival Time: ' T�7 Departure Time: C ; �' County: l Region: (�
Farm Name: _ a �C_ %y%�y�,r._ ! 1 <T�'`f Owner Email:
Owner Name: r� . f;— . %'�r� �y�� Phone:
Mailing Address:
Physical Address:
Facility Contact: -JOA i G y��� Title: f.r_j y, r,/� Phone:
Onsite Representative: Integrator:r.�
Certified Operator: Certification Number:
/�-
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Current
Design
Design Current
Swine
Capacity op.
WetPonl#ry
Capacity
Pop.i°
Cattle
Capacity Pop
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
,ViFeeder
to Finish
i'
.' r-!7
I
„��� `
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P,oal
Ca aci ;
. Po
Non-Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
I
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
IE
_
t]tfier
Turkey Poults
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
[—]Yes
0--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
G;k'go
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
0 1<io
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection: —/
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? 0 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 El -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 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ffNo ❑ NA [j 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 0—No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ET'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):
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
[D, 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
01io
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
F7 o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below. EJ`Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [] Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections �❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑`No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes []' o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

4
i
Facili Number: - jDate of Inspection: jZr
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. 1s the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes El 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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes I3 <o
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [D'<lo
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 3-1�o
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 C3 No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 21Zo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 01<0
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 ❑ No
k_1
iary).
4eJ:��
- L�� ��t ��l[,�)�Yi� �H • t `J ;jI",r`�il! J-G`r° 'y � t c � � r t'-1.�0- a.
v4
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
�ONE
1A ❑ NE
�❑ NE
A ❑ NE
[IRA
❑ N E
❑ NA
❑ NE
❑NA
❑NE
Phone:
Date: Z ----/2
21412015

llivls-ion of Water Resources
Facility Number ®- © Division of 5oi1 and Water Conservation
Other Agency
a.
Type of Visit: ChNnipliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: i County: 04S, Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: u 940 _ ,!'r_G ��a v.,_ Title: 6Wej-z-r Phone:
Onsite Representative: ��r-4� Integrator: ^ 5'�j?l / r. /�
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish La er
DairyCow
Wean to Feeder Non -La er
Feeder to Finish
DairyCalf
DairyHeifer
Dry Cow
Farrow to Wean Design urren
Farrow to Feeder D , Roultr, Ca aci P,o
Non-Datry
Farrow to Finish Layers
Gilts Non -Layers
Boars Pullets
Beef Stocker
Beef Feeder
Beef Brood Cow
Turke s
Qther �`: Turkey Poults
Other L 10ther
Discharees and Stream ImDacts
1. Is any discharge observed from any part of the operation? r
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ;!3..t;o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes Cg-No
❑ Yes Ej�_Alo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 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 ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ---�'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ®, No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yes
CffNo
❑ 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
JE No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
INo
❑ NA
❑ NE
maintenance 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/ 1❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. CropType(s):D_ru/NYa�
13. Soil Type(s): sr 717
II-LI r7,O11<` - --- -
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 29-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2,'No
❑ NA
❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
]RNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ELNo
D 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
r%� No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
q No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
Page 2 of 3
21417015 Continued

Facility Number: - Ds ection: —/ 9"
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ;EI-No ❑ NA ❑ NE
. 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ NA [] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ®,No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ea No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes RNo ❑ 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 &jNo ❑ 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
[allo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Mt No
[DNA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Q No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[�]_No
❑ NA
❑ NE
Reviewer/Inspector Name:
T�
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: 5`12 J�
21412015

