820125_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

lkw-L- is u T R)
on of Water Resources
N"Weill Number - 7 Division of Soll and Water Conservation
O Other Agee; y
Type of Visit: Commliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: &Routine 0 Complaint 0 Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: {Q C� r � Arrival Time: c c7 Departure Time: ' , Oa County: 'F& ca'k
Farm Name: C IV( re �` Ory S Owner Email:
Owner Name:Phone:
Mailing Address:
Physical Address:
Facility Contact: 9LO"1 Title:
Onsite Representative: L
Certified Operator:
Back-up Operator:
cv
Location of Farm: h) ea+t o
Region:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
kl ��4 110�'00-6(J'7 ��0 �,,� 3 7 4) 2 I
Wean to Finish
I.,
I I Layer I
[DairvCow
Wean to Feeder
Non -La er I
Dai Calf.
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
D , P,©ult , Ca aci
Layers
Current
P.o
_PryCow
Non -Dairy
Beef Stockei
Gilts
Non -Layers
Beef Feeder
Boars
i
Pullets
I Beef Brood I
Poults
Discharges and Stream Impacts ,
I. Is any discharge observed from any part of the operation?
❑ Yes
NA
❑ NE
Discharge originated at: .❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
©-KA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
C!fN1A
❑ 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
U.?6
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
RNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
t 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ED-NT❑ NSA ❑ 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 Ej No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes U],1�
❑ 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 q oo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes E© 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 Q<0
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes To
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes CJ/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): Sn re�"s Re[jZ)
%
13. Soil Type(s): O r'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
[3NE
15. Does the receiving crop and/or land application site need improvement?
/
❑ Yes E�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
No
17. Does the facility lack adequate acreage for land application?
❑ Yes [�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �3<o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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 fNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes VNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes [�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [(No
[] NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [9 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [' 1�0 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ®'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Q11q`o­ ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
ff5o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EyNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
L_f lqu
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[Pia'
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Dell*_
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
aio
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[: No
❑ NA
❑ NE
Reviewer/Inspector Signatw
Page 3 of 3
Date: g
21 015

if ii t t Iii , I stf I 1) ^ ',,a �� i r•;. I 9. _���lIN'CI+T`'''a�I IiFl.l.lial,€,li,tlli1ili !liYiitI„�t �"f=iiil1aysI lN1tu�l ll, n�hll b€ ^ileIl ��riY€I I1 � lli,
�li ^;' ;Ii Git.z I!I 'yY'= ` Il�'�tai€ 1 9.t�..i��.. ;d . I , !i3lyl� i •s���, s ( € {8 l�Ef•'Q I -li €uOqtl€h! r�r(r
l
;. RcSaur
0 hisianoWteee;CS or^i�si•� rv-st-iai n
I oi€ 1 r j'L-
erAgncy i I'
I
'
Type of Visit: mpliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Q'l<outine O Com taint O Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: _�''%� Arrival Time: Departure Time: County:W Regionlcl;ao
Farm Name: ,�C f yG�.. Owner Email:
,rL-�c
Owner Name: C _ �` Y �'! Phone:
Mailing Address:
Physical Address:
A
Facility Contact: (%C4CgV_ ru"` Title: Phone:
Onsite Representative: r Integrator: '
r 1��'
Certified Operator: � Certification Number: 2
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
+N If slli i'� l�l i1! ?j{�'sill ,s€ J•1ll.
Other
Latitude:
Certification Number:
Longitude:
.Design' Current
Wet Poultry Ca a
p ci Pd#l;, Cattle
�+I+ �iae N� l i,LlV,lll� �I '•'�.E , L. p �
11s Layer i
�--+�--1 R1 [ i
`; Non -La
hti Non-L
11�EE
i Pullets
i
I urke
�f. T
`' I)eslgn CgirrentR'i ��
Capncity,, ' iPop. '
Design Current
Capacity Pop.
Dai Cow
Dai Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [✓] No ❑ NA 0 NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [] No [RINA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [] No [rNA ❑ 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 2/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 PwrNo ❑ NA 0 NE
of the State other than from a discharge?
M
Page 1 of 3 21412015 Continued

Facillij Number: Date of Inspection:
N%kste 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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): °Z—
[4ff__❑ NA ❑ NE
❑ NoL7 < ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., 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
E- o
❑ NA
❑ NE
❑ Yes
fo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ®-N&, ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [j'1To__ ❑ 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 [B'rq-o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 04o1lo' ❑ NA [] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes Imo`o D NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN M PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C 1'j A
13. Soil Type(s): & 60 o
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 ❑ NA D NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [1,14 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E: ?Wo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑Ko ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [30ONo ❑ NA ❑ NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [2Vo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes QAo ❑ 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 ETNo ❑ 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 VrINo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes YNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Faciii Number: jDateof Inspection: j,61u.,
r
24:Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2'Ko_ ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �' o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2010 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�o -
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[]44o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
D Yes
[c <o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[?'No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
D Yes
[i]'»o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�o
❑ NA
D NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: A, i 1
f
2/4/20 S

