820035_INSPECTIONS_20171231

2 'N
NOHTH CAHDLiNA
Department of Environmental Qual

Type of Visit: O'Compliance Inspection U Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Q'tcoutine O Complaint O Follow-up O Referral O Emergencv O Other O Denied Access
Date of Visit: Arrival Time: L�; o c7 Departure Time: ; c�c7 Couaty: Region:
AV
Farm Name: t 742 ` p y cxrrls _;E17r, =�
Owner Name: Cap` �-�� �e✓M G ,
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: /-ZVdr ,+MTitle: Phone:
Onsite Representative: �`.+� Integrator:
Certified Operator: _5 Certification Number: Z'
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
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
WE Heifer
Farrow to Wean
Omi
Design
Current
Dry Cow
Farrow to Feeder
M511111
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_.....
Turkeys
Other
` „
Turkey Poults
Other
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
Io
❑ NA
❑ NE
❑ Yes
Io
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: jDate of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in): r
Observed Freeboard (in): ,3 1
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
EYN'o ❑NA ❑NE
❑No ❑NA ❑NE
Structure 6
[D Yes [] No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[3` o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[f]-'No
❑ NA
❑ NE
S. 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
fo
❑ 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 �To ❑ 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
z ,I
12. Crop Type(s): J -I icefa-
13. Soil Type(s):
14.
Do'the receiving crops differ from those designated in the CAWMP?
❑ Yes
[j N
❑ NA
❑ NE
15_
Does the receiving crop and/or land application site need improvement?
❑ Yes
El"No
❑ NA
❑ NE
16_
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ J o
❑ NA
❑ NE
acres determination?
IT
Does the facility lack adequate acreage for land application?
❑ Yes
�io
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
0 Yes
[D No
❑ NA
❑ NE
Required
Records & Documents
,�.�
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
10
❑ 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 [2 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [D-N'o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [fNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [/] No ❑ NA ❑ NE
` 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ED es ❑ 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: r 7— 20/�
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [3No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E-714o ❑ 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? (Le., 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 ILf Ko' ❑ NA ❑ NE
❑ Yes F_-Ko ❑ NA ❑ NE
❑ Yes io ❑ NA ❑ NE
❑Yes [Dfo ❑NA ❑NE
❑ Yes
E3 o
❑ Yes
B<o
❑ Yes
I3 N0
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: _ cry tS::2� �--
Reviewer/Inspector Signature:
Phone: /D-3�3�pIS1
Date: %-���!
21412015
Page 3 of 3

Type of Visit: o/mpliance Inspection Operation Review p Structure Evaluation O Technical Assistance
�F
Reason for Visit: � Routine Q Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: o Departure Time: County: = Region: ?
.01
Farm Name: C - FZtml. -�V—ne-. Owner Email:
Owner Name: �' -bo llarffs GPhone:
Mailing Address:
Physical Address:
Facility Contact: �cr rr`y f]R rr��`yi �f Title: Phone: �—
Onsite Representative: LlJq��� �77"j/� Integrator: :::2
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
i Current Desigu Current
Design C►urrent
IsDesign
m,
Swine Capacity Pop. Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish I 11-ayer
iry Cow
Wean to Feeder
I
INon-Layer I
i Calf
Feeder to Finish
_
Dai Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Non -Dairy
D , P,oul
Ca aci Ro
Farrow to Finish
La ers
Beef Stocker
Gilts
Beef Feeder
Non -La ers
Pullets
Beef Brood Cow
Boars
t w _
+
Turkeys
Other _•t ,� `. "`
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes QNo ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
0 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
allo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection: (d --
--f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): % g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[RNo
❑ 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
F2 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?
21Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
3 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
Q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
,EQ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C5-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): _Vr-etjjet`
13. Soil Type(s): 6h
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
MNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ o
❑ 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
[E 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 �o
❑ 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 [ o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®Nio
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 2! -No
❑ NA ❑ NE
125. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes �o
[] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes MNo
❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes [allo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑Yes r'M 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 [23�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 Pg7No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
[D No
[DNA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
0—Yes
❑ No
❑ NA
❑ NE
Comments (refer to gnestion #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
7 �� j.�-�.,� � •,pc:..il�S/��X`�/��s��'—,�j�Yr��C�/f�JCJZt/'� �Q�Cd��rcc�
D � � a
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date:
21412015