7
Type of Visit: Q"Coroutine
nee Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emeraency 0 Other O Denied Access
Date of Visit: f %r 1 Arrival Time: i1 ', D c7 Departure Time: , O County: pl sate-- Region: � 0
Farm Name: Lace %�tG -ram FaOwner Email:
Owner Name: Lok k— } al C Phone:
Mailing Address:
Physical Address:
Facility Contact: 0 1'%i c_ I YCtw Title: g} (:4 ) k7 Phone:
Onsite Representative: !,'dre�_ Integrator: �nt•T��r`'�fdt
Certified Operator: S� f Certification Number: "��TL9�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
FPM
Design Current
Design
Current
Design Current
Swine --
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
�..:
Wean to Finish
Layer
D ' Cow
Wean to Feeder
Nan -La er
Da' Calf
Feeder to Finish
D Heifer
Farrow to Wean
Design
u en
Dry Cow
Farrow to Feeder
D , Poultry
Ca aci
Po .
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
r
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
[a -No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[-]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify 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
L&No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[aNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412014 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ffj No D 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): fill
Observed Freeboard (in): — 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P 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 [Z 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?
0-Yes
Oeo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
(j 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
[allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes
[allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ 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): �r v� ILIA r
l3. Soil Type(s): _R& �� 1 ]�-jy / i�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E[ No 0 NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E�,No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Eq No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
MNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
0 Yes
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3,,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 J, 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 SKNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes (No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - , Date of Inspection: /
(,
24. Did the facility fait to calibrate waste application equipment as required by the permit?
❑ Yes
P4,No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes
�No
❑ NA ONE
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
ZEgNo
❑ NA 0 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
&o
❑ 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
P—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
[!Wo
❑ 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
PjNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
QLNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
;Q No
❑ NA ❑ NE
Comments (refer to question #) Explain any YES answers andfor:_any additional recommendations or.anylother eontments-- -
444
Use drawingsof facility to better explain situations (use:addittonal.'pages as necessary)..``. ; w
Y��4,.� 45 /?I4 � Srr- +'may O1�G D� ����►2- ��``' ``
Reviewer/Inspector Name:
Phone: }ytg oz�
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412014

Date of Visit: Arrival Arrival Time: ; Departure Time: ; ► f�5' County: -�
Farm Name: l fj �� �x-�,� `:.; Owner Email:
Owner Name: �j A, t4 m ,,, Phone:
Mailing Address:
Physical Address:
Region: Y:2M
Facility Contact: J,_ /w /'i'1[.Aru----- Title: BZ[ 7r`r Phone:
Onsite Representative: Integrator: /yfA�ly ' d "-
'TTT
Certified Operator: S'_ Certification Number: /.1319
Sack -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design "r Current
Swine Capacity Pop.
Design Current
Wet Poultry Gapacol ty Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
airy Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish i
Farrow to Wean
Design Current
D , P,oW Ca a ' Po
Layers
Dai Heifer
Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
r
Beef Brood Cow
Q#her
Turke s
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [RNo ❑ 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 L No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ®,No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continned

Facility Number: 7rY - Date of Inspection:
Waste Collection & Treatment
4. Is capacity storage ca g p ty (structural plus storm storage plus heavy rainfall) less than adequate.
❑Yes
[allo
❑ 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): Z„'Of—
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ 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
[2 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
(3 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
[a No
❑ NA
❑ NE
maintenance or improvement?
Waste Aoolieation '
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 [allo ❑ 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):
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 M No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes JR 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 0,No ❑ NA ❑ NE
❑ Yes a No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [a No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes fE No
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection: -- 7 —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes F--T No ❑ NA ❑ NE
i
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Q No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E,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 allo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑Yes
®No
❑NA
ONE
❑ Yes
El No
❑ NA
❑ NE
❑ Yes
LKNo
❑ NA
❑ NE
Comments (refer_to=question ft Explain:°anyoYES_answers. and/or any additional recommendations -or any other comments: N ;=
Use drawings of facility to better explain situations (use additional pages as necessary). ..
Reviewer/Inspector Name: .5-1 r
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 0 /,
Date:�"fP -y33 330n
21412011

Ub
Type of Visit: (SCliance Inspection U Operation Review 0 Structure Evaluation p Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access n
Date of Visit: Arrival Time: Departure Time: ounty:�1py( Regioniw
Farm Name: ext.kvL N Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
�G�.
Facility Contact: J C]`t�� t 6i�I Title:
i�
Onsite Representative:
r�
Certified Operator:
Phone: 7`+ L
Integrator:
Certification Number: Jr 3 {
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
. Design Current Design Current :. i Design Current
Swine Capacity Pop. _ Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
I
I Layer
Dairy Cow
Wean to Feeder
I
INon-Layer I
Daiff Calf
Dairy Heifer
Feeder to Finish
Design Current
ity,P,o P.
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Turkeys
Turkey Poults
OtherL12ther
Dischary-es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [I-Ko ❑ NA ❑ NE
[:]Yes [:]No 2'NA ❑ NE
❑ Yes ❑ No 0.1XA ❑ NE
[:]Yes [:]No
❑ Yes [2-go
❑ Yes [2,'K'o
Q AA ❑NE
❑NA ❑NE
❑NA ❑NE
Page l of 3 21412011 Condnued

