820080_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qua!

iype of Visit: rcMomp ' nce Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
hry-
Date of Visit: tij b Arrival Time: o (3 D { Departure Time: p County:. (�1 f1 Region: fE
Farm Name: 1 6LyKC-j Owner Email:
Owner Name: zo �' /6 �` Phone:
Mailing Address:
Physical Address:
Facility Contact: o I S �?a--fVI V Title: Phone: 7
Onsite Representative: ��� Integrator:
Certified Operator: — N 1 pv- Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Nan -La er
DairyCalf
Feeder to Finish
�]GI$
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,outt
Layers
Design
Ea acit
Current
P,o
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
IL Other
Turkeys
TurkeyPouets
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 [3-N ❑ NA ❑ NE
❑ Yes ❑ No ®--NA ❑ NE
[:]Yes ❑ No Q-NA ❑ NE
❑ Yes ❑ No
❑ Yes Ej-tto
❑ Yes E]No
D-NA ❑ NE
❑ NA ❑ NE
DNA ❑NE
Page 1 of 3 21412015 Continued

Facility Number: - a Date of Ins ection:
rite Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N A ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No Q_6A � NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 D
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes (�❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
®'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q-Ko"'
❑ 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`o`
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [-]Yes [q o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _ C 6 If ./ P.� ! s& C9 c 6-0-9
13. Soil Type(s): 1 3 l 1y L �t
14. Do the receiving crops differ from those designateJin the CAWMP?
❑ Yes
LS],Ko
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[3"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ ' o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[D 1Vu
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑,<
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
El' -No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E ,<o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
rl<o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[D-<o
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
�Io
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection; 'Z,- {>
2.4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ©416- ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E] No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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
®.ado
❑ NA
❑ NE
❑ Yes
[!J`No
❑ NA
❑ NE
❑ Yes
[anTb
❑ NA
❑ NE
❑ Yes To ❑ NA ❑ NE
❑ Yes t j No ❑ NA ❑ NE
❑ Yes U rvo ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Reviewer/Inspector Signature: 1 Date:
Page 3 of 3 V 21412015

RECEIVED
DEQ/DWR
Water Resources r
Environmental Quality
Robert Naylor
James Naylor Farm
2988 Church Rd
Clinton, NC 28328
Dear Robert Naylor:
JUL 18 2017
WQROS
F7AYET1-EVILLE REGIONIAL OFFICE
July 12, 2017
ROY COOPER
Governor
MICHAEL S. REGAN
Secretary
S. JAY ZIMMERMAN
Director
Subject: Sludge Survey Testing Dates
Certificate of Coverage No. AWS820080
James Naylor Farm
Animal Waste Management System
Sampson County
The Division of Water Resources (Division) received your sludge survey information on July 5,
2017. With the survey results, you requested an extension of the sludge survey requirement for
the lagoons #2 & #3 at James Naylor Farm facility. Due to the amounts of treatment volume
available, the Division agrees that a sludge survey is not needed until December 31, 2020.
The next sludge survey for the lagoons #2 & #3 at James Naylor Farm facility should be
performed before December 31, 2020. Please call me at [phone] if you have any
questions.
Sincerely,
-'e4-0/y �L.
Miressa D. Garoma
Animal Feeding Operations Program
cc: Fayetteville Regional Office, Water Quality Regional Operations Section
Permit File AWS820080
-,:->—Nothing Compares:: ---
State of North Carolina I Environmental Quality I Division of Water Resources
Water Quality Regional Operations Section
1636 Mail Service Center I Raleigh, North Carolina 27699-1636
919-707-9129

ivision of Water Resources
Facility Number _ - sf O Division of Notand Water Conservation
Otber Age�nc_y
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 040utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ''►DD Departure Time: b County:
J
Farm Name: r, vt(e5 e`tf lop -
Owner [—a,/yN Owner Email:
Name: n b r,,J F tfy ! o✓` Phone:
Mailing Address:
Physical Address:
Facility Contact: k_,;t Title:
Onsite Representative: ( <
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
integrator: 5_ c11 A "A IV
Certification Number: /If Yr 4
Certification Number:
Longitude:
Destgn Current = pDesignr Ciirrent,; = Design Current
Swine Capacity,Pop -k; Wet Poultry Capactty Po Cattie Capacity Pap.
EGi
Finish La er DairyCow
Wean Feeder Non- -Layer DairyCalf
o Finish S bx(. T, .:, DairyHeifer
, �.F.
o Wean Design Current Dry Cow
o Feeder '� `' Dry P,ouI , Ca ace P;o airy
o Finish Layers Beef Stocker
.:
Non -La ers Beef Feeder
Pullets Beef Brood Cow
«�
_ �� Turkeys
Other F Turkey Poults
Others Other
Discharees and Stream Impacts
1. Is any discharge observed from any pan of the operation? ❑ Yes LDNa--❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑-I A ❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWR)
❑ Yes
[:]No
�A
❑ 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
ff"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
E:fNo
❑ NA
0 NE
of the State other than from a discharge?
Page ] of 3 21412015 Continued

