820110_INSPECTIONS_20171231

NUHTH CAHULINA
Department of Environmental Qual

Wean to Finish
Wean to Feeder
Feeder to Finish
Z
0
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
y>NG o1 r 1131t: W L.u�� ,+uuuc 1uwu v v �NCupcuuu cv ll � u..r�crr iutwv u�a: l c Grulaualull ■ ckual n�ll aatuumc
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: /�rrival Time: Departure Time: f Od County:
Farm Name: -� �Y �t't4� Owner Email:
Owner Name: 14Phone:
Mailing Address: °
Physical Address:
Facility Contact: l f ((/ Title:
Onsite Representative:
it
Certified Operator:
Region:
A
Phone:
Integrator: - 's
Certification Number: a 7 b
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
+!. %Y'l+i I �ii€r,!!.!
^3 ".Ih r' EEt r esign 'CurrY e.co
t!;lrar !.n`,Y,gll II ! I, !'ilSwine„ CapaPop Wet. Poultry CapacitPop t+ Cattij,Capecyli%I..YE
�
,
lllYv sl+Yli;:.i!�j i!':
Layer DairyCow ,
�3 [Non -Layer er `�ItDairyCalf
I I i '4 rtrt� r p'vly, 'II t Dal Helfer I('
i��i yjl j arz �111 �+ Y ry llili + r91Yy yllY Y !1M t z ?rrY 4 e zi�l ,Iv it (`,Ilih f 1 Is Ylr�� ill
9' Desigin Current :,I D Cow
i,l, D P.oult ICa acl ej1EII.Po` I[dil'lsil) Non-DairyPll.
�N ` La ers � Beef Stocker Ilr�i
Non -Layers 6i!dl�,l Beef Feeder
Pullets ;�4L Beef Brood Cow hIR1'Ifl
01 ; ril ,Iq+l i Il 1 1 Yi �iiri I!! II i it li , f ! u7Yl'''
Turkeys
!I'j�' I 1YII"r Y l r
Nir r! rt t ( „fI I i4tn
.Other, s + ,t," Turk e Poults Y�+' E i lli' r I�t ,Il:(I.a l �Y,,.,,, it iiYt I �' tY
I ! yu Kl� ;i I �9�i,ap i4i i�1 I Ill il�4 sE I,l tY la E r4I I �lli
yy Y
IR
�ri' „4':Y,. EI IIIVYYi?; is?jhiitt{�1 ildYY.E1Ei14€r�jiI !l ill 1i,'1 !
Other Other n } I , " ,1 'I
` 9l,�OKuIYYII��
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
to �❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[�']
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[�"l�C
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
2-No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E: Edo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of .3 21412015 Continued

Facility Number: FX - 0 Date of Inspection: 3 <<ti
7 1—
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes y[C�l E] NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ED-NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes � ❑ 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 E3-Ne—❑ 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
[j[_NQ ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[e— ❑ 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
NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
4E 1"o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes bNo ❑ NA ❑ NE
❑ Excessive Ponding 0 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):�'tr .S G
13. Soil Type(s): A1f a
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q-Ko ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [E jl\ o ❑ 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?
18. Is there a lack of properly operating waste application equipment?
Renuired Records & Documents
❑ Yes E3"No
❑ Yes 9111qo
❑NA ❑NE
❑ NA ONE
l9, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑'fVo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[3-No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
allo.
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑`No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facilit Number: jDate of Inspection: �y
24; Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes [ o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [D-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 eE:j'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?
❑ Yes [�-hro
❑NA ❑NE
❑NA ❑NE
❑NA C]NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ['No [DNA ❑ NE
❑ Yes [fNo ❑ NA ❑ NE
❑ Yes [allo
❑ Yes [,No
❑ Yes [7"No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Eomm riits,(reUr to question #): Explain any Ylg S answers and/or any;addltional recommenda}tions or, any other, commenttgs F :0 � ai 1
: RnnAA. fnarac sMAitl_ liari ifr`i�avinssa"itP'1nrIII4V-to"hatter•s+xnlslin.cituatinnc,hlca tPnnopa" ua cslrvl: Y'
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
11D _3o� b ODI
1 1� Phone: 4�1�` q�3-3s 4
` �(
re: Date: � ll-t( 1 U
21412015