7 7--/ ('6
Type of Visit: kJ Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: a, routine 0 Complaint 0 Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: s /G Arrival Time: 0— .° Departure Time: '0 v County: �Z �—
Farm Name: CO1r y-S D Z l�arrryc s i7 c- J- 9""' Owner Email: `�—
Owner Name: C'�l ✓/ f3 ty ��r� �� G • Phone:
Mailing Address:
Region:'[?
Physical Address: Facility Contact: Z-0'r 7 n �n'� 0i� S Title: Phone:
Onsite Representative:integrator:iTi
Certified Operator: S .�• - _ Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
III
Design
Current
Design Current
'Swinep ity Pop.
Wet Poaltry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
I Dairy Calf
Wean to Feeder Non -La er I I I
Feeder to Finish
...
Dairy heifer
Farrow to Wean
Design
Current
Dry Cow
Non -Da'
Farrow to Feeder D , P,oul Ca aci P,o .
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other''
Turke Poults
I 10ther
Other
I
Discharges and Stream lmnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ZNo
❑ NA
[:]NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
0 No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes JZJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ,� 7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P3 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
r-71 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 strictures require
❑ Yes
2�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 Jallo ❑ 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): '1*2 0l' VjX
13. Soil Type(s): u1 ct—B
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 O No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes (. No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [ No ❑ NA ❑ NE
❑ Yes 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 ELNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 Lg-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: ;�'.�- - �'3�f jDate of Inspection: `7-- S`j/L��
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [a No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes H 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 DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[;R 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
E] 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
)Eg 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
JS 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
M No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑X —No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Crl 17 �U� u- 0 r" Lai-.,L 7". 31" `
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: 7/V_
Date: �
21412015

jType of Visit: e'Coroutinne
ce Inspection O Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ! / Departure Time: County:!! yY,o Region:
.01
Farm Name: �, f 1`�-/ j Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: /16/y 1*tpmp" y Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
r
Design�Current
Design Current ^{ "
Design Current
Swine
Ca aci
tra
Pop.
Wet Poultry
Cap city Pop.
Cattle Capacity Pap.
Wean to Finish
ILayer
Dairy Cow
Wean to Feeder
f. o"
70& (9
1
INon-Layer
I
Dairy Calf
Feeder to Finish
"''
Dairy Heifer
Farrow to Wean
2a Cow
Farrow to Feeder
c=,
D . • P,o_ul
Ca aci Po
Non -Dairy
Farrow to Finish_°
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ❑T -No ❑ NA ❑ NE
[:]Yes ❑ No
[—]Yes [:]No
❑ Yes ❑ No
❑ Yes CEg.No
❑ Yes S No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
®.No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure
4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): `#
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[f 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
[3j No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[3 No
❑ NA
❑ N E
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
nNo
❑ 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
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E23No ❑ 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): W1,,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ 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 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
[a No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[25 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ o
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - 3. Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [f.No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes 5? No ❑ NA ❑ NE
❑ Yes
JZ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
Comments (refer to question ##):. Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional DaQes as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Wp- 3)bo
Date:-
21412011

ivision of Water Quality
Facility Number ®- ,3 S Division of Soil "and Conservation
Other Age ney
Type of Visit: j57oompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: &Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
o.4E.5
Date of Visit:
Arrival Time: ,` D Z) Departure Time: / 100 1county:
Farm Name:+✓/7Ya rris �c • _ _ '�"`
Owner Name: �[`r� ✓ ✓ 7 flrenl_4 _-C M C_
Mailing Address:
Physical Address:
Owner Email:
Phone:
Region: rjt-o
Facility Contact: L,f= z�mz--S Title: ,r Phone:
Onsite Representative: sr_ Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm -
Latitude:
Longitude:
Design Current
Design
Current
Design Current
ECapacity
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Pop.
Wean to Finish
La er
aig Cow
Wean to Feeder Q XS%
on -Layer
aia Calf
Feeder to Finish
aig Heifer
(:arrow to Wean
:-
Design
Current,..jDry
Cow
Farrow to Feeder
Dr. Po_ul
Ga aci
Po
Non -Dairy
Farrow to Finish I
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
[:]Yes
f 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
12q No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
§g No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

• Facili Number: - jDate of Ins ection: s
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
Q No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in): l
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ej 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
r" 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
allo
[DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ 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
n No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E, No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C&No ❑ NA ❑ NE
0 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
)I ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): 4�k2 ,
13. Soil Type(s): �AAZ '
14. Do the receiving crops differ from those designated in the CA WMP? ❑ Yes E!j 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 fjS 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?
Required Records & Documents
[:]Yes allo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[gNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Ej3-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
allo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard [] Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
[:]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
C.No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[Eq-.No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ENo ❑ NA ❑ NE
the appropriate box(cs) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? 0 Yes CNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
E No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ELNo
❑ 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
L&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
0,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
[,No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
R] No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments..
Use. drawings of facility to better explain situations (use additional pages as necessary).
l S . /n�ac� LUG ✓tom �'J �Dd r-.r� CrDP —All %i' 4411
11
Reviewed]nspector Name:
Revi ewer/] nspector Signature:
Phone:
Date: Goo/ y
e
21412011
Page 3 of 3

