820011_INSPECTIONS_20171231

NORTH CAHULINA
Depaftent of Environmental Qual

Date of Visit: / Arrival Time: Departure Time: County: Region: %mod
Farm Name: f�%��/jr2 vti. �irt/� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: a7— Title: Phone:
Onsite Representative: Integrator: _Z/
Certified Operator: ^ u Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design Current
Design Current
Swine Capacity :Pop.
Wet Poultry
Capacity Pop.
Catta 1011p.
�ap.a0
_
H
Wean to Finish
La er
Non -La er
' '
',
Dairy Cow
Dairy Calf
Dairy Heifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
i,
D , Poutt ,
La ers
-Layers
Pullets
Design 1 Carren't
Ca aci P,o
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Turkeys
m
Other
Turkey Poults
Other
Otherr,°
Discharges and Stream Impacts
_ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes L'J 1Ve ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[] Yes Q No
❑ Yes [3 wo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number:- //I I Date of Inspection: j,2 -7/ <­"
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): /9- LC�- /9
Observed Freeboard (in): .30 — — �Z? Z/�
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
[� N
❑ 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
[3 4o
❑ 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 E]'-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence orff Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)= r.�rc�i� �iflr�rrc1 / -a _-s
13. Soil Type(s): /(1427T/ 77—o / / /;.4a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ffNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Vo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
F
❑ 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 E2-lgo ❑ 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 [ff❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1Noo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes NNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes CA o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signatta
❑ Yes Io ❑ NA ❑ NE
❑ Yes L3--Iqo ❑ NA ❑ NE
[:]Yes E] N ❑ NA ❑ NE
❑ Yes [D] N ❑ NA Ej NE
Yes
No
❑ NA
0 NE
0 Yes
No [
❑ NA
❑ NE
Yes
[]
❑
Phone:
Date:
21412015
Page 3 of 3

r
(Type of Visit: (LWompliagcc Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Goutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ' J (7 Departure Time: Q ; r7 County 9 Region: r---Z> I�
Farm Name:Owner Email:
Owner Name: Zr­ Phone:
Mailing Address:
Physical Address:
Facility Contact: Phone:
OnsiteRepresentative: Integrator:
Certified Operator: `jr..�_ Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Cnrre it ' ' Design current
S e Capacity Pop. ��I WetPo Itry Capacity Pop.
DeSlgn C'nrrent
CaEUe Capacity Pop.
Mean to Finish
La er
_
Dai Cow
an to Feeder
Non -La er
Dairy Calf
Dairy Heifer
Feeder to Finish
p
c-i
i'E
Design Current
D" P.oult . Ca aei P.o
La ers
Farrow to Wean
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
1
Other
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ®No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
[—]Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes L No
❑ Yes ® No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili 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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): - 3 1 219—'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [N�No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
®,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
(. No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes g No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ 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): �Ylfytu�� `Oy/err-e/ %j
13. Soil Type(s): �/�DL7 f1 f _ iC '� C%7 rx / T� a 2
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes G�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes M 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
[a No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
®No
[:]NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [] Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [� No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

r Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 54 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CR No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [] Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes }� No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [2 No
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes R1 No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes allo
Reviewer/Inspector Name:
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[]NA ❑NE
❑NA ❑NE
Phone: 2/0 �?O—
Reviewer/Inspector Signature:
Page 3 of 3
Date: 1 7
r
21412015

i ype of visit: C_7 t_.ompnance inspecnon V operation Kevtew V structure tvatuatton V t ecnnical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / f— Arrival Time: Departure Time: , /f' _ County: Region: C�
Farm Name: �r/r—/S�^�C!/I�� - Owner Email:
Owner Name: ��✓�ig/I��_ � �r/�dSo�--� Phone:
Mailing Address:
Physical Address:
Facility Contact: � jrN %fir-/zr,�» Title: 6yeol'L7--, Phone:
�T
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design. CttrrentDestgn Current- Design Current
S ..ne
Capacity Pop. Wet Poultry� - Capacity Pop. Cattle :. Capacity Pop.
. _
Wean to Finish
airy Cow
Wean to Feeder
Non -La er
Dairy Calf
eeder to Finish
D(�
D
_ "' 4R....
Dairy Heiler
Farrow to Wean
Y
- aDesign Current
Dry Poultry,_ -,_Ca �aei PaoIN
Layers
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Bcef Feeder
Boars
Pullets
Bcef Brood Cow
=
Turkeys
Qther
Turkey Poults
#fib
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 2INo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412015 Continued

facili Number: /I Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 -No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2L 1;_2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C,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
UZ 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
allo
❑ 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
P9No
❑ 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 [allo ❑ 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 Hare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 3r_Urr�'
13. Soil Type(s): D
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Lig No ❑ NA ❑ NE
15, Does the receiving crop and/or land application site need improvement? ❑ Yes F No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EgNo ❑ 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
[LNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
VLNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
n No
❑ NA
❑ NE
the appropriate box.
❑ WUP ]Checklists ❑ Dcsign [:]Maps ❑Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
R1 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
[6-No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

i
f Facibty Number: / Date of Inspection: /L
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [&No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List Mcture(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29_ At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ NA ❑ NE
❑NA ❑NE
❑ Yes
fflNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes '[,No ❑ NA ❑ NE
❑ Yes C!�No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
allo
❑ NA
❑ NE
No
❑ NA
❑ NE
® No
❑ NA
❑ NE
[&No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better exulain situations (use additional Dnees as necessarv),
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:/D�,3a� o 1-5--j
Date: /12— / -Y-19yXi�
21412015