Facility Number: 820125
Inpsectlon Type: Technical Assistance
Reason for Visit: Routine
Data of Visit: 11/02/2017 Entry Time: 10:00 am
Farm Name: Circle L
Owner: Freddy Wayne Langston
Mailing Address: 769 Langston Rd
■ Division of Water Resources
El Division of Soil and Water Conservation
❑ Other Agency
Facility Status: Active
Permit: AWS820125 Denied Access
Inactive Or Closed Data --
County: Sampson Region:
Exit Time: 3:00 pm Incident 0
Owner Email:
Phone:
Newton Grove NC 28366
Fayetteville
910-594-0314
Physical Address: 735 Warren Mill Rd Newton Grove NC 28366
Faciltty status: ❑ Compliant Not Compliant Integrator. Murphy -Brown LLC
Location of Farm: Latitude: 35° 14' 01" Longitude: 78" 24' 00"
Rt 13, about 6 miles north of Spivey's comer. Turn north on Warren Mill Road (SR1647), 0.7 miles. Farm road to left (west),
Question Areas:
Technical Assistance
Certified Operator: Freddy Wayne Langston Operator Certification Number: 24129
Secondary OIC(s):
On -Site Representative(s): Name Tide Phone
24 hour contact name Freddy Langston Phone
On -site representative Freddy Langston Phone
Primary Inspector: Bill Dunlap Phone:
Inspector Signature: Date:
Secondary Inspector(s):
Inspection Summary:
On November 2, 1 visited with Mr. Langston regarding his pending sludge removal. He plans to pump and haul on his own to a
remote location. I reminded him that he still needs a POA and a Waste Utilization Plan (WUP) with both soil samples from the site
on which the waste will be applied and the waste itself.
We also reviewed some other fields with poor crop performance. After looking at the fields and those surrounding it, we did some
digging and determined that the problem may be a hard pan at about 6 inches. The soil is predominantly Rains, which can be wet
natured and prone to a relatively high water table and hard pan development. Mr. Langston indicated that he had experience
reduced yields on this field for several years. I suspect it is due to the hard pan and permed water table. He plans to get a v-ripper
and thoroughly rip the field before planting wheat.
page: 1

Permit: AWS820125 Owner - Facility: Freddy Wayne Langstc Facility Number: 820125
Inspection Date: 11/02/17 Inppection Type: Technical Assistance Reason for Visit: Routine
Regulated Operations Design Capacity Current promotions
Swine
-77
Swine - Wean to Feeder 3,800 4,010
Total Design Capacity: 3,800
Total SSLW: 114,000
Waste StruStM me
Olslgnated Observed
Type Identifier Closed Data start Data Freeboard Freeboard
Lagoon 1 19.00 33.00
page: 2

p iVK�'5 1.s S' (I3 73 L)
ivi"lion of Water Resources
� F cllity Nutnbcr ®- ® � Division of Soil and Water Conservation
� Other Agency
Type of Visit: Q-Eom fiance Inspection Operation Review Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: k4rrival Time:Departure Time: County: s'
Farm Name: C1"AJ-e LT Owner Email:
Owner Name: Ati Phone:
Mailing Address:
Physical Address:
Facility Contact: °� C' ti Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region: I .
Phone: D
Integrator: m !J S
Certification Number: f �T
Certification Number:
Longitude:
Design
Current
Design
Current
Design
Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity
Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I INon-La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , P,aulh.
Ca acl
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
' Qthe
Turkey Poults
Other
J IOther
Dischary.es 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 [ o ❑ NA ❑ NE
❑Yes ❑No
[]Yes [] No
❑ Yes []No
❑ Yes r—
❑ Yes [�No
B-NA ❑ NE
ONE
D A
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Page 1 of 3 21412015 Continued

Facility, Number: I Date of lns ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q.Na--❑ NAB❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ A No O� ❑ 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 [??<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 Io ❑ 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 [5No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [ 1 o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes [3�<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [ErNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 6 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):
Q
13, Soil Type(s): ,r_.... 1 ��- Pd G 0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes r �o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ 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
[3"ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
P;rNo
❑ 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
Ea 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
Callo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�rNo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: Date of Inspection: _Sgp
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(]-idb
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[jrNo
❑ 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
EJ o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[—]Yes
Pogo
❑ 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 ❑-No ❑ NA ❑ NE
❑ Yes 2'N"'o ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA FINE
❑ Yes [�o ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
[ rNo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
Comments (refer. to'questlon #) Expla1&any,YES_:answers: and/or - -any additionai recommendations or. any other comments
Use, drawlnp of facility to better explain situations (use additional: es aix necessary).
OW- 6 Jw�r a I& - 6- t 2= l
S[ 'e sp" F,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 33_ 3 3 ,]
Date: 15 5,JC�0
21412015

GIDGislon of Water Resources
Facility Number ®- ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of visit: ercompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: t'. 16utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: TTFxfrmArrival Time: pp Departure Time: 0 County:
Farm Name: Cl,,�: r% Owner Email:
Owner Name: rz;e' CcE' v L ,.,r S4 Phone:
Mailing Address:
Physical Address:
Facility Contact: F;r-rQ �O 4 Title:
Onsite Representative:
Certified Operator: t Z
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
Latitude:
Region:
Phone:
Integrator: f1w
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
F IL
ayer
Dry roultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Ily 45 ❑ NA [] NE
❑ Yes [:]No
❑ Yes [] No
[:]Yes [:]No
[:]Yes ZNo
[:]Yes E2�No
ET'�A ❑ NE
Cj_NA ❑ NE
2�NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Page 1 of 3 21412014 Continued

i
Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q'Ko-- ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes [] No NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier;
Spillway?:
Designed Freeboard (in):
Observed. Freeboard (in): 32,
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q-IGo
❑ 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
[a-Ko
[DNA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
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
�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
[2"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 CTNo [] 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): sov AS
13. Soil Type(s): Alk #I*,
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2-No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3 o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ ..Rn ❑ 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 [5,Nn ❑ NA ❑ NE
❑ Yes ❑"No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [�j No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �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 F-LNo
47
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ff No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

f
Fa6li Number: - Date of Inspection: 97
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [!fll;ro ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes io ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes D<0 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ Io
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®.lilt!
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
O -] o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[:]Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Rio
❑ NA
❑ NE
34, Does the facility require a follow-up visit by the same agency?
❑ Yes
[� o
❑ 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).
13 Cejc
r(u-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: , � U�. S
21412014

