820113_INSPECTIONS_20171231

�V
NORTH CAROLINA
Department of Environmental Qual

1�s %,As 4_1 JuM, rS --
I-Ission of Water Resources
Fa lity Number Lug - © O Division of Soll and Water Conservatlan
v Q Other Agency
Type of Visit: omn�pliance Inspection Operation Review Structure Evaluation Technical Assistance
Reason for Visit: erf outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: nt�sgry
Farm Name: :J�Q V14 eELL( Fa'r VA- Z Owner Email:
Owner Name: Sky- t j, Phone:
Mailing Address:
Physical Address: /
Facility Contact: C' L..,ti.{!s�W tL� Title: Phone:
Region: Q`0
Onsite Representative: t C !! Integrator: L lTIA'
Certified Operator: sc,-c- bot acG' le�'" Certification Number: /���
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design ,Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Pouitry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
Layer
Dairy ow
Wean to Feeder
Non -La er
Dairy alf
Feeder to Finish
L� Z
Dairy eifer
Farrow to Wean
Design
C►urrent
Farrow to Feeder
Dr, P,oultr,
Ca act
Pa
Farrow to Finish
La ers
cker
Gilts
Nan -La ers
der
Boars
Pullets
ood Cow
Turkeys
Other
Turkey Poults
Other
Other
lii\ iY4._4.1 r'ik 4:1Y6�1�CCBCRXI
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? `
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Epftr—O NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
[:]Yes [ o
❑ Yes No
aNA ❑ NE
Q-KA ❑ NE
h]A ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

Facility Number: Date of Inspection: li ka,
Waste_Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NAB ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
q
Observed Freeboard (in): L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q<o ❑ 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 g 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 [B"No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes io ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes F. o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ug,<o ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [11-11U ❑ 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): 6 GtJ 13 S& 0
13. Soil Type(s): go NO go,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R]-tl o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q'No❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 3-/❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes Vo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes E2 `vo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes a wu
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes EP11011—
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists [:]Design [:]Maps [:]Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes No
[] NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [] Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" 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
21412015 Continued

Facili Number: - Date of Inspection:
24. Didthe facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑-too ❑ 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
[ } ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Q-Ko-­❑ NA
❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
Permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ NA ❑ NE
❑ Yes L No ❑ NA ❑ NE
❑ Yes EaNe-- ❑ NA ❑ NE
❑ Yes ❑❑ NA ❑ NE
❑ Yes
[;.N°
❑ NA
❑ NE
❑ Yes
[]-No
DNA
❑ NE
❑ Yes
[2 o
❑ NA
❑ NE
Comments (refer to question #}: Explain any YES answers and/or any additional recommendation_ s or any other comments.
Use drawings
Lof facilityto better explain situations (use additional ages as necessary). /
o_ 3. 2 p, �.A � L(
' i( Tc-- 30,s�- b8 s t
Reviewer/Inspector Name: _ V ` n _ Phone: tl o ` 3 3 `3 �3
Reviewer/Inspector Signature: hI 0y2j� Date: ' i J 'P- l O
Page 3 of 3 21412015

Y- ^ S I- Km 0 q0
- KRion of Water Resources
Facility Number , - 0 Division of Soil and Water Conservation
•0 Other Age�ne'y
Type of Visit: erCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (O Routine 0 Complaint 0 Fallow -up 0 Referral 0 Eme'rgency 0 Other 0 Denied Access
Date of Visit: Arrival Time: r DSO Departure Time: 3 s County:
Farm Name:' Owner Email:
Owner Name: Sri e. (�j, �`���✓� Phone:
Mailing Address:
Physical Address:
Facility Contact: _. a.,415 , Ia/tr e Title:
Onsite Representative: Y
Certified Operator: sty, t% , qy_A1 e*-
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Integrator: jj._6—S
Certification Number: Pl I a r
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
G Z-
1 0')
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
nrF P�oultr,
Ca aci
P.o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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)?
❑ Yes S-No ❑ NA ❑ NE
❑ Yes ❑ No [3-NA ❑ NE
❑ Yes ❑ No [3NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No Q NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes C3-No ❑ NA [] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters 0 Yes ffNo O NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili ty Number: rk - 1 JJ Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[E-N&
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[y <A
❑ 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
rll-K0
❑ 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
❑ 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 E]�No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 6/No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes []No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA [] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3 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): G%.J f o
13. Soil Type(s): /�eL Fri p
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E2�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 [✓rNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes �]'No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
Required R_ecords_& Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes y[]rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [D"'No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ❑- No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes F',XNo
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 21412015 Continued