Type of Visit: E�'Coroutine
nce Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / —/ Arrival Time: a Departure Time: County:��ry�sg-�.-_� Region:
Farm Name: T Y� rS 9Gz /'` Owner Email: ��
Owner Name: S%y�„��,� /r��4- Phone:
Mailing Address:
Physical Address: �—
Facility Contact:���,-���cr� Title: QzUr��.�� Phone:
Onsite Representative: Integrator: %I'! z
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop.
Wean to Finish La er
Design Gurrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
jNon-LMer
I
Dairy Calf
Dairy Heifer
Try Cow
Dairy
Beef Stocker
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Drv;P,oul Ca _aci Po
La ers
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream lmoacts
1. Is any discharge observed from any part of the operation?
[::]Yes
Ej�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
allo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
S—No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: - jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�1Vo 0 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): 0? /9 l /pe-
Observed Freeboard (in): _ (� / L ,� -
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes I, No
❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[a.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
EEJ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ELNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Z. No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
23-ISo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CENo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload 0 Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
%%Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
�Gx
12. Crop Type(s): - - AL 2 /�e_ -ive
13. Soil Type(s): JCJD15 /�L / ��;. /l `jt� I ZY, a
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [allo ❑ 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 allo ❑ NA ❑ NE
❑ Yes CD -No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [• 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 Z-No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JZ] No
23_ if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P�No
❑ NA ❑ NE
0 Weather Code
❑ Sludge Survey
[] NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued -

Facili Number: - Date of Inspection: 1 / /S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [2�No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes SNo ❑ 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 fast survey indicating non-compliance:
2b. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes C.No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes MA No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[]Yes
Callo
❑ 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
allo
❑ NA
❑ NE
If yes, contact a regional Air Ouality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
GjNo
❑ 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
[allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Callo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
LZI-No
❑ NA
❑ NE
Comments (refer to question 9): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewerllnspector Signature:
Phone:
Date:
21412014
Page 3 of 3

r o--16--1 LA
(Type of Visit: O'Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: 01,0ndne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: 'ftef _ Region: /�y
Farm Name: ��!j�' �it/t+-� Owner Email:
"��_
Owner Name: 71��/t �- ����,^� �*-- Phone:
Mailing Address:
Physical Address:
Facility Contact: �� l! t- Z►--- Title: Nlr-e�ll t— r/—
Onsite Representative: _5,.r' Integrator:
Phone:
Certified Operator: ,�.z Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
t _-z �. ..64
Design Cu lent y �" TMDesign Current _4 Design Gnrrent
s. s .+ .-
Swine Capacity _ Pop__' Wet Poultry` Capa ity PopCattle Capacity Pop.
Wean to Finish La er Dai0fDa
Wean to Feeder Non -La er Dai
Feeder to Finish Dairy
Farrow to Wean Design Current D
Farrow to Feeder D " P,oult Ca aci �P..o " No
Farrow to Finish Layers BeeGilts Non -La ers BeeBoars Pullets Bee
Turke s
OtherU Turkey Poults
Other Other
Discharges and Stream Impact
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 Dr No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
[:]Yes [:]No
❑ Yes A No
❑ Yes 5- No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

' Facility Number: - /1 1 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in). 131;z- 31 as
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
4401rMNo ❑ NA ❑ NE
[:]No ❑ NA ❑ NE
Structure 6
3.;?--
[:]Yes [.No
❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[a 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
V] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[S 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 altematives 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 [Z No ❑ NA
❑ 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): �/)Lll "//}[1d� z�� l
❑ NE
13. Soil Types}: �,Jp / p Y �c4Q / 1<,4A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 5 , No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [&No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [�No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Required 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 (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 ;ELNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes Callo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [S No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA []NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: Q--
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below_
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CS 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 XNo ❑ NA ❑ NE
❑ Yes [2g No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[:]Yes L&No
❑ Yes 0 No
❑ Yes O-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 fuse additional oaaes as necessarvl.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: -33 e0
Date: Z0
21412011