Facility Number: - ?0 jDate of inspection: '
Waste Collection & Treatment
4. Is.ctoragetapacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
[;� NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑-NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 i Slp
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
�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
[a -No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[a'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
W. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[:rNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): c rv�t s8 ,, o rIva
13. Soil Type(s): ,1 w _ Q']I o 'LV
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q10
❑ 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
[3-No
❑ NA
❑ NE
Required
19.
Records & Documents
Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
MNo
❑ NA
❑ NE
20.
Does the facility fail to have all components ofthe CAWMP readily available? If yes, check
❑ Yes
[!fNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3'-No
❑ 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 Ef� Jo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FfN0
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑,<o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
QKo
❑ 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
Ll lvc
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[2-No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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 Q o ❑ NA ❑ NE
❑ Yes []-Ido ❑ NA ❑ NE
[] Yes [-No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes Q'No
❑ Yes CJ'No
[:]Yes [a'No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA 0 NE
jj11 r
Reviewer/Inspector Signature: ?,C/ Date: ?Io-q33- 341
Page 3 of 3 21412015

Date of Visit: p-b - Arrival Time: Departure Time: ��?,, County:`'. Region:j��
Farm Name: �rTrx - 5 Owner Email: �
Owner Name: /-` Phone:
Mailing Address:
Physical Address:
Facility Contact: tr'r/ dam• Title:
Onsite Representative:
Certified Operator:Gu1
Back-up Operator:
Phone: Integrator: j _�/�! //
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Desk -Current._
Design
Current
Design Current
Swine
Capacity
. Pop
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
°
Q R
DairyHeifer
Farrow to Wean
°
Design
Current
D Cow
Farrow to Feeder
D .. P,oult .
Ca aci
P,o
Non -Dairy
Farrow to Finish
e _
La ers
Beef Stocker
Gilts
Nan -La ers
I
Beef Feeder
Boars
Pullets
Bee f Brood Cow
. ,.
,
Turkeys
z .
Other, _
� � t- V
Turkey Poults
Other
Other
Discharges and Stream Imnacts
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 M No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes
[-]No
❑ NA
❑ NE
❑ Yes
[. No
❑ NA
❑ NE
❑ Yes
[�-No
❑ NA
❑ NE
Page I of 3 214120I5 Continued

' Facility Number: - 14W jDate of Inspection-
r
f Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z[No ❑ NA ❑ NE
R
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): Z2 -3 Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[�X No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
_Wa_s_te 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 E2�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): �/ / U�l�-r kern 4z-�l __( r1-1
13. Soil Type(s): �.[Ja�r - / ,� -/ �o ""�P- !k , l L V,---
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;F�No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
5 No
❑ NA
❑ NE
❑ Yes &,No ❑ NA ❑ NE
❑ Yes UNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [Z�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes allo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;&No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ®No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ;ZI-No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Rj No
I
1 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes J&No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes JKNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M 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 rLe"14 No ❑ NA ❑ NE
❑ Yes C, No ❑ NA ❑ NE
❑ Yes VQ No ❑ NA ❑ NE
[:]Yes RNo ❑ NA ❑ NE
[] Yes
®, No
❑ NA
❑ NE
❑ Yes
Jallo
❑ NA
❑ NE
❑ Yes
5� No
❑ NA
❑ NE
Comments (refer to question.#) Explain any YES answers and/or any additional -recommendations or.any other continents.
Use drawings of facility to better�eaplain situations (use additional pages as necessary) , . =f
A,
CrrxXi��' ' '-�.' �.S�e�d�i✓ fur_ .d� rh� a � v�o/�
Reviewer/Inspector Name: S/Y��
Reviewer/Inspector Signature:
Page 3 of 3
Phone:l�33
Date: //D
21412015

Type of Visit: om ance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Cr Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: : 0 o Departure Time: ; 3 O County:. �p
Farm Name: Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address:
Facility Contact: _4f2-,� .e- r /*D r -r� Title:
Phone:
Region:
Onsite Representative:
�� _
Integrator: �,�
_
Certified Operator:
x
X y
�z-�/ /�
/�/`
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
iT Mesign Current Design Current
Design Current
Swine kr.
Capacity Pop. R'et Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Da!a Calf
Wean to Feeder
Non -La er
Feeder to Finish
-
Dairy Heifer
Farrow to Wean
Dg Cow
Farrow to Feeder
I) , P.oul Ca aci Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Other
Discharizes and Stream Impact
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 g No ❑ NA ❑ NE
[:]Yes [—]No
[:]Yes [-]No
[:]Yes ❑ No
[-]Yes ®..No
[:]Yes EE[No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
2/4/2014 Continued

Facility Number: - jDate of Inspection: — 3 per/
Waste Collection & Treatment
s 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes rMNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): q / 5-
Observed Freeboard (in): 33
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
tom, No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Apptication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No [DNA ❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 2] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops
from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
E3 No ❑ NA ❑ NE
® No ❑ NA ❑ NE
JZ No
❑ NA
❑ NE
Callo
❑ NA
❑ NE
[3.No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes f2g-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 jg No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ l20 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? 0 Yes CE-No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JQ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