Wean to Finish
Wean to Feeder
8�
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Date of Visit: Arrival Time: 0 ; o 0-1 Departure Time: County:,s�gr—
Farm Name: Owner Email:
Owner Name: da*d/" 13D % 1Arrre3 Dyne, Phone:
Mailing Address:
Physical Address:
Region: ��
Facility Contact: Ae"Lato�"_i Title: Phone:rr�--
Onsite Representative: C,� Integrator:ll'j�O�G_
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
M One—
_€ T
Des' Current Design Eurrent� g Design Current r tgn •
Swine Capacity Pope Wet PoultryCapacity Pop Cattle Capacity Pop.
La er DairyCow
Non -La er; - DairyCalf
µfa Dai Heifer
Design Current D Cow
s +Dty P,oult .r :Ca act Po Non -Dairy
u Layers i Beef Stocker
ti
Non -Layers Beef Feeder
Pullets " Beef Brood Cow
Turkeys
Otber TurkeyPouets
Other Other
Discbarees 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 CS
of the State other than from a discharge?
❑ Yes Eg No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA r] NE
Page
I of 3 2/4/2011 Continued

acili Number: - Ds ection: G -- T J
Waste Collection & Treatment
d. 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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
®No ❑NA ❑NE
❑ No ❑ NA 0 NE
Structure 6
Designed Freeboard (in):
Observed Freeboard (in): 3y
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?
0 Yes
JZ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
J& No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[. No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R 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): ��tsrda 4Cicrs r-.-p!
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Z No ❑ NA ❑ NE
15_ Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment'?
Reauired Records & Documents
❑ Yes 01 No ❑ NA ❑ NE
[:]Yes 0 No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? if yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑ WUP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[0 No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: &— 7— /3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3 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?
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
® No
❑ NA
❑ NE
❑ Yes
Co No
[] NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes �g No (DNA ❑ NE
❑ Yes [K No ❑ NA ❑ NE
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [RNo
❑ 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 2 No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes C&No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Gevc15
Reviewer/Inspector Name:
Phone: L D" 1t3h-3 3`0 r-
Reviewer/Inspector Signature:
Page 3 of 3
Date: & — 7 = ,-;bfj
21412011

Type of visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0<0'utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: :3a Departure Time: ;3'p County: a Region
.41
Farm Name: f� �r �aems ZirG. _ Owner Email:
Owner Name: /�„ �r.al 1;a1*5 Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: �L,_J n pry Phone:
Onsite Representative:Integrator: j�l aj�iry�
Certified Operator: �j a.�.�_ Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design#Current
Swnem - Capacityiop
Design Current
Wet Poultry; - Cap city +Pop:
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Q}
`S
Non -La er
Dat Calf
Feeder to Finish
Farrow to Wean
- ".
Design-
D . I',oult . @a aci
"`
Current
1P,o s
Dairy Heifer
D Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
- - -
Other
Turkeys
Turkey Poults
Other I
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ 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
EQ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ZC No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
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
[Z 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
MA 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): Zr--rn xa �
13. Soil Type(s): bu & Z5
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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Re uired 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 [Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
❑ NA ❑ NE
0 Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes CZ 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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes I'm No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[—]Yes ® No
❑ Yes L No
❑ Yes ZLNo
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
Comments (refer to question #) Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date: &I j
21412011
Page 3 of 3

fvpe of Visit: Q�ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: (p r J Arrival Time: t7 Departure Time: t if County:
Farm Name:.. A:yj O"X /— �/at.c J-z G , Owner Email:
Owner Name:Phone:
Mailing Address:
Region: (�
Physical Address:
Facility Contact:,/T ry� �n s Title: new Phone:
Onsite Representative: trox , �! Integrator: ;E�za7�,a—
—.
Certified Operator: �� � Certification Number: / jk311--2-
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current _ Design Current
Swine Capacity Pop. " - Wet Poultry Capacity Pop.
Design Gurrent
Cattle Eapact Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Layer
Non -La er
I
Daia Cow
Dairy Calf
`;=
Design Current.
ltr Ca aci P,o
Dairy Heifer
Dry Cow
Non -Dairy'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Pullets
I
Beef Feeder
Beef Brood Cow
Boars
_'" _
Other
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (byes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes L&No ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ® No
❑ Yes J -No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - ,3j Date of Inspection: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
[YLNo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
[] Yes C3-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 DWQ
6.-
7. Do any of the structures need maintenance or improvement? 52�-Yes wgt❑
NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes CF;,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 fj�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _ yjf j2jLnra- !7) yj
7
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes K No DNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [gNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes S No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[5No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[a No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
allo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. [E Yes ❑ No
[-Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 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 allo
23. If selected, did the facility fail to install and maintain rainbrcakers on irrigation equipment? [:]Yes allo
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes ®. No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes 5� 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 2 No
DNA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
❑ Yes allo
❑ 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 [vNo
❑ 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 [M 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 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
QNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
uS� /U�ccJ
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: 2'g
Date: (§, —"�_ _­Z21011
21412011
Page 3 of 3

