820032_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

I}
Type of Visit: 9 Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: I Routine O Complaint Q Follow-up Q Referral O Emergency Q Other O Denied Access
Date of Visit: D✓ /rrival Time: !)Z7 Departure Time: County:
Farm Name: AlAx—/111 Owner Email:
Owner Name: �i!>f1e1r,�7U�r1q� /YlH�TiJS Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: _2� �pnrL1= Title: Phone:
Onsite Representative: —S'i Integrator:
Certified Operator: eqlejs q t , ° _ J&I!:2 S _ Certification Number: 2�0!�kZ
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
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ow
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DischarLyes 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 orthe operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes [jNo ❑NA ONE
❑ Yes
rp No
�EpNo
❑ NA
❑ NE
❑Yes
❑NA
❑NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
o No
❑ NA
❑ NE
❑ Yes
Ix No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued
1\I\

Facility Number: - 32, Date of Inspection:
Waste C Ilection & 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): 19 ►L—� _
Observed Freeboard (in): 2 .S ,14
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
�] No ❑ NA ❑ NE
[� No ❑ NA ❑ NE
7� Structure 6
❑ Yes R No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? 0 Yes M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes W No
❑ NA
D NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) 77��
9. Does any part of the waste management system other than the waste structures require [] Yes No
Ep
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
[ No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes W No
❑ NA
❑ NE
❑ Yes [P No
❑ NA
❑ NE
❑ Yes 1PNo
D NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? 1f yes, check the appropriate box below. [] Yes] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412015 Continued

` Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
( No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[p No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? -.
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
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/lnspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �M No ❑ NA ❑ NE
❑Yes 0No ❑NA ❑NE
❑ Yes t No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes No
❑ Yes [] No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
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Reviewer/inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: qlt), 9333, 4109-
Date: 1'7yQ'G 7�1
2/4/2015

�S—
Type of Visit: ('Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: p ,` County: J Region: /'�o
11,
Farm Name: '&tC p'z—
Owner Name:�jfTQ/Jf,�,r
Mailing Address:
Physical Address:
Facility Contact:Title:
Owner Email:
Phone:
Phone:
Onsite Representative: �'� « / Integrator: ,Trnr//tT�Y/A
k
Certified Operator: C_; 70 Li- ZHA.; Certification Number: AOvz
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
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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 [allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
DNA
❑NE
❑Yes
No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
®-No
❑ NA
❑ NE
Page J of 3 21412015 Continued

Facili Number: - 1 1 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [g[ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structurel2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:T`�"
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 O '3
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes ONO ❑ NA ❑ N E
(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?
0 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
M•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 [gNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground 0 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):/YZ
13. Soil Types).
14. Do the receiving crops r from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
ON I -
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, 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
RNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis []Soil Analysis
[] Waste Transfers
❑ Weather
Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" 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
ENO
❑ 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 RNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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)
❑ Yes
Eallo
❑ NA
❑ NE
❑Yes
5DNo
❑NA
❑NE
❑ Yes
nNo
❑ NA
❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes Co No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? Ifyes, check the appropriate box below. [f Yes Z No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes &No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0 No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ELNo
f� 11M �ctj�/' 'C oa'v�d1 6C �(J �i G' `� ��—{` //9 J
T Q
Reviewer/Inspector Name:
Reviewer/[nspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Phone:
Date:
21412015

stlel
- Division of Ws�ter Resources
Facility Number ®- O Division of Soil and Water Conservation
Other AgencyApW
Type of visit: ompliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: outine Q Complaint Q Fallow -up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: ; : D County: y---- Region:
Farm Name: -L
JZae oo,_ Owner Email:
Owner Name: �! / i5 p/t �-/ t< -Mz % i 5 Phone:
Mailing Address:
Physical Address:
Facility Contact: 6 rYe%-� Title: y� SjfiGG, Phone: /
47
Onsite Representative: cw: 4, Integrator:
Certified Operator: � 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. Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to FinishCOO"t_
.�fry�"�'r�,
:Design
Dry P,_otltr. . Ca aeit
Current , A.
Pa
,'!;
i
Dair Heifer
Farrow to Wean
Dr Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
Non -Layers
Pullets
Beef Feeder
Beet Brood Co —
Qther
Turkeys
Turke Poults
Other
Other
Discharges and Stream Impacts
i. is any discharge observed froth any part of the operation?
Discharge originated at-, ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters ofthe 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&No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [21 No
❑ Yes JZ No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Ins ection: —3p-
4 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 0 NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: rrp--'" .13a
Spillway'?:
Designed Freeboard (in):
Observed Freeboard (in): .3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i,e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify 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
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
❑ NA
[] NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl [] Application Outside
of Approved Area
12. Crop Type(s): nO/-/i /GUl9ro
13. Soil Type(s)' ��L�2/` �-•- ��f) r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2, No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
[allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0,No
❑ NA
❑ NE
acres determination`?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
1171 L21No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
®. No
❑ NA
❑ NE
20. Does the facility tail 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 [RNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes RNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0-No
DNA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: — p G
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � No ❑ NA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes D-No ❑ NA
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 tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NE
❑ NE
❑ Yes E ,No ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes ®, No ❑ NA ❑ NE
❑ Yes &� No ❑ NA ❑ NE
❑ Yes RI No ❑ NA ❑ NE
❑ Yes g. No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
allo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
®-No
❑ NA
❑ NE
Comments ( q } p am any YES:an9wers°andloi any additional recommendations or any other comments.
Use drawings of facility, to better, expla in'Rsituations;.(use.additional pages as.necessary).
1-,. 00 Hoir q- j<.J- F-/
n F�t7 n� /4?,_6
j�Ou N r Aa u -G a �n2i i,r�►rO1 {�; Yam- Gam- , j
C r ea)
!rW rq�/1tVuxot C D (�/� �` ���``�c � i
�' L
;t_yv4 1-2----��-���L
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
r
Phone:
Date:
Page 3 of 3 21412015

