820158_INSPECTIONS_20171231

NURTH CARQLINA
Department of Environmental Qual

kT.\s19<1GIIK"
(Type of Visit: 0 ?R0outine
iance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: t( Arrival Time: .Q
Departure Time:
J
County:�,rt�}SM
Region
Farm Name: r_ atljl/
Owner Email:
Owner Name: Pao o
pa-t1 rev—
Phone:
Mailing Address:
Physical Address:
Facility Contact: dYl V Qf Cu'— _ Title: Phone
Onsite Representative: ! t Integrator: p t"q C
i
Certified Operator: ll Certification Number: 1e7
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Wean to Feeder O SbQ
Wet Poultry
jLayer
Nan -La er
Design
Capacity
I
I
Current
Pap.
I
Design Current
Cattle Capacity Pap.
Dairy Cow
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
M
Dr P,ouI
Layers
Design
Ca aci
Current
�a
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Yorkey Poults
Other
Discharges and Stream ImnaCt5
1. 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
C 3-1qA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[g'&A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
�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
' bNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

I
lFacility Number: - Date of Inspection:
'Waste Collection & Treatment �11
,��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E] O ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [c-N€f — ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [D'Iqo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
®--Go
❑ NA
❑ NE
•
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
r
�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-Mo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
B-1'go
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C G r' f F S G O
13. Soil Type(s): A10 4,1 3 a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
®'P ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
U o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[N6 ❑ NA
❑ NE
acres determination?
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
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
11 o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[31 roDNA
❑ 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
�i,�
[�, o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[j N
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
r24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Eq-Ko. ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ '7 oo ❑ 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 (j_Na ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 12- ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E]-
❑ 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
[&Noo-
❑ 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
0],I�o
❑ 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
al-Mo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CjR - o
❑ NA
[] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[a-N0 NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
o
❑ NA
❑ NE
to:
f /'-J
Cam( `fD -36g-_
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
` Phone:L -
re: o Date: 0�
21412015

rl ­J�D
ypr u■ r 13u: �.umpuauce Enspecuvu �j vpr■-aeon nevivw U arrucrure a va1uauuu v I ecnrucai ,'►ssisrancc
Reason for Visit: 01outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: , Departure Time: i0� County:�, Region: FT'410
Farm Name: Cet" F,,. Owner Email:
Owner Name: 41OL6k t a,44<1. Phone:
Mailing Address:
Physical Address:
Facility Contact: _ tj I at r ` Title: Phone:
Onsite Representative: it Integrator: 42Le. 14q L-e
Certified Operator: Certification Number: f get/ 2-3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
SwineKotawman
Design Current
Capacity Pop.
'Vet Poultry
Design
LaIpaity
Current
Pop.
Design Curreut
Eattle Capacity Pop.
Dairy Cow
Wean to Finish
Layer
Wean to Feeder
of
• '71
Non -La er
I
Dairy Calf
Feeder to Finish
D , Pohl
1 a ers
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
Design
Ea aci
Cnrrent
l',o
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood I` —
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
I Discharges and Stream Impacts
1. 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
�A
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
E4-?+A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
F11,GA
❑ NE
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
.g-Mo
[] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E;d o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: jS jDate of inspection: c
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes QD_Na--❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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
[6] oo
❑ NA
❑ NE
waste management or closure plan?
Ifany 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
2-fro
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
g K-5
❑ NA
[] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
0 Yes
E]. o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
fTNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes F� o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind
Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �3 J"tM A�CIA
13. Soil Type(s): t
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [ ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E4j,1qo' ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [Lk+ff— ❑ 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 [tr ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
LK11'o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [-]Design [—]maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E:I-"o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather
Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
3'oNo
❑ NA
❑ NE
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection: c
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes v-+ ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [dam[] 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 U�7 ❑ NA ❑ NE
r
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes GD.J�ie 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 tiie drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Signatui
❑ Yes ❑ NA ❑ NE
❑ Yes Q'1 oo ❑ NA ❑ NE
❑ Yes [g-do ❑ NA ❑ NE
❑ Yes
E]-155—
❑ NA
❑ NE
0 Yes
[]D..M
❑ NA
❑ NE
[-]Yes
[R-No
❑ NA
0 NE
❑ Yes
U Vo
❑ NA
❑ NE
Date: sr
21412015
Page 3 of 3