Type of Visit
ompliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
"outine O Complaint
O Follow up Q Referral O Emergency
Q Other ❑ Denied Access
Date of Visit: 1hr—ZLLP] Arrival Time: $ 0 Departure Time: : 3D County: `"—' Region: >==jz0
Farm Name: JAd1'a-r r5orz G1 Owner Email:
Owner Name: id %r✓ _ � M't- n G Phone:
Mailing Address:
Physical Address:
Facility Contact: /_62 K4Z /¢ &MMU-4 Title: ��7��'' Phone No:
Onsite Representative: Sim « Integrator:
Certified Operator: Operator Certification Number: /JP__T%2_ .—
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [:::] o [::] ' 0" Longitude: [::] o E::] ' 0 u
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity PoplationY
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Wean to Finish
❑ Layer
Wean to Feeder
pfr'D
❑ Non -Layer
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turke s
Other
❑ Other
E] Turkey points
❑ Other
Number of Structures:
I rJ
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (I f 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 [ffNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: -,3,5 Date of Inspection
Waste Collection & Treatment
. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes 19 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / g
Observed Freeboard (in): jy
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
29No
❑ 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?
ayes
0 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ 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
[gNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
{?-No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CRNo
❑ 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
(R No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
($No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA ❑ NE
Comments (refer to questions #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facHity.to better explain situations. (use additional pages as necessary):
r
Reviewer/Inspector Name
Phone: :d3 0 D
Reviewer/Inspector Signature:
Date:��
Page 2 of 3 12128104 Continued

_Facility Number: 12 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 [g No []NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ® 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
E[No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B 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
10 No
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
®.No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9LNo
❑ 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
E.No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
MNo
❑ 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
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
10 No
❑ NA
❑ NE
Additional Comments and/or
Page 3 of 3 12128104

0
0
Type of Visit (61=ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: p Departure Time: CountyRegion:
Farm Name: 2 ucliaar r Fa ern-6 fir! c_, Owner Email:
Owner Name: 9, � / d=:5u/✓).75 --Zh G - ^ Phone:
Mailing Address:
Physical Address:
Facility Contact: L tt Title: (?,\-t t.1--,14-- Phone No:
Onsite Representative: Integrator:
Certified Operator: SL"{— Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = , =di Longitude: = e 0 g ❑ u
Design Current
Design Current
DesignEPCurrent
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capaciopnlation
❑ Wean to Finish
110
Layer
❑ Dairy Cow
Wean to Feeder
I &0-fMq
03 ,1110
Non -Layer
I
Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy Heifer
El Dry Cow
❑ Non-Dai
❑ Farrow to Wean
ElFarrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Non -Layers
El Pullets
❑ Turkeys
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
❑ Gilts
❑ Boars
Other
❑ Other
❑Tur ey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation'?
❑ Yes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
R No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
CNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

r
Facility Number. — Date of Inspection 7 -D
Write Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure I Stntcture 2 Structure 3 Structure 4
❑ Yes [$No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure ; Structure 0
Identifier:
Spillway?:
Designed Freeboard (in);
Obsmed Freeboard (in): 3
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Pq 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
[14 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered) yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
rVNo
El 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
[NNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Rq No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Winddo"w E_vide/nce of Wind Drifl ❑ Application Outside of Area
` �❑
12. Crop type(s) , ; W J'r. /� y�;S
13. Soil type(s) W a'-K
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination i ❑ Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P� No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(,2-No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
II
La�por"- b�� ia/`_ or 'qv.S,
7
Reviewer/Inspector Name Phone: /j% ` A/Tjr— �O
Reviewer/Inspector Signature: a Date:
' !' 12128104 Continued

Facility Number: — Date of Inspection:
llcquired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [RNo ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ n Desi g ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ RainfalI ❑ 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
RNo
❑ 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
to No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[RNo
❑ NA
❑ NE
Other Isslles
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
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iet discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
W No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit 42r"L`ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: t`i' Departure Time: ,� County' Region:
Farm Name: u /Pqe- - Owner Email:
Owner Name:��Ga /I C Phone:
Mailing Address:
Physical Address:
Facility Contact: Am owo'n-f _ Title: Phone No:
Onsite Representative: SQ Lr� _ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude- =1 e = u Longitude: = o = I = u
Design Current
Swine Capacity Population
Des�n� Current Design Current
Wet Poultry Capacity#�1'opufation Calle��a" Capacity Population
❑ La er ❑ Dairy Cow
❑ Wean to Finish
Wean to Feeder O
S O
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
�,... ❑ Turke � Poults
a
__
El Dairy Heifer
❑ Farrow to Wean
❑ D Cow
❑ Farrow to Feeder
�� El Non -Dairy
,
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
El Beef Feeder
❑ Boars
❑ Beef Brood Coyj
Other ,l
;� {,4 _.
"
Imlier of�$truetures:
❑ Other
❑Other
; A� .r.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[B No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
9 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[9No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — .3.J Date of Inspection 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I
Identifier:
Structure 2 Structure 3 Structure 4
El Yes D9No El NA ❑NE
El Yes El No ❑NA ❑NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JE� 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 [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?
IRYes
[:]No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ 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
MNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[SNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)q
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
ER NoNo�
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?®, Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
aNO
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
{ &No
❑ NA
❑ NE
Comments (refer to.question #) Explain any YES an"savers andlor any recommendations or any other comments.,
Use drawings of facility to better explain situations. (use additional pages as necessary):
crL-i ~iS
U �
RevReviewer/Inspector Name
piewer/Ins �j •—�
( �d>;� Phone./a- ,33 3o
3D
Reviewer/Inspector Signature: Date: — 3a
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection -
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P!�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C![No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9No ❑ 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
RNO
❑ 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
[9No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
J No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
8 No
❑ NA
❑ NE
2T
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
V4No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
MNo
❑ 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
14 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
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
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E,No
❑ NA
❑ NE
Additional Comments and/or Drawings:
A
Page 3 of 3 12128104