i ype of v [sir. V'd-x.ompuance Impmtion v vperanon rceview %.J Structure r vaivanon LJ i ecunicai Assistance
Reason for Visit: ( routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ITZ=Departure Time: County: �s�-� Region: 'Q.
Farm Name: 0-2V_Owner Email:
Owner Name: �� Qfj �.t it j��!� �- Phone:
Mailing Address:
Physical Address:
Facility Contact: S���.-�- >' ��Title: Phone:
Onsite Representative: _ja.� _ Integrator: ^/M&'� 0 ry a-,•as�,•�,
Certified Operator: Jcsa� Certification Number -
Back -up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design
Current �tlDesign
_ _
__
Current y ..
Design Current
Swine
Wean to Finish
Capacity
PopiVet
Poultry
Layer
Capacity
Pop.
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
DD
Dairy Heifer
Farrow to Wean
Farrow to Feeder
D , Pooult .
Design
Ca aei
Current
o
Dry Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
I Pullets
Beef Brood Cow
:.. Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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 [g No ❑ NA ❑ NE
[-]Yes [-]No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes L No
[:]Yes Pg No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: - I 1 jDate of Inspection: g /7 /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes ® No
a. If yes, is waste level into the structural freeboard? ❑ Yes CA No
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: q
Designed Freeboard (in):
Observed Freeboard (in): � �` p� —24
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
'1291-
❑ Yes 0 No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[gNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-5 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
[2 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z 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
R 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 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): U JL- ,DVr Z222�0%�t��-
13. Soil Type(s): Al t2 Z Iy b f 1�X / C � � 1¢ d AQ Ai _ --
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 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 10 No ❑ NA ❑ NE
acres determination?
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
[a No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
(Q No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check
[] Yes
Cg No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®. No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: �-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [a No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28_ Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes CR No ❑ NA ❑ NE
❑ Yes Jallo ❑ NA ❑ NE
❑ Yes (�j No ❑ NA ❑ NE
[]Yes 0 No ❑ NA ❑ NE
❑ Yes EZ No
❑ Yes Pq No
❑ Yes ® No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
9 _ ) P Y Y ttons or any other convents 3=¢'
Use drammng of facility to better explain situations (use additional pages as races at�voj mends t
f
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 91-0--z13'5—_330p
Date: /
21412011

(Type of Visit: 6Mompli nee Inspection U Operation Review U Structure Evaluation U "Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: + p County: Region: (�]
Farm Name: Owner Email:
Owner Name: ,5`j` ,� .1 ��-��r5 cs---- Phone:
Mailing Address:
Physical Address:
Facility Contact: j Tr ) r--- r5-0 — Title: h�,r" Phone:
Onsite Representative: Integrator: A01. i
Certified Operator: S,. Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
��re��,,�,. f
Design Curnt,
Desi C gu urrent
Swore
Capacity :Popes
�x
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
-
Layer
Dairy Cow
Wean to FeederI
INon-Layer
I
Dairy Calf
-
"" "
" t
Dairy Heifer
Feeder to Finish
Farrow to Wean
�.
Design
Current
Cow
D , wl?oult :
^ 3-aphci
Pop., `
Non -Dairy
Farrow to Feeder
~
Beef Stocker
Farrow to Finish
I Layers
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars
Pullets
},,..
Turkeys
Other
-
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA [] NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [5� No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes [R No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

1
`t
jFacUity Number: - Date of Inspection: d —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 91
Observed Freeboard (in): � 0
— 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2 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
CKNo
❑ 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
[Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[5d'No
DNA
❑ 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 I 0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s) /3�ra y/ �?ytr5 ��d r F:�?-Se-u'
13. Soil Type(s): 4/,n! rio rx A,5., A
14_ Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
[DNA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes IQ 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 R] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes a No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

'i[Facility Number: jDate of inspection: ;;?- / p —
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Callo 0 NA 0 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 to provide documentation of an actively certified operator in charge?
❑ Yes
® No
[DNA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[ZNo
❑ 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 'R No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes ® No
❑NA ❑NE
❑ NA ❑ NE
0 NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additionalrecommendations or any other comments.
Use. drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: }�.� �— Phone:
Reviewer/Inspector Signature: ,�� Date:
Page 3 of 3 21412011

Type of Visit: ��om��pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: (-Routine O Complaint O Fallow -up O Referral O Emergency O Other Q Denied Access
Date of Visit:' — Arrival Time: i DA Departure Time: lCounty: Region:
Farm Name:Owner Email:
Owner Name: e,, 01 Phone:
--T
Mailing Address:
Physical Address: yy�
Facility Contact: �1�r� ._- %-' �"�--~ _Title: ;L/�c =_ Phone:
Onsite Representative: c
Certified Operator: jam_. 1%,
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
r
Des �C ent
DestgnCu'rren#-
Design Current
Swine
Capacity _ Pap.
Wet Poultry Gapa"ciiyPa Ep
apacity Pop.
airyDCow
airyDCalf
Feeder to Finish
G'
PjGt
=
Da' Heifer
Farrow to Wean
FDPe!'=Current
D Cow
Farrow to Feeder
D , Poult . ) ci ?Po P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
t
Turkeys
Other
TurkeyPoults
Other
Other
Wean to Finish La er
Wean to Feeder Non -La er
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 ® No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
E] Yes No
[-]Yes No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page l of 3
2/4/2011 Continued

[Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?;
Designed Freeboard (in): —! —
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes ® No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
O'No
[DNA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
M No
DNA
ONE
(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
[S Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
O-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes B-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):C.
13. Soil Type(s): Alo,3 eX l
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes S No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 5] No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application`?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes 5D No ❑ NA ❑ NE
❑Yes 21No ❑NA ❑NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
p[ 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
[�3 No
❑ NA
D 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
[S No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
® No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file 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 Co No ❑ NA ❑ NE
[:]Yes ® No ❑ NA ❑ NE
❑ Yes rU No ❑ NA ❑ NE
❑ Yes f,;3 No ❑ NA ❑ NE
❑ Yes 21 No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes �B No
❑ Yes ® No
[:]Yes kf52AI 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).
`�� G;�L1 n. jf� of r r�;;7 /'�i - �'�'`- l G' �' c � ''` �-� � ;e � �� ft f l.1 C'4 (J `�-�j • j 'S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit (D-C-o`mpliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit Routine Q Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: G /a Arrival Time: r� B Departure Time: O County: Region:
Farm Name:ai'SS/''�� /��f -�- Owner Email:
Owner Name: lf��-� �r��1SD'—' _ Phone:
Mailing Address:
Physical Address: ram -
Facility Contact: _ 5 %ry�.�.�- Tr- V-%_ Title: 8�eb ) ;i,—/— Phone No:
Onsite Representative: SSA_ Integrator:,oW&A11A4'
Certified Operator: _311�. Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = I ❑ 11 Longitude: = ° ❑ = u
Design Current n� e WNW 4�141.
9Design Cakr ent Design Current
`. x ,-,
Swtae _ li Capacity Population Wet Poultry Capacity 10pulation Cattle Capacity Population
❑ Wean to Finish ❑ Layer ❑ Dairy Cow
❑ Wean to Feeder ❑ Non -Layer ❑ Dairy Calf
Feeder to Finish
p
�'
Dry Poultry
❑ DairyHeifer
❑ D Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
ElNon-Layers
td ElPullets
❑ Beef Stocker
❑ Beef Feeder
Beef Brood Cow
❑ Gilts
❑ Boars
per•
❑ Other
_ ,� ElTurkeys
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ®,No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
®,No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
Page I of 3
X
12128104 Continued

Facility Number: — f 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): 9
Observed Freeboard (in): 6 S7 z 7
, Te>
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes allo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes C�jNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ® No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ yes ®No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require
❑ Yes gNo
❑ 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 [KI 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) AV k2u rse"11
13. Soil type(s) ��VW I Eg % rZ X ry k
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ANo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [9 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes [51 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes allo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes R-No ❑ NA ❑ NE
IReviewer/Inspector Name s ,.� Phone: Y=25132�-- --33ro I
Reviewer/inspector Signature: Date: // (. — / p
Page 2 of 3
r CA„Hnuod

Facility Number: — f f Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ($ No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ AnnuaI Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
(Z 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
JKNo
❑ 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
19 No
❑ NA
❑ NE
Other Issues
29.
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
91 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
ERNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerllnspector 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
10 No
❑ NA
❑ NE
Additional. Comments+and/or Drawings:'j �11
a
12128✓04

a
Type of Visit Q Compliance Inspection C7 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral Q Emergency Q,&her ❑ Denied Access
Date of Visit- L -i` Arrival Time: fl Departure Time: 1 County: Region:
Farm Name: �rr5fl',Gt/ln�, Owner Email:
Owner Name e A ffr%, r Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: -
Back-up Operator:
Phone No:
Integrator: O
Operator Certification Number: %�v��5�
Back-up Certification Number:
Location of Farm: Latitude: 0 e =]" Longitude: = o =' = W
Design
C►orient
Design Current
Design Current
Swine Capacity
Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
JE3 Laver
❑ Dairy Cow
❑ Wean to Feeder
Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
08
1110
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
❑ Layers
Non -Layers
❑ Beef Stocker
❑ Beef Feeder
❑ Gilts❑Non-La
❑ Boars
❑ Pullets
❑Turke s
El Beef Brood Co
_
Other
❑ Turkey Pouets
❑Other
Number of Structures 5
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
®-No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
?. Is there evidence of a past discharge from any part of the operation?
❑ Yes
S No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
E,No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: �% — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®,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): % (�
'gG
Observed Freeboard (in): �! 717— 14 (p -
q,3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
t3-No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Arc there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
0'9E_
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 D,�W�QQ
7. Do any of the structures need maintenance or improvement?
El Yes
El No
❑ NA
2<
8. Do any of the stuctures tack adequate markers as required by the permit?
❑ Yes
C9No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any pan of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
[TNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
D
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ®•Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift Application Outside of Area
12. Crop type(s) r oC�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
ElE7,NA
E<
5_E
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? fR Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
E<
18. Is there a lack of properly operating waste application equipment?
9-Yes
❑ No
❑ NA
❑ NE
an other comments Comments fYES answers and/or an r
Use drawings of factltty to better' ex lam -situation s; use adclittonal ages
s as necess
S ccrJu �eJ A� -�-.� �1.: �
w ,
16
I e I��ds cc�r`
"wood 6-0'a�
Fy v v
�-__ --, - - ----
Reviewer/Inspector Name '' cr— _` +"`` Phone: %`!O ~�J3 330Q
6.;
Reviewer/Inspector Signature: Date: a�
F ' 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ® Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA E371qr
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
[:]Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA [ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA B 10
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 E3-<E
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes KNo ❑ NA ❑ NNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes El No El NA 3111
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
D<E
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
21;IE
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
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?
KYes
❑ No
❑ NA
❑ NE
Addlrtiunal�ComnientsandJar Drawings:
rr ,
yrt^�� �s1i�e3;�n. /Yl�� ��'��r-.3v�. fia� �►�nrdl � ���r �r--� Baer-?p
h�� �G� �c.�Q,�cc. ��r c�c�rr��n���a-�-� ��w�11 r����►L
-- —aq l'e viro
,c ih IL �Y h ; 5 Cs� Car- f3 `7 � � � �
P
u1 a Ajeolvej- Re l-- k n
61f
12128104