T T ivision of Water Resources
1 Facility Number - V O Division of Soil and Water Conservation
O Other Agency
Type of Visit: (3-Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Q`lfoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: :5.�4 Arrival Time: .; Departure Time: V� County: �VI �-t Region:
Farm Name: ]/�. LOwner Email:
Owner Name: l w { ,if1t1 Phone:
Mailing Address: '3p0 S V k4 G f`Ghc
Physical Address: ' t t'Alb r
l r
Facility Contact: Title: Phone:
l — Onsite Representative: Integrator: lk(� S
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0-150- ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No O'1gA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DW R) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No 05ONA ❑ NE
2. Is there evidence of past discharge from any part of the operation? o ❑ Yes Q No ❑ NA ❑ NE
,;s
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facilit umber: - t10 Date of Inspection: { -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3--No- ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No[j ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes El"No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
V7rNo
❑ NA
❑ NE
K. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
En"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 butlers, setbacks, or compliance alternatives that need
❑ Yes
dNo
❑ NA
❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0"No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s): l'1-Ccl-+/�Cu�,Qrr G 0
13. Soil Type(s): o
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Q o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [�J`No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes vo ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [J No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EE 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. es
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ElWaste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ElMonthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Q o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [`No
i6� ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 21412015 Continued

Facility Number: flo Date of inspection:
24'Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, checkNA ❑ NE
the a ropriate box(es) below,
the
to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �fo ❑ NA ❑ NE
Other Issues ,
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E�-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 [9'f o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes I_]'No ❑ NA ❑ NE
permit? (i.c,, discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ffNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes dNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes allo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [rNo ❑ NA ❑ NE
Comments (refer to question:#):,,Explain any YES answers and/or any, additional recommendations or any other comments.
Use drawings';offacility;to better explain situations (use additional pages as necessary).
l
4-2-5— o t -c(-
Reviewed]nspector Name
Reviewer/Inspector Signature:
Page 3 of 3
C,,tC CI(j)-b�- 68sr
Phone: Lis
I Q - 4�3 .S
Date: l l -"e
21412015

16 �
D vision of Water Quality
Facility Number ®- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: 1�
Farm Name: 7-r16 r T M'0'. --i Owner Email:
Owner Name: ,rC Phone:
Mailing Address:
Physical Address:
Facility Contact: �y-►� y-ev7 Title: Phone:
Onsite Representative: 1 ( Integrator: A((S_s
Certified Operator: f / Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Neu z�I - C_0 �3
c t t f
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Gilts
Boars
Other
Other
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La
Pullets
Other
Poults
Design Current
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [RITo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [:]No [RNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[j3-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
CTNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ o
❑ NA
ONE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[ o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: jDatcof Inspection:
Waste'Collection & Treatment
4. Is storage capacity (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 [] NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[LNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[2'No
❑ NA
[] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[n"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[fNo
❑ 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
[ '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): iot-'CA t ' '0
IF
13. Soil Type(s): NID -_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes U:.No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
r_,no
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[n—No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[fiNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
[] Yes
[ Ro
❑ NA
❑ NE
the appropriate box.
❑WUP [I Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes F!(No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ENo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes CR o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
[21"No
❑ NA
❑ NE
❑Yes
0No
❑NA
❑NE
❑ Yes
[if No
❑ NA
❑ NE
❑ Yes Ef No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ['f No [DNA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [RII�es ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ZNo ❑ NA ❑ NE'
34. Does the facility require a follow-up visit by the same agency? [:]Yes [allo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES:answers and/or any additional recommendations or any other comments:.:
Use drawings of facility to better explain situations (use additional pages as necessary).
Sk. .e , 0(L
3 7-
�`b�� �► �-- dirt- t7 — f �
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
l�1 Phone:
Date: b
2/4/ 011

12II3 F- 6-
Structure Evaluation Inspection
Facility Number: -- `( ) 0 Date: 2'1 (SG A
Time in: MaD ,P Time out: (2 I S'
Farm Name: I v d yi Farm 911 address:
Owner Name: C v eJ Ty 1cv— Phone
Facility Contact: 1 t
Onsite Representative: I t Integrator: R
Certified Operator: f1 Cert. Number
Is storage capacity less than adequate? Yes r/No
If yes is waste level into the structural freeboard? Yes No (/
Was non-compliant level reported to DWR Vrs POA received ye,'
Structure: 1 2 3 4 5 6
Identifier:
Spillway?
Designed Freeboard (in.):
Observed Freeboard (in.): 15
Are there iany immediate threats o the integrity of any of the structures
observed? Yes _ No ," U
Do any structures lack adequate markers as required by the permit? Yes _ No
Does any part of the waste management system need repair Yes No
Condition of field's
Condition of receiving crop ( v ocP Sid'-.d
Comments:

AIMS 201()eclS
r CV Division of Water Resources
+ Facility Number ®- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: AZ;�'Cbmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (4outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: `a-�9--f-'�rrival Time: � Departure Time: County: � � Region: ��
Farm Name:: �� _��/►�.S' Owner Email:
Owner Name: C ✓'" Phone:
U'1G
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: I t Integrator:
Certified Operator: It Certification Number: r
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
ury YOWCry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non
-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes D.N6_ ❑ NA ❑ NE
[:]Yes
❑ No
�fA
❑ NE
❑ Yes
[—]No
iA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) [:]Yes [—]No E] NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [:j"No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters o. [:]Yes [�No [] NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

l
FacilityNumber: - Date of Inspection:, it
.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes p.b[n_ ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [c -WA- ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): p+
Observed Freeboard (in): -1 O
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �NoE] ❑ 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
05-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3-N6
❑ 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
C;.No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
/
D—N
❑ NA
❑ NE
maintenance or improvement?
eo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
3
❑ 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
AA
12. Crop Type(s): � �'�V`VH !.t_�A(� S O � .. .
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
024o'
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[9No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Vo
❑ NA
❑ NE
acres determination?
No
17. Does the facility lack adequate acreage for land application?
❑Yes
2
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E5No
❑ NA
❑ NE
Re ulred Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ffNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ZNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfali ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[gjNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[-]Yes
dNo
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

`!]Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ZIP/^ [3 NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [g'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
L{Ao
❑ NA
❑ NE
[3 Yes
[j?90
❑NA
[3 NE
❑ Yes
[:�Ao
❑ NA
❑ NE
[]Yes [Z?Po ❑ NA ❑ NE
[:]Yes [�10 ❑ NA ❑ NE
[:]Yes Z'No'o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes E214 ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional vases as necessary).
CGt t�%V` 4 V vt
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
OC_ T 13 _)_0 (�
a-�,6
Phone: V13 - 3 3
Date: 19 &'4�
21412014

I i� � �ID M
011Division of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ��,,ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: CTKoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:I-L_Lsl l County:
Farm Name: �y�Ct/''��` Owner Email:
Owner Name: +/' Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: .( +IL.
Certified Operator:
Back-up Operator: L[
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedej
Farrow to Finish
Boars
Other
Other
Title:
Latitude:
Phone:
Region:
Integrator: _ Mir Q/ -7
Certification Number: / t J '- IO
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
11 �� Layer
Non -Layer
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Puults
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
-.
Dairy Calf
Dai Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Bcef Brood Cow
❑ Yes D40____E1 NA ❑ NE
[:]Yes [:]No ❑ NE
❑ Yes ❑ No ❑ NE
[:]Yes [:]No
❑ Yes C2 ""
❑ Yes [.;.No
[�,XA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facilit Number: - Date of Inspection. Q
Waste Collection & Treatment �
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [g-N`o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No C]-�[:] NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): � 2
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[5-Nu ❑ 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
E'No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
r? 1qo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[:]`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
[]'1Vo ❑ 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 [2 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 ofWind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): j� f'' -'�ot S' 6 -
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
�o
[DNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
To
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[a No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�fo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
t. -No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
LE1Vo
❑ NA
❑ NE
the appropriate box.
❑ W UP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [""o
❑ Waste Application ❑ Weekly Freeboard [3 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 [TNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes' � No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Ll
It acillt Number: Date of Inspection:
2'4. Did the facility fait to calibrate waste application equipment as required by the permit? ❑ Yes V],No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes Lam 5 ❑ 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 ®4o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �10 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes /_j.Xb ❑ NA ❑ NE
UPW
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
[;�<o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
®Ko
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[�LNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Cg�<o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0<
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use addition"ages as necessary). :
0C
kj��
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: J { &V
21412014