Facility Number: KZ - 11,,3 D I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q-Ko
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [D- -0
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 [J-No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes LJ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes + No ❑ NA ❑ NE
❑ Yes [�<o ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
[]Yes [2*No ❑ NA ❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
[21-10
❑ NA
❑ NE
❑ Yes
C2"'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 pages as necessary).
Reviewer/inspector Name: i3 m Q) Udw Phone: 3
Reviewer/Inspector Signature: L tP.0 Date:
Page 3 of 3 21417015

Y
.f
Type of Visit: G<ompliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ® Arrival Time: ' Departure Time: ' U t� County: a Region: i7
Farm Name: �a4r^_ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: r Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator:Sjl1'G2/
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop.
Wean to Finish La er
Cattle
Dai Cow
Design
Capacity
Current
Pop.
Wean to Feeder
Non -La er
Dairy Calf
Dairy Heifer
Feeder to Finish
(�
ppD
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Design Current
D , F,ouItr, C•.a aci P
,o
Lavers
Non -Layers
D Cow
Non-Dal
Beef Stocker
Beef Feeder
MI
Boars
Pullets
Beef Brood Cow
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes E5-No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E!�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
MNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

[Facility Number: 3 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[. Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
E-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
S 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
rRNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
V No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[] PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): (20o `n /GU/Z-,w Ils"d:-0—L-5
13. Soil Type(s): _ -JOP D ',I S
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 E, No ❑ NA [] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E5No ❑ 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 E No ❑ NA ❑ NE
❑ Yes 0].No ❑ NA ❑ NE
Re wired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes S—No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JE 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 5D..No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,Eg-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[]Yes
allo
❑ NA ❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
EE�_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
O-No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
CR-No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. 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 E�_No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
E] Yes CZ -No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
[:]Yes
allo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
�o
❑ NA
❑ NE
luCo�rtnientsl(refer to questio"n `#): Expiein any.XES answers dnd/or any a[lditiona_ 1'reeommendations?or any other comments ; s
,.7 .t. �"c;v=<< f�i�,r�^i .i � a t u e:�t�.v
se,dra+vitias offacility t`©:hetter"explain situations�(use,additlonsl paeesca'§rnecc§sary).' i, , .; .�. ,s
/�. ��/iY1 �r o�t� /�'s ` ��''r-c ��?d ✓t� f a uy iyr�� �' / , �>�
% rrii rcc� yD vr' 1�,Z rms y0 ke
�.!S ��'.�+.- .�� '0O d / ' �� Y �,/�"/ v � r GNU l Vt �-�2�►a ns i �/? .� � n'!C /'�l� ��S � D GC
av/6e v/C-- '0�p��dz4flds N 0�n�
reo—
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f t C/ 7' e- Gd� • �U✓� LOGC'CS�G� �L Ii�CJt'! -GUd ��
G/t �Y/r_'
Reviewer/Inspector Name:
Phone:
Reviewer/inspector Signature: _
Page 3 of 3
LUG
Date:
21412015

+ 11 Facility Number -
Type of Visit: 91CImpliance Ins
Reason for Visit: outine 0
(0-Division of Water Resources
0 Division of Soil and Water Conservation
0 Other Agency
Operation Review 0 Structure Evaluation 0 Technical Assistance
0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time: /;CID
Departure Time:
County: Region:
Farm Name:
Owner Email:
Owner Name: _ r S
u 7- Gy1Cr'`
Phone:
Mailing Address:
Physical Address:
Facility Contact: e5 ' r_- Title:
Onsite Representative:
Certified Operator: ,fUlY
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Phone:
Integrator: /r/.p,
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes & No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes allo
[]Yes E,vo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

[Facility Number: J[;E- /J3 [ [Date of Inspection:
,i Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3
Identifier:
Structure 4 Structure 5
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in): /7
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
�No ❑ NA ❑ NE
❑ No [DNA ❑ NE
Structure 6
❑ Yes C-No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[!3—No
❑ NA
D NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
,F!No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E�jNo ❑ 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): tul w%A �S 0 v -r--e'
13. Soil Type(s): fC / / �z; S iv rtD
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes gNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [SNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes allo ❑ NA ❑ NE
❑ Yes CE5-No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes SLNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [RNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JH[ 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 allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C&No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

ti
Facili Number: - 3 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes allo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes allo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [&No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes gLNo ❑ NA ❑ NE
❑ Yes [-No ❑ NA ❑ NE
❑ Yes
[�_No
❑ NA
❑ NE
❑ Yes
RLNo
❑ NA
❑ NE
❑ Yes
J&No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers, and/or any additlonal recommendations or- any other�cgmments
Use drawines of facility to better explain situations (use additional PSO& as necessary).`
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: �l
21412014