e of visit: [v Compliance Inspection V operation Review V structure Lvaluation CJ feclinical Assistance I
Reason for Visit: (Q•Routine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,O Departure Time: County:
01
Farm Name: CBS 7y✓wI Owner Email:
Owner Name: ia to 1% t-✓` Phone:
Mailing Address:
Physical Address:
Facility Contact: # 414,tyauikTitle:
Onsite Representative:
r�
Certified Operator: to
Back-up Operator:
Integrator:
RegionF/?-%3
Phone:
cff M-e,-7-�
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes [�o ❑ NA ❑ NE
[:]Yes
❑ No
[VA
❑ NE
[:]Yes
[:]No
Eg-NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) [:]Yes [:]No [21NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes 2r'No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [�No ❑ NA ❑ NE
of the State other than from a discharge?
Page I 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
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
ET -No ❑ NA ❑ NE
❑ No [ 1VA ❑ NE
Structure 6
❑ Yes [] Ro ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
g2r?10
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
j�o
�T
❑ 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
<o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes YINZ ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 0 Application Outside of Approved Area
12_ Crop Type(s): COS g-eJ ef zy V by, M".0"
13. Soil Type(s): /Y
14_ Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ NE
[:]Yes
[I?Ao
❑ NA
❑ NE
[:]Yes
[] No
❑ NA
❑ NE
[:]Yes
[:?Wo
❑ NA
❑ NE
[:]Yes <o ❑ NA ❑ NE
[:]Yes E No ❑ NA ❑ NE
❑ Yes [ h10 ❑ NA ❑ NE
❑ Yes [3No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below_ ❑ Yes U40
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑Crop Yield ❑ 120 Minute Inspections El Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [3'No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - J Date of Inspection;Li 10
2e Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
®.,i
❑ 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-Ao
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[R<o
[] NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [54No ❑ 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 GRINo ❑ 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 [2'14o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E2rlfio ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes eNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes eNo ❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or anyadditional recommendations or"any other comments
Use drawings of facility to better explain situations (use additional pages as -necessary).
1
S'v
- Y
bo p K6CdV'XS, �l,?�G1ee� T tv� I
O vL &JC 4�e, a" 6ajti
�''�7 oar
�'%ems ►�-��
Reviewer/Inspector Name: N13 t r UvOap Phone:
Reviewer/Inspector Signature: bg!�A Date:
Page 3 of 3 214 011

I ype of visit: Qdy. Uompliance inspection V uperation Review u structure r;vaivation V i ecnnical Assistance
Reason for Visit: f1Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: fSa Departure Time: County: u r01 Region:
Farm Name: .[,/► Owner Email:
Owner Name: r[ Gt u I ` Phone:
Mailing Address:
Physical Address:
Facility Contact: �1 Q., Pa �, F Title:
I
Onsite Representative: I
Certified Operator:
tt
Phone:
Integrator: P.I.-C 4C J
Certification Number: r 0 ¢
q Z3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
1111111
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Cnrrent
Pop.
Cattle
DairyCow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
DairyCalf
DairyHeifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oui
Layers
Non -Layers
Design
a aci
Caps
Current
P,o
Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Othe
Other
HOther
Turkeys
Turkey Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes C[, Mo ❑ NA ❑ NE
[:]Yes [:]No E3-NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[::]Yes
[::]No
[]-'RA
❑ 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
[alto
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[;To
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facifl Number: - Date of Ins ection: . `
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M-Ne—­❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No �A D 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
6No
❑ 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
1_ 46
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3-No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E24o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[I/No
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window Evidence of Wind Drift ❑ Application Outside of Approved Area
p❑
12. Crop Type(s): �r./►r��.`��i j� �rJ��� c� (�
_
13. Soil Type(s): ., ,! ,. o A j3
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
I3 Lo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
LJ 90-
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
[9 o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L_f < o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[1 o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[TNo
❑ 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
dNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[f(No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

' FaciIi Number. - Date of Ins ection:
5
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ed—"—" ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑-No ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
Q No [] NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
[9-❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[—]Yes Io ❑ 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 L9 o ❑ 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 CAWIv1P?
❑ Yes UNo ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes B11140 ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E(No ❑ NA
❑ NE
ments (refer to question #): Egptain an YES answers and/or an 'addthonal.recomineadatrons or an other comments.
FlUse.dra,wings
of facilityto better explain -.situ ations- use addittonal pages as necessa
CAj��14
L( �J, P
Reviewer/Inspector Name: Phone: U S' 3
Reviewer/Inspector Signature; Date:
Page 3 of 3 21412014