. 6 I 11kr w. d 0
Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Cliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: u� Arrival Time: Departure Time: � County& Region
..r
Farm Name: r^: �n P ° lr l.t-+if Owner Email:
�l
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 'r .� Title: Phone:
Onsite Representative: Integrator: 'Jg6?
Certified Operator: ( Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
Design Current
Dry Pnultry Capacity Pon.
Layers
Non -Layers
Pullets
Turkeys
iTurkey Poults
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?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes [�Wo
❑ Yes [2,f4o
E�XA ❑ NE
[PINA ❑ NE
[(NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Ak
Facili Number: : - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (struc#ral plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 02 or ❑ 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 10 [DNA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenZo
eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes to ❑ 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 �0[:] NA r] NE
maintenance -or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C340
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
— /
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 Cjroop Window ❑ Evidence ofWind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): No
I4. 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
D7 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
fo
❑ NA
❑ NE
acres determination?
No
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑
❑ NA
❑ NE
18. is there a tack of properly operating waste application equipment?
❑ Yes
jrNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
c
❑ NA
❑ NE
20. Does the facility fail to have all components of the 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 �fo ❑ NA [3 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and ] " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facilit Number: f- Date of Ins ection•
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 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? ❑YesPo
NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes ❑ 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?
❑ Yes OK ❑ NA ❑ NE
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E3,W<_ ❑ 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
L.LYr`'�
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes..
II<J No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility'require a follow-up visit by the same agency?
❑ Yes
VNo
[�] NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
7
Use drawinizs of facility to better explain situations fuse additional pates as necessarv).
S (c4,t sK.� E�c a IJ ec.,3 [ Zolb
I -14-12
6C20 cc
Reviewer/Inspector Name: 1
Reviewer/Inspector Signature:
Page 3 of 3
Phon10
Date:Lo- " Iq
21412011

Ur Division of Water Quality
Facility Number ®- 1 O O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: d Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: %Vt 0 �tl County: 5A to b0n
Farm Name: I fy[�� F P+ Owner Email:
Owner Name: [�Q r� `�`�1qr- Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: 1 g-eyc 'Cy 1tr41� Title: O ui nck Phone:
Onsite Representative- S pkm t- Integrator: 7 Row
Certified Operator: SAP-, Certification Number: 14
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Non-L
Pullets
Other
Poults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
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?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [�;o ❑ NA ❑ NE
❑Yes [:]No [DNA []NE
❑ Yes ❑ No ❑ NA [:]NE
❑ Yes ❑ No
❑ Yes E� o
❑ Yes [
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number; a - Date of Inspection: Job
z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[� No
❑ NA
[] NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
® NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 24
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[v]�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
gNo
❑ 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 [fNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [R�No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ 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): bltR MUl3 A ,
13. Soil Type(s): _ NA- I WA
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 dv No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
l9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
[d No
❑ NA
❑ NE
❑ Yes
LYJ No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [4 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 d No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes []dNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

IA
J Acility Dumber: c,'? - �Jp Date of Inspection: 10 lj
24. Did the facility fail to calibrate waste application equipment as required by, the permit? ❑ Yes &No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E� No ❑ NA ❑ NE
the appropriate box(cs) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
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:
❑ Yes
© No
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Q No
❑ NA NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No
❑ NA [] NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ff No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any, other comments.',i
Use drawings of facility to better explain situations (use additional pages as necessary).
Cor\ c,vt_ woRY_a^5 car Sma,,\ bocce ARf.taS A���a L $�rri
�- �Actr. 1,J f 11 tRP3n�1�n�.D
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Cbi-303-0S
Date: I.Alig(",
21412011

Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit; 01 routine O Complaint O Follow-up Q Referral 0 Emergency 0 Other O Denied Access
Date of Visit: DtjLt� I Arrival Time: /•'b� Departure Time: County:Region:
Farm Name:1� �s Owner Email:
Owner Name: T ��/'' Phone:
Mailing Address:
Physical Address:
Facility Contact: 7 /,, - 1'"J Title: qa,,`j t-,-- Phone:
Onsite Representative: ,g5.4-4` Integrator:
Certified Operator: Certification Number: /012Ln/
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine
Can
apacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
7
b
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P.oultr,
Cu acit
P,o ..
Non -Dairy
Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qth.er
Turkey Poults
Other
Other
Discharges and Stream lmoacts
1. Is any discharge observed from any part of the operation? ❑ Yes (RNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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)
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
[]Yes JSL No
❑ Yes 1,&No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility Number: JDate of Inspection:
Waste Collection & Treatment
t 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? []Yes [& No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes M 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 environment !eat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes WNo [DNA ❑ 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 Apnlication
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 [:DNA ❑ NE
JAMJ
�] Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s): � r/I7W.4 /��/�j�t�
13. Soil Type(s): A14 1AID ¢'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes &No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes � No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes +M No ❑ NA ❑ NE
❑ Yes M4 No ❑ NA ❑ NE
Rec�ulred_Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 19711 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 8 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 Jallo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - p jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes j$ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes IS No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
jo No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
� No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air duality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
,® No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
� No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
,[ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any othercomments hz ti p
Use drawings'of.facility'to better explain situations (use. additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: �1749--�5 —Mry 6
Date: 2/Z _72� //
21412011
Page 3 of 3