M
C"ivision of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: omp ante Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: U� Arrival Time: O 1 Departure Time: fl County: Region:
Farm Name: CTIA-/- arm o� Owner Email:
Owner Name: 97 ,C _f . 3d&:N Phone:
Mailing Address:
Physical Address:
Facility Contact: /�T� /%$r� Title:
Onsite Representative:
Certified Operator:
54a--C. Phone:
Integrator:
Certification Number:
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.
Layer
Non -La er
Discharees and Stream Imnacts
Ury Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes
&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[3 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[] Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facilit Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c3;r
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
0 No ❑ NA ❑ NE
No ❑ NA ❑ NE
Structure 6
❑ Yes CR No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes R No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes to No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [g No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ANo
❑ NA
❑ NE
maintenance or improvement?
I I - Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C�3 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): e,
13. Soil Type(s): %'JYi�'TD %/� rri Z_.Im-12
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes 10 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable []Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[,No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
gLNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
LS 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
21412011 Continued

- Facility Number: - Datc of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Cg No ❑ NA ❑ NE
4
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 1Z 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:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
[—]Yes ® No
[::]Yes No
❑ Yes ® No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of.facility to better explain situations (use additional Daces as necessarv).
Reviewer/Inspector Name:
Phone: k�
Reviewer/Inspector Signature:
Page 3 of 3
Date: -
21412011

r JOD�W3---rC-" b33�
Division of Water Quality
Facility Number - © 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Com ante Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: GrRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ; C7 County,;�d-rrx,tr�... Region:
Farm Name:Owner Email:
Owner Name: (/�'�k>!h rT*��.,.__.,..,----- Phone:
Mailing Address:
Physical Address:
Facility Contact: f�r�' %f f pg Title: 'q" . i 'id, Phone:
Onsite Representative: e*_%ja_ Integrator:
Certified Operator: 5,1� ./,(� ,�jy�,}�� 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
1_10ther
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
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)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
on -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes KNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes In
No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facilit Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes
&To
[] NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
to 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
nNo
❑ 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
W) 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 environmenta.L threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ER No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CQ 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 Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12, Crop Type(s): �.�1 � M1f ,v� Z .19V�Aw" 6 G'O4-'rle
13. Soil Type(s): Jf�� l 1 .��HS l i jw/r
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
E4 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ER No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E&No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA E] NE
23. If selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection: —1 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
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
0 No
❑ NA
❑ NE
❑ Yes
S[ No
❑ NA
❑ NE
❑ Yes
�g No
❑ NA
D NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes J&No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
tN 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 ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
2za 1?10 h 13 b�►
X 7 6
• ��>�� r r9 yr N �t �''�,�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:l7 "3
Date:
214.12011

r ivision of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: (2 Ffoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: q- / Arrival Time: Departure Time: County: �s.yr_
Farm Name: ��Nr.s Jj }a �_ rar''�� � Owner Email: `'��—
Owner Name: 2ay=y4 f�" t 'h-/" Phone:
Mailing Address:
Region: 1� D
Physical Address:
Facility Contact- y_,c /?��#}�`� Title: Phone:
Onsite Representative: ��'--� Integrator:
Certified Operator: J �L� f�t �- Certification Number: ja
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer...
rou
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dai Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[3 Yes [3 No ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
[2_No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility Number: J13 Date of Inspection: ►
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): / 2!
Observed Freeboard (in): :Iq 1�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JZ 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 Z No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public stealth or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? 571Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ENo
❑ 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 l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination`?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
the appropriate box.
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes ELNo ❑ NA ❑ NE
❑ Yes R[No D NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5;q 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 [�R No
23. Ifselected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E�No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: 0 —
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 C3,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? [3 Yes Z] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M_No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes CNo ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes D-No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes [:]No
[:]Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any`other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
le�a5 �� iTi2 L��Oa • s.
w �cg
Reviewerllnspector Name:
Reviewerllnspector Signature:
Page 3 of 3
Phone:
Date: 112•-7
21412011