("ivislon of Water Resources
` Facility Number - ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: erCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ill Arrival Time: ; 0 c7 Departure Time: ; 30 County: Region:
Farm Name: %/ zZA-' ; V%_ 'a / D .-v Owner Email:
Owner Name: /� �� r 100�zQ 1 Phone:
jr
Mailing Address:
Physical Address:
Facility Contact: 1910de-- Title: ✓4-
Onsite Representative: �-•�-
Certified Operator: CI—r , 6 r d r5
Phone:
Integrator:
Certification Number: IA�wq�z_
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
on -Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
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?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [allo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [ o
❑ Yes Eg-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2014 Continued

Facility Number: - 3 Date of Inspection: s--
Waste Collection & Treatment
r�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[]Yes
5jNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):Observed
Freeboard Freeboard (in): ,..�.�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q3_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?
0--Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[]Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Aaalication
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 5g--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 ❑A Evidence of Wind Drift ❑/Application Outside of Approved Area
12. Crop Type(s) CD/`Jti /lt/�r jJ`8�6rra�s lzns 7z_u a �9y�.rIF
5,.-r—�(
13. Soil Type(s): Werra t ,/ Ner
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
2No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
21,No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ 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
[2-No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
I�LNo
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

r
lFacility Number: Date of Inspection: iS
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes (7,jVo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes r_--I-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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
2& 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
ZLNo
[DNA
❑ NE
❑ Yes
Ea No
❑ NA
❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
SLYes ❑ No ❑ NA ❑ NE
❑ Yes CR No
❑ Yes .l No
❑ Yes Jallo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain',any YES answers.an or an, y additional recommendations or any other comments.
Use drawings.of.. facility to better,. ex lalnsituations: (use additional pages as necessary).
�k7 O►Y•,f�Il Yp � ram- � ��
7V
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ?�ty�
Date:
21412014

10
ivision of Water Quality
Facility Number ' Z - 0 Division of Soil and Water Conservation'
O Other Agency
Type of Visit: ,.,o.,mCpliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
0rc Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ArrivalTime:l joloV I Departure Time: County Farm Name: �2z2 K i ry- Owner Email:
Owner Name: Ck rr �, �yma ; 5 Phone:
Mailing Address:
Physical Address:
Facility Contact: (91}-r-r lnpa r=_ Title: i Phone:
Region: r9zD
Onsite Representative: Integrator: VKog a✓ Z)I-U
Ar
Certified Operator: rr'r*� JyIQ7~ %S Certification Number: �Qp�
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
on -Layer
Pullets
Poults
Design Current
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? '-
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
on -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[] Yes � No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
LR No
❑ NA
❑ NE
Page 1 of 3
21412011 Continued

S
1E'aellit Number: jDate of Inspection: .
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C,No
a. If yes, is waste level into the structural freeboard? "' ❑ Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 12 �g
Observed Freeboard (in): 3P 4 5
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
Yes
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
Eg Yes
o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[& No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑/Evidence of Wind Drift ❑/Application Outside of Approved Area
L
12. CropType(s): oepl �G�hr %Sati(r.�.-.� �J4.�ryi'v�at /.9rrc-
13. Soil Type(s): (Nag j,0 ,, / pt?,- fin
_,roe_
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 E&No ❑ NA ONE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [4 No ❑ NA ❑ NE
❑ Yes ER No ❑ NA ❑ NE
Required_Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [Z No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [RNo ❑ 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 (2,No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®, No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

[Facility Number: - 3.2_— jDate of Inspection: b
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?
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?
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)
❑ Yes ® No
❑ Yes 52 No
❑NA ❑NE
❑ NA ❑ NE
❑ Yes [4 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[]Yes [3 No ❑ NA ❑ NE
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 No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ® No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [3,No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments {refer to question #): Explain any -YES answersand/or any additlonai recommendations or;eny other comments r r
Use drawings of facilityto better Oi 'lain.situations (use additional a'geJs as necessa ).
d' ems/ nS'�V
5�,�•� � 11-13-0201y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2014

O'bivision of Water Quality
Facility Number ® - 0 Division of Soil and Water Conservation
N 0 Other Agency
Type of Visit: OCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 00 Departure Time: ;3"4 County: Region:
Region:
Farm Name: D Owner Email:
Owner Name: _ Cj ,r; S 1 01t Y r- �ce �S _ Phone:
Mailing Address:
Physical Address:
Facility Contact: r!"r �r f%'%D9rr`-L- Title: �. Phone:
Onsite Representative: Integrator:1✓�-
Certified Operator: _ 4314P_';y 'W'74" Certification Number: /—g-Od1�-
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
arrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharees and Stream_ Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �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 N No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes Q�.No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
21412011 Continued