48rDivision of Water Quality f 'r
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit A.CWmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outing 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: G- Departure Time: ri�� County: Region: 2&Q _
Farm Name: �%r i T- / `'�" Owner Email:
Owner Name: _ '/e—/� Phone:
Mailing Address:
Physical Address:
��'' Title: ��1 Phone No:
Facility Contact. ----_ Z:kz _
Onsite Representative: �'��---t� Integrator: _G'✓i�/f
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm -
Back -up Certification Number:
Latitude: = c = = 11 Longitude: 0 ° 0 1 = 1F
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
Dry Poultry
Non -La
Pullets
Poults
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
1. Is any discharge observed from any part of the operation?
❑ Yes
N No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ),,,h,R,0
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 adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
&No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — jja I Date of Inspection
i
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
9No
❑ 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): _ r / 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
j 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?
gYes
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[&No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
RNo
El NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 91 No ❑ NA ❑ NE
f
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Ac_�_«_"L_
13. Soil type(s) 1Vs,,0f /jk
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 9 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes F,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 0 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes CiNo ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes E No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any.fecommendations or any other foments
Use drawings of facility to better explain situations: (use additional pages as necessary.):
a.t.<A. .`'x . .
7 �u�.G�-4rk�,y.6�
�l�ul.�r�� u��3 �,��o�o�lrc_•
Reviewer/Inspector Name
Phone: fie,
Reviewer/Inspector Signature:
Date: 4u -- 'q � /O
Page 2 of 3 01 12128104 Continued

Mt Facility Number: — Date of Inspection
-`! Required Records_& Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? []Yes U[No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check []Yes 9No ❑ NA [:]NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes RNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
(J No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
®No
❑ NA
❑ NL
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2LNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
91 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
®No
❑ NA
❑ NE
Page 3 of 3 12128104

uivision of Water Quality �-�
Facility Number O Division of Soil and Water Conservation
- - Q Other Agency %a )G ---a y
Type of Visit
omplia ce Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
02ututine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Dented Access
Date of Visit: - Arrival Time: (% G Departure Time: Y County: Region:y
Farm Name: I` 7 I �r 5 Owner Email:
sr �l �z�I
Owner Name: Phone:_
Mailing Address:
Physical Address:
Facility Contact: %,�� �Y%/Title: d 1 n N�� Phone No:
Onsite Representative: Integrator:
Certified Operator: �~� Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
!Feeder to Finish
Farrow to Wean
U Farrow to Finish
❑ Gilts
Back-up Certification Number:
Latitude: = e = & Longitude: = ° = t 0 6I
Design Current Design Current
Capacity .Population Wet Poultry Capacity Population
11 ❑ Layer
❑ Non -Layer
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: F—D]
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 DjLNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
L.No
❑ NA
❑ NE
❑ Yes
[BNo
❑ NA
❑ NE
12128104 Continued

I
( Facility Number:—1101 Date of Inspection
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
19 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): 4 ��
Observed Freeboard (in): (r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
NJ 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
10 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?
Plyes
❑ No
❑ NA
❑ NE
& Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
PM No
ElNA
ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
C.No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
1RNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes j4No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) %or/�r�I r��
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes O�No ❑ NA ❑ NE
15, Does the receiving crop and/or land application site need improvement? ❑ Yes KNo ❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
No ❑ NA ❑ NE
2�lo ❑ NA ❑ NE
04111v ❑ NA ❑ NI?
Y �' '' � -k ja�aJ3'`
Comments'(rcfer to'questlon #) 'Expla�ri any YEShanswcrs and/or any r`;ecommendations or arty other comments
Use:drawings of facility tci lzetter,explain,situations (use:addltional pages as necessary):'x ;: �'`r p
4
A.
Reviewerllnspector Name �- - - _ - - -
- .� Phone:
Reviewer/inspector Signature: /
Date:
"� 12128104 Continued

i
Facility Number: f D Date of Inspection p —/5-E
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. `Yes eNo❑ 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?
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
❑ Yes
JR No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes Co No ❑ NA ❑ NE
❑ Yes C,No ❑ NA ❑ NE
❑ Yes LZ No ❑ NA ❑ NE
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes
LL^I No
❑ NA
❑ NE
❑ Yes
B.No
❑ NA
❑ NE
12/2&104