It
FacHity Number: - Ds ection:
14. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [,No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes C&No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0 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
MNo
❑ 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
gNo
❑ 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
jg� No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
ELNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[—]Yes
2. No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
EE�No
❑ NA
❑ NE
Comments (refer to question #): Explain any.,Y]E answers and/or any additional recommendations or any other comp' nra
ts
Use drawings of facility to better explain situations (nse addtlonal pages as necessary). „ d
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: ff /—vim/b
2/4/20M

a
iype of isrr: 40 c once inspection V vperanan Review CJ lirucrure r vatuagon V i ecltmcat �►ssistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: j 9 County: Region: O
J :
Farm Name: �H+tts NLai/pr M7l ,�ynWg��Eyto,'rWh [l O Own r Email:
Owner Name: Kp el-st- F Phone:
Mailing Address:
Physical Address:
Facility Contact: l'YY� por C Title:
Onsite Representative: �L
v
Certified Operator: -�� �jarx fn'r-
Back-up Operator:
Location of Farm:
Phone:
Integrator:yr frydc�vv�
Certification Number`:
Certification Number:
Latitude: Longitude:
resignCurrent
DestgQ Current +.._
Design
Current
Swine
ty .., I,
Caper Po
Wet P oultry
"Ca acr =�Po
p P
Cattle Capacity
Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder Non -La er
Daig Calf
Feeder to Finish
p p
Dairy Heifer
Farrow to Wean
D�esi�Current ?
D Cow
Farrow to Feeder
D . P.ault .
Ca` ciPo`
Non -Dairy
Farrow to Finish La ers
Beef Stocker
Gilts
Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
err.
�`
Turkeys
..
nerAMEMPLA
Ot"'
Turkey Poults
Other
Other
Dischar es and Stream lm acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 2[No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes [3-No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes CjjkNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - 8'0 Date of Inspection:
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in): Ny
Observed Freeboard (in): 65�v OYD , j 3.3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[ tN 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
[ANo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
j&o
❑ NA
[] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
I0. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
UNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ONo
❑ 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 ❑
Outside of Approved Area
�Application
12. Crop Type(s):l-rn u�u gJVr�Sz-��
13. Soil Type(s): V k
14. Do the receiving crops di r from those designated in the CAWMP?
Yes
f&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
CZ No
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
[ONo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[RNo
[] NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
[:]Yes
r No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
K No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E&No
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 113ate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes R No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 54_No ❑ NA ❑ NE
❑ Yes F6LNo ❑ NA ❑ NE
❑ Yes,, Q No ❑ NA ❑ NE
❑ Yes CE"o ❑ NA ❑ NE
❑ Yes CK No
[:]Yes [gNo
❑ Yes [;a No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Phone: 4?10— 3 ,3mp
c
Reviewer/Inspector Signature: Date: /l
Page 3 of 3 21412011

Type of Visit: &Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint Q Follow-up O Referral Q Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: 1 /O,' At County: rry
Farm Name: AL ..jF A e�Lr 2 FT Owner Email:
Owner Name: 1 �0 N �y �p/Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: .'l'Y!" Iftwy, Title: �o� � �� Phone:
Onsite Representative: 1 integrator: f /T+wr
Certified Operator: Le--?t %V L�y�/ _ ! - Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design C_ u"rren#
Design Current
Swine
Capacity Pop.
Wet Poultry
Eapacity
l?op. -
Cattle Capacity Pop.
Wean to Finish
Layer
Non -La er
R
Dai Cow
Dai Calf
airyHeifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
D , Poultr.
Design
Ca aci
@urrent
Po .
_Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Non -Layers
Pullets
Turkeys
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars
Rher
<:
Turkey Poults
C►tlter z "
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
[:]Yes [—]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ER No
❑ Yes 0 No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: 92- Ds ection: — J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�KNo
❑ 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:r
Spillway?: Pr
Designed Freeboard (in): f � 1 `'j`
Observed Freeboard (in): _3 5-- yL1 1�2 1.5� q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[[g 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
SNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
kNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
gNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
D?-No
❑ NA
❑ NE
maintenance or improvement?
I I. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Types) �h�Q I i�fJ rI�.S A'DIrt. / t 4--270' A&-SM -+s
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes [a No ❑ NA
❑ Yes No ❑ NA
❑ Yes ® No ❑ NA
❑ Yes ® No ❑ NA
❑ Yes M No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
® No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑Yes
®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
CF�No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Go No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection: —!S"I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q;No
i t 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [a No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 53 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 E�No ❑ NA ❑ NE
❑ Yes E4 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
❑ Yes No
❑ Yes ®, No
❑ Yes 5?LNo
❑ NA] NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to tquestion ft Explain any YES answers and/or. any additional recommendations or any other comments:
Use drawmgs.of facility to'better explain situations (use additional pages as necessary). 'v
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 22-p- 03
Date:
21412011

ion of Water Quality
Facility NLLM er L &0 Division of Soil and Miter
� Qlher Agency
Type of Visit: mpliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Moutine 0 Complaint O Follow-up O Referral O Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: D •O l7 Departure Time:1 County:�rz Region:
ff �
Farm NameOwnerEmail:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: e r _�%b:� Title: ,%alYc.• Phone:
Onsite Representative: integrator:
Certified Operator: Certification Numb�e"r'�/'�y/�.
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Ca aci ty Po P•
P
T
Weoultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Fren
Dr. P.oul Ca aci P,o P.
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
La ers
Gilts
-Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys_
Turkey Poults
Other
Discharges and Stream Imuacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ff[ 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
0 No
❑ 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 1 of 3 21412011 Continued