>+aclli Number: - Date of Inspection:' O—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Yir+%IrG�C
Spillway?:
Designed Freeboard (in): / 1
Observed Freeboard (in): 139-11 1347
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[§ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
R No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[X No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[a No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes &INo ❑ 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 f❑ Evidence of Wind Drift ❑/ Application Outside of Approved Area
12. Crop Type(s): ?]rs► �L�+Lr�r /� � �1S' n'rts�sr� �B-vr��S 1-0/
❑ NE
l '
13. Soil Type(s):
14. Do the receiving crops differ from those designat in the CAWMP?
❑ Yes
Jallo
❑ 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
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EZ 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 El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes 0 No
❑ Waste Application ❑ Wcekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2!�Alo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: ej
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z 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 RNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes (4 No ❑ NA ❑ NE
Other Issues
2& Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 1p'No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [D Yes SNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes Z No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes J&[ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ,�No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 2g,,No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes JR—No
❑ NA
❑ NE
Camments'(refer t6'q6estion #) �Explaln"any YES answers and/or any additional recommendations or any other comments.
Usedriwines?':. .
of facility to better explain situatians (use additional naves as necessary).
�e IMP .1 A�ry_
�v�S' 7 o K J1 Cr r��s ir''��
13
Revi ewer/] nspector Name:
Reviewer/Inspector Signature:
Phone:
Date: / E' / P-1-3
21412011
Page 3 of 3

£'TDivisioo of Water Quality j�
Facility Number fT�— - ,3Z 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 7rompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: eY outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: --/ f-/ Arrival Time: ; p D Departure Time:County:, Sv- Region:
Farm Name: %71e,- Owner Email:
Owner Name: 0_�e )'STD r,�-„Y K /11j `S Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:,fl Spr-G, Phone:
Onsite Representative: �$�,,e� Integrator: %l ra ✓ p%y
Certified Operator: C Certification Number: .pp 61'-7—
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Discharees and Stream IMDU B
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
l . Is any discharge observed from any part of the operation?
❑ Yes
,® No
`�
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ELNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes JR[No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes Eq No ❑ NA ❑ NE
D Yes 4 No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
[:]Yes
[allo
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
[allo
❑ NA
❑ NE
uestion # :, Explain: an YES .answers ` omments (refer to,question p y � and or -any additibnal recommendations or any other comments:' -
Use drawings, of facility to better ex lain situations (use additional ages'as nece§sary).,
f/'va`!5'-- CYv p� i Gl� o✓`���pr
ReviewerlInspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone: Cl)
Date:
21412011

[6ellity Number: - 3 Date of Ins ection: --f
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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Lr�
Spillway?:
Designed Freeboard (in): 9
Observed Freeboard (in): 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
� No
❑ NA
❑ NE
waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
5ZYes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
,® No
❑ NA
❑ NE -
maintenance or improvement?
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s): 114/`�� �...��
14. Do the receiving crops differ from those designa ed in the CAWMP?
❑ Yes
MNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
qNo
❑ NA
❑ NE
acres determination'?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
qNo
❑ NA
❑ NE
Required Records & Documents
19, Did the facility fail to have the 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
MNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes MNo
❑ NA NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Division of Water Quality
Facility Number - L� 0 Division of Soil and Water Conservation
0 Other Agency
Fype of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Gr1 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: at7 Departure Time: County
Farm Name: • h L .� Owner Email:
Owner Name: t rjS��IrOi1�5 Phone:
Mailing Address:
Region:/ 7~CZ
Physical Address:
Facility Contact: Title: _ e, Phone:
1001
Onsite Representative: Integrator:Kr
Certified Operator: 6 0. 42f� 6? Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
[Layer
Non -La er
Non -La
Pullets
Other
Poults
Design Current
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)? w
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
DEX Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes allo []NA ❑ NE
[:]Yes ❑ No
[:]Yes ❑ No
❑ Yes [:]No
❑ Yes .� No
❑ Yes 2[ No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
0 NA ❑ NE
Page 1 of 3 214120.11 Continued

.. Facility Number: - 3 Date of Inspection: 8—
/
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: �stvf�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ,�{r
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
2[No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ 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
MNo
❑ 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):
13. Soil Type(s): r
14. Do the receiving crops differ from those esignated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
0 NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
®No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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
gNo
❑ 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
[Z 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

K Facili Number: - Date of Inspection: O
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ICU
N,po� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 2-Yes De o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Ton -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: -- ;!7* Of?-,
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 10 No [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes CR No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
[D 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
Co No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comsnentsc
Use.drawin'gs of facility to better explain situations (use additional pages as necessary}.
/KV1 u- F:D'-4c SaeA,
ro'l_
i er ,,�z isr � Yz /ti7 / r i `v, "-�.`.
drrsriooe ; 11s;Ole- Or Pyrer sue„-,�.� ��_.._ tee
Reviewerdnspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Date: I :;ja'-�
21412011