(EMIvislon of Water Quality f
Facility Number ®- 0 Division of Soil and Water Conservation g -VIf
0 Other Agency
Type of Visit: CoZu'tme
nce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:y�iCh /'' aro-%_-.a`T- Owner Email:
Owner Name: J�h'��3_ IFu71qe/"' Phone:
Mailing Address:
Physical Address: /
Facility Contact: Title:` Phone:
Onsite Representative: `�
Certified Operator: �.� = 1!/>✓_ „
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
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Non-L
Pullets
Other
Poults
Design Current
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 0 No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ,® No
[] Yes 5,No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes jKLNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes � No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? WYes ❑ No
NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes J, No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes �-Io
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes J&No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN n 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): �i Z A/ B /z�4l S
13. Soil Type(s): V,9j&—
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
23 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CR No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?]
Yes
No
❑ NA
❑ NE
18. Is there a tack of properly operating waste application equipment?
❑ Yes
[allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
QO'No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
2rNo
[DNA ❑ NE
the appropriate box.
❑WUP ❑Checklists [3 Design [] Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
C, No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ I20 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
M No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo�- ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 2-Yes e o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
RNon-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 1� No ❑ NA ❑ NE
❑ Yes S No ❑ NA ❑ NE
❑ Yes 6No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additionalrecommendations or any other comments
Use'drawings of facility to better explain situations (use additional pages as necessary)._p�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
`io4.1
Phone: t2-d/,3sy—,3 C)
Date: -�Z-/. w
21412011

M
Q Division of Water Quality -0.1
Facility N.mber Q Division of Soil and Water Conservation
- -- - - Q Other Agency
Type of Visit 0"60'mpliance 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: - a Arrival Time: ' Departure Time: County; V_ Region: {Z
Farm Name: i7'nz!s r� te,r�1
-i'1dZ !--I Owner Email:
T
Owner Name: U a-✓i'! K:-5 13 fry Phone:
Mailing Address:
Physical Address:
Facility Contact: Su u�`Ir/ Title: Phone No:
Onsite Representative: /" Integrator:
Certified Operator: 3'411,'- xzl�/ Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
U Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude; 0 0 0 4 = Longitude: = o= t 0
td
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Roults
❑
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
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: E-J]
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 J,No ❑ NA, ❑ NE
❑Yes
❑Noy-U1NA.=❑NE
[:]Yes
[--]No
❑ NA
❑ NE
❑ NA
❑ NE
[]Yes
❑ No
❑Yes
®No
DNA
❑NE
❑ Yes
®-No
❑ NA
❑ NE
Page I o f3 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 1 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 structure s 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 [9No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes C.No ❑ NA ❑ NE
❑ Yes U-No ❑ 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? E.Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes $4No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or l0 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
i
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V 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
52 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
5a No
❑ NA
❑ NE
ReviewerlInspector Name(-'�,"'re s. ��- Phone:
ReviewerlInspector Signature: Date: ��� t 17
Page 2 of 3 12128104 Continued

f
1=
Facility Number: Date of Inspection 4— c
f _
' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CKNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ 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 Reviewcr/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
21 No
❑ NA
❑ NE
❑ Yes
(g No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
[8 No
❑ NA
❑ NE
❑ Yes
CZ No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes 5LNo ❑ NA ❑ NE
❑ Yes R_No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
,Yes ❑ No ❑ NA ❑ NE
12128104

11- 23 -- zooq
✓ Bj�u5
Type of Visit
ompllance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
i�utine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: OI ; /J' Departure Time: .7 ; O County: _54—PSpN
Farm Name: �� S �LSu`� fur Owner Email:
Owner Name:��{��+�e-s �u7Flrar Phone:
Mailing Address:
Region: . 'OW
Physical Address: Facility Contact: 6Fwp- /Yoprv_ Title: 7 aP. AA�A1Phon1/e No:
Onsite Representative: irc� k&p tit integrator: M, h ti giyi Al
Certified Operator: S7+Ac- aLL-Nck- Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = 6 = Longitude: = ° = ` = "
esign
Current
DesignSwine
Capity ulation
ilNRr
Wet Poultry Capacity
Population
Cattle Capacity Population
❑ Wean to Finish
I
101-ayer
I
I
1
❑ Dairy Cow
❑ Wean to Feeder
1 10 Non -Layer
❑ Dairy Calf
D-feeder to Finish 7 Z I
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ Layers
❑ Non -Layers
[I Pullets
❑ Turke s
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Cow
Other
[E—ITurkey Poults
umber of Structures:
❑ Other 10 Other I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2No ❑ NA ❑ NE
[--]Yes
[]No
2 NA
FINE
❑ Yes
❑ No
[�?NA
❑ NE
[31<A
❑ NE
❑ Yes
❑ No
❑ Yes
d<
❑ NA
❑ NE
❑ Yes
[a o
❑ NA
❑ NE
12128104 Continued