0-01a ttN
Facility Number - Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Mompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Qlio�utine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time:® Departure Time: County:
Farm Name:� �-, Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Fv e/ Title: Phone:
Onsite Representative: i Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
on -Layer
Design Current
Discharaes 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?
Region:�D
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dal
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes IS NFU ❑ NA ❑ NE
[:]Yes
[:]No
[.NA
❑ NE
[:]Yes
[:]No
[]�KA
❑ NE
[:]Yes
❑ No
❑<A
❑ NE
❑ Yes
[3-No
❑ NA
❑ NE
[:]Yes
E'No
❑ NA
❑ NE
Page I of 3 21412014 Continued

Facil ity Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes l6J'"" ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [1>0r- ❑ 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 Q.Ne ❑ 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 to ❑ 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 [3r ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ N ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �fo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ej< ❑ 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 Typc(s):
610
13. Soil Type(s): yL*---Q � aac-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Zk]Qo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑190 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [3] No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
I S. is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [3 o
❑ Yes [..NNo
❑ Yes [ No
❑ Yes �o
❑Other:
[DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
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 Eq<o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes To ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

(Ifillility Number: - Date of Inspection:ON
c'024. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ZKo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Cg,<o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [�o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [DAo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Ck o
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[Ll<o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
C No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[;Ko
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[Ko
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[,'Flo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/pr, any)additional recommendations or any other comments.
Use�drewln s offacility to better ex lain situations use additional:a es as necessa
c4ly+j�-j I �__ 1-3
r (
11 Reviewer/Inspector Name: 1 L� Phone: 333
Reviewer/inspector Signature: 1 Date: j�
.- •---
Page 3 of 3 2/4/2014

�i f fj u
ivlsion of Water Quality
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: C2om�fiance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit; {JRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: rrival Time: Departure Time:
Farm Name; ��(' Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: G'T 0vi Title: &WM Phone: q5("L
Onsite Representative: jt Integrator:
Certified Operator: �� Certification Number: [ O�
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -La er
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)?
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dory Heifer
Dry Cow
.Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes R-o ❑ NA ❑ NE
❑ Yes
❑ No
Q PtA
❑ NE
[]Yes
❑ No
IA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ No
❑ Yes ❑'1Qo
❑ Yes 21�o
Lc`J'' A
❑ NE
❑ NA
❑ NE
❑ NA
[] NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes R.?do ❑ 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): QL� �•
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ej< ❑ 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
Ce'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
On LYO
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
F�Ko
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑'K'o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
R�O`No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
I6
❑ 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): ,i n
13. Soil Type(s):
14. Do the receiving crops differ from hose designated in the CAWMP?
❑ Yes
Quo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
23<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
M-Tlo
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E2-No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
❑'Ko-
❑ 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
lf-i''''o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking D Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
No
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
I__i
❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
FI<o
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

J
Facili Number:
- Date of Ins ectioni
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E3,R ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
[n' oo ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[E�?o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
/
[f'NO
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
M.W
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Cl Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
rTNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
CE '<o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any. additional recommendations or any,other comments, ;1,
Use'drawings of facility to better explain situations (use additional panes as,necessary).:
ca(N t3
duA\e /13
Reviewer/Inspector Name:
Phon :/0
Reviewer/Inspector Signature: W I W& q Date:
Page 3 of 3
21412011

Division of Water Quality
Facility Number $ - ® 0 Division of Soil andLWater Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1�^l!x �� Arrival Time: d'litb 4fA I Departure Time: County: �psR
Farm Name: Csk\cah Owner Email:
Owner Name: ` RT_OC).{ �PnSS�ol� Phone:
Mailing Address:
Physical Address:
Region: r Q
Facility Contact: '�(iT�pt7�S� On 1 Title: p W fU 4 Phone:
ti
Onsite Representative: P, Cr Integrator: M Q(ke�� &ZOW A
Certified Operator: V(ktr_ b1 W LI Nr_ � OTNr 454_0 f Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder 00 (�
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -Layer
N
Other
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?
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Daig Heifer
D 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 E�No
[]Yes gNo
❑ NA [] NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Condnaed

Facilit Number: 73 1 Date of Inspection: 10 !E'
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes <o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes [:]No Ea/NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: )'aWU07--
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a '
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q] 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
F044o
❑ 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
EV No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
[D'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
R"No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Arc there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2/No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes M/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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): Cc7 (Ln . 1�3�-Pry SG V 6LC} 05
13. Soil Type(s): !'1 park$ o 0, 101 1� o�
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 [v"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [I], -1�4o ❑ 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 [DNo ❑ NA ❑ NE
❑ Yes [;,,,No ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [EfNo ❑ NA [] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3"'No [] NA [] NE
the appropriate box.
❑WUP ❑Checklists [3 Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ff No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ErNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
[�NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: W), - \15: [Date of Inspection: jojtQX
24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes E"No [DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E3No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No QOI�A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
EJNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[�fo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
[24o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[]2<o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes '
Qef4o
❑ NA
0 NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[<"No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any; additional recommendations or any other comments #.`�Aa +
Use drawings of facility to better explain situations (use -additional ales: as:necessa ).
Reviewer/Inspector Name:
Phone: 'A\0.30% AL.c \
Reviewer/inspector Signature: Date:
Page 3 of 3 214120I1