r .CQ 0 Division of Water Quality
Facility NumberEMI - ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: -tom Arrival Time: Departure Time: County:�_Region:P—RP—
Farm Name: P4A Owner Email:
Owner Name: 1- �S" A� rnC, -u Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ��Ci Lall-.44
n
Certified Operator: S P
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
Other
Title:
Integrator:
Phone:
r
Certification Number: (&V f? V
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
i
aer
on -Layer
Dry Poultry
Layers
.Non -Layers
Pullets
Turkeys
Turkey Poults
Other �T
Design Current
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)
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes W No ❑ NA ❑ NE
❑ Yes
❑ No
[�j NA
❑ NE
❑ Yes
❑ No
[ZNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [' NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters []Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Fogility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
OpNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[] Yes
No
1�NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:_
Spillway?:
Designed Freeboard (in):
Observed Freeboard
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[' No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
FZNo
❑ NA
❑ NE
waste management or closure plan?
ff
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
1P
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require
❑ Yes
EP No
❑ NA
❑ NE
maintenance or improvement?
Waste ApRfication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�hNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No [] NA [] NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑] Evidence of Wind
Drift ❑/] Application Outsideeiof Approved Area
cc
12. Crop TYpe(s).' '—DO "` S�� Y���tR ul ! 5m i
13. Soil Type(s): 7C t 12oan O
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [4 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Ep No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes [6 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 V'�:d 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 ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
r] Weather Code
❑ Sludge Survey
0 NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Fqfility Number: Date of Inspection: -1
/
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[� No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
[ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
rg NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
No
❑ NA
❑ NE
m and report mortality rates that were higher than noral?
r
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[� No
❑ NA
❑ NE
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Ne"drawinits
mments (refer to question #): Explain any YES answers andlor`any additionalrecammendations or any, other comments i`i s ,
;of.facility to better explain situations -(use additional pages'as necessary)......
s re v ie,,e')
ReviewerlInspector Name:
Phone: 01/6":j3j_7 ?40
Reviewer/Inspector Signature:
Page 3 of 3
Date: fyy:yt
21412011

ivision of Water Quality
Facility Number 30 Division of Soil and Water Conservation
--- 0 Other Agency
Type of Visit O-e6mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (9'11outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: t Departure Time: O County: Region:
Farm Name: ga-zan 2 /1 0 — _�_ _ Owner Email:
Owner Name: C vL 9/ _�,— Phone:
Mailing Address:
Physical Address:
Facility Contact: 3� _ Title:Phone No:.�
Onsite Representative: g t-p- AVOW— Integrator:
Certified Operator: m�r-S Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
[.Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Back-up Certification Number:
Latitude: [= e 0 4=, Longitude: O c=
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dai Cow
❑
Dai Calf
❑
Dairy Heifer
❑
D Cow
❑
Non-Dai
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: ®�
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 9.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
39.No
❑ NA
❑ NE
❑ Yes
V-No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: —3
Date of Inspection
l 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: 72�2 _
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 37a 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 23,No ❑ NA ❑ NI
(ic/ 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'?
C9 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
19 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
RNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
[]Yes
9,No
❑ NA ❑ NE
❑ Excessive Pond ing ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) ev
13. Soil type(s) j-C a �..
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
allo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
53 No ❑ NA ❑ NE
17, Does the facility lack adequate acreage for land application'?
❑ Yes
RNo
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
ZLNo
❑ NA ❑ NE
s
,��f ��:c: 4 �;' /a5�l�ii'� a,i s �r
Reviewer/inspector Name aA. t.r .gy p?'. t f JCS ' . a'a .' Phone:
Reviewer/Inspector Signature: Date: //— 9-1990/0
Page 2 of 3 12/2&04 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes jjqNo ❑ 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 [I Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 91 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
P4No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
q No
❑ NA
❑ NE
26,
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[jWNo
❑ 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
[KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
&No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
'�[No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
// __
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[JNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
I --] NA❑
NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[KNo
❑ NA
❑ NE
Page 3 of 3 12128104

3lluS 12 -16 --Zoo 9
Facility Number
('lUvision of Water Quality
O.Division of Soil and Water Conservation
O Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ArrivalTime: ti Departure Time: Z_351._ County: Ste"^ s� r+� Region: 1520
Farm Name: K''� 96LCO / Owner Email:
Owner Name: 1!i .+'S Ilt'a+4g'3 Phone:
Mailing Address:
Physical Address: ''//
Facility Contact: 6reG(- /�►uD/ C_ Title:�p e-r—' Phone No:
Onsite Representative: (:� ne. i- Man r-r - - Integrator: M` &-&' AJ
Certified Operator: y r3 115 Operator Certification Number: 0 eo IV 2-1
Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0e =; = 16 Longitude: 00 04 =
61
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish J&Zo I120
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other_...., _ -- - ---
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Pou Its
❑ 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
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes
❑ No
2KA
❑ NE
❑ Yes
❑ No
2lA
❑ NE
A
❑ NE
El Yes
ElNo[R
[I Yes
9 o
❑ NA
❑ NE
❑ Yes
2<o
❑ NA
❑ NE
12128104 Continuer!

ti
Facility Number: 82 — 3Z 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: L I &w^rO 2(cK)
Spillway?:
Designed Freeboard (in): Ap l %
Observed Freeboard (in): -30 01
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 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes I_QreNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Io ❑ 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 to ❑ 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 Pond ing ❑ Hydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
6
13. Soil type(s) NoA WoLB
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
2 Imo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
D o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
B�<�o
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA
❑ NE
Reviewerllnspector Name
, t, 9lO, �3s y 3Phane:
Revirllnspector 3D b
Signature: �....Cv Date: /2
12128104 Continued