Facility Number: 132 — //,3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3 N ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 3 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /-a.�5
Spillway?: 40
Designed Freeboard (in): / 7
Observed Freeboard (in): 20
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes ' <o ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.) ``
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 2 o ❑ 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 D'�Io ❑ NA ❑ NE
8. Do any of the stuctures lack'adequate markers as required by the permit? ❑ Yes I_TNo ❑ 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 0 Yes 0 N ❑ NA ❑ NE
maintenance or improvement?.
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EMo ❑ NA ❑ NE
maintenance/improvement? ,�
I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes D<0 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) a y^/ — Ut114,_C,_� &" Al S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
['To ❑ NA ❑ NE
Boo ❑ NA ❑ NE
0"'NNo ❑ NA ❑ NE
Q o ❑ NA ❑ NE
Eilvo ❑ NA ❑ NE
Comments (refer t( u.estion ) t'xplam any, YESiRncwers andlor any recommendations ar
Use drnwinls of facility to better explain Situations.{uac s►dditicinal pales as nc essR y� .
any other comments.
Reviewerllnspector Name,I
Phone: 149, 933. 330 a
Reviewer/Inspector Signature:
Date: //-16 " 200 9'
12128104 Continued

Facility Number: E3 2 — /f3 Date of Inspection
Required Records & Documents ,�/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [I Yes L7 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes B<o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
io ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections El Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
L��'r,, o El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E o ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,�
EK' ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E?qoo'�'❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[I Yes
C�,,//]o
LTNo ❑ NA
❑ NE
Other Issues ,.,,
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ 3 Yes o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L7No
❑ 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
10
❑ 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
Io
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
O NNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
U No
❑ NA
❑ NE
12128104

✓ sjw's /lo 8 - o 1 R/L—
Facility Number
ivision of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit
inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
(Del
(Del routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 12-62--0f)Arrival Time: U%; 1S Departure Time: ��; '� County: ^* s Region: r
Farm Name: -e—V -At Z Owner Email:
Owner Name: "es at #'v I Phone:
Mailing Address:
Physical Address:
Facility Contact: rGC�f�.. /+(UDi L Title: Phone No:
Onsite Representative: 6;rLGs- Integrator: _ t-<-+' RA N
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
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = 6 = i =gj Longitude: = o = i = {1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer I EEJ
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pou Its
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: a
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 3'90 ❑ NA ❑ NE
❑ Yes
❑ No
[3NA
❑ NE
❑ Yes
❑ No
❑'1�iA
❑ NE
E3<A
❑ NE
❑ Yes
❑ No
❑ Yes
B<o
❑ NA
❑ NE
❑ Yes
0-<oo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number:
Date of Inspection I /Z-OZ-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
r
Observed Freeboard (in): _ 33
Structure 2 Structure 3 Structure 4
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 ,ISNo ❑ NA ❑ NE
❑ Yes L'I No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes M<o ❑ NA Cl NE
❑ Yes 9'go ❑ 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? El Yes l-'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2<01 ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,.,
3
4. Does any part of the waste management system other than the waste structures require ❑ Yes L'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,�,�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L�" o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0-Ko' ❑ 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) WLt,, S
13.
Soil type(s) t�nA aoA FoL
-• -/
14.
Do the receiving crops differ from those designated in the CAWMP?
ElYes
O 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
L< No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
EJ'No
NA
El NE
18.
Is there a lack of properly operating waste application equipment?
Yes
El2
<o
❑ NA
❑ NE
01i1�. v ` t, I8 iAYJv " '!WY �k �tY���9E%P 4 SF9lY FiPyFn...:. � _,
Comments(�referto uestion#i) ;Explaina'nyYgES.answersandlar any recommendations ar any other comments,
Use drawings°of.facilltNlo bdtt er�Axpll�ln,situ,atpions�u c"additio ai pages as necessary}:
t.�..lA7:i 5a4a.h!v4 i�-kz4f' .L'�'tlrwa$'."::"SJ^
Reviewer/Inspector Name I' -- W ` +Z I% - Phone• We,f/,33. 3300
Reviewer/Inspector Signature:A K Date: 12- 02 -2U0(3
Page 2 of 3 12128104 Continued

Facility Humber: 'M — /f Date of Inspection f2-oZ-0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ 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
❑ Yes [] No ❑ NA ❑ NE
❑ Yes 3 No ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 3 o (_ A ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
°' NNo
[I NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
L�J N'o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[R'No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
3<o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E3<o
❑ NA
❑ NE
Other Issues
28. Were anv additional problems noted which cause non-compliance of the hermit or CAWMP? El Yes [� No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
DIC
❑ 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
L'fN-0
❑ 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
Ej<o
❑ NA
NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L<a
❑ NA
❑ NE
Page 3 of 3 12178104