Division of Water Quality 5/`
Facility Number s O Di-sision of Soil and Water Conservation
Q Other Agency
Type of Visit ClEr;Routine
­mpl' nce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: tJi7 Departure Time: a D County:
Farm Name: jR L4_d a t- >�a /M- _y_--7n G . _ _.. Owner Email:
Owner Name: Ruo1 Car- 1'191'Py1- -_E717 e- Phone:
Mailing Address:
Phvsical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: "'`' Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Region•/0,;R 0
Location of Farm: Latitude: =O = { = 11
Longitude: 0 0 = 1 = u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
D6 ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ©'
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
12/2"4 Continued

Facility Number: —3S Date of Inspection 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes R No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 13 ! -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? C9,Yes ❑ No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
®,No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
(RNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
EKNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Z No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cropr El Evidence of Drift El Application Outside of Area
`Window Wind
12. Crop type(s) ' r I �} fl e_ r, Hof
13. Soil type(s) Wa
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
JRNo
❑ 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
4 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
CR No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment'? ❑ Yes
?K 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):
AL
Reviewer/inspector Name
Phone:
Reviewer/Inspector Signature:
Date:a��C��
12128/04 Continued

•1 r
Facility Dumber: — S— Date of Inspection a 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
[Z No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[SNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ffNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[R No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Eallo
❑ 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
[9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
CR No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

0
0
Divisiom of Water Quality
Facility Number 3 j 0 Division of Soil and Water Conservation
i
Other Agency
Type of Visit ErCompliance 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: Arrival Time: IO! p Departure Time: County: Region:�Z i�
Farm Name: .— ad CQ,r �C e,?U Owner Email:
Owner Name: 2 UJ n, e &2 S te+ G . ____ _._.. Phone:
Mailing Address: 1 l 0 . �3 ox, =6 % 0— L i ►"e --rz) Gr6z 9- 3 19- 8�_
Physical Address: �}
Facility Contact: � j I' di rrr eya s Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: / r s ,7 :A- e_
Operator Certification Number: 04JE /3.2-
Back-up Certification Number:
Location of Farm: Latitude: 0 0 E=] ` = Longitude: = ° =' = u
i
iiiiiiiiiiggsigCurrent
F Designs
, Current Design Current
Swine Capacity Population
Wet Potiltrypacitya Population Cattte Capacity Population
N
❑ Wean to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder
p
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
�t ��''
' ❑Dai Heifer
❑ Farrow to Wean
Dry ..�.:.:,:.
'
"' D Cow
Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Beef Stocker
❑ Beef Feeder
10 Beef Brood Co
❑ Gilts
❑ Boars
Other._
❑ Other
�= Dumber of Structures:
z:_.:,� 1Ell
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Puuets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
� No
El NA
❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
El Yes
KNo
El NA
❑ NE
b. Did the discharge reach waters of the State'? (if yes, notify DWQ)
❑ Yes
KNo
❑ NA
[:3 NE
c. What is the estimated volume that reached waters of the State (gallons)'?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
PQ No
El NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
(4No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters ofthe State
❑ Yes
ER No
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
12128104
Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
.
❑ Yes
R No
❑ NA ❑ NE
a. If yes. is waste Ieve s into the structural freeboard?
❑ Yes
54 No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
rNo
El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[3ZNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
W 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
CKNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
MNo
El NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[KNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
p-
13. Soiltype(s) 9)a%�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[&No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[9No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
V4 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
N No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CRLNo
❑ NA ❑ NE
-Comments (refer to question:#) '. Ezpiain auy. YES answers and/or auy.recommendatioas or, any other comments.. "
Use drawings of facillity to better explain situations. (use additional pageg.as necessary):. .
Reviewer/Inspector Name' " t/t Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection Cb
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes KNo ❑ 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. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes - 14 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
19 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
J4 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
X No
❑ NA
❑ NE
25_
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
MNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ 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
54 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[K 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
(O No
El NA
El 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
[RNo
❑ 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
{R No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
El NA
El NE
Additionai;Comments and/or'Drawings:
12128104