.e .
Facility Number: —52
Date of Inspection
Itequired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
L� No
El'
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E No
❑ NA
❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
,,_,/
L7 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi] 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
LJ No
❑ NA -
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
30No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E3No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ETNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0<o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWW?
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?
Additional Comments and/or Drawings:
❑ Yes ,[_�],/60
El Yes L1 No
❑ NA ❑ NE
El NA El NE
❑ Yes
{ NO
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
❑ Yes
E3 No
❑ NA
❑ NE
12128104

-il; ✓ BS►L,s i -o6--o l IZ 9-
L
f Visit 0-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit e Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: /� �Oj' �.,, County: bAl Region: F�
Farm Name: MQK;Aj S ctco ram% Owner Email:
Owner Name:.__ C�►n-1 44gALL-s Phone:
Mailing Address:
Physical Address:
Facility Contact: tg in t-tr MtJVYr— Title: jA4J_ �Pr;+` _ Phone No:
Onsite Representative; Integrator: N.t r-��,�. ��a✓'�
Certified Operator: Operator Certification Number:
Sack -up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: E-1 o E_T E-1 Longitude: 0 ° F-T
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
El Farrow Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Non -La
Puilets
Other
Poults
Discharaes & 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
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: M
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 &W ❑NA ❑NE
❑Yes
❑No
B- A
❑NE
❑ Yes
❑ No
B-NW
❑ NE
EtIgX
❑ NE
❑ Yes
❑ No
❑ Yes
[�lo
❑ NA
❑ NE
El3 Yes
o
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 2--32 Date of Inspection I 1Z-10-0
Waste Collection & Treatment /
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 3 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0'�Io ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: jPr-bA/�_ lga,_k
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3j 7 Jf
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes D<o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,��,//
6. Are there structures on -site which are not properly addressed and/or managed El Yes E1No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Q, N_`/ ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit`? ❑ yes [a'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 El Yes l—TNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ESNo ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes ET110 []NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > l0% or ] 0 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[I NA
El NE
17. Does the facility lack adequate acreage for land application?
El�,
Yes
�/fo
EE
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
_wNo
Ed1va
❑ NA
❑ NE
Reviewer/Inspector Name I'i.k ', GVS i Phone: 1/0. 5/3.3,330
Reviewer/Inspector Signature: Date: iZ —/op
Page 2 of 3 12128104 Continued

a -•
Facility Number: $2 — Date of inspection /2 -/0 7p
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q`Ko ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑< ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[I-Ko
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections El Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
B No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
TNNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
to
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit`?
❑ Yes
E o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
3<o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PEAT) certification? ❑ Yes io {] NA ❑ NE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L7 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[F o
❑ 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
[SNo
❑ 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
L7<o
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
El Yes
�,/
L4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

9-rAls Iz//y/zda 7
® Division of Water Quality
Fa+~iiity Number Z 3 Z Q Division of sail and Water Conservation .
Qn. Other A genc
y.
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /: S Departure Time: Z :20 County: San!
Farm Name: 9A k'iy i3Qeonu _ Owner Email:
Owner Name: �► 44a44-Ae s „_.., .._,.__ Phone:
Mailing Address:
Physical Address:
Region: ?*D
Facility Contact: to �`«-1r M0errL- Title: T--e-4 . Phone No:
Onsite Representative: e r ►' Integrator: _Q/6 ��"�✓^�
Certified Operator: L �{ s k. klia-+i -s Operator Certification Number: Zu o V Z
Back-up Operator:. re_." Mar44.'s Back-up Certification Number: 200 r/
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
n-n — w . . .
U Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Latitude: = o ❑ 4 ❑ Longitude: = ° ❑ d 0
gl
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_T� ❑ Laver I� �' ❑ Non -La et
N
Dry Poultry
Non-L
Pullets
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
i
❑
Dairy Cow
❑
Daia Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Co;[
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any 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 [9 No ❑ NA ❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
® No
[--]Yes
[�No
❑ NA
FINE
[:]Yes
Z No
❑ NA
❑ NE
12128104 Continued

A
" Facility Number: 032. Date of inspection /Z-//- 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
[3 No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier. r+rr_Ar t 'E>C-,L. --
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered ,yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
O Yes
❑ No
❑ NA FINE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ERNo
❑ 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
2No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M No
❑ NA ❑ NE
maintenance/improvement?
1 I. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
93 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. Croptype(s)
13. Soil type(s) ILA iA 1g,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[F1 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]
Yes
[8 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
19. is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
/4 PO A N c S G K G,1 Q/a w/ L -4 r -A0 4,-. cla n+ L W T�u—
IrtataY01S 'AP c.0-1-1--e— 1..r e-1,0 o•v i.vs%*lam l..r�o r s<r�s .!
Reviewer/inspector Name ' g t�e_w CJ S Phone: 9i0,y.33.3.30 0
Reviewerh nspector Signature: H6A R Date: / 7 - // - Zoo O
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 CAWMP readily available`? If yes, check ❑ Yes [0 No ❑ NA ❑ NE
the appropirate box. ❑ WDp ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge'?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit`?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
V3 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
TNo
❑ 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
{ZNo
❑ 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
ERNo
❑ NA
❑ NI-
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
al Comments and/or Drawings:
12/28/04