Type of Visit 0 Compliance Inspection 0 O701low
on Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint up 0 Referral Q Emergency O Other ❑ Denied Access
Date of Visit: [ Arrival Time: ��� Departure Time: 3 County Region: O
Farm Name: . Tcz7ae-'SEov-z 't. Owner Email: _
Owner Name: /ca;2h,—n kH � PrSV,�_ Phone:
Mailing Address:
Physical Address:
Facility Contact: T�� P�'L �CIP_%SPw'Title:
Onsite Representative:
Certified Operator:
a
Back-up Operator:
Phone No:
Integrator:
Operator Certificat on Number:
Back-up Certification Number:
Location of Farm: Latitude: =o ET 0" Longitude: =o =, =
Design Current
Desig_0 n Current
Design C►urrent
Swine Capacity Population
Wet Poultry GapacitjPopulation
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Dairy Calf
❑ Wean to Feeder
10 Non -Layer I
Feeder to Finish `
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑Dry Cow
❑ Farrow to Feeder
❑ Layers
ElNon-Dairy
El Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Deriou Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
RNE
Discharge originated at: ❑Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
KNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
RNE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection 9-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA [3'N--E
a. If yes, is waste level into the structural freeboard? ❑ Yes I --]No ElE 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
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA [•16E
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 E41d
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA O-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 Q-NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA B<
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. [' 1yes ❑ 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 R1 Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(3-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
54 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
RYes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
],�A No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
R Yes
❑ No
❑ NA
❑ NE
E N
Comments refer to uest�on # • E lain an YE53answe ' ( q ). %p y
. y t� y� menu :
_ I
rs andlor,an recomnendations�arxan other com
Use drawings of facility to better explain situations (usel7additional pages as necessary),..,.
q tl' leas 3,`7-01-�-c L)Dohs_ UAL.-i /-��%waj �� ) Wad
Reviewer/Ins ector Name ,? `� Phone: OO
p er ._ -� �' �. 22 A �t33 _
Reviewer/Inspector Signature: Date: v q
� cic vi vy 4Vri{Fri"r-

Facility Number: — Date of Inspection
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? eyes E?�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes tgNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ 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 ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24, Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
,},T, NE
El Yes
El No
El NA
IJ NE
❑ Yes
D9 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
E'1ClE
❑ Yes tZ No
❑ Yes ❑ No
❑ Yes � No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA D<E
❑ NA ❑ NE
❑ NA 2TE
❑ Yes
J] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
B NE
❑ Yes
J4 No
❑ NA
❑ NE
❑ Yes
Eallo
❑ NA
❑ NE
AL
%%"�6• ��U S�� Gv0.S�r.�C� pa9 ��G�i✓��� G-� i hi� a- Alo dr`vc�-J
'Y—
z
,Sae
f t�
' -`.5 r,S Ao o Gl
� IC 1 Fvr J, Lt�r
I" aivo6lc J�u-iJ� �� �lP� ep� uD9�L af`G'aS �t�'i` ✓!C%kBfeat i n G 2 04