Division of Water Quality PIN /7
facility Number Q Division of Soil and Water Conservation 1> �Zy 1.
O Other Agency j.
Type of Visit "� Compliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit V Routine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 1 Z Q-] Arrival Time: Departure Time: ® County:
Farm Name: Owner Email:
Owner Name: V "�Phone: ,,..,,
Mailing Address:
Physical Address:
Facility Contact: Gl Y_ tZ �` Title: C�/'� <
Onsite Representative: C �+
Certified Operator: A lyV^_
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
Region:
� 6I 5 (01M
� Phone No• ,,,_„••
Integrator:
Operator Certification Number: 9 1 , /3
Back-up Certification Number: ` ` 3 ` 9
Latitude: ❑ o = t 0 Longitude: ❑ ° = L ❑ 1f
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I I— 1 ❑ Nan -La ei
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current.
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: [E
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes1�0
❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [:]No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? []Yes # 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? ✓ _
12128104 Continued

Facility NVmber: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ NA
❑ NE
S rueture I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
ElNA
ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes )ONo
❑ 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?
Xyes ❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ;R�qo
❑ 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 ❑ NA ❑ NE
maintenance/improvement? II
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes-,ki No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drili ❑ Application Outside of Area
12. Crop type(s) `Mf rl - U__k ?tom
13. Soil type(s)
r
N rO
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�oo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ANo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
*o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
-r WC Phone: 1� j Q ` 33 .3 Sip
Reviewer/Inspector Signature:
Date: ( "7 .2:r)7
12128104V Continued

Facility Number: — , Date of Inspection I"+
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes *o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ANo ❑ NA ❑ NE
the appropirate box. ❑ W­Up D Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )!J'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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?
Additional Comments and/or
❑ Yes [I No
❑ NA
❑ NE
❑ Yes ❑ No
IBNA
❑ NE
❑ Yes ',rlo
❑ NA
❑ NE
❑ Yes FNo
❑ NA
❑ NE
❑ Yes /1�1 No
❑ NA
❑ NE
❑ Yes ❑ No
�NA
El NE
❑ Yes o
❑ Yes No
❑ Yes )No
❑ Yes
�pNo
❑ Yes `,"No
❑ Yes //J2?No
-- �� N &n, hatr vz 6a & 1/7,
b3l_ k k .
I� v' x -6 4,br %-z:,* 4 -r.n,,p sj, s
El NA El NE
El NA ❑NE
❑NA ❑NE
❑NA ❑NE
El NA El NE
❑ NA ❑ NE
12128104

Facility No. --++- >> Time I-n Time Out
Farm Nameykftb ) �w--
Owner 4.M9-a v,,�ii 1►
Operator Sx,
Back-up �-
COC
Date
Integrator ,?rt_Std-
Site Rep C`\,I (t K
No. Cl I T13
No. - 39�
Circle: General or NPDES
Design
Current
Design
Current
Wean Feed
Farrow - Feed
Wean - Finish
Farrow - Finish
e r in
1
Gilts 1 Boars
arrow - can
Others
FREEBOARD: Design
Sludge Surrey Z -16 -CFI S 1p
Observed
Calibration/GPKI ou- 2- 0
Crop Yield Waste Transfers--Z�'
Rain Gauge lam' ✓ Rain Breaker
Soil Test V PLAT Wettable Acres
Weekly Freeboard / Dr-1,
}"aily Rainfall 1-in Inspectiod
Spray/Freeboard Drop �i - .1?-0 -
Weather Codes
Waste Analysis:
120 min Inspections
Date Nitrogen (N)
Date Nitrogen (N)
t 2 Z
■�
o

�:uc w ���

Type of Visit 0 Compliance Inspectlon 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: a 3 O County: S4 "'p-rO�✓ Region: �2b
Farm Name: _Z4wti-s A44-1M Owner Email:
Owner Name: SlLe Ew -(A. Phone:
Mailing Address:
Physical Address:
Facility Contact: SD e-. Liu jle y- Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: RP-c waiu r.. S24 ✓
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = f = Longitude: = ° = I = `J
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -La er
❑Dai Calf
Feeder to Finish
i7b
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood ConJ
❑ Turke s
Other
❑Turke Poults
❑ Other
❑ Other
E�]
Number of Structures: f�
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes [8 No ❑ NA ❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
[]Yes.
q No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[KNo
❑ Yes
[PNo
❑ NA
❑ NE
❑ Yes
[;NNo
❑ NA
❑ NE
12128104 Continued

Facility Number: ?Z, — 113 Date of Inspection
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 37
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 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Dfl No ❑ NA ❑ NE
❑ Yes ® No ❑ 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? ❑ Yes IN No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 99 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes M No ❑ NA El 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 ®NNo ❑ 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) IfurnJ jj,) ed..f .s r..cA.cS T
13. Soil type(s) o Ids- '
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �rNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2fNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [XNo ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or anrecommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary)
ReviewerllnspectarName /�iC _ eJc.%S Phone: 0/o0$V—Tr 330
Reviewer/Inspector Signature: Date:
Page 2 oj'3
12128104 Continued