Type of Visit
ompliance Inspection
0 Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
191fo-utine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: J O� Departure Tirne: County: S
Ir
Farm Name: Chit: � _✓�, �J3 a r rn^- Owner Email:
Owner Name: matt), ;__5 -_ Phone:
Mailing Address:
Physical Address:
Facility Contact: ►-;"s %�% 4_L3 Title:
Onsite Representative: �� r;/7 t ut�;
Certified Operator: ___ hidCLC`__ _47tw; I
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: ❑ o = 1 Longitude: = o = i =
it
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er I II
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Fleifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: ®,
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If ycs, 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 frorn a discharge'?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
[INo
❑ NA
❑ NE
❑ NA
❑ NE
[]Yes
& iNo
❑ Yes
o No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection LsZL..CL9�
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
RNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
El 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?
r"71 Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
CR 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
29 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
X No
❑ NA
❑ NE
maintenance/improvement`?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > l0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop ❑ Evidence of Wind Drifll ❑ Application Outside
of Area
/Window
�trsf11s7'a.
12. Crop tYPe(s)110,
/
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
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes
[RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
®.No
❑ NA
❑ NE
(0 Remw e 94) 4zsy �QD�+ - t� �ar�p1 W Oflc D--%, �;5 fJ i�y'; e' Gvft77o7`1,e
W D f � ► � fin' ,�lQd`t_ dt/`� � Q"''�--- �Ou"�- �6�T�5 �� p�,�r1C �r�
Reviewer/Inspector Name ` ' �� , �r a , ` '. Phone:
Reviewer/Inspector Signature: Date:f�}��OQw
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check J&Yes ❑ No ❑ NA ❑ NE
the appropirate box. WUP ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [X No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
(KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CK No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
FNO
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus Voss assessment (PLAT) certification?
❑ Yes
(allo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5Z No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Z No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
5Q No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ANo
❑ NA
❑ NE
v JJ fr L �v
04A N e W W ZTirr 19�yd t, OVI b tAou mY ViUGtJ �r I J Pw t C Llo y �•lJ i rl l
MIA,
12128104

!Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation j
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number ? 3.2 Bate of Visit: b' %7 _o Time: •OUI°
O Not Operational 0 Below Threshold
Etll ermitted [3 Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
FarmName: ..... /j'!4tx1 ............................................................................ County: ..... 'rG.1,,%N.ta.............................. .rF .......
OwnerName:........... .a.S....................... ..� 1711 I.............................................. Phone No:..... /D.r.. S . P.....- sG. .............................
MailingAddress: ..... 121..........4 .ten .......... LAn.................. j � IY� ra............. ' L.......2 0.3 �R.................. ..................... ..........................
Facility Contact: ..».............. ...........Title:............................................................... Phone No:....9/0....179G..... 0 y9.�
Onsite Representative: M4 e Integrator: yr
Certified Operator: ..................4� ......... Operator Certification Number:.
Location of Farm:
[;Wwine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 64 Longitude ' 4 "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [3-<0
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes El<o
❑ Yes ❑'56—
❑ Yes 8'tgo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes -N
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes []ITo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes 3NO
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ............. I.................... ...................r-.,... ....... ........................... ......... ................................... ................................... ............................
r
Freeboard (inches): Q Lj W 3 '
12112103 Conr'inued

Facility Number: S ] Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ff f o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes B o
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 91T0
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes EM
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑-N"o
elevation markings?
Waste Anulication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑-M
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes M16
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type k Y5
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 9No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [allo
b) Does the facility need a wettable acre determination? ❑ Yes ❑-No
c) This facility is pended for a wettable acre determination? ❑ Yes [3-No
15. Does the receiving crop need improvement? ❑ Yes 9-M-
16. Is there a lack of adequate waste application equipment? ❑ Yes [9'ido
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes QNa6
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑*o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes [-}-1 6
Air Quality representative immediately.
Final Notes
NanS e,
/p
/Ay Pr lav+t� /0� rf .� Gvey �r d irlp a!o
'�Oi
taM �o?,n vt �p wdr,c 41r► .6a►ie .Sro7� G� �'Ov,.cl 1Q9 oon,
r r s s f n,�� 'TP i
Reviewer/Inspector Name {.# �' !# ', >z r war , �1,, ;,.xi, # i1
Reviewer/Inspector Signature: ht" Q ,z1_ . Date:
12112103 Continued

Facility Number: _ Date of Inspection i p
Required
Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
0<0
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WVr, c,�3seklists, d MA"T,, etc.)
❑Yes
❑-Pdb
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0-Wo
❑ Waste-,A.pPh"0P_ ❑ FYCebwa ❑ iV s e-�4nal3�eis ❑ 6 -6 tp1 bF'
24.
3,1 3,0 6- - 7 -1 7;1, ,
Is facility not in compliance with any applicable set hck criteria in effect at the time of design?
❑ Yes
M V'o
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
UK
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
62,<o
(ie/ discharge, freeboard problems, over application)
❑
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
M<o
28.
Does facility require a follow-up visit by same agency?
❑ Yes
E;-W
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
9-11o�
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
es
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0Wo"
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
U-N-6
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
Q�<o
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Steeking Eann ❑ Crop Yield Form ❑ Rainf&+ ❑
❑ ❑
❑
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