IType of Visit 0 Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit 0 Routine Q Complatnt Q Follow up Q Referral Q Emergency Q Other ❑Denied Access
Date of Visit: D Arrival Time: ® Departure Time: County: �h
Farm Name: P SOn FiwM Owner Entail:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ', Title:
a
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
integrator: 4LAULK4 `
Operator Certification Number: 04 915_'�
Region: 04
Back-up Certification Number:
Location of Farm: Latitude: = o =' = Longitude: = ° = I =
Design urrent
Design C*urrent
Design
C►arrant
Swine Capacitynlation
e
Wet Poultry '-GapactI Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
El Dairy Cow
❑ Wean to Feeder ❑ Non -Layer
El Dairy Calf
Feeder to Finish 00 8
Dairy Heifer
ElFarrow to Wean
Dry Poultry
El Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
El Beef Stocker
❑ Gilts
Non -Layers
El Beef Feeder
❑ Boars
❑ Beef Brood Co
Other
❑ Other
Number of Structures:EKI
❑ Layers
❑
❑ Pullets
El Turke s
El Turke Pouets
❑ Other
Discharees & Stream impacts
1. is any discharge observed from any part of the operation?
El Yes
*No
'
❑ NA
El NE
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made?
El Yes
El No
T NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
El No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
El Yes
El No
LP NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
Kh No
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[!;No[INA
El NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: j' Date of Inspection t3 S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes hKNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
IINA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes qOo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes RNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes R No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes [ANo
❑ 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
[:1 NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below_
❑ Yes E] No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside ofAcceptableCrop ❑ Evidence of Wind Drift ❑ Application Outside of Area
Window
}
12. Crop type(s) t. 4d &4" do �SS 1"k." "V5 " J r JM. G"rZ o , (PC[S'7"j
13. Soil type(s) a,� /g ,--Ckf4) J�S� � � R � t 4 tI
er�otL—Le,1; 1 P0.W A e_— PX
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
91No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acre determination?[:] Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LP No
[INA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[&No
❑ NA
❑ NE
Reviewer/Inspector Name; �, 7 i , Phone:
Reviewer/Inspector Signature: Date: OS
Page 2 of 3 12128104 Continued

• Facility Number: (� Date of Inspection S
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes V No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ 4No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
05 No
❑ NA
❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
pa.No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
SNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ESNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CKNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
MNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
CDNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
[I 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
,nj No
❑ NA
❑ NE
....w
Additional C©mmenis ead/or?DrawWgs
i
Page 3 of 3 12128104

1 2 ® Division of Water Quality
F'acility^`Ndm' er f 0 Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
j
Date of Visit: I1 p Arrival Time: � 1 PQv.. Departure Time: I b -50a County: 5'ArnJ050" j Region: 140^
Farm Name: _Pelson FaevV� Owner Email:
Owner Name: her. E + P,� oh _ Phone:
Mailing Address: PD aoK me 1 90Lrr -C l f S I AIC_9LO t{ j !j
Physical Address:
Facility Contact: 21ff �� F' fe!k'1 sfl% Title: Phone No:
Onsite Representative: Integrator:
�Ot�3vti
Certified Operator: h Operator Certification Number: 184A S
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: F—I e 0 I = « Longitude: = ° = I = "
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -La er
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
00
1 J3 YOO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & 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 Population;', a
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Rocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: �S
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 PNo ❑ NA ❑ NE
❑ Yes ❑ No (�NA
❑ NE
❑ Yes ❑ No FNA
❑ NE
❑ Yes ❑ No 91NA
❑ NE
❑ Yes P No ❑ NA
❑ NE
❑ Yes P No ❑ NA
❑ NE
12128104 Continued

Facility NurnUr: _ ' Lz_ [ t 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
29 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: _ _ d2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CP No
❑ NA ❑ NE
(ieI 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?
1
f
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
T Do any of the structures need maintenance or improvement?
❑ Yes
IRNo
❑ 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
5allo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
JiJ 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 ofAcc�e�ptafble Crop Window ElEvidenceof Wind`Drifl ❑ Application Outside of Area
12. CroP type(s) G�l � 1 4 [Ad. . rQ5' / Si+� •
`
S�.�t �aS` )
13. Soil type(s) V,.. 71 k--- AJ. g, - L,, A i kV1 If —PX , CL"p L — C" , —
14_ Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
1�3 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
§a No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
(P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
'�?' No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[P No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
GO62erh , wM ma` ,t a`^ .ed r e ao--A,
Reviewer/Inspector Name f Phone: 0 t_, rs DD
Reviewer/Inspector Signature: :Z�lx M&,-&
Date: 1
16/Lb/U4 LOHUHuea