Facility Number: Z — Date of inspection / �Q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 16 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
VNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
I;RNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[�JNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C�No
❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[P No
❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[53 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
7 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
q 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
EWNo
❑ NA ❑ NE
Page 3 of 3 12128104

r
52 H // 3
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /0: VS' I Departure Time. County:, _-S ar-+, jai-, Region: lea
Farm Name: J'o►v.. C.4 Owner Email:
1 ,�}
Owner Name: .� Giw. c� sc.. C &^AAC_1r Phone:
Mailing Address:
Physical Address: J-S 1 ` 6 r a /✓ C .2 U3 2 F
Facility Contact: .�} Title: Phone No:
Onsite Representative: &AJ L- aLA.Y,r_ Integrator: �r�.+-.i ►+-� ,,,� 4 �n.F�
Certified Operator: S" P_ l3 L-*Ac_r Operator Certification Number: 4v- 19307
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ 0 0 1 0 N Longitude: ❑ o = , =
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
11 ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischart=_es & 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
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: �I
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 []o No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
❑Yes
❑No
❑ Yes
[2 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

r ►
Facility Number: !�,Z — Date of Inspection /Ell
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[!9 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Stricture 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c23'1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
U1 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
[Z No
[I NA
El NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
® Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [[] No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Q No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% 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) erm��a. i�a�. 1A ALLL-(-. X6�,k CV L11 he— SC'
13. Soil type(s) /Vp n �s a r e.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[V 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
Q No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(3 No
❑ NA
❑ NE
Reviewer/Inspector Name ,� G r ::x° ;:A. n Phone• irp y ?�� /s y rac7
Reviewer/Inspector Signature; Date; a /y / DS
12128104 Continued

c r
FacilityNumber: — Date of Inspection or
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes ❑ No ❑ NA ❑ NE
the appropirate box. g
El WUP El Checklists esi n ❑ Ma s p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 21�es ❑ No ❑ NA ❑ NE
❑ Waste Application 'L(' Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
[Rainfall EKocking [Crop Yield E;1'20 Minute Inspections , 9onthly and I" Rain Inspections �eather Code
22. Did the facility fail to install and maintain a rain gauge? 21ies ❑ 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
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[X No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Co No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® 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
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency? '
❑ Yes
© No
❑ NA
❑ NE
Additional Comments ar'nd/oDr+'awings
nG :i: y . t'•� 1 y? s� r�.'.
- 1 • a Galin ^t—. L4sG - e- ftiLa r e sK h
t
12128104

L,
R
Facility Number hate or visit:" o Time: �A
NNot Operations] O Below Threshold
UVermitted El ertified © Conditionally Certified © Registered Date Last Operated or Above Threshold•
FarmName: ..... .... cc+�G ............................................................... County:....................................................................................
Owner Name: �it'rs..5 VK��r.�., Phone No: 910 ���..-................................
Mailing Address:
U
Facility Contact; ............ ............. Title; ......�!,'!'!'! 4
�!tD.......5�!i'.!tr.�............. 5�..,
Onsite Representative:........!i"....iN..kllr...;^..................................................... /
CertifiedOperator:.......... W�+bj .....WA .............................................................
Location of Farm:
; t ................./.!� ...................X3. 9..
.............. I ...................
7Phone No:...................................................
Integrator:...... 1....rr !`!.!'^....S4.,Jr- ............................
Operator Certification Number: ..... 1. a ..............
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��� Longitude F �1 44
i f f i De_ sign rr EE ''„Current' ' ' .' € C e �, {; ';f Design i Current 1, r�r ' DeSlgn ^+L Crlrreilt
:.,Ca aci Po "alatiioe E�, ii'I'qultry uR ,� , , a acii po 'nlationttle 1 =-iiPo iuEataon ;
�.E :. �?i. P,.'. _,.,..I
i
Dairy
;i; ❑ Layer r:, ❑
❑ Non -Layer E ❑Non Dairy `
El��t��33 t� �l �x iP�piE�Elll� �IwE{'
❑ Other'
�I� �, f i� u.�..t � � Ir a lrt �' of
tl r t€ 1 ey t o t9 tF I��IS Ef P i s�ef
x°€€ f f p
. ,Total Design,Capac>tty,r� k§
,' i
Sfq• t f i%�' E°u (� '�f�. �'a �;t^if �Totai SSLW
aft
,,f r -� "Number of Lagoons of E ,�} Pf
�EEE���Sf- � 'yit4
r� a .(.. r •i[r,.4f d fk�i�.vr' " 4�i �l.Lb 1 -� t�f�e � S.I , ;fE a ;�� r�ti w" �.�5 f�Z6 i
❑ We o Feeder
eeder to Finish
7�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑Boars
Discharses & Stream lmnacts
1. Is any discharge observed from any part of the operation? ,�,,�
❑ Yes �tvo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes a<
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes O1Qo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Imo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............. ........................................................ ................. ................... ................................... ......................................................................
Freeboard (inches): ;,�5
12112103 Continued