1~ acili Number: - jDate of Inspection-,
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [&No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;5-No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yes
[2--No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
P 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
fK No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
[3No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
CE[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 WindDrift❑ Application Outside of Approved Area
f❑
12. Crop Type(s): Yb,-L e/` `z-nf Z �5�1t r, Z !t icLLZ &.. i!4w"yi
13. Soil Type(s): a.N� 1 � j 4�,:jogcy jS _ L y/1 ,,j'
—
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
01 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Callo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
(allo
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [-]Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E) No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes )I No
❑NA ONE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection:
• 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JM No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Dg-No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
® No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature.
Page 3 of 3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes Eg No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes No
❑ Yes f2l No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 2-- %�
Date ��D- 3'330�
21412011

I'm
Type of Visit: <DlCompliance Inspection O Operation Review p Structure Evaluation 0 Technical Assistance
Reason for Visit: outine O Complaint Q Follow-up Q Referral O Emergency 0 Other O Denied Access
Date of Visit: �%/ Arrival Time: p ; 3 Departure Time:�r County _3'
Farm Namer3`/V�,,�� ,J to j wner Email:
Owner Name: n !, Prr acq Ln�` Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 5�qr�
Certified Operator:
Back-up Operator:
Location of Farm:
r—
nYCI- rnOOre Title:
Integrator:
Certification Number:
Region: f�Rj).
Latitude:
Phone:
Certification Number:
Longitude:
Currents � g � rrent
Design Current
1111111111tues',ign
Swine !
ty VPop T Wet Poult
ci. ry
� �
Ca achyI'
p P P ty p
Wean to Finish'"
Layer
DairyCow
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
O ,.
DairyHeifer
Farrow to Wean
Design Current
R
D Cow
Farrow to Feeder
4 :D "' P,.oulf': Ca ati Po
Non -Da'
Farrow to Finish
4! Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
rood Cow
Beef Brood
,..< -. Turkeys
Other
Turkey Poults
fib"
Qther
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes P21 No ❑ NA ❑ NE
[:]Yes [:]No
[:]Yes [:]No
❑ NA ❑ NE
❑NA ❑NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [gNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

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

•
Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [-]Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes ® No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ® No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes '2 No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 0 No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes allo
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑NA ❑NE
[DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA I—] NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Phone:`��
Date:
21412011

Type of Visit (�rCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Romputine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1 — Arrival Time: '. [J Departure Time: i] County: Region: / A D
Farm Name: �rrc1�5 LLAZ Al- 1��'r� _ Owner Email:
Owner Name: Ra f7, L- f— Phone:
Mailing Address:
Physical Address:
Facility Contact:Title: �` Lt�rl r/` Phone No:
Unsite Representative: h m-slor/�7t7'Crr� 'integrator:'
Certified Operator: f___ Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = 6 = {1 Longitude: = o =, = «
Design Current Design
Swine-. Capacity Population __ We't Poultry Capacity
Current
Population
Cattle
Design Current
Capacity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish
Dry Poultry
❑ Layers
❑Non -Layers
❑ Pullets
❑ Dairy Heifer
❑ Farrow to Wean
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Beef Stocker
Gilts
❑ Boars
❑ Beef Feeder
Beef Brood Co wl
Turkeys
Other
_j
Number of Structures:
❑ Turkey Poults
❑ Other
❑ Other
�11
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes f4 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
(A No
❑ NA
❑ NE
❑ Yes
C,No
❑ NA
❑ NE
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 P9 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): % g g /`- / !
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes BNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes L,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 C!kNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [gNo ❑ 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 DINo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Qq No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [ RNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V�FNo
❑ 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
5� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CgNo
❑ 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):
/T r p 51j
G !� ! i tj fL�► Zi v V \ + i ��f
Reviewer/] nspecto r Name I LVI d— e� f Phone: O r 3-770
Reviewer/Inspector Signature: Date: rV
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 [23No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes [gNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ER No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[X No
❑ 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
5d No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�RNo
❑ 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
J,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
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
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
12128104

i
_&TM5 1I-z 3 -zoo 9
Type of Visit 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: //; S`SAy.r Departure Time: /Z; J'o County: �uw-ps-e:J Region: /�'O
Farm Name: R o6e✓� /i/G.X t'O r v,.•► _ Owner Email:
Owner Name: k>vb.fr--I�' A141.1oy Phone:
Mailing Address:
Physical Address:
Facility Contact: _CZ r- r_ e, ✓ M ao re_ Title: 724_ 4Phone No:
Onsite Representative: (gre-e-r- ,,ll�.c_-n-r-e _ _ - Integrator: AA4-Kp ''d �-►�
Certified Operator: —R06ev Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0' 0' [�:] Longitude: 0 ° [= I = N
Design Current
Design
Eurrent Design Current
Swine Capacity Population Wet Poultry
Capacity
Population Cattle C►►apacity Popla ution
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
Non -Layer
❑Dai Calf
Feeder to Finish
[I Dairy Heifer
Dry Poultry
❑ D Cow
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
El Beef Feeder
❑ Non -La ers
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ TurkeyPoults
Number of Structures:
❑ Other
❑Other
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
V
Discharees &Stream Impacts
1. is any discharge observed from any part of the operation?
❑Yes
,.,
,_y
l'No
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field ❑Other
a. Was the conveyance man-made?
❑Yes
❑ No
[}i�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
0-1'rA'
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
El Yes
❑ No
B'1�A
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑Yes
NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑
,[..i��da�❑
LJYes No ❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