Facility Number: Roq--1( Date of Inspection � o
Required Records & Documents
y _
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 59 No ❑ NA ❑ NE
.the appropiatc box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E[No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
IFNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
� No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
F No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
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
qNo
❑ 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
[)TNo
❑ 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
PNo
❑ NA
❑ NE
12128104

r~�
Type of Visit 49 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I Arrival Time: Q • a Departure Time: County: Region: RZO
Farm Name: PfdefS Ch Owner Email
Owner Name: Oh Phone: 6io) S3a-2q.B
Mailing Address: PO go)( 10b� 1'IQXY'e.115 ell- ,2bg9q
Physical Address:
Facility Contact: er► �� ~��so✓1 Title:
Onsite Representative: S I 2h Frede/59-0
Certified Operator: -r�&1
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [--I o I--] E Longitude: = n ❑ . = "
Design Current Design Current.
Swine Capacity Population Wet Poultry Capacity Population
[❑ Wean to Finish
❑ Wean to Feeder
19 Feeder to Finish 1 9600 1 q000
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other -
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current.:::
Cattle Capacity Population? j
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 [)SNo ❑ NA ❑ NE
❑ Yes
❑ No
D9 NA
❑ NE
❑ Yes
❑ No
(XNA
❑ NE
U NA
❑ NE
❑ Yes
❑ No
❑ Yes
iANo
❑ NA
❑ NE
❑ Yes
�SNo
❑ NA
❑ NE
12128104 Continued

Facility Number: q391-11 Date of Inspection 1 3 O
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[9 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�] NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: oZ 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3Zi/ t f
3 Y If
5. Are there any immediate threats to the integrity of any of the structures observed?
Cl Yes
No
El NA
El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0No
❑ 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
EP No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
To
❑ NA
ElNE
(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 ® 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 Driflr❑ Application Outside of Area r
12. Crop type(s) Coct 82Yw1uUR ,�4rA SS Cn i �k c CPas e�I sy-m 6ya2 ,, iwF�R#t er r Q4�5�
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
[n No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination':[] Yes
[4 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
7INo
1LW
❑ NA
❑ NE
Cantments (refer to question #): Explain any YES answers and/or aay recommendations or any other comments.
Use drawings of facility to better explain situations. use additional pages as necessary,):
Reviewer/Inspector Name 119.1� C Phone: [ r D) q 33 - 33CV
Reviewer/Inspector Signature: Date: l l ZI 3 D4�
12128104 Continued

Facility Number: Date of Inspection 11 13 b
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes fp-,No ❑ NA ❑ NE
the appropirate box. ❑ WDp ❑ Checklists ❑ Design
g ❑Maps ❑Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 19 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 DD4o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KI No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
O&No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
WNo
❑ NA
❑ NE
29.
Did the facility tail to property dispose of dead animals within 24 hours and/or document
❑ Yes
N 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
NJ 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
0 No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J;3 No
❑ NA
❑ NE
Additional Cornments:andlor Drawings:
12128104

r
Division of Water Quality
Fadfi ' Nuifllbel' 8a i f f 0 Division of Soil and Water Conservation
.. 0 Other Agency s
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Foilow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: .5-,0L0A2 r Region: _FRp
Farm Name: be11tw4 Fdcm Owner Email:
Owner Name: Sleee e/ .tiz7�_ _ Phone: 7/0-f3-7- - `IS8
Mailing Address: P.a. Aar lair -2199yyy
Physical Address:
Facility Contact: Title:
Phone No: 0/0.3gr —!707
Onsite Representative: Cf�..��afs Integrator:' o..Ms�d.?� 4•�j;g __
Certified Operator: S7te�z - pt��/tnq Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: ❑ 0 0 6 0« Longitude: E1o=`❑ u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Nan -La er
❑
Wean to Finish
❑
Wean to Feeder
ED-Eeederto
Finish
Gcb j
g000
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkevs
❑ Turkev 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 ratan -made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
Number of Structures: Ez
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?
I
❑ Yes 2 o ❑ NA ❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ENE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes0.W'6
❑ NA
❑ NE
❑ Yes
4 o
❑ NA
❑ NE
12128104 Continued
I -

r
Date of Inspection G,39 0
Facility Number: g,,2 —/I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
�
Pilo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure'] Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: _ , 3
Spillway?: ,n fl _ no_
t
Designed Freeboard (in): if / �r A / IA
r
Observed Freeboard (in): -3 8 o '� &
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
o
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑-<
❑ 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?
❑des
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
2-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
20 o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
2<o
❑ NA ❑ NE
maintenance/improvement? -
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
[moo
❑ 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
❑ Outsi pt mdow ❑ Evidence of Wind Drift ❑ Application Outside of Area
l! 3-/b/ N !� 7jG-�Qb 9-936 /0-157 2,/G
f 12. Crop Ir r woo.,Ir, e
F
13. Soil type(s) A/QTf p � [� ,t� IL"04
14. Do the receiving crops differ from those designated in the CA WMP? ❑ Yes
D Ko
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
D-Igo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
❑ No
❑ NA
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA D-NIE
1$. Is there a lack of properly operating waste application equipment? ❑ Yes
L��o
❑ NA ❑ NE
Comments[{refer�to questionf#) E>lam any YESsanswers and/or"any recommendations or any other commen
tqts.
'a r L y �15it r ,s
Use drawrngsoffacilrty to better eaplainesttnatrons.°° {nse sddataonalpages as necessary);
7• a�a�os� AGS 16bv!'* Sa.we Marie ..wee.,, 4W
rt/t+•n
QJ JGctj54,,
r1
Reviewer/inspector Name Phone: 9/a yy�i/sY� e,ci'�3
Reviewer/Inspector Signature: Date: (e -1q-U%—