I
Facie Number: jDate 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
k2'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
[�Jo
❑ 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
B<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EU 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
[Zk5o
❑ NA
❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[:'N'o
0 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): &�RS6 'D c'
13. Soil Type(s):2_0"IAON u
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q�lo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Levo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [: l[ ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [ hio ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [Po ❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes E] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L.13Xo ❑ 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 [g No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall 0 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 do ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ER4 ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facilit y Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
v fo
[] NA ❑ NE
the appropriate box(cs) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
Cgl<
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
D/No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[; o
❑ 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
B<o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? Ifyes, check the appropriate box below.
❑ Yes
Q No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
dNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ZNo
❑ NA
❑ NE
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3

Type of Visit: (D C-ompliance Inspection U Operation Review U Structure Evaluation 0 Technical Assistance I
Reason for Visit: t`fxoutine . 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
el
Date of Visit: Arrival Time: Departure Time: 4CL%
County: Region�
Farm Name: !Ej ' KGL 41 E!It ellil Owner Email:
Owner Name: _ VyVQ YA!j, l r'-qC/-A-S Phone:
Mailing Address:
Physical Address:
Facility Contact: . 7 t� _Title: ' Phone:
Onsite Representative: trry Integrator: [�
Certified Operator: r u Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
:ry �� l�� `�'� - �.
Wet�yPoultry
Design Current , � U Design Current
Capacity Pop. 1.-Cattle.: Capacity Pop.
Wean to Finish
,µ`�
La er
Dai Cow
Dai Calf
Dai Heifer
Current . D Cow
P,o Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Wean to Feeder
Feeder to Finish
Non -Layer
D ,Foul
Design
Ga aci
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Gilts
Non -Layers
Boars
Other
Pullets
Turkeys
Turkey Poults
Other
Other I I
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes EK ❑ NA ❑ NE
❑ Yes
❑ No
E NA
❑ NE
[:]Yes
[:]No
[f NA
❑ NE
❑ Yes
[:]No
.] NA
❑ NE
[:]Yes
s No
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
Page I of 3 21412011 Continued

r
FacIty Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [:]No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes ❑ No
❑ NA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s)- -1fPf -%4 U �rY., �[,� ,a Q
13. Soil Type(s):
14. Do the receiving crops differ from those designated ^min the CAAWWMP? ❑ Yes [ZI❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [j�AT'v ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 10— ❑ 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
io ^
❑ NA
❑ NE
❑ Yes
[3'5o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E3 o ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yeses
❑ 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
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o ❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facifi Number: n- Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check 0 Yes [g-K5'_ ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes <o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
��
❑ Yes Mlo
❑ 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 [qlo
❑ 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 Cp4o
❑ 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 M—N/0
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �io ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any,additional recommendations or any other comments r_
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
s�2-2-
Phone v' l J3'�
Date: i 7
21412011

Type of Visit: ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Arrival Time: C.l, Departure Time: 1 '3a County:�—
Farm Name: `-Sf1C_"}�' (AC LEA Ro VA R m S Owner Email:
Owner Name: -:"f% 1A , nl C.1 LA a Phone:
Mailing Address:
Physical Address:
Facility Contact: 460\r\ n u. M t i t p V4 Title:
Onsite Representative: .4�v E.A ej
Certified Operator: -Xd �t\ V\, C I A. A)
Phone:
Region: ''M
Integrator: M1a p ph.f V]P'nw lo
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
" a' Design Current Desi`gn Current
Design Current
S 'me `Capacity _ Pop. Wet Poultry Gapac t} .Pap.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Dairy Calf
Wean to Feeder
Non -La er
A
Feeder to Finish
Dai Heifer
X,
*� xg,
t
Destgn��Current
Farrow to Wean,
Dry Cow
_'
DryPoultr, = Ca act gPo
Non -Dairy
Farrow to Feeder
X.
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
�t
Boars
Pullets
Beef Brood Cow
Turke s
Turkey Poults
iA ,Other �_ ,
101 Other
I
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes FU"'No ❑ NA ❑ NE
❑ Yes
❑ No
[3,NA
❑ NE
[:]Yes
0 No
F—kYNA
❑ NE
d. Does the discharge bypass the waste management system? (If ves, notify DWQ) [—]Yes 0 No &NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [::]Yes QNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes MIo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