C
r3 ►Hs 011
Division of Water Quality
Facility Number ®- ar 0 Division. of Soil and Water Conservation
0 Other Agency
Type of Visit: aCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (g-Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 111 (0 11 F-1 Arrival Time: Departure Time: tfi County: f Region;
Farm Name: C Owner Email:
Owner Name: Fteddv Lo14 rQ� Phone:
Mailing Address:
Physical Address: 735" (`//fin Hill W_ Vev4Q2 6100'a _
Facility Contact: Title: Phone: a�%`�Oo177
Onsite Representative: Integrator:
—
Certified Operator: iNdyyDpe- Lonl i-.6 Certification Number: �yra9
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 2]No ❑ NA ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [:]No
[:]Yes CD No
[—]Yes Dil-No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

=[Facility Number: - ja Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[R No
❑ NA
❑ NE
a. If yes, is waste 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): La
Observed Freeboard (in):��
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ 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
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes i 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
I� I
12. Crop Type(s): C&A . ►.h&1I spy b P0rl
13. Soi] Type(s): ' 6d bOt IS
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CR No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ER No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP [:]Checklists [:]Design [:]Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, c k the appropriate box below.
ZL— Yes
® No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard aste 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
®- No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
NA
❑ NE
Page 2 of 3
21412011 Continued

•IFaclifty Number: Sa, jDate of Inspection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? WYes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ® NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [5j No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [R No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ® No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes,, check the appropriate box below.
❑ Yes
Eg No
❑ NA
MR NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
?D 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 afollow-up visit by the same agency?
❑Yes
L0 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any, additional recommendations,or i ny othei-�mments
Use drawings of facilityto better explain situations (use additional pages, as necessar ):
al,Tva Sr Cve►`�J In Novato �6'�COv�ed. by pOfie
� h^�T�. �Sar►�f �, prd�.c>°� sa fd h�
-0o(g�~b fost one, , Z100) W10 check /PALS,
ay, Plebe Moll @010 Cat bv$'41 fO
AN', hoar
aas �� , s�, � �e 71
lye#�i lle_ NC_ M 30 )
asp Sjt�� Pxl�l�o� v�fir � aol `�, r
7l VxC��B�` �IL.INV ! ��C.Q�IIiQ�i ��l,r�t���J dl!//'IT1G� lrll.�glrlM7�%�S�r �Q[I
U001 �/
nonbevo`}--ha
�'`}l`�e
33, PmdlJw h It
kvee4-1y ro POW- eP4*4, 34S fec* gvgUv dlseWjS b� hasp,
Reviewerdnspector Name:
1
Reviewer/Inspector Signature:
Page 3 of 3
Phone: qI 9­3300
Date:
AM`]]

Facility No, la -tag- Farm Name
Permit---, COC ✓
Pop.
Type
Design
Current
U(Ci'e L Date
OIC NPDES (Rainbreaker PLAT Annual Cert)
FB
Drops
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge De th ft
Liquid Trt. Zone ft 4
Ratio Sludge to Treatment Volume
Design Width__
•1I--�-�
Actual Width
• I I
. I
. '
-----
Soil Test Date d (r(}$ }�5-(0'-��g Wettable Acres s� RAIN GAUGE
pH Fields Sr(D "tea arlo� WUP ,/ Dead box or incinerator
Lime Needed `I,1 Tjp�C Weekly Freeboard Mortality Records
Lime Applied 1 in Inspections v I111pE� a SG sf,* T131I p
Cu-1 ✓ Zn-I �b w 120 min Insp. t��aa
Needs P Weather Codes jr
Crop Yield Transfer Shipets►1 6PS fl1071(0—)103
NOWITO. fit
NOW:.
..
..
of I
C�
MWAI''gar
9 - G t 3� 15P -15 6-11 Net -M �
Verify PHONE NUMBERS and affiliations
-}ti51b� !� yvhQildfiPcorn
Date last WUP FRO Daat� IgSt UP at farm App. Hardware
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump 4bt
Start Pump V�,O
Conversion- Cu-I 3000= 108 Iblac; Zn-I 3000= 213 Ib/ac

C��rci� L Ar
toA,-
N6 a1�36�
10
q,X3:30
���o-Y�Jo
4c
-
3_ s 131110 S6 1 l— 3.00
Sla, Ito- s 6'- f /4c
SIW 11601i
q- a lay I !- Sr.
Na-a fail!!—sb

6 ( to 3VS 1011110
FFacifity Number r;
J
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Q[Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 19 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Rate of Visit: LldLitU! L�1J Arrival Time: r 5 Departure Time: EL.L.M County:
1C
Farm Name: I'u t ! Owner Email:
Owner Name: 'T L �►.5 Phone:
Mailing Address:
Region: 10
Physical Address: j
Facility Contact: rood Title: OWA?,, Phone No: a37-(,2776 .J
Onsite Representative: Integrator: �— 13 _
Certified Operator: + Z6 Operator Certification Number:
Sack -up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Back-up Certification Number:
Latitude: = o= f = Longitude: Q° 0 d= 46
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er —
38on Non -Layer J
Other }
❑ Other-
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharp,es & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daia Calf
11
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: M
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 RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes N'No
❑ Yes D?-No
Page i of 3 12128104
❑NA ❑NE
❑NA ❑NE
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
RNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
HNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
§2 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �RNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes t'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 PNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �kNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes tRNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
CRNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[W No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Z'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ErNo
❑ NA
❑ NE
Comments (refer to,question,#):.Explain any YES answers and/or an recommendations or atiy other camrtients fir, �a
Use-`drawin` s of taeilit to bcttei•. explain situations: (use -additional a es as ne
g y . p p µg .. :, cessar,Y}
0 a--
(OV,
Reviewer/inspector Name _ t Phone: f
Reviewer/inspector Signature:
Date:
Page 2 of 3 12128104 Continued