'd€ �
;ion of Water Qualrly ,
doh1-1'ofSail and Water COnseryatioa `i ,;a��� '' ,f 9.1
i,1111 61'3y�M 's •� i 39 3 I. � �r _ k i.
:6j,•. 1 k.-. , i-. ..... .i-'i'.� k ,:.f .j p-3 .E r, 1,q isIq_.'jr}$:re i E �ia, �r . , {i.`-e1l l
:
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other
❑ Denied Access
Facility Number
Date of Visit: / 4I:M Time: / 8O Printed on: 7/21/2000
2,
Q Not Operational Q Below Threshold
® Permitted ■ Certified 0 Conditionally Certified [] Registered Date Last Operated or Above Threshold: .........................
FarmName: .................................... County:....... ........................................
Owner Name: ...... a%z ....,, r7. .. -............................................................ Phone No:. �1 .... 0.r..3�i��....................
Facility Contact: ...... I'll"... .....&I ,e?,lll� -r ................Title:................................................................ Phone. No....................................................
MailingAddress: ........ lz ..Z.... ....................................................... ..........................
Onsite Representative: ........ (rtz .....fll...... Integrator:�t��... ......�f.......................
.......� ......... ......
Certified Operator:..... -� , ,,/ ........... Operator Certification nmher:..'RePA/ .............
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 64 Longitude • d «
Design Current
Design Current Design ' :Current
CaoaeltVPo relation
Poutry
n Cattle,
act Po ulat3oCa ` dii Po ulation
!! 1 Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish 12,o /z
❑ Non -Layer
❑ Non Dairy
a r Farrow to Wean
1 f
�t Farrow to Feeder
❑ Other
!<
„ ., ...
Farrow to Finish
Total Design cepado
P. ❑ Gilts
i
J"i Boars
ToW S SGW
I }I•E z'�t [fNtl�ntl/e! ef'Lagooins i' - 1
❑Subsurface Drains Present ❑ Lagoon Area Spray Field Area
!�
i, Holding Ponds IBolid Tamps ❑ No Liquid Waste Management System n
lischarges & Stream Impac
Is any discharge observed from any part of the operation? ❑ Yes{ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes RNo
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ) [] Yes allo
c. 11' discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes JgNo
there evidence of past discharge from any part of the operation? ❑ Yes XNo
re there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Collection & Treatment
1
age capacity (freeboard plus storm storage) less than adequate? ❑Spillway ❑Yes AN0
Structure I Sta'ucture 2 Structure 3 Structure 4 Structure S Structure 6
or
icnlificr:...............4zAr ......................................................................................................................................................................................
inches):
t
Continued on back

r ,
Facility Number: FZ — 3,Z Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
RYes
❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovemen t?
❑ Yes
19 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
gj No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
9No
over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
11. Is there evidence11
❑ Yes
ES No
.eof
12. Crop type O iA•i �Vtlr ' .tW1-W
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
@ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
12rNo
b) Does the facility need a wettable acre determination?
❑ Yes
& No
c) This facility is pended for a wettable acre determination?
❑ Yes
K No
15. Does the receiving crop need improvement'? ❑ Yes i3 No
16. Is there a lack of adequate waste application equipment? ❑ Yes 0 No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available'?
(ie/ WPT ,' check�'sts, design, m2p, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? `
Did the facility fail to have a actively certified operator in charge?
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Does facility require a follow-up visit by same agency?
Were any additional problems noted which cause noncompliance of the Certified AWMP?
41'iipi0000s * 40"Icienom •wgre jnoW. 00109 this;visit; - Your ;will -teet'iye q fu�th r
corxesporidence: a�;uut this :visit: ' : ::: ' :::.................... .
❑ Yes 15 No
❑ Yes 9'No
❑ Yes ® No
❑ Yes ® No
❑ Yes A No
❑ Yes N'No
❑ Yes Ca No
❑ Yes M No
❑ Yes 10 No
�. Ca.✓�«r ac,�.r.,�s � ,€s�f-'� � cam 7,�rrr � �..E..Q' . �r�a4
`Inspector Name Y
nspector Signature:
Date: 5/00

Facility Number: — ,3Z Date of Inspection // Printed on: 7/21 /2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below 10 Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Eg No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes JfJ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes pJ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 10 Yes ❑ No
J'Additional'Cornments and/orDrawings:

Division of Soil and Water Conservation ❑ Omer Agency' €
Division of Water Quality
m
Routine O Cont taint O Foil ow- u of 1) WQ inspection O Foil ow-u of DS%VC: review O Other
Date of Inspection ID-r?1-97
Fatality Number 2
Time of Inspection /0!°� 24 hr. (hh:mm)
M Registered M Certified Applied for Permit U Permitted JE3 Not O erational Date Last Operated; ..........................
Farm Name:.......... �%�`^}...�'J County :............. 1.........................................
........................................................................
Owner Name: ........... al. .............................................................. Phone No:... `' ..s 1�d....:..............,................,...
Facility Contact: .............. iL2rs.. ., ..... Title.................,............................................... Phone No:...................................................
Mailing Address:..... �..71...,.!!z' /-r�.......
[.��i^fis•J %VG,f........ �zl�................................................. ...... ........................
.................................... ............... .
Onsite Representative: ......-*!..f� Integrator:....C:ram Y...........Qln. r'
Certified Operator,..........�e................................. ....... ..... ... Operator Certification Number:....2 M0 %Z
Location of Farm:
......................................................
A
� ��jj y } J .....
.3rJ�-/� !�' �j/ tr,....s�,.�f.d
............... `...(r........................ a'....
Latitude 0• 6 46 Longitude 0. 04 46
Design " .Current
Swine ::. » .. Ga>aacttv�Pontu6tton . Poultry
❑ Wean to Feeder
9Feeder to Finish
O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
LJ Layer
❑ Non Layer
❑ Other
7 Total De
r- [ Jo Subsurface Drains Present
g `;' ❑ No Liyuid Waste Managen
z
Lagoon Area l❑ Spray Field Area
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes P No
2. Is any discharge observed from any part of the operation? ❑ Yes PffNo
Discharge originates! at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Witter? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gaumin?
d. Does'discharge bypass a lagoon system? (Il' yes. notify DWQ) ❑ Yes No
3. is there evidence of past discharge from any part of the operation? ❑ Yes ,#1 No
4. Were there any adverse impacts to the waters of the State other than from a discharge`' ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
T Did the facility fail to have a certified operator in responsible charge? ❑ Yes ] No
7/25/97 Continued on hack

al
Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lapoons,Ilnldintg Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: ................................ r...................................
................................
Freeboard (ft): ......r4.....�i►7 -,. ..,.....,. ....................... I..........
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
❑ Yes 9No
❑ Yes
03 No
Structure 5 Structure 6
❑ Yes
19 No
XYes
O-No
OfYes❑
No
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes X No
Waste Application
14, Is there physical evidence of over application? ❑ Yes CTIo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type --�✓,e�. �f:tr..�,�,'�G�. 2 % .fat(J...............................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes RNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
10 No
18.
Does the receiving crop need improvement?
❑ Yes
❑ No
19,
Is there a Iack of available waste application equipment?
❑ Yes
P No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
C9No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JO No
22.
Does record keeping need improvement?
❑ Yes
lJ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
13-No.violatians-or deficiencies.were,noted-dur.ing this;visit.-.Yoh'Wvill recei've-fiwhirther:
•correspondence ati.out this:�isit.- :. � � � � ::. � : � • : - - �. , � �. . :. . � .. •:: • :::: � :. � :..... ,, ..
t 1. �,.9 � �Z d,����-�-s .��� E,���•-� r� P���'���� ,
7/25/97
Reviewer/Inspector Nano y
Reviewer/Inspector Signature: Date:

2.. � � r�
Site Requires Immediate Attention: r U U
Facility No.--U-82.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: V 1 � 10C , 1995
Time:S�
Farm Name/Owner: VPVW-, AP A
Mailing Address: t o
County: S
Integrator: 'JyL tmvm s INN Phone: -
On Site Representative: s t S Phone: 5,;-
Physical Address/Location: 10 % f.,S SoV h o Z ' v►
t� A. 11\11 •
Type of Operation: Swine Poultry — Cattle
Design Capacity: ZAP Z. Number of Animals on Site: syiz- _!
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon sufficient freeboard of 1 Foot + 25 y 24 hour storm event
(approximately l Foot + 7 inches Yes o No Freeboard:_�Ft.�Inches
Was any seepage observed from th (s)? Yes o o as any erosion ob ed? Yes o
Is adequate land available for ray? a No Is the cover crop adequate? �r No
Crop(s) being utilized•
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or l o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue ne: Yes or No
Is animal waste discharged into water o No state by man-made ditch, flushing system, or other
similar man-made devices? Yes o ) If Yes, Please Explain.
Does the facility maintain adequate was management (v es of manure, land applied,
spray irrigated on specifi crew a with cover cro )? Yes
Additional Comments:
Inspector Name
cc: Facility Assessment Unit
Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
Time:
Farm Name/Qwner: _ I vk, -q�u Go " -- "Aq-4 77, A+ `S
Mailing Address: �G a X 33ZC0�►.-t VA o j\j K]_ C . Z$ 3� -
County:H
Integrator: u AYLOS `Z Phone: 0 --Lill
On Site Representative: Phone:,Z
Physical Address/Location:
Type of Operation: Swine Poultry � Cattle
Design Capacity: �*_1_ Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon ufficient freeboard of I Foot + 25 year 24 hour storm
(approximately l Foot + 7 inches Yes r No Actual Freeboard:�Ft. ,Inches
Was any seepage observed from the agoon(s)? es r No Was any erosion observed? Yes or(i
Is adequate land available for sp ') Yes r Is the cover crop adequate? Yes or�
Crop(s) being utilized: AsIt,
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin s7 Yes r Na
100 Feet from Wells. Y4 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or Io
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Ein'e: Yes orCO)
Is animal waste discharged into water o�state by man-made ditch, flushing system, or other
similar man-made devices? Yes or If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es r No
Additional Comments:
Inspector Name
Sigenat
cc: Facility Assessment Unit Use Attachments if Needed.
event