K-9
Type of Visit: , ance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
. I h/
Date of Visit: Arrival Time: Departure Time:�f County:
Farm Name: P,ra �+Nlf Owner Email:
Owner Name: _T `y��PLat+ -cam Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Phone:
Integrator: �{
Certification Number: �f�J
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Designer Current
Design Current
Swine
g
Gapacty`Pop Wet"Poultry CapacttyP p =
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
Feeder to Finish
Farrow to Wean
E rent
—DairyCalf
Dairy Heifer
D Cow
Farrow to Feeder
_D , P,oultrvrDZosijcjX&
a a�Po
Non -Dairy
Farrow to Finish
Gilts
La ers
Nan -La ers
Beef Stocker
Beef Feeder
Boars
-
Pullets
Turkeys
Beef Brood Cow
-
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes []I- o ❑ NA [ ] NE
[:]Yes
[:]No
E3-VA
❑ NE
[:]Yes
❑ No
Imo' ""'A
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No [3NA [] NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [2 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes g]�No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

GLA
Facility Number: - Date of Ins ection: e.
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Qltf" ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
FIA'A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): s5
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
__
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
br_
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E3 ")
❑ 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
10
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Eg-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
`lam'
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ej No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes DZo ❑ 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): 3 e'U tPlp' S' (0 -0
13. Soil Type(s):
14. Do the receiving crops differ fr6m those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
IS. Is there a lack of properly operating waste application equipment?
❑ Yes
ERINo
❑ NA
❑ NE
[:]Yes
[�No
❑ NA
D NE
❑ Yes
94o
❑ NA
❑ NE
❑ Yes [�Io ❑ NA ❑ NE
❑ Yes [,Io ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �fo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ea<o ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes (D X-o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes C3 o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EEf No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faeflity Number: Date of Inspection: ji
_l
_ 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ZLX56 ❑ 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 L.T44o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E Vo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes To ❑ 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 Cj/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 EJ/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 a3lNo ❑ 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 MAO ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �To ❑ NA ❑ NE
Comments (refer to question #j: Explain any YES answers and/or any additional recommendations or any other comments;
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: ,� t �) Phone:
Reviewer/Inspector Signature:hA Date:
Page 3 of 3 21412011

(Type of Visit: Compliance Inspection V Operation Review U Structure Evaluation Q Technical Assistance I
Reason for Visit: Vfioutine Q Complaint p Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County:�Region: ( tw
Farm Name: Owner Email:
Owner Name: (.. a,ir LZ "' Phone:
Mailing Address:
Physical Address:
Facility Contact: h1t Title: Phone:
Onsite Representative: Integrator: "Ls
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
_ ..
Design
Current.
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop:
Cattle Capacity Pap.
Wean to Finish
Wean to Feeder Vy4eo
Feeder to Finish
Layer
Non -Layer
=_ "'
I
-
' -'
Dairy Cow
Dairy Calf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
D . 1'onIt .
Design
@a aci
CurrentDry
Po
Cow
Nan-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
_
Pullets
Turkeys
Beef Brood Cow
he
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[—]Yes
Q.Ko
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
dNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
E3 NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[D-C1A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[24o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

w
Facility Number: n 13ARIf jDate of Inspection:UCA
Waste Collection &Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes to ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [R'<10 ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?: 1
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[! No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
r7l" fo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 46 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
[j�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[I�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
'�C/
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[VXo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [Vo ❑ NA ❑ NE
❑ Excessive Pending [] Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop W�indow�}� [] rEvidence of Wind Drift ❑ Application
(O�utts►id/e�of Approved Area
12. Crop Type(s): �c r V4t.t�4�1 l . N �CT
13. Soil Type(s): r. r}- l AL
14. Do the receiving crops differ those designated in the CAWMP?
❑ Yes
U2,No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[kRo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[;�No
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
Zj'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;Y�o
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Vo
❑ 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 GrNo
❑ 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 Et No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNO
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facie ' Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Uj�<o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �To ❑ 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 [21<'o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [21 o ❑ 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?
Reviewer/Inspector Name:
❑ Yes fit- o ❑ NA ❑ NE
❑ Yes ff j No [DNA ❑ NE
❑ Yes ff?"N�o ❑ NA ❑ NE
[:]Yes U] No ❑ NA ❑ NE
❑ Yes [+rNo
❑ Yes 52'No
❑ Yes []lo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: l W 13 _
21412011