Faciliiy Number: 'ok— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes f'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9 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 9 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �R No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No RNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit`?
❑ Yes
CKNo
[INA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
8-No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
E�FNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
RNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�?No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
N-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
N-No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
Did the facility fail to notify the regional office of emergency situations as required by
El!S Yes
No
PSNo
❑ 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
2T To
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9-No
❑ NA
❑ NE
Additional Comments and/or Drawings:
+fs set
Q-' 04-W aO ry
1, YtI)� An�sey all aC t-6 �a�1
� 1 111A fi 1fl - lut ' t�LV�] [ C01TArn l- addt, lad
7
Goo- records olid.8ocd—) ayv01 coy-e�-,
P)an n `�o phtt rvhea�-re� so),?,
Page 3 of 3 12128104

;FaCllity No. Farm Name
Permit Q--�COC --�
01CI`e t .2, Date /0
OIC_ NPDES (Rainbreaker PLAT Annual Cert )
FB
Drops
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Design
,�%.-----�—
r -
Actual�ri�—-----
"Itp—
Soil Test Date
Wettable Acres ✓ RAIN GAUGE
pH Fields
WUP Dead box or incinerator
Lime Needed
Weekly Freeboard :s Mortality Records
Lime Applied t/S
1 in Inspections tv
Cu-I Zn-I YJ
120 min Insp. ��
Needs P
Weather Codes f
Crop Yield
Transfer Sheets
J
Mid OF
��
•
f
f •
• f
■ l�
I % u a
lip 1FMMAMI
f VerifyPHONE NU MBER3 S and affiliations `D�
Date last WUP FRO (fls log Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump'
Conversion- Cu-1 3000= 108 Iblac; Zn-I 3000= 213 Iblac
App. Hardware

/I- 04 - Z009
A-Xlqs.
Type of Visit compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit eRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1b-25-,0Arrival Time: /C. 'QL),?s•, Departure Time: County:
Farm Name: G�i r4]��- IL Owner Email:
Owner Name: f"rtL��4t 4J, Phone:
Mailing Address:
Region:
Physical Address: i
Facility Contact; Title: oLwe. r- Phone No:
Onsite Representative: OeTNz L1�'-�/ Integrator:�
Certified Operator: Are,1,14 U. G.�w,J:; lr•�s Operator Certification Number; 2'V12_47
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 c ❑ ` ❑" Longitude: = o = 4 ❑ «
ent Design Current
Design CurrLr
Design
Current
Swine Capacity Population Wet Poultry C•ap�city Population
Cattle
Capacity
.Population
El Wean to Finish
1110
❑ Layer
❑Dai Caw
Wean to Feeder 13A)
Non -Layer
❑ Dairy Calf
❑ Feeder to Finish 1
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
ElNon-Dairy
❑ Farrow to Feeder
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑Gilts
❑Non -La Non -Layers
❑ Pullets
❑ Beef Feeder
❑ Boars
El Beef Brood Caw
❑ Turke s
©then ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharaes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 Io ❑ NA ❑ NE
❑ Yes ❑ No L<A ❑ NE
❑ Yes ❑ No 1<A ❑ NE
❑ Yes ❑ No &<A- ❑ NE
❑ Yes [�a,"1 a/❑ NA El NE
ElLIYes 11_0 ❑ NA ❑ NE
12128104 Continued

Facility Number: 821 -/2S
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: 0-1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes CT/No
❑ Yes ❑ No
Structure 5
❑NA ❑NE
iA ❑ NE
Structure 6
❑ Yes 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 three, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Io ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E3<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 El Yes 0<0 ❑ NA ❑ NE
maintenance or improvement?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes DIN. ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes io ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ihs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window// ❑-LEvidence of Wind Drift El Application Outside of Area
12. Crop type(s) Se; _,,6e4�AJ.S GIN e...t. T CO i n! (Gr-.i,.v� 6 f'I r d nr
13. Soil type(s) f/cA
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
S. Is there a lack of properly operating waste application equipment? ❑ Yes
[No ❑ NA ❑ NE
Rio ❑ NA ❑ NE
No ❑ NA ❑ NE
ET'No ❑ NA ❑ NE
No ❑ NA ❑ NE
� '..i.• :'i:. _--.: `>�� .m 1 5��['S 13 iE� ���� I� ��
Comments (refer to question #) <. Explain any YFS Answers andlar" any.recommendatIons gr any other comments.
' + .�4 ► ' '
Use drawings of facility to hettcr expla3n.situgahons.(uw additignal paggepsi�a�s ¢necessary, c
Reviewer/Inspector Name f ;;.G,.�Ye�S "'. 'R ._y. Phone: y/[�«
Reviewer/Inspector Signature: r Date: /0,2 Ste- Z00'9
12128104 Continued

i
Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP El Checklists El Design ❑Maps El Other
❑ Yes No ❑ NA ❑ NE
❑ Yes Erl10 ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ffNo ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L7<O ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B"NO ❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2�o ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O o ❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
fo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
3Po
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
��,/
E j o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
LTNo
❑ 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
30 o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
12128104