y
Division of Water Quality s
Facil>ttv'Number a 3S �Q Division of Soil and Water Conservation
— --- Other Ageney
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: Arrival Time: : DO Departure Time: County: Region:
Farm Name: R%41 C All C VV.%z T rXe • Owner Email:
Owner Name: inn C a• r Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: _Larr ` rv+rnoNps Integrator: '` s
ff
Certified Operator: 1_at, K%4 to r.-IV,.o,.., s Operator Certification Number:
Back-up Operator -
B
ack -up Certification Number:
Location of Farm: � ° =' = " is = o = ,
Latitude: Longitude:
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
El La er
❑ Non -La yer
❑ Wean to Finish
® Wean to Feeder
Op'O
177
Other
❑ Other
Dry Poultry
Pullets
LJ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ❑ Application Field ❑ Other
a. Was the conveyance than-mad0
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
ElBeef Stocket
ElBeef Feeder
ElBeef Brood Co
Number of Structures: Y
b. Did the discharge reach waters of the State? (If ves, 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 ofthe State
other than from a discharge`?
❑ Yes A No ❑ NA ❑ NE
❑ Yes
Number of Structures: Y
b. Did the discharge reach waters of the State? (If ves, 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 ofthe State
other than from a discharge`?
❑ Yes A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
❑NA
❑NE
❑NA
❑NE
El Yes
❑No
❑ Yes
]No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection S �$
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [)a No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 y44e
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�O No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
® No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
00 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence/of Wind Drifi ❑ Application Outside of Area
12. Crop type(s) Ble r "-wa- r,a / S G — OS
13. Soil type(s) liC1a.
14. Do the receiving crops differ from those designated in the CAW MP?
❑ Yes
M No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinationi[)d Yes
01 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
4 No
❑ NA ❑ NE
Comments (refer to question f. Explain any YES answers and/or any recommendations or any other comments.
Use. drawings of facility to better explain situations. (use additional:pages.as necessary):
ON �NGs+ r,) + 6 ct r<_S.
Reviewer/inspector Name { ,� , ,(>r j Phone;
Reviewer/Inspector Signature: J171.9 Date: J��-?���
1L/L8/V4 c.ununuea

Facility Number: 8oZ — 3S 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 JX No ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (M No ❑ NA ❑ NE
0•G
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes [Y No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E9 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit'?
❑ Yes
❑ No
NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
® NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
DO 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
P 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
[A No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32_
Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33_
Does facility require a follow-up visit by same agency'?
❑ Yes
V9 No
❑ NA
❑ WE
Addiiitio1nai/Com ents,andlor Drawings:
C_ (�� D r
1 1 I 0 G #'-t 0 AJ P Q yr e' r w a r� S C. 0..S c. S C L,tir 4L C-1 G C �O .04 �.1 b ul Ir
GC)C �.. ,ra�acc �+ t..] i�'i- y�atOG!'wOrk, F
5 tudlcj-e- sur„cxt aKd2 r e �r4�iQj, r <bwt v- by o c4 06
12128104

Type of Visit • Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Date of Visit: �� d>✓ Time: �% �3A
Facility Number Sa .�S
7 —.t-Qp eration21 0 Beiraµ' Threshold
Permitted EM Certified C] Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm flame: _ Quejc o v Fat ti. s T nc, Count-: 5= ►•• in so r. _ fz )O-O
Owner Name: .3 r•. r('nI--.- _ Phone No. -
Mailing Address: P a0A 9S C ��AZ C o78sas
Facility Contact: LOr/,r.4)a-%rvsor.: s _Title: Phone No: C?10) :&-1- 4'76S
OnsiteRepresentative: Lu►rw %�r+si.+v�+s Integrator:JaEFez+r.,_s
Certified Operator: L cz.,.i Operator Certification Dumber: 18
IF
Location of Farm:
it Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ` - Longitude '
Design Current
Swine ranae•itL. Pnnnlalinn
afl Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
�
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultr- Ca acitV Po ulation Cattle Capacity Population
❑ Laver ❑ Dairy
❑ Non -Laver I I JL]Non-Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Ls oon Area 10 S rag' Field Area
Bolding Ponds I Solid Traps [] No Liquid Waste Management System
Discharges g Stream Impacts
1. Is anv discharge observed from any pan of the operation?
Discharge originated at: ❑ Lagoon ❑ Sr)rav Field ❑ Other
a. If dischargt 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 aal/min?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure ? Structure 3 Structure 4 Structure
Identifier:
Freeboard (inches); 3 ,2
❑ Yes P No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Q4 No
❑ Yes 2� No
❑ Yes M No
Structure 6
05103101 Continued