i •
Facility Dumber: 82 — 80 Date of Inspection
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? r
�I'xN -ftW
El Yes 3 No ❑ NA [I NE
Structure 1 tructure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: Lag 2 Gq9 3 _ r�4Z_
Spillway?: NO /VD NQ NO
Designed Freeboard (in): R ZY Q A* Z 91
Observed Freeboard (in): ,25' 2Ca 3 (a 13G
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes C7 1No ❑ 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? El Yes fi' No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [3 o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 3"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes D o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Lfitvo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 6,2:,4 c.J _ Cc, A!
13. Soil type(s) &Ps Loy NQ f} EJa-9
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
L- No ❑ NA ❑ NE
10 El NA El NE
D'O'No ❑ NA ❑ NE
E o❑ NA ❑ NE
B<ff❑ NA ❑ NE
'Comments:(refer to question #): Eiplain'Iany YESanswers andlar any;recommeudations or any other4comments.
t b b .., e,
ations. (user additional pan ges as ecessaryj: Use drawings of facility to better explain situ
r.s
1ajGrd 43 it, G.-itcrlS V S •cJv�c�,
Reviewer/inspector Name r-W C X Phone:
ReviewerAnspector Signature: Date: //—/6 -- z00C/
12128104 Continued

Facility Number: 82 — 8o Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other
❑ Yes f No ❑ NA ❑ NE
❑ Yes 2 o ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application [:]Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Weather Code
Rain Inspections, ❑
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
�
2 o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
93'N' o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B<o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9, o
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
o
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El1_`7Yes
,2
r10
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [�io ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
©<o ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�,�
L� go ❑ 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
ElL
,--,
T1vo ❑ 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
�--, �,�
IDS, To' ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L7ivo ❑ NA
❑ NE
12128104

Ei
t`/ �� /- 0 e - 0 1 RiL-
-
Type of Visit O'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 tgoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Z-D2-O 8 Arrival Time: Departure Time: %Z.'45' County: 940" A -Region:
Farm Name: k2n bcr ��str_ / v Owner Email:
Owner Name: 10"l ✓f ct /o✓ Phone:
Mailing Address:
A'Ao
Physical Address:
Facility Contact: re c l,- Title: sec • Ye er#—1 Phone No: r�
Onsite Representative: Gr e-e-i/' Roovt Integrator: lrem, ,axi
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e Longitude: = ° u .
`�Desi 'Current
Design Current
Design Current
CKapracityPop�ul�a'on
Vet Poultry Capty Population
Cattle
Capacity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
❑Non -La er
❑ Dai Calf
Feeder to Finish
❑ DairyHeifer
El Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
FEI�No�ne�-L]aje]r]s�
❑ Beef Stocker
Gilts
❑ Beef Feeder
HBoars
❑ Pullets
❑ Beef Brood Co
Other - � _M �� :ems
❑ Turkeys
❑ Turkey Poults
Other
❑Other
Number of Structures:It
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
t No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
El No
,�,/
LONNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
L✓J 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)
ElYes
❑ No
�NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
E No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Q'�o
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

]Facility Number: 6L gD Date of Inspection it oz-0
Waste Collection & Treatment
�,/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
NNo�o
[I NA
[I NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
,E��
L� No
❑ NA
❑ NE
Structure I Structur4) Structure® Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 7-1 3-3 Z �/ 26
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
D o
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ffNo
❑ 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
ETgo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[ -go'
❑ 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
C3�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
,.,�
[No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes 2lvo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift❑ Application Outside of Area
12. Crop type(s) G4-kL4 Lk de"_ C6Iaag, lr r✓ , l+ C, t3fcr n! S ;� 4!�;t-a�'r✓S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes &- ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes D'go ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[3'7�o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[I-N—o
[INA
❑ NE
18. Is there a lack of properly operating waste application equipment? ElB Yes
wo
❑ NA
❑ NE
Reviewer/inspector Name li L' ��ew�� Phone: %/df f 33 •
Reviewer/Inspector Signature: Date: fZ—OZ — 2-94 g
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 E I�o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes D-o ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EKo ❑ 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
El-<o
❑ 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—
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
B'5o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
<oo
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Yes
Ell<
r[-,}
o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ to
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LJ 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?
El yes
��
EKo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
['No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElLJ�Yes
��
5o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑wo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit `R Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit )D Routine Q Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: jt�`j I Arrival Time: 6 Departure Time: ' 150 1 County: SO1 Region: ►`"=
Farm Name:�_a s. Maw.Aa Fv,, !� F- !� Fo4~t i- k>t`[ 1V7*Owner Email:
Owner Name: q?'G6� +__
Mailing Address: `
Physical Address:
Phone:
Facility Contact: Qlf= ..! !-halt- ^ Title: ` Phone No: l 10
CLI
Onsite Representativeaft
Integrator: ��
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: [� o [= Longitude: = o ❑ 6
Design Current
Swine Capaty Population Wet Poultry
Desii,� i Current
Capacity Papules
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
' ❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ DairyCalf
eder to Finish
g5
Dry Poultry
❑ La ers
❑Non -La ers
El Pullets
- ❑ Turkeys
_= ❑ Turkey Poults
Y` } F .
❑ Dairy Heifer
❑ Farrow to Wean
El Farrow to Feeder
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
El Beef Feeder
❑ Beef Brood Cowl
❑ Boars
Other
Number of Structures:
Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
❑ No
JA
❑ NE
❑ Yes
❑ No
>I&A
❑ NE
❑ No_ZSkA
❑ NE
❑ Yes
❑ Yes
1Qj4o
❑ NA
❑ NE
❑ Yes
J
❑ NA
❑ NE
12128104 Continued