D fMJ 0-V1 D7j!$ri
Facility Number
QMlvision of Water Quality
O Division of Soil and Water Conservation
0 Other Agency
Type of Visit (9 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 1W Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: MNTIE Arrival Time: ® Departure Time: �� �3 County: Region: L�
Farm Name: r. t rt Owner Email:
Owner Name: GV LAIPhone:
Mailing Address:
Physical Address:
Facility Contact: tQ L Title: Own 3n L Phones No:
Onsite Representative: r - Integrator: t lV!"1D�i`�drowj"1
Certified Operator: LdtL}s Operator Certification Number: AWA 0 910
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
Other
❑ Other
Back-up Certification Number:
Latitude: = o = i = Longitude: = o = L = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
3 Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ PUllets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes bjNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
[I NA
El NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
H No
❑ NA
[IN I,
Page 1 of 3 12128104 Continued

64
Facility Number; a— Date of Inspection
Required Records_& Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ]RNo ❑ NA ❑ NE
. the appropirate box. ❑ WDP ❑ Checklists ❑ Design El maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IgNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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 Drawings:
❑ Yes
0jNo
❑ NA
❑ NE
❑ Yes
[:]No
IRNA
❑ NE
❑ Yes
ZfNo
❑ NA
❑ NE
[]Yes
®No
❑ NA
❑ NE
❑ Yes RNo ❑ NA ❑ NE
[]Yes ❑ No t'NA ❑ NE
❑ Yes VNo
❑ Yes [�tNo
❑ Yes 9 No
❑ Yes RNo
❑ Yes [�KNo
❑ Yes 9'No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
El NA ❑NE
❑NA El NE
❑ NA ❑ NE
19, Nefte deer Co c. wi-h► 0>_ reuqj, (Chmed 4-'F d c(tP-pt),
ao PIOA bey �Addin i � el.s
ink rew k�a�. now . .9 dC hea, road.
71 £xC'e W cove. 0n 1 004, PlftVnCw insrdegr6 IfJO41 w��•, bah a
is _Li h� 4hnvbs s, y �FoIto w (dog Pnt 8107p°�&#lry),
aS,SIVd9e„ V/Ife d)le1n a00-7 , cy-emp'1- aooe,r'od.anoNe,Svly r 009.
� H 6A b, d6f n o}OOfor PP�, Onf_'fA 11 toA/'
Is, ILIme, Wa.r afft(Pk _f%1sstir 1it . �P�so �.r ffiA►�a� �
Berds ham em e� o���'f 9.0 oa��'mli�d�o� m y a�1 yam'),
1
No aep r) aoo - en d d oarh `H e(b,
Page 3 of 3 12128104

"Facility Number. — ).)�
I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
XNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
VNo
❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
IQ No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
;K Yes
[]No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�Q No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
tFrNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
W No
❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
(KNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > l0% 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
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
RrYes
[INA
ElNE
15.
Does the receiving crop and/or land application site need improvement?
YestNo
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
RNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
Q No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
CffNo
❑ NA
❑ NE
Reviewer/Inspector Name 1 J Phone: — D�
Reviewer/Inspector Signature: Datc: j
D.. 'f _, 2 ki 77/7R/AA r-nfln..ed

+ Facility No. D o Date IT Farm Name Ct fdt L_
Permit COC OIC� NPDES (Rainbreaker
PLAT Annual Cert )
Design Width
.•
-��--��
Soil Test .3Q
pH Fields pH Lagoon ✓
Lime Needed 6r
Cu
Zn
-r64o Un EA1r(O h,%.
Wettable Acres '� �j*f` Rainfall >1"
Crop Yield �/' 9�OraG07fJ 1 in Inspections
Rain Gauge 120 min Inspections
Weekly Freeboard Transfer Sheets
. ..
nurmu-�mm0
FMn
m
Pull/Field Soil Crop Pan Window
fl Oct
S
.S6
9 .
rt0= 'Twotead� below a L fme� 1 j 0-w— " �►

- X
ivision of Water Quality
Facility NurAer ,� 0. Division of Soil and W, ate'r Conservation
Q Other Agency
q
rr
Type of Visit .Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 17Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: �p `i Arrival Time: Departure Time: County: h Region: P
Farm Name: r �1 r. L.,
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: h Title: QtS!Y1Q—y_ Phone No:
Onsite Representative: Y Integrator:
U G}
Certified Operator: ` rem. U Operator Certification Number: �� f
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
Uther
❑ Other
Design Current
Capacity Population
Back-up Certification Number:
Latitude: = c ❑ I ❑ t1 Longitude: = ° = ` [� `t
Design:— Current'
Deng
Wet Poultry
Capacity, Population
Cattle Capac
Layer
❑ Dairy Cow
Nan -Layer
❑ Dairy Calf
-
❑ Dairy Heifer
Dry Poultry
❑ D Cow
❑ La ers
ElNon-Layers
El Pullets.
ElTurkeys
Pouets
ETurke
Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
`p
Number of 5truutures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes )�No ❑ NA ❑ NE
❑ Yes
❑ No
A
[INE
Yes
ElNo
rNA
❑ NE
F NA
❑ NE
❑ Yes
[:]No
❑ Yes
No
❑ NA
❑ NE
❑Yes
No
El NA
❑NE
12128104 Continued

Vo
FacilityNumber; — Date of Inspection l bI 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ANo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes allo 0 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ,No ElNA El NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo ❑ 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 *o ❑ 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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes �RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes y] No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) Na 1
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 DPNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes X No ❑ NA ❑ NE
hn
17. Does the facility lack adequate acreage for land application? ❑ Yes p No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes �PNo ❑ 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):
ReviewerlInspector Name ( N Phone:
ReviewerlInspector Signature: Date: V
Page 2 of-3 12178104 Continued