Facility lumber:
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes Ky No
❑ Yes [V No
El Yes 5No
❑ Yes Z No
❑ Yes ® No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
[A No
11.
1s there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hvdraulic Overload
❑ Yes
E, No
12.
Crop type Ae-ri.+u g6& S/r+a rOti Qs
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14_
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes]
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15.
Does the receiving crop need improvement?
❑ Yes
[� No
16.
is there a lack of adequate waste application equipment?
❑ Yes
No
Reouired
Records & Documents
IT
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
® No
18.
Does the facility fail to have ali components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
Q No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
M No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems. over application)
23.
Did Reviewer/lnspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
m No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
'P`' No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer.to,queshnn #): Explain "y'.YES inswers sndlor:any recommendations or any'otfter comments. .
Use drawings of faciltty to better explaioi .sictuatiotis. ti addtt onal pages as necessary) ;:; Field Copv _- ❑ Final Notes
P70 Amtk,AAj W i fit' Gu b a t.k son. c 4, a4-"7 X rA16 r.p. O n
11li'AoQ .Y,ua��,rce on
Reviewer/Inspector Dame
Re,.iewer/Inspector Signature: Date: '- dly
05103101 Continued

a
■I �.'I.=_�'-.`�.?"'=_.7-.=-}w�._. •:E?�• .�i'-'._'�C'Y.�i,T:£,.^ _ __ _ - _ .. _ r--_ -i --. .4 �._r i x.�•II
Type of Visit IS Compliance Inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit ORoutine 0 Complaint C)Follow up O Emergency Notification O Other ❑ Denied Access
Datr cif N'icit: IO _0 Time:
Facilitz_' Number 3 t
FO Not Operational 9 Below Threshold
{� Permitted M Certified 13Conditionaliv Certified D Registered Date Last Operated or Above Threshold:
Farm Name: rm_5 It G County: SQPn.s4"
Owner -Name: aim (�,r r Pbojne No: p
Mailing _address: PO ,�,r T S 7 �%t �7�n -'VC_ 02 Q3�'O
Facility Contact: LVtr'rV kMM04,5 Title: Phone No: y/D :56�{ -�
Onsite Representative: La rry l-yof 1 S Intecrator: lPs
Certified Operator: err f+r7A10HS Operator Certification Number; 19 3
Location of Farm:
0 4�61p__ ,1rcy_-_ �► Cattle ❑ Horse Latitude ' z - Longitude ' • �=
Design Current
Design Current Design Current
Swine Ca acity Population
Poultry
Capacity Population Cattle Ca acity Population
® Wean to Feeder
❑ Laver
❑ Dairy
❑ Feeder to Finish
❑ Non -Laver
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
[] Bow
Total SSLW
Number of Lagoons 1_�J ❑ Subsurface Drains Present 11EILagoon Area IEJ 5 rat• Field Area
Holding Ponds I Solid Traps No Liquid waste Management System
Discharges & Stream Impacts
1 _ Is anv discharge observed from any pan of the operation?
_ - ❑Yes � No
Dischar_e originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑Yes ❑ No
b. If discharge is obsen-ed, did it reach Water of the State? (If yes, notifti- DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ)
2. Is there evidence of past discharge from any par[ of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes W No
Structure 5
Continued

Facility Number: — 3_6-
Date of Inspection 4- 4-
5. Are there anv immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion.
seepage, etc-)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered ves, and the situation poses an
immediate public health or environmental threat, notifi• DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes ® No
❑ Yes [B-No
❑ Yes ® No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, eauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ®No
'Waite Application
10. .are there an,- buffers that need maintenanceiimprovement? ❑ Yes ® No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes EN No
12. Crop type _Cogst-ea-d AI�V,GfA
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAUNP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ®No
c) This faciliry is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? ❑ Yes ® No
16- Is there a lack of adequate waste application equipment? ❑ Yes ® No
Reguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ®No
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W'UP, checklists, design. maps. etc.) ❑ Yes ® No
19. Does record keeping need improvement? (ie' irrigation. freeboard_ waste analysis & soil sample reports) ❑ Yes '.No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility fail to hax-e a actively certified operator in charge? ❑ Yes 90 No
22. Fail to notify regional DNz Q of emergency siriations as required by General Permit?
(ie` discharge. freeboard problems. over application) El Yes [� No
23- Did Reviewer,'Inspector fail to discuss review/inspection with on -site representative? ❑ Yes M No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Wert any additional problems noted which cause noncompliance of the Certified AW`MP? ❑ Yes No
(® No violations or deficiencies were noted during this visit. You will receive no furtber correspondence about this visit.
a: ..; - _ .. _ - -.. .. ... ._h...,-» _..Se;.«a`'4`"_ ";iz -x.^---.,�.e�.,• :,^'a ,,°;e.. ,�-'`� °""w� ^...-.
Coaiinents (refer to giaes4on f: -Explain afi :.-YES answers atmlor xa recomme tiattons:or anv, othe a mmentz -
Use drawings of facility to better explain situations (use additional pages as necessary) ❑ Field Copv ❑ Final Notes
Reviewer/Inspector Name � "i• �:
. �.�., (� �a - _ �..- : �.��� ,e .�.-;. rar'�
Reviewer/Inspector Signature: Date: /p-03
O5103101 V Continued