M
ti
Cd vision of Water Quality
Facilit Number Q 0 Division of Soli and Water Conservation'
Y Q Other Agency
Type of Visit ,c.,o�mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit E7 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time.. t� County: P`Region?!�R 0
Farm Name: �� �� 7— Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ri°r7l �t1/ter Title: Phone No:
Onsite Representative: Integrator: f1714&
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: ❑ o = 4 Longitude: = ° = 4
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ on -Layer
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
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: FT
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
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
PLNo
❑ NA
❑ NE
❑ Yes
§Z No
❑ NA
❑ NE
12128104 Continued

Facility Number: — 11D I Date of Inspection
h�
Waste Collection &'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ 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): mil'
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EZ 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 9No ❑ 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 X No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ 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 .4 No ❑ NA ❑ NE
maintenance/improvement?
I.
Is there evidence of incorrect application? If yes, check the appropriate box below. [--]Yes
PrNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manurc/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) �Upf ryI rL /�fi�,s �Q tTr y�,
13.
Soil type(s)�]'
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
�3 No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
RNo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes
,R No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
RNo
❑ NA ❑ NE
18.
is there a lack of properly operating waste application equipment? ❑ Yes
RNo
❑ NA ❑ NE
Co ment8 (efer tolquestion` #) z luinfnny YES-,Ans'wers undylor any recam da�ti0it5 O[ > �t�1 CCU ts.j
lice d w*yin s a(frfacili,' 'to`better ez lainlsituations t" pse ndditinnal sa�s at s neeess ff)):
u�S:'A `�7k�sIRL ,W"U, 159�`E aS. 9�AF
Reviewer/Inspector Name T- - — — �o — - T� Phone: 9 l/ '�•—.3��0
Reviewer/Inspector Signature: Date: /j9 --2L -?;gob
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection 42—
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ED No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
9 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZINo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
19 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
CR No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
5� No
❑ NA
❑ NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EgNo
❑ 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
9 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
RNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Page 3 of 3 12128104

A
ivision of Water Quality Facility Number p Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit EY06ompliance
Inspection
O Operation Review O Structure Evaluation
0 Technical Assistance
Reason for Visit
outine Q Complaint
O Follow up O Referral O Emergency
Q Other ❑ Denied Access
Date of Visit: V-r v r+ Arrival Time: ',3 fJ Departure Time: County: Region: 1::XZ
Farm Name: 7/--%.Fi%4 r_ -^ _ 45d1-d.s Owner Email:
Owner Name: 49 /" Phone:
Mailing Address:
Physical Address:
Facility Contact: 7-r koe-' Title: I Phone No:
Onsite Representative: v'�-�-- Integrator: _MU,-4 �4
Certified Operator: Operator Certification Number: ,«fr.-74
Back-up Operator -
B
ack -up Certification Number:
Location of Farm: Latitude: = O = I ❑dt Longitude: 0 ° = , =
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other`
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I- ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Hcifet
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes X No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
El 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 dWi;jrge, bypass the waste management system? (If yes, notify DWQ)—ET-Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�No
El NA
[I NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
SNo
❑ NA
❑ NE
other than from a discharge?
12128104 Continued

Facility Number: V— p I 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 I Structure 2 Structure 3 Structure 4
Identifier,
Spillway?:
Designed Freeboard (in): !4
Observed Freeboard (in):
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
19 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
�9 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
9 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
J9 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
9 No
❑ NA ❑ NE
maintenance/improvement'?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
iA No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) !$nt PYh „�, Z,2u cC
13. Soil type(s) % - x Zj la
_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
D4 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
50 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ 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):
Reviewer/Inspector Name Q-,.�� Phone: D- M-,3O D
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — p Date of Inspection 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RSNo ❑ NA ❑ NE
the appropirate box. ❑ WUp 0 Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
6ANo
❑ 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
5d No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[51No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
R No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(4 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit'? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;, No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