Facillty Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0,No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No,
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
*o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Wo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�Vo
[INA
[INE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑No
50 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes'Io
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�gNo
❑ 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
ElNA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ANo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
NjNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
6rcj' : trr, nr 4=1 1 D u Vas J c��'e. /I ,
CC)(, -o7 v rr, 0-7
Py nis GAI en 1 (% 'acDA SQra�-�
Sstaoov� . O
- Sl kA% Pb R
Page 3 of 3 12128104

lzn
Facility No. 91:;Time In _ U Time Out Date / ©�
Farm Name ' r L Integrator ,-
Owner r "� Site Rep F
Operator No.
Back-up No.
COC Circle: General or NPOES
Design
Curre t
Design
Current
Wean -
00
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed, Finish
Gilts / Boars
Farrow —Wean
Others
FREEBOARD: Design
30:udge -Survey
Crop Yield l�
Rain Gauge
Soil Test PLAT
Observed 3 Z-
Calibratier.!GPM t/ ! 90
Waste Trans ers
Rain Breaker
Wettable Acres Q(�
Weekly Freeboard Daily Rainfall 1-in Inspections
Spray/Freeboard Drop
Weather Codes 120 min Inspections
Waste Analysis:
D to Nitrogen (N) Date Nitrogen (N)
Pull/Field Soil Crop Pan Window
0

1'
Type of Visit Itompliance Inspection 0 Operation Review () Structure Evaluation O Technical Assistance
Reason for Visit 0160utine ()Complaint O Follow up O Referral O Emergency (:) Other ❑ Denied Access
Date of Visit: 7 f*7 Arrival Time: d1 Departure Time: County. Region: �e C)
Farm Name: �t YU l� Owner Email: Owner Name: L Phone: 910 q — CPa +�1
l
Mailing Address: ` 6 NJ C)
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: '
Back-up Operator: *
Operator Certification Number: -2 i LC_�
Back-up Certification Number:
Location of Farm;
Latitude: =j
= i = 14
❑ ° = 6 = 11
1
11q_ rvi • 1 v � +1 13
}c
0 ] -2kk,, f er-., � A � )
( I �
r /Longi�tjude:
r l0 r
Design Current
Des€gn C•urrent Design C►urrent
Swine Capacity Population
Wet Poultry
C►apacity Population Cattle Capac€ty Populat€on
Wean to Finish
JEI La er I
I
❑ Dairy Cow
canto Feeder
3 6D
❑ Non -Layer
❑Dai Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy Heifer
ElD Cow
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow Farrow to Finish
❑
❑Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
Boars
❑ Pullets
❑ Beef Brood Co
[ITurke s❑
tj[11
Other
Turke Poults
❑ Other
Number of Structures:
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�Vo
❑ NA
[I NE
Discharge originated at: [I Structure El Application Field El Other
��f
a. Was the conveyance man-made?
❑ Yes
❑ No
A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
El No
A
❑ 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
o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

:,
t Facility Number: Z—�'z,
Date of Inspection b
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): �r
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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 )INo ❑ NA ❑ NE
❑ Yes a No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes NNo ❑ 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 t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes j o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes )ONo ❑ 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 9No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J&No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes )gpNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of {Accc_eptable Crop Window I❑ Evidence of Wind Drift j ❑j Application Outside of Area
A
12. Crop type(s) :..Ja lid �_ Po-s4u,4 . - j ICL l I � f, 0,s e) o Y" sk[ Qx
13.
Soil type(s) No -
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes XNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes 't;-I:1Vo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes JR No
❑ NA
(I NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes )!RNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes XNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments t= �;
Use drawings of facility to better explain situations. use additional g ty p ( pages as necessary):�_-
YL i.�5'4i' MY �c5
` 1
AL
GYud �s:s +/isu4s ,
Reviewerllnspector Name �`�L /u --
- Phone: D r
Reviewerllnspector Signature:
Date: GI
Page 2 of 3 12/2#,f14 Continued

Facility Number: Z- Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1�0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate -box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
*o ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No %P4A
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No ANA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No_gNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�No ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[--]No IN NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 3.No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes *0
❑ 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 KNo
❑ 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 Y 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 Wo
❑ NA ❑ NE
12128104

U
\D I
Facility Number__ ( _ Date: �� Time 1� r Out
Owner
Farm Name ��f
O.I.0 5`Ce5 f' �No.
C.O.C: V eneral ' NPDS '
Design Current' Design Current.
Wean to Finish can to Fee 3 600
Feeder to Finish F ean.
Farrow to Feeder Farrow to Finish
: Gilta Boars
Other
Soil types _
Crop Types & r toa Pa6Pan Window
Soil Testsi Plat 174,
r
Designed Freeboard k� Observed Freeboar _
Rain gauge Rain breaker Daily Rainfall
Calibration of spray equipment ' G.P.M.
4&, - ,Uc-/
Waste Transfers
Sludge, Survey Crop Yield; 120 Minute inspections
1 in. Rain inspections Weather code Weekly Freeboard
a •��� 3 7 a �/ Atid KL� Lat�
Pumping time P` /
Waste A alysis % & Month A/'a �� ~_a�• � �7 ��? �
Comments