Type of Visit ® Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit D Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Z Date of Visit: C Time:
rO Not Operational 0 Below Threshold
Permitted ® Certified 13Conditionally Certified Q Registered Date Last Operated or Above Threshold:
Farm Name: County:
Owner Name:_�N.G f C _ Phone No:
Mailing Address: /� t�•��P_C2 .
Facility Contact: �A.�i C}i++�*^�,1 Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ' " Longitude 0 6 �K
aw>ue
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design _Current _ 'Design Current
Poultry Capacity Population Cattle
❑ Layer I I ❑ Dairy
❑ Non -Layer I I JE1 Non -Dail
❑ Other
Total Design Capacity
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Laszoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
Total SSLW
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
es
Freeboard (inches):
05103101
❑ Yes XNo
❑ Yes R'No
❑ Yes KNo
❑ Yes K7No
❑ Yes PQ No
❑ Yes OFNo
❑ Yes ONo
Structure 6
Continued

Facility Number: & — f5— Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvemcnt?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aonlication
❑ Yes N No
❑ Yes 9No
❑ YesXNo
❑ Yes EQ No
❑ Yes KNo
10. Are there any buffers that need maintenance/improvement? ❑ Yes KNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ANo
12. Crop type-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes KNo
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ElYesJNo
15. Does the receiving crop need improvement? ❑ YesNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes P0
Required
Records & Documents
17_
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes 4 No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP,hecklists , design, maps etc.) / ✓
❑ Yes �No
19.
^/
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes �K]No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes RNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes XNo
(ic/ discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes CNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes X"o
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes X No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Gomments (refer to question #iJ: Explain any YES answers and/or any recommendations or any other comments.
Use draRi iiii of fact7ity to better explain situations. (use additional pages as necessary,}: ❑Field Copy El Final Notes
/"�i/Y%��^iJ�j/��� �i�%� N'r///�(/d��� /�C�'V eC-✓�-�.�' r L.I�9/�/5/r-/�',C�����.] �?'�,��
EA
.s. _adult r
Reviewer/InsPector Name ,� -
Reviewer/Inspector Signature: Date: r/Z
05103101 Continued

Facility Number: Y
J2— ,� Date of Inspection e; dz
4slor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i_e_ residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
34. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan bladc(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
XYes ❑ No
❑ Yes ONo
❑ Yes RNo
❑ Yes X-No
❑ Yes etNo
❑ Yes XNo
❑ YesANo
05103101

of Visit V Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit % Routine O Complaint, O Follow up O Emergency Notification O Other 1 ❑ Denied Access
Facility Number a Date of Visit: ;0 0 Time: : 30
Q Not Operational Q Below Threshold
10 Permitted Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ............
Farm Name: ............. .(.5„&A4'r..... F!"?................................................................. County:......... -!! ....._............... ... n!!�q.......
Owner Name: __. . .... .. S%.............. ........... Phone No: ............
Facility Contact: ...... 2". .. .an_5............„......... Title:.....O W.1 v...................................... Phone No: ..... _ ... _
MailingAddress: . Pb �6x.... z. 7n............................................ •--................... ... .... ....... ...... ..--.................. ... -
Onsite Representative: .........AA_J ! y...... !�!►. ..................................................... Integrator:...... an:�i .G......................
CertifiedOperator: kgqAm~r►--x .................. Operator Certification Number: AE3y'
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �' �" Longitude
Design : , Design r Desegq umnt Current . Current r C
,CacPtoCapacity e • - don,
-n ury '.
Wean to Feeder &pW ❑ Layer ❑ Dairy
Feeder to Finish r [] Non -Layer ❑Non -Dairy
El Farrow to Wean
Farrow to Feeder ❑ Other
Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW; .
FAiaagoons Subsurface Drains Present Lagoon Area ❑Spray Field Area
Holdeng Poeid§ /Soled Traps_' No Liquid Waste Management System 3
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b- If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) Yes ❑ No
e, If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any pan of the operation? ❑ Yes A -No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes K-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 90 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier : .................................... . ........
Freeboard (inches): 3P
5100 Continued on back

Facility Number: ga — 35 Date of Inspection o2v t f
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? ❑ Yes $fNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12, Crop type 6.v,.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? KYes
16. Is there a lack of adequate waste application equipment? ❑ Yes 0 No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
Q No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes in No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes [g No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes Dd No
Q yipgtejris;off dgfcitn�i wire pot;e4-dg phis;v�s�t; Yost wii� >iee�iye titiu>t#tr . ;
Corresoinidence: a)wut this'visit_
_se' - =estuao. _ o eo
16— _. �. .New •b cuAe- on eo4 i o cd T�`en 4s�cc�s e`+�W-S�jro� P.(AU)ajl N e
rtt to I clr- t n to- 4a, Wo 11- orn %dr � b a a[ a S "p ,' areas PP°55i I R eery
c W1
6 ar-'6s4Lre_ CO.,iS r�qe_ Ccarnp�4j � 5c., l - I
..._ JACU3 VPin_'j2 ta.so^ at kCL o�LC� 5.`[��cvyvy C> 4e.' �s nPV-"kle
rs -
Reviewer/Inspector Nameq�--
Reviewer/Inspector Signature: _27- 551 _ Date: 4 .200 5/00

Facility Number: Qa -3S Date of Inspection 4 o
Odor Issues
26. 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?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 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 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 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100