W
Type of Visit
ompllance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: ®/ Arrival Time: Departure Time: County: Region: ��
Farm Name: 7—r; j2 Jr-ni S Owner Email:
Owner Name: Tr`'ryL_� L. e✓Phone:
Mailing Address:
Physical Address: r
Facility Contact: ► r�+'� �t/L-�� ,Title:
T
Onsite Representative:
Certified Operator: _ r
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
0
Latitude:
Phone No:
Integrator: _/-Y 444,6- --_-_-
Operator Certification Number: f 7i��to
Back-up Certification Number:
0 Longitude: =° =, =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer i
---- - -_ E ❑Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Been Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: F Fj�
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 Q?[No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 Z No ❑ NA ❑ NE
❑ Yes P&No ❑ NA ❑ NE
Structure 5 Structure 6
[--]Yes 9 No ❑ NA ❑ NE
[:]Yes XNo ❑ 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? CA Yes ❑ No ❑ 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 9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
tKNo
❑ NA ❑ NE
❑ Excessive Pond ing ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) 3 r-a=maL . 4:cagad 6 ca, rL.
13.
Soil type(s) N D A 141 !�
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
jKNo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
R No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,❑ Yes
EZNo
❑ NA ❑ NE
17,
Does the facility lack adequate acreage for land application? ❑ Yes
M,No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
"No
❑ NA ❑ NE
Reviewer/Inspector Name fJ-; ��Jw�=� Phone:
ReviewerlInspector Signature. Dater �OD%
12128104 Continued

Facility Number: —I Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IR No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ®.No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
14 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
X No
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment�as required by the pen -nit?
❑ Yes
;,No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
C,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
[9No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
14No
❑ 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
1Z No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J&,No
❑ NA
❑ NE
w
AdditlnnalkCatiri�ents,,an il"Iqr".:Druwrii;s �,� ��k�+`^r��'',g�'�'`
12128104

V/
�.e{ 7...}!. g d �I i'- N": € d€j�° a �fiF 3 ! !g d0 t
j I i .a d s l Ea iig €
D Ffivisidn pf Soll and Water Conservatiaa
n 1 I 4 hl: 'giF 'iEk--
r i 0, Oilier ageACj� ¢ t d tl .. gi?'@ s ,r g €
I:toE;I €11,,l.,.„. ; Illy<,.,t...,ii-,ii .€€,;, € ;!Sglti,:i, fF€:.'f!;
c _ .<.,,P,::€, 3,;i.s@= .<^_€8t ,.!id€.7,:iFou€,,.=s> ¢ .1,.<l >..t•-,, ,,i,�€. 41l+iir,....,n i, rda,i�ta,_E,-
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Hate 01'Yisit: i - �"O Time: • 30
$ 1
of Operational 0 Below eshold
EI/Permitted 0-clertified D Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
F 11 �A/
Farm Name: � TrIfa1P. � � r� S - Counh: JQrn,O�'Bn
Owner Name: Tre t._ I v l e r Phone No: g10-
Mailing Address: 3005-- Wr xe AcaaeL R�h�i 0;n1o.-7 IV .=?9302 _-
Facility Contact: _ 11'r0f- fPr Title: Phone No: �rrn "�� 0 n �
Onsite Representative: Trp. 41er Integrator: ml"' aLU
Certified Operator: f- _ _ Operator Certification Number: f g47'26t
Location of Farm:
Uti Ine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 �• 0 u Longitude 0 1
Design Current CDacsacity ,rPa ulaHoa , €.Cattle,,. ! n !,,,Design.,.wCurrciat Current;,.' s
r4 0l
S�r'ine...-- Ca aclty -=Pa ulat�on [ Roultrr , . a acity„l�ro uEsitaan�, E@
❑ Wean to Feeder ❑ La er I I Fji&: airy I
eeder to Finish ,Z Non -Layer 0 Non-Dahy I IC'
. , ❑Farrow t0 Wean r� s°.�
ElFarrow to Feeder ❑ Other s
Farrow to Finish
@€ Total DefsignlCapaclty , !
Hilts
E 1`� ❑ Boars
V it
Number` of Lagoons: AD Subsurface Drains Present ❑ La non Area ❑ S rav Fidd Area
ffolding''Ponds fdSofld:Traps ��` '��' No Li uid Waste Mana ement S stem '`!"g',° 1�€� ;i �( Ir!€1�y
.. .j a , .IE.J, i3 r..d 16:
Discharges & tream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Stiray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste -Collection & Ireatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: !
Freeboard (inches),
05103101
❑ Yes ED No .
❑ Yes ! o
❑ Yes 0-N6
❑ Yes S-No—
❑ Yes E]'No
❑ Yes 0-No
❑ Yes B-No
Structure 6
Continued