Type of visit: QrCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: lS(Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
rf /
Date of Visit: Arrival Time: I 10 t4g qn I Departure Time: s ounty:Region: f 1b -
Farm Name: C it n-Z u aJ V1gE4T1s Owner Email:
Owner Name: t\LA40 ?Pk" ` , Phone:
Mailing Address:
Physical Address:
Facility Contact: (x Lo.'AA Title: L'1%Phone:
Onsite Representative: 5 A :_ Integrator: a &'4!m
Certified Operator: C�A1,r\ I--- Certification Number: Nq a3
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
GatNe Capacity Pop.
Finish
La er
Dai Cow
Feeder
Non -La er
Dai Calf
o Finish
Dr Heifer
o Wean
Design
Current
D Cowo
Feeder
F
D . Pauli .
Ca aci
P,o
Non -Dairy
o Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
Ocher
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (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 2"No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes [RrNo
[:]Yes RNo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: a - t. g Date of Inspection: /O 611aL
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E2fNo ❑ 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): %1_��
Observed Freeboard (in): _ a�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Eg/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
[3"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
E(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
[311�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ey o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 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 9Q*_Ckm%j Htvv .Ql1r5SuR5.� • O
13. Soil TYpe(s): iV 0 A �.►d —• -•
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [rNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [rNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a tack 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.
❑ Yes [�fNo ❑ NA ❑ NE
❑ Yes [;(No ❑ NA ❑ NE
[:]Yes [�No ❑ NA ❑ NE
❑ Yes [grNo ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2No ❑ NA [] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 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 [SP<o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No [YNA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: a, - I Date of Inspection: !D ! a
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes v['No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes dNo
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 [2 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes dNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ["No ❑ NA ❑ NE
[:]Yes [ o ❑ NA ❑ NE
0 Yes []eNo ❑ NA ❑ NE
[:]Yes [ No ❑ NA ❑ NE
[:)Yes
[TNo
[:]Yes
allo
[:]Yes
[!�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: Date: ?O 1
Page 3 of 3 21412011

Type of Visit: 'Compliance Inspection U Operation Review 0 Structure Evaluation U Technical Assistance
Reason for Visit: 01Zoutine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: Coutity:' rr7 Region:
C � •
Farm Name: Owner Email:
Owner Name: — �'wf / Phone:
Mailing Address:
Physical Address:
Facility Contact: -'.} kc Title: Phone:
Onsite Representative: ;S':� Integrator: Prea'_c./
Certified Operator: Jlc.-p Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design C■urrent Design Current
Swine. Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop,
-
Wean to Finish Layer Dai Cow -
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
Design
D , P,oultry Ca acity
Layers
Current
. Po
Dairy Heifer
Dry Cow
Farrow to Feeder
Non-Diiry
Beef Stocker
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
1pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
0
Discharees and Stream ImDaet5
1. Is any discharge observed from any part of the operation?
❑ Yes
!mod o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
E '<A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
[ElIZA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
[g A
❑ NE
2- Is there evidence of a past discharge from any part of the operation?
❑ Yes
to
❑ NA
❑ NE
3- Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes g1l:ro�❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Nu ber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No i❑<A ❑ 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 [3"15-o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yes [RIZo
❑ 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 DWO
7. Do any of the structures need maintenance or improvement?
❑ Yes [91<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes Ej l"O
DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes R. o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes F,;Ko
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes L1Ko
❑ 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 ind Drift ❑Application Outside of Approved Area
12. Crop Type(s): � �
13. Soil Type(s): A/V X3
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [211: o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [Rfq-o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ "go ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[iJ o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[211 o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ONo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FQ 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 ®No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes D;Ko
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NSA ❑ NE
P'<A ❑ NE
Page 2 of 21412011 Continued

Facility Numller: - Date of Inspection: / I
24_ Did �thc facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check D Yes E3<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 Ej<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA H'11�
Other Issues
28. Did the facility sail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 015o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes E3<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 Er No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the faciiity? if yes, check the appropriate box below. ❑ Yes II111c ❑ 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 []4- o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Io ❑ NA ❑ NE
Comments (refer to question#}. `l xlilain any YES answers andlorany addrtional recnmmendafians�oranyrother comments. -
Use drawings of facility to better explain situations (use.additional pages as,necessary) �;, .;
Reviewer/Inspector Name:
ReviewerAnspector
Page 3 of 3
Phone: /�fi
Date: U L/
24112011 1-4

Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
OHMuRtme 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: f ` Departure Time: % / County: Region: 17c�71
Farm Name: } _Owner Email:
Owner Name: _ �,e�`> -•� gab'
el s ��Mj y Phone:
Mailing Address: 4
Physical Address: Meld-
Facility Contact: �Ip&r,e 8u Title: Zr-Jyl Phone No:
Onsite Representative: s�"�- Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E--] o E--] ' ❑ " Longitude: = o =
Design Current
Design Current
Design
Current
Swine C►apacity Population
Wet Poultry Capacity Population
Cattle C►apacity
r
Population
❑ Wean to Finish
JO Layer
❑ Daia Cow
❑ Wean to Feeder
11 10 Non -Layer
1
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
Farrow to Wean IAI& V --
Dry Ponitry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cod I
❑ Turkeys
Other
❑ Other
❑ Turkey Puults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection1/_5;Z:'7'9AP
E Waste Collection & Treatment
r
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E9 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 9 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 21 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[]Yes
❑ No
91NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ yes
❑ No
8 NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
ERNA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No
Z-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)t A izz /)i 6/'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
&No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes]
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
g-No
❑ NA
❑ NE
p y
Use drawings offacility to better explain situations: usea s.andJor any, recommendations or any othe..r comments ( question # : -. Eg lain an YES answer
p ( dditional pages as necessary).
-To
r rm
Reviewer/inspector Name .rr F.t Bares x Phone-
Reviewer/Inspector Signature: Date: %30
Page 2 of 3 12128104 Continued

Facility Number: —f Date of Inspection 12" 30;::A0
' Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes BNo ❑ NA ❑ NE
the appropriate box. ❑ wup ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [&No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers- ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
59 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JgNo
❑ 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 lass assessment (PLAT) certification?
❑ Yes
J9 No
❑ NA
❑ NE
Other Isles
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9No
❑ 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
ESNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®,No
❑ NA
❑ NE.
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
9No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
99-No
❑ NA
❑ NE
Addxti no at�Comments and/or Drawings;
12128104
12128104

Type of Visit �pliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0111ts6tine O Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time:C1Q'r7Q Departure Time: .r7- County: Region:
Farm Name: .,q,2 Ll s" rt- Owner Email:
Owner Name: ����-ta�a% _ _O �'! rl Phone:
Mailing Address:
Physical Address:
Facility Contact: /% aaf-d /`S D i r1,0-1— I Title: Phone No:
Onsite Representative: 5 :•-� _ Integrator:/�f ,uel�
Certified Operator: SQ Operator Certification Number: .
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o [::] ' = Longitude: = o =' = u
F.
Design .
Current
Design Current
J'L"Cation
Wet PoultryCapacity Pgpularion
Cable Population
❑ Dairy Cow
❑ Wean to Finish ❑ La er
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
y'»`
Dairy Heifer
19 Farrow to Wean
7,0 ti
T
Dry�q�trv„
❑ Dry Cow
El Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
El Non -Layers
❑ Beef Feeder
❑ Boars
❑Pullets
❑Beef Brood Cowl
Ohre
^, .a
ElTurke s
❑ Turkey Poults
❑ Other
❑Other
ti: Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
�&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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
�KNo
❑ NA
❑ NE
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Eallo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

,x
Facility Number: —/ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): ,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CR No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [&No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? PS Yes ❑ 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
L,No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
25,No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
®.,No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Hare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �C
13. Soil type(s)&T MOB Aa-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
;5No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
5d No
❑ NA ❑ NE
l6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
2INo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[KNo
❑ NA ❑ NE
Reviewer/Inspector Name J Phone: �%t'D�!33 33 u o
Reviewer/Inspector Signature: Date: //-_ 3—w"ZO Z>S,
­6 J .. . �... v...T ...........»....