Facility Number: $Z —11 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9NO' ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ®<o ❑ NA ❑ NE
the appropirate box. ❑`,,rO ❑ Che sts �❑ O
s^ ❑De ❑Ma
21. Does record keeping need improvement? If yes, check the appropriate box bel w. G- es []No ❑ NA ❑ NE
0'-q8? l.� /'i -. 4, 7.G . 4
❑ A v'•eekly FreebeauL ❑ -waste Ant&Iysic, ❑ ❑ ❑ Aeflual GertifirzrMn
❑ mil, ❑ Steeki g rop Yield ❑ ❑ e
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
UKo
❑ NA
❑ NE
❑ Yes
O-Ko
❑ NA
❑ NE
❑ Yes
MIlo
❑ NA
❑ NE
❑ Yes
Plgo
❑ NA
❑ NE
❑ Yes
UNo
❑ NA
❑ NE
❑ Yes
Eg- o
❑ NA
❑ NE
❑ Yes ago ❑ NA ❑ NE
❑ Yes 2& ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes
B<o
❑ NA
❑ NE
❑ Yes
Afo
❑ NA
❑ NE
❑ Yes
[?rNo
❑ NA
❑ NE
Addrtroiaal Comments'aud/oraDrawings <r
lid
�. TA.SyIe >�a✓ rr; /� "'�•�� 6i apy a70 Ns
le Agrovil e viewC /
-�'><�c a-•�.�` f Ae e
T M 'qa/I 1
NC /Qe9:. ! A9 rOn 1pt.s
9/a-3� q - yq aq
12129104

w ❑ DSW C Animal Feedlot Operation Review,
DW Q P P Animal Feedlot Operation Site Inspection
fibRoutine O Comulaint O Follow -ern of DWO insnection O F ollow-un of DSWC review O Other
Date of Inspection
Facility Number
Time (if Inspection Dzin24 hr. (hh:mm)
1h Registered .13 Certified [3 Applied for Permit 0 Permitted [3 Not Operational I Date Last Operated:
Farm Name:...............��x. rs......�aSs'!"!.. .... County:............[��t....s...►................................................
Owner Name:........:; � ........� P'! ..... ........... ....I... Phone 10• .............................................
Facility Contact: ....... YYttn.....{et Phone No ............
...........
Mailing Address:......... . �t4... �.. a...r�..C—�d.Y fS........
.....I.. ....
CW
Onsite Representative.............................................................................. Integrator:............-z.-..kk....... ............. ...................................
Certified Operator......... �x-ye:........� e��rSo+....................................................... Operator Certification Number .. ............
Location of Farm:
Latitude • Q° .4 Longitude • ' .4
SWM, a .;
Capacity. Population
❑ Wean to Feeder
Feeder t o Finish
ej &oo
po
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design, Current, -
Poultry Capacity.. Population Cattle, Capacity Population "-
❑ Layer ❑ Dairy
❑ Non -Layer ❑Non -©airy
❑ Other
Tota! Design Capacity
Total SSLW=
Number of Lagoons l Holding Ponds JE1 Subsurface Drains PresentjjEl Lagoon Area JDSpray field Area '�
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed_ was the conveyance man-made`'
b. If discharge is observed. did it reach Surface Water" (lf yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/ntin?
d. Does discharge bypass a lagoon system? (It' ves. notifv MA Q)
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 la�,�oons/holding ponds) require
maintenance/improvement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes
EkNo
❑ Yes
$ No
❑ Yes
E!I-No
❑ Yes
B No
❑ Yes
ER No
❑ Yes
O No
❑ Yes
ig No
❑ Yes
No
❑ Yes
No
❑ Yes
Of No
Continued on back

Farm Name/Owner:
Site Requires Immediate Attention:
Facility No. S z- i I .
DMSION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 -_�> 7 , 1995
Time: -t
X/
Mailing Address: t'�� o 9 f1i9 C Z
County: �.
Integrator: J -6 ( Phone: Fla s- 3 2< — 4 72-
On Site Representative: S • -, ��� +J Phone: .s3 - — Z -•fs;r
Physical
Type of Operation: Swine x Poultry Cdttle
Design Capacity: 9600 _ Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (A� or
Was any seepage observed from the lagoon
Is adequate land available for spray? Nes
Crop(s) being utilized:
s4
No Actual Freeboard: Ft.4Z-0 Inches(;d44ra,1 4900011)
;s)? Yes or(S� Was any erosion observed? es r No
r Vo Is the ver crop adequate? es or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelling 9 e or No
100 Feet from Wells? es or o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? es or o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue me: Yes o No
Is animal waste discharged into water of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o�o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on spec is reag with cov r )J? or No
Additional Comments: .p , l'.9 .c� Q-A' .lea
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.