Facility Number: 10
Date of Inspection `
�t
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
010
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
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
Q-No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
M-N
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
ffgo—
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
Mi o
11. is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ Excessive P//��onding PAN ❑ Hydraulic Overload [IFrozenGround [I Copper and/or Zinc
11❑
12. Crop type ALI Oy"rs&ocd
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[ tvo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
2'rCo-
b) Does the facility need a wettable acre determination?
❑ Yes
Q o
c) This facility is pended for a wettable acre determination?
❑ Yes
0-N—o
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
EFlqo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes U.No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Qggo_
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 9-N6
Air Quality representative immediately.
4i<! ,'� 'i "'I. .!a. r.t;sat-,'v .t'nt ?.•"-1..v'Y 'Fi !- "• i- a" .7
Comments'(refer,to quesgon�lt) 'F.xplaunagyarYES;answersand/ox any irectamedakiat�s.oraany„other cotnmeats'ij;
'ta J;r?s..::ar.�.. t.i .'+, .E3��:5e:..f .Fr..r>,i€�.€a++,tun..M,.::..+uuw}s�:€�€#f�#f>$a€a€LIS'�E�iifj
Use drawanks o�f facility to better explaun situations. {useaddit,orial pages as necessary}:Carield Co Final Notes,
;
l..re:r,t €s .
.!
Tr Pr hag -75 fd rm�oro✓e tv"/A ek G/7�r Slia„�
p �auSra I. / !e GvanTS �d o�a f tie N7a�'n�tncntc av, fks G,A 4P,,,, � �e
(gas/a./ SCcrson, ale �as-���l�� w ` � Ms �'..w, ya/1 cavh
Gn r��e Goar„�, ��ia� Spr cit� h,`
0'1 410w 70 1r,lPilp�� �j 'S
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
12112103 Continued

Facility Number: - Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes EW
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? ��
(ie/ Wes, chcQkHst , de aps, etc.) ❑ Yes EI No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ w-0
❑ WMM1gP ioatieu- ❑ I eeboard ❑ ❑
24. Is facility not in ompliance wi any applicable setback critena n e feet at the time of design? ❑ Yes 9-Wo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes EJN6
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ❑ No
28. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑-No-
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) es ❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ yes
am,
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
MAit�-'
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
EP46--
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑-Pfi�
35.
Does record kefor NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
[�-1�
'eping
- kirig-FOrm' ❑ op lieklTdarm_ ❑Jtainf J1L❑ansper.r:nn AfrnY I" R-Ain
0IC C7/
- Mimite4n5pectior:s ❑
12112103

Division of Environmental Management 0
On Si
Maw
Physic
Animal Feedlot Operations Site Visitation Record
Date:-7 T
Time:
Latitude:_ / 1 Longitude:
ation Description: (based on design, characteristics)
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Cattle No. of Animals
O Sow O Layer O Dairy
0 N=e y O Non -Layer O Beef
0 Feeder
OtherType of livestock r "n tea. __ Number of Animals:
Number of Lagoons:�I (include -id the Drawings and Observations the freeboard of each lagoon)
Facility Inspection:
Lagoon
Is lagoon(s) freeboard less than 1 foot + 25 year 24 hour storm storage?:
Yes U
Nq�%—
Is seepage observed from the lagoon?:
Yes ❑
No$ -
Is erosion observed?:
Yes ❑
NqRL-
Is any discharge observed?
Yes ❑
No;3;�-
0 Man-made C Nat Man -trade
Cover Crop
Does the facility need more acreage for spraying?:
Yes 0
No
Does the cover crop need improvement?:
Yes O
. No
( list the crops which need improvement)
Crop type:
Setback '
.Criteria
Is a dwelling located within 200 feet of waste application?
Yes 0
N
h a well located within 100 feet of waste application?
Yes ❑
V
Is animal waste stockpiled. within 100 feet of USGS Blue Line Strearn?
Yes 0
No
'Is animal waste land applied_ or spray irrigated within 25 feet of Blue Line Swum?
Yes a
No
A01— Janu=T 17,1996

MaEnlenance
Does the facility maintenance need Irwovement? Yes ❑ No
Is there evidence of past discharge from any part of the operation? Yes ❑ No}
Does record keeping need improvement? Yes 0 No ie
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes C! No O
Explain any Yes answers;
Signamm-
car Facility Asseiment Unit Use Attachments if Needed
Drawings -or - Qbswmtionj.,
1 rn.,L 6 D P-r = p� F-1'
Y leP, � •+R►. �Y •.J • �f •l/l �.� . d l� se• •�IIL, LP.4. W
, �i{{�.• L.' rti f .��5�..•a.nn" •.1•w•1� •i1 �Rr;a l�(:4• N!•��:`/�.:. v�w+..�r1ws.� w r�. _ ..
AOX — January 17,1996 ,