Facility Number: W Date of Inspection
I Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: L
❑ Yes No
❑ Yes No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): o
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) jQ
9. Does any part of the waste management system other than the waste structures require El yes A No ❑ NA ❑ NE
maintenance or improvement?
Waste Aunlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesVo El NA El NE
maintenance/improvement?
11 _ Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes ONo ❑ 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 AcceptableCropWindow El Evidence of Wind Drift ❑ Application Outside of Area
12_ Crop type(s) t.v, C-, t ols S A
13. Soil type(s)
14. Do the receiving crops differ from those designated in thaAWMP?
❑ Yes�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes _/60
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[]Yes X No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �PNo
❑ NA
❑ NE
Comments (refer to question Explain any YES answers and/or. any recommendations or any othef4commients. ;
;i1se drawings of facility, to better explain situations (use 'additional pages as necessary)•*:; _ z�
-- Q fir �e S�n s ,'L-d su �+ ; n 44,, ,a6c, r 1 . � 5a S �
Reviewer/Inspector Name [ K
Reviewer/Inspector Signature:
Pape 2 of 3
' 0 3 60
Phone: Date: 3tx-t l Q c:N:)
12118104 Continued

Facility Number: — Date of Inspection �1
r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design (—]Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
aste 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
_kNo
❑ NA
❑ NE
23_
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
ff NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
IqNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
10 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes kNo
❑ NA ❑ NE
29_ Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes Ijs10
❑ 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 )ONo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
,
El Yes t'6 No
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes o
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes Wo
❑ NA ❑ NE
Additional Comments and/or Drawings:
'..
21 , Owncr m us� �' �' ! [ a � -� Corn I-e e o >1
sorer
i
` y W Y1QYt fO �f i C O Ir15 L� i�tt� ✓1
NQcd 4 prau 1- a,cc L, va4f u n, ; n
P 5
>
S f k! 1* Qn �
P P S�uYc�,�zo,�,;r,cc
�� ► re13�
.
Page 3 of 3
12128104

Date Facility No. =� Time In 10 (30 Time Out
Farm Name rr fvwld Integrator M_
Owner Vj 12LSite Rep �tii1��L
Operator No. 1
Back-up No.
COC Circle: � or NPDES
G
Desi n
Current
Design
Current
Wean - Feed
Farrow — Feed,
Wean_-_
Farrow — Finish
eed— Finish
Gilts 1 Boars
Farrow — Wean
Others
FREEBOARD: Design
oiuu c
Crop Yield O� � D� �
Rain Gauge r_ . /
Soil Test �� PLAT io k- "
Weekly Freeboard ..=r Daily Rainfall %_
Spray/Freeboard Drop 3 0 S I J� 4
Weather Codes 120 min Inspections
Waste Analysis:
Date Nitrogen (N)
L�1%�01 l.� 1.5 1.�i /•`�
3
Observed Q �i S'&
Calibratior!!GPM Sla316V 3 as -
Waste Transfers
Rain Breaker
Wettable Acres
1-in Inspections
-1 l7
s ! S"110
Date Nitrogen (N)
Pull/Field
Soil
Crop
Pan
Window
l --3 3
i4
�3 a
S
°
lCl.
�-►e
s a
s
W4
w
rCi--
3n
S
l�o
4
is
C
S
J
18�
w
Z.a ) Llti2Z)
-Z3 s'x V
S

11�
I- w t

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �- �dQwti Departure Time: (� f ��QI " County: �^ Region:E:9-0
�
Farm Name: jannPS
// O I OwnerEmail:
Owner Name•.. � t 66k3:�3 1gr— Phone:
Mailing Address:
Physical Address:
Facility Contact: �T Title: Phone No:
Onsite Representative: �JLtrlil('� R�" vO V-'- Integrator: Pf �y►'lr4GIM 7T��tgQryl
Certified Operator: r""� � Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = a Longitude: = o = f I= u
fDestgnurrent
esign
uurinatDesign
Capacity 'Population
Wet Potltry Capai�tCurrent
cl o elationSwine
Cattle Ca aci Po n
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Nan Layer
❑Dai Calf
Feeder to Finish] 7ot�
❑ Dai Heifer
Farrow to Wean
1)ryPoultry `'
❑ D Cow
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ $oars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other �s..�- s:: ..
❑ Other
0 Turkey Puults
10 Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 0 No ❑ NA ❑ NE
[--]Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
M NA
❑ NE
[11 NA
❑ NE
❑ Yes
❑ No
❑ Yes
191 No
❑ NA
❑ NE
❑ Yes
R9 No
❑ NA
❑ NE
12128104 Continued