14
Facility Number: Date of Inspection
R
} Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [.No [INA ❑ NE
,
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ® Yes f'No ❑ NA ❑ NE
the appropirate box. ❑ W­Up ❑ Checklists ❑ Desig
n El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [9 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis (0 Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�4 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
91No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes,® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
®'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[21 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Eq 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
jallo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�RNo
❑ NA
❑ NE
(9 re`iur2 L� I,,,-F► r Dv r r�C8r7��
r
C��tt�.sl7;
P
7-o ot, d7e 9/,-
II
wrap rL54 9��dJ
Page 3 of 3 12128104

tvi- of Water Quality
=1=!=Eacilityumber - Division of Soil and Water Conservation
Q Other Agency
Type of Visit �pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 'i7t� Departure Time: County: Region: �n
Farm Name: �;J s.�e Fp s 4A Mf Owner Email:
Owner Name: ?"4 % n. SD-r-- Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: ?!kz 7 �'� _ _ Phone No:
Onsite Representative: _Sa�,_ Integrator: �,JOstz�
Certified Operator: i3� j��ar� _ Operator Certification Number: 9E?,:;2
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ o ❑ ` ❑ " Longitude: ❑ o = ` a
esign Current
1196—acif.jPyv--Ulgfion
Design Current
Design Current
Swine
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
1 10 Non -Layer I
❑ Dairy Calf
❑ Dairy Heifer
❑ Feeder to Finish
Farrow to Wean
ZIM O
'!O r
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
El Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
LED Beef Brood Cowi
El Turkeys
Other
❑ Other
❑Turke Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
I _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes J.No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
§.No
❑ NA
❑ NE
12128104 Continued

ti Facility Number: Date of Inspection Dr
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
®No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
allo ❑ 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? J&Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
f4 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
J@ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ayes
� ❑ NA ❑ NE
❑ Excessive Ponding 51HYdraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s) A,�1�&2
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
ER No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
9 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
9 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
ERNo
❑ NA
❑ NE
`Comments (refer to queshoa'#) Explain any YES an and/or anyecommendations orian}'other c� om em nts ~
�r etterAex lain situations. use addttronal aas necessa
:Use drawings'af fac�li to"b f
�e P ( P g r3}�f
/�JflJ �-s oQ9u�� -T0 no
Y
A
Reviewer/Inspector Name
Phone:
Reviewer/Inspector Signature:
Date:od}-
12128104 Continued

Facility Number: — Date of InspectionD�
Re uired 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 allo ❑ NA ❑ NE
the appropriate box. ❑ wup ❑ Checklists ❑ DesignMaps
❑ Mp El Other ��
21. Does record keeping need improvement? If yes, check the appropriate box below. 9Yes ANo ❑ NA ❑ NE
aWaste Application aWeekly Freeboard D4Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking J3 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
Eg:No
❑ NA
❑ NE
❑ Yes
IN No
❑ NA
❑ NE
❑ Yes
,allo
❑ NA
❑ NE
❑ Yes
21 No
❑ NA
❑ NE
❑ Yes
19 No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
91 No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
[I Yes
ZNo
El NA
El NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
�►dditronal Comments andlor Drawir�s:
��' /�: Gvn-��• "r-r .-� !`r- � CLs�rl 6 ��� �01 �7� ., R14 D
ez
dAgle, AAV To- ;gy r
Ira /�r'Y�[ G(Jaf�G � �y%S er��"J' �00 S a)A n AJ�u�
l
r1 �1.�i� G�rn�f in c� our Gig/f' 1�r"I`p� {prop`
CV
Prot cs "�aj
l2,2VO4

ivisio4 of Water Quality v
Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ,Mine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �!i Departure 'dime: ! 3 County• Region: r
Farm Name: ►'� U� ` Owner Email:
Owner Name: Z 7ia.,1,1 f . �lp � t Y1 S a-"— Phone:
Mailing Address:
Physical Address: }
Facility Contact: &2=& :s a— Title:
Onsite Representative: % a=A fLa_
Certified Operator:
Phone No:
Integrator: _ZzdQ,4
Operator Certification Number: Jl�li3a-
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = n [= f 0 « Longitude: Elo =' = u
Swine
Design Current Design • Current
Capacity Population Wet Poultry Capacity Population
/ ❑ La er
% DO ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
El Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
El Boars
Other
❑ Other
Dry Poultry
❑ Layers
ElNon-Layers
El Pullets
❑ Turke s
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made'?
Design' Current .
Cattle Capacity Population
El Dairy Cow
El Dairy Calf
El Dairy Heife}
El Dry Cow
ElNon-Dairy
El Beef Stacker
El Beef Feeder
El Beef Brood Co
Number of Structures: T.
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 X No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[71 No
❑ Yes
tE�No
❑ NA
❑ NE
❑ Yes
J&No
❑ NA
❑ NE
12128104 Continued

a
q Facility Number: &L—
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ,3
Structure 2 Structure 3
Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ,� No El NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ONo ❑ 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? W Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [Z No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10_ Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2t No ❑ NA ❑ NE
maintenance/improvement?
. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M.No ❑ NA Cl NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Ber"UJ &
13. Soi l type(s) P) / 5 D 9 I +t/ A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [2 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes ® No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
19. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 9LNo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
117
Reviewer/Inspector Name �_ Phone: 14?VD--t133-33 0tf'
Reviewer/Inspector Signature: Date: f% 7— D 7
12128104 Continued