IFacilq Number: jDate of Inspection:
1 ;1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[jyNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[v]'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
[2'14o
❑ 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
❑'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E2^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
[ZVo
[DNA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
VNo
[DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window 4❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): SCR rnV n A 01,4 1 ..i G (I
13. Soil Type(s): 91 pa- v\ Ep 1�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 62r No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [v]"No ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [Zkf4o ❑ NA ❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[9No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
ff No
❑ NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[20%
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q,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
Callo
❑ NA
❑ NE
❑
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
0 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
[Sa'�4o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[::]Yes
❑ No
[5�NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [g� o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes G],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 QIINo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes C21'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 [1INo ❑ NA ❑ NE
[:]Yes []INo [:]NA ❑ NE
❑ Yes 2-No ❑ NA ❑ NE
[:]Yes �o ❑ NA ❑ NE
❑ Yes D1<0
❑ Yes ❑'No
❑ Yes [t"No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any^YES`answers and/or any additional recommendations or any other comments:`
Use drawings of facility to better explain situations use additional pages as necessary)•
4�EP�S� �l�p �evfZ P.�C.CsROs plZDtyR RLl_ R�costO s ,.�
F%v(vz � a)D\P-
i Q5 kQ0 Ili- D 600 D-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit: U Compliance Inspection V Operation Review U Structure Evaluation (> Technical Assistance
�
Reason for Visit: � xoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Q 2$- Arrival Time: Departure Time: County: I�:Fem
Farm Name: = ` e� L...E� FRr_Owner Email:
Owner Name: *ZO� J 41, Me- Phone:
Mailing Address:
Region:
Physical Address:
Facility Contact: ,v Title: Phone:
Onsite Representative: Integrator: [^�,
Certified Operator: A, A'(C_1-moo. nj Certification Number: t 3 311
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design Current`
Design Current
Swine Capacity Pop.
Wet )Poultry
Capacity p _
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
]Non
-Layer
Dairy Calf
Feeder to Finish
` "`
Dairy Heifer
Farrow to Wean
Desigr►�C,u_rrent'
D Cow
Farrow to Feeder
D . Paoul
Ca acEl'o
-
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
ry
Other
Turkey Poults
Other
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes n No ❑ NA ❑ NE
❑ Yes ❑ No
[-]Yes ❑ No
[]-I�A ❑ NE
❑ITA ❑ NE
❑ Yes
❑ No
EfNA
❑ NE
Yes
®No
❑ NA
❑ NE
❑ Yes
PEJ<o
❑ NA
❑ NE
Page I of 3 21412011 Continued -

Facility Nu ber: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑Yes ❑ No ❑ K ❑ NE
Structure I. Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2 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 [el<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 DWQ
7_ Do any of the structures need maintenance or improvement?
❑ Yes
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E3'1Qo
❑ 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
ET o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�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): +
t�(
13. Soil Type(s): fVA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CTNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
B No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
H"NNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
F% No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2<0
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E3,90
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
21 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 belo
� Yes
❑ No
❑ NA
❑ NE
❑ Waste Application El 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
[DNA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[/] NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Mate Date of Insnection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®-Ko
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
to
❑ NA ❑ NE
the appropriate box(es) below.
0 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
LJ n'o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
❑ No
❑ NA I3 11E
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 B 110 ❑ NA ❑ NE
[:]Yes I3 No ❑ NA ❑ NE
❑ Yes �10 ❑ NA ❑ NE
[:]Yes 1, o ❑ NA ❑ NE
❑ Yes
EKO
❑ Yes
❑ Yes
a
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Use drawings of facility'to betterEezpiaenrs situations (use dditlo a!YES answers a ay eras necesstional a�ommendahons.or any other,coentml � i
( question. ) P_ Y.
P g ... ry).
` c "
� M, Z M'' I �
Reviewer/Inspector Name:
Reviewer/Inspector
Page 3 of 3
Phone:
Date:
4/Z011