.11f
!Facility
Number: e);t — $ D
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes [N No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No [�tNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: # I _ L a5 �- _ Lau 1 3 is
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 39 y P'ie 3 to" tq 9 :f
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [A No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes r.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 AcceptableCropWindow El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) rti.cialQ 6!4LX_ i LJJaa-+, .SoN . �,� fl6e,'Sae"/ -
13. Soil type(s)
bob, Lrn
14. Do the receiving crops differ from those designated in the CAWMP? CO*YesJKNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[n No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[Z 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
® 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 sitteattons.-(use additional pages.as necessar*) �I ,.
Reviewer/lospector Name D �� ^~ Phone: /O2 �%3 -3,3G�
Reviewer/Inspector Signature: Date: 9 ;24 -n("
Page 2 of 3 12128104 Continued

Facility Number: lea — 0 Date of inspection
Reciuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C� 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 El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [I 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
[19 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KA No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[XNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
P] No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
U No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
F�J No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
tZ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
q No
❑ NA
❑ NE
Additional Comments and/or Drawings: ,i+.;w
Page 3 of 3 I2/28/04

r
WE
07
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine Q Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 3 /S v S Arrival Time: $; w a Departure Time: County: Saa�nsan Region:
Farm Name: 21-1a2..S Z. Ala, lac �ie�_`_�eri�r7� a„Owner Email:
Owner Name: /QoAa: f a. J ru y+-s %I%a—A/- _ Phone: 9,v- SGY_-_G_Q��
Mailing Address: a C C/ NC .-2
Physical Address:
Facility Contact:
Onsite Representative: dfa�y,4 N.y 4,
Certified Operator: /►/� . AeAL /..
Back-up Operator:
Location of Farm:
Swine
Title:
KO. 49
Phone No: yea• SZ er - G rsseJ
Integrator: Aleewia"
Operator Certification Number: / V ` ll-
Back-up Certification Number:
Latitude: = o = Longitude: E—_1 o 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
h ❑ La er f
❑ Non -Layer
❑ Wean to Finis
❑ Wean to Feed
[ ccder to Finish
7 oo
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
�.
❑ Boars
Other
❑ Other
Dry Poultry
_Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges & Stream Impacts
I _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ DairyCow
❑ DairyCalf
❑ Da' Heifer
❑ D Cow
❑ Non -Da
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
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 [Q<o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
El f4o
❑ NA
❑ NE
❑ Yes
91�o
❑ NA
❑ NE
12128104 Continued

L
f
Facility Number: 8g — gD Date of Inspection 13 & -as
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
Identifier: r-f _-2. 3 �L� _
Spillway?: 170 _
Designed Freeboard (in): "�.`��� _ _ /y'�_ C1-��p !090w, y;�
Observed freeboard (in): z2 i 217
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 2'N'O ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ['No ❑ NA ❑ NE
❑ Yes D-fio ❑ NA ❑ NE
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? 131Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[jNo
❑ 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
2rNo
❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
M'No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ElApplication Outside of Area
-rs2,
"'1t�."2r 10"yo s � � 3 ii7 L i.c ],t -1w 4-10
�
:OA 79
12. Crop type(s) a r
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
Dofgo
❑ NA ❑ NE
IS. Does the receiving crop and/or land application site need improvement? ❑ Yes
EINo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
❑ No
❑ NA UNE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA DOKE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
GINo
❑ NA ❑ NE
-T'nsopecAs ;/s
hof 5(,ec
.f *A4t
.1es,-j,
a-10` Trte;e.,t +fie. Fr-.7, A/,•// can5vl�
e179,'.1e4rr [!n/1
Ptrf rv1 q
fj��iw
v� �o
e�pri �� oe ee s.,4
Reviewer/Ins ector Name
p [Yr% �r�n Phone: ? O G ` ov/ P o
Reviewer/Inspector Signature: Date: 3- IS-o ff
LL/1Lc/(!4 r-onnnuea

Facility Number: ga — SV Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? B<s ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ � ❑ Cl fists ❑ Design ❑ M� ❑ Ot�e�
21. Does record keeping need improvement'? If yes, check the a3prQpriate box below. [�5'es [--]No ❑ NA ❑ NE
ElEl� eeb--w d ❑ as — E N 7-:;e��4iraiysrs ❑ > st7,1:1 v
❑ Rein" ❑xteekitvg ❑'( rop Yield ❑ L s �onthly and 1" Rain Inspections ❑ VAath"ede
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
O'f10
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
�lo
❑ NA
❑ NE
❑ Yes
[20No
❑ NA
❑ NE
❑ Yes
�lo
❑ NA
❑ NE
❑ Yes
9'No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
Qigo
❑ NA
❑ NE
❑ Yes
E2'1 o
❑ NA
❑ NE
t1 Ne -e,,
LCl /e
of cawow5e
0.c 0006c."t
6�f
)44t heti
/eer—,V- �s
Lei
rHsPec7'o+
t+,'H a1G.�
rw. C. fv
it
y~ , /%iwse
p/eee
c_dpel
r
31, 1°%4,�e I%ie00 Gro ;et rG .,-
Zns�peGl:o-rS. /�9,91rf cis. /� J
drr us,'na J TPta�oq�p� /O*pe
1.700.1 le ve /s ar,.� ra '., f;�/1 G ✓ems , J
Please
Oor?�
flr�!
Svrv�7. i�
�Grn7 rC�pt�s
C.Grner e{
Lo9oon 7r
rf4S
,So+7t G�ot.�
Gn� Cave
Jt /rig
12/2&04