Facility Number: — Date of Inspection f d
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Q No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes dNo
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 maintenancelimprovement? ❑ Yes O No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes S No
elevation markings?
Waste Anvlication
la. Are there any buffers that need maintenance/improvement? ❑ Yes GrNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes G314o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type WkeA+i
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes E�No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Z No
b) Does the facility need a wettable acre determination? ❑ Yes R90
c) This facility is pended for a wettable acre determination? ❑ Yes �io
15. Does the receiving crop need improvement? ❑ Yes Ergo
16. Is there a lack of adequate waste application equipment? ❑ Yes 'No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes Elrqo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ff�io
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0?11 o
roads, building structure, and/or public property)
20, At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes � No
Air Quality representative immediately.

Facility Number: g,Z — Date of Inspection
Required Records & Document.~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes WNo
❑ Yes �No
❑ Yes 03"No
❑ Yes 3"No
❑ Yes [Of4o
❑ Yes B<O
❑ Yes R&o
❑ Yes [ *fqo
❑ Yes [Q'�lo
eyes ❑ No
❑ Yes [�No
❑ Yes [�No
❑ Yes eNo
❑ Yes &No
❑ Yes Q No
12112103

---tacajry Nunebtrl
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Dater
Time: !D.•otz
General Information:
Farm Name: _ e r "Swim- ram. m= County: r
OwnerName: SRM34 &J*-:r. ....--none No: O
On Site Representative s, lfOn AfC rsok% Integrator:_ v&Qk-i
Mailing Address: KO-k f fy,.jN
*Aiy
L 83Z
Physical Address/Location:�
., �,., A, US„ VA Nw d+ C%iVfa n .
Latitude: I 1 Lon 'tude• -- 1 ,•j
eration_Descrintiam (based on design chameterlsties)
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Cattle No. of Animals
O Sow O Layer O Dairy
O Nursery O Non -Layer O Beef
O Feeder
Other7jpe of Livestock +'n i s in i rya Number of AnimYals:. 347A -
Number of Lagoons:_ (include in the Drawings and Observations the freeboard of each lagoon)
Facility I=e jQpl
Lagoon
Is lagoon(s) freeboard less than 1 foot + 25 year 24 hour storm storage?: Yes 0 Now
Is seepage observed from the lagoon?:
1s erosion observed?:
Is any discharge observed?
❑ Man-made
Cover Crop
❑ Not Man-made
Does the facility need more acreage for spraying?:
Does the cover crop need improvement?:
{ lirt the crops which need improvement) 7
Crap t* 7 Acreage:
Setback Criteria '
Is a dwelling located within' 200 feet of waste application?
Yes O
NoU�,
Yes O
No0-
Yes O
No$
Yes 0 NoSK
YesX . No 0
Yes 0 -No 0:­
Is a well located within 100 feet of waste application? Yes 0 Vo �-
Is animal waste stockpiled.. within 100 feet of USGS. Blue Line Stream? Yes O No$
Is animal waste land applied of spray irrigated within 25 feet of Blue Line Stream? Yes 0 Nob
AOt — Jsnnar717,1996

Maintenance . --- ---"- - - .
Does the facility maintenance need improvement? .Yes ❑ Not?
Is there evidence of past discharge from any part of the operation? Yes 4 NOCr
Does record keeping need improvement? - Yes 0 NAB —
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes O No$_-.._,
Explain any Yes answers-
Signahm.. , Date:
e� Facility Assessment Unit Use Attadunenu VNeeded
��-
No raver c.roP P�
. s..flii •••1..7:'Kr.
AOT — Januar7►17,1"6
• • • • i4s 1.feiai_t' L .
' � ... _ a n..Nl.�• +n►. ��•�. Mtn v.a.. `�` ljrtaY, t/�w��+^�7wre v.a. �r w'�k•::. "
- iV{�•./��•.n/�.• ..l+w•�• 'n �,�t2 1 :{ w�t.'i .{.ra/.+..y��lr•.� wry. � ....