Division of Water uality
Facility Number S 2 - 150 Division of Soil and Water Conservation
tD Other Agency
Type of Visit 40 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Z = Departure Time: 3 :1 County:Region: FP-0
Farm Name: r`je- Owner Email:
Owner Name: ;S f'" Phone: 91 � � .�"9Y - Q
Mailing Address:
Physical Address:
Facility Contact: f Title:
Onsite Representative: Fre_�v e.
ki
Certified Operator: LAL�Mq_4-fr�
Back-up Operator: A�ejl� Ij 4It
Integrator:
Phone No:
P5 F
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ 0 0 ' ET Longitude: 0 e ❑ T ❑ "
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
I ❑ Layer
31000 3 (a 00 1! 10 Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy.Heifei
❑ DEZ Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
e. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [2�No ❑ NA ❑ NE
❑ Yes
❑ No
KNA
❑ NE
❑ Yes
❑ No
[9NA
❑ NE
❑ Yes
❑ No
MNA
❑ NE
❑ Yes
IE�No
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
12128104 Continued

acillty Number: $ Z — 25 Date of Inspection I 2 I 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: M0
Designed Freeboard (in): rZ y
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes ❑ No `® NA ❑ NE
Structure 5 Structure 6
❑ Yes X No ❑ NA ❑ NE
❑ Yes JK 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 9 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;KNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 09 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [9No ❑ NA ❑ NE
maintenance/improvement?
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ANo ❑ 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) Ise r +A u64A.
13. Soil type(s) 0p
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5�,No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JKNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
KNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
19 No
❑ NA
❑ NE
Reviewer/Ins ector Name " '' = � ' - tt'_ yl `�d �, �+ Phone: 7/0 86
p / S
Reviewer/Inspector Signature: Date: 2-1I 8 lOE-
12128104 Continued

Facility Number: g Z —rZS Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes EB�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily avai{able? If yes, check [--]Yes JRNo ❑ NA ❑ NE
the appropirate box.
❑ WUP► -❑ C17ecklist:e El Design El Maps' [I Other
21, Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CKNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard' ❑ Waste Analysi;r ❑ Soil Analysis# ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall► ❑ Stockings ❑ Crop Yield # ❑ 120 Minute Inspectionsr ❑ Monthly and 1" Rain Inspectionso, ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes O.No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment`? ❑ Yes ❑ No I�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
I,No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge`?
❑ Yes
®.No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[:]Yes
9LNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CK 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
9No
❑ 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
09 No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[9No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
RN
❑ NA
❑ NE
Additional Comments and/or.Drawings:
�►l�-she A�(�c�s: rl��IaY i•Y ��/Bi�Y �•�
`I (f /•3 z���os �.�
_+ r,
2I. b 1 sou S se) vt u4 r e_ j u1 r atiyA,'rs 4rt7+� s •(-� �et�-rd 5 C t a:.��na[� 6i-oc�+
crop 1; old , � c4;►,. �.•,t:�e�iw� eQSe �5e.-`{�•a. arpcv`f,�e..ol 4ot-�e,
�'� GLtM,e, Witt - ii-c ULe vJ Q �K [-,-4 �8tw d µ'�-�.� Oc,t 6 & f !
J
ZOO `{
Z �l,1
IZ,S. = re_COW-w� 4t%A-17 Akr . LA..�pw S� GO"ti� �[ N O-r-
zc s p e&_� k �+ at o U-i- Uca,rr.t •i —q o
6 j.r�ce •s „rve4 re w.Q..,.-'� c l 1rt-+I' ,
12128104

1
f
Date of Visit:
® Permitted [3 C rtified 0 Conditionaliv Certified 0 Registered
Farm Name: l.;&Ie, L
Owner Name: &/ wD -- -- -//-►►
Mailing Address:G k !�1• - -Oibt iTl
�LiI=TJTime: E=
=Not Below Threshold
Date Last Operated or Above Threshold:
Count•• r!�LWP_SeN„
Phone No: ? 031
VM. NC as
Facility Contact: Title: Qwmrr Phone No:
Onsite Representative: 'h Integrator: 1>01LUdDej
Certified Operator: n W' JA Operator Certification Number:
Location of Farm:
LrJ s'wine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 u Longitude ' �
Design Current
Swine ! anarifv Pnnulssfinn
Wean to Feeder
I T.00
I 1900
❑ Feeder to Finish ,
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boats
Design Current Design Current
Poultry Capacity Po uiation Cattle Capacity Population
❑ Laver JE1 Dairy
Non -Layer ❑ Non-Dairy
❑ Other
Total Design Capacity t�U
Total SSLW
Number of Lagoons I i ,� y ,' �U Subsurface'Drains Present J1LJ Lajuon Area J❑ Spray Field Area
Holding Ponds / Solid Traps ystem 0 ❑ No Liquid Waste Management Sit ;'
Discharges & St._ ream IMpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Laeoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Try ent
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
❑ Yes S fro
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [-�M
❑ Yes [94roo
❑ Yes ❑ No
Structure 6
05103101 Continued

Facility Number: 5 — Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste An lice ation
10. Are there any buffers that need maintenance/improvement?
11, Is there evidence of over application? ,❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type IlerMA&L A44 Z i;,% - ImM
13. Do the receiving crops differ with those Aesignated dthe Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment?
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
19, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time ordesign?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Zere any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes i_ 401
❑ Yes 2 No
❑ Yes Vo
N❑ Yes
❑ Yes Ly�No
❑ Yes i,.'No
❑ Yes No
❑ Yes CKO
❑ Yes E
❑ Yes 90
❑ Yes Ly '
❑Yes jNo
B
❑ Yes No
❑ Yes M?110
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ents referto' uestian # : Ex lain an YES nand/or an recioman orcomments.,
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Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: D
05103101 Continued

Facility Number: A —Q5 Date of Inspection 1x=
Odor Issues '
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes BNo
❑ Yes [R<o
❑ Yes �o
❑ Yes Lld'No
❑ Yes ��
El Yes VNo
El Yes
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05103101