(Type of Visit p'Comgliance Inspection O Operation Review O Lagoon Evaluation
for Visit (WRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of visit: / v Time: /�•-
Facility Number p
Q Not O erational O Below Threshold
[Permitted dCertified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: .... _.............
Farm Name: II 7 R° ..... �a_rY+a 5..... I o r..........__...._._. { .��3..... i o �------------.�...._._ county: _._.����^ _....... ......�..._...._._ ....._.__._.W_.
Owner Name:... � s ¢... Rb bcr 4-.� A1.W /,R � ._.. Phone No: g/0- �G - �j sit
'Mailing Address: „ a9t$'±...� _—� I r� i!N _ .1 C C gs2
Facility Contact: �v'i A-10�0 Title•w� Ma.+ Gr Phone No: - �... _. �_... ----
1...I................ .-............................ ... yit..---------- }
OnsiteRepresentative:.. �° `�._-M J" 1, m. __.. Integrator: !+,iw. T p�d�•/� __ __ ._
Certified Operator:._._.,,-_J, _ --l-- W Gt� ��Q _ Operator Certification
Location of Farm:
❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 r_�46 Longitude 0 & &A
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes o
Discharge originated au ❑ 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
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [RINo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [ O
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [j3/No
Structure I Struct�r 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 3
Freeboard (inches): 30
12112103 Continued

Facility Number: 89 — Zp IDate of inspection ! a
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [3No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes GkKlo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) ��!!
7. Do any of the structures need maintenance/improvement? ❑ Yes L2'No
8. Does any part of the waste management system other than waste structures require maintenancerirnprovement? ❑ Yes�VC
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes �o
elevation markings?
Waste Application
I0. Are there any buffers that need maintenance/improvement? ❑ Yes [No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes L o
❑ Excessive Ponding ❑ PAN , ElHydraulicOverload ❑ Frozen Ground ❑ Copper and/or Zinc
s
12. Crop type �pt5*ka M+ rl [ f j t�eCa! f7, &X N , -fl l GcwS . * A04 G
13. Do the receiving crops differ with those designated in the CeC
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Animal Waste Management Plan (CAWMP)?
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
I-6-ys l'.W �'j '-'j " Lam„ 0'11*�..t,4.
Reviewer/Inspector Name
❑ Yes r_D�4o
❑ Yes Q'�lo
❑ Yes 9(No
❑ Yes 2 Igo
❑ Yes dNo
❑ Yes 2%
❑ Yes No
❑ Yes 940
❑ Yes &O
❑ Yes
❑ Final Notes
Reviewer/Inspector Signature:
Date:
12112103 Continued

41 Facility Number: it — gV Date of Inspection
Required Records & Document~ �
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes lk<O
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes OTo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M,
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0'No
25, Did the facility fail to have a actively certified operator in charge?
❑ Yes
Q*f4o
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
lfio
(ie/ discharge, freeboard problems, over application)
27_ Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Lfivo
28. Does facility require a follow-up visit by same agency?
❑ Yes
9<0
29. Were any additional problems noted which cause noncompliance of the Certified AWMP7
❑ Yes
m4 o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
eYes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
B-110
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
2 Z
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
ER o
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
2
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
2<0
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
12112103

Site Requires Immediate Attention: ,
Facility No. pe't
DIVISION OF ENTMONMEENTAL MANAGEMENT
ANIMAL FMLO'T OPERATIONS SITE VISITATION RECORD
DATE. tD Au.a--t , 1995
Tine: I'CO D
Farm Name/Owner:. Sob to NA "K..* L
Mailing Address: 1 1 B wL Zl - C.-CJ-A+J� o N 111. C . Z$'.5 L$
J�
County:. 5 ABM � S o 1 j
Integrator: -Ti\QUR N FAA LO.5 E m C. phow: ! 4 oo- O'ci -- Z 1 t T
On Site Representative: o1e. N& Y LOK_. Phone: 910 - S i4— (aW
Physical Address/Location: un.t,jj Sc— t-103 A " f'a kS
Type of Opm6on: Swine Poultry Caine
Design Capacity: Number of Animals on Site: i �10
DEM Certification Number: ACE DEM Ceitificadon Number. ACNEW
Latitude: • �' Longitude: '
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour stow event
(approximately 1 Foot + 7 inches) `Ye or No Actual Freeboard: 3�t. to Inelms.
Was any seepage observed from the oon(s)? Yes N0 was any erosion ob ? Yes No
Is adequate land available for spray? es or No Is ft cover crop adequate , or No
Crops) being utilized: -Q kSC Jai-."
Does the facility n;-cet SCS minimum setback criteria? 200 Feet from Dwellings . es or No
100 Feet from Wells? ©or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Sumo? Yes or®
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes OQ
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes No If Yes, Please Explain.
Doer the facility maintain adequate waste management records (volumes of manum, land applied,
spiny irrigated on specific acreage with cover crop)? Yost No
Additional Comments:
Inspector Name V Si
cc: Facility Assessment Unix Use Attachments if Necdtd.