` Facility Number. Date of Inspection FEA
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ayes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E,No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. R1 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application (Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
0 Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections 0,Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
19 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
10 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
E. Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
VLYes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
(RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
f@ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
E] Yes
KNo
❑ 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
JR No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[,No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
5] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
® Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
11 c u 7 s a
3. Wr �� e �f� e Ar 7rO S� r
I2/2VO4

0 Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation `
t 0 Other Agency
Type of Visit Compliance Inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint ollow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: 177,099 Departure Time: `l� County: O� Region: ��D
I or
Farm Name: + PI_ 3&rl!lr _5 Owner Email:
�//
Owner Name: ^ O nZ2_ , „ , .. Z_Q.h ; ►1 �zQr � Phone:
Mailing Address:
Physical Address:
Facilitv Contact: / l B 90 ✓ l V— Title: Phone No:
OnsiteRepresentative: clJ'r.:CO�i►?5�"t— Integrator: _yice*
Certified Operator: _ s�w'�—�— Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder.
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: =] o [:]' =] « Longitude: =] ° = r = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
[] Layer
�. ❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharces & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
-Design Current'
Cattle Capacity Poi pulatioe
❑ Dairy Cow
❑ Dairy Calf
El Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: Ul;
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 ❑ No ❑ NA R NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
W NE
❑ Yes
❑ No
❑ NA
jo NE
12128104 Continued

Facility Number: — , j Date of Inspection
i Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ERNE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
❑ No ❑ NA L? NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
❑ No ❑ NA 0 NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
❑ No ❑ NA ONE
8. Do any of the stuctures Iack adequate markers as required by the permit? ❑ Yes
❑ No ❑ NA P NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
❑ No ❑ NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No [j NA NE
maintenance/improvement?
]I. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes
❑ No ❑ NA ® NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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
❑ No
❑ NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
❑ NA
® NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
JaNE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name Phone:
Reviewer/inspector Signature: Date:
IL/GV/VY l..V/1 LIIL NGf/

• Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes fi3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA [0 NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
[INE
23_
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
® NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�LNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JR No
❑ NA
❑ NE
26.
Did the facility fail to have an'actively certified operator in charge?
❑ Yes
❑ No
❑ NA
J2 NE
27_
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
[R NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
Q NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
R 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
J'NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
® NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
J,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ZNo
❑ NA
❑ NE
Additional Comments and/or
12128104

h
Type of Visit Compliance Inspection O Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit outine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: `t Arrival Time: i% Departure Time: 0 : 3D County: �' `~ Region:
Farm Name: gui n 5 p` F—a or n4 6 , _ -� j r1 e- 1 Owner Email:
Owner Name: fR Bs-t� L,.f �BC> >+� SDI Phone:
Mailing Address:
Physical Address: ff
Facility Contact: X erA"'dL xl) _ Phone No:
Onsite Representative:
Certified Operator: '"-�--f O
Back-up Operator:
Integrator:
Operator Certification Number: 13
Back-up Certification Number:
Location of Farm: Latitude: =' =' Longitude: = ° [--] ' =
Design Cgrrent
Design Cu rent
Design Current
Swine
Capacity Population. Wet Poultry
Capacity 3Popu ation
Cattle Capacity Population
❑Dai Cow
❑ an to Finish
❑ La er
❑ an to Feeder
❑Non -La er
❑Dai Calf
❑ Feeder to Finish_:
❑ Dairy Heifer
.Farrow to Wean
00 Dny Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
Brood Cowl I
Othe-r ..
❑❑Beef
Turkeys
❑ T urkey Pouits
❑ Other
IEJOther
I
umber tructures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2SNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ERNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
29No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

a
Facility Number: — <j Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes C,No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ f
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[X No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
❑ NA ❑ NE
through a waste management or closure plan?
,KNo
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? 9Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
19No ❑ 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
D9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
g No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
L.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ti!'r""a[a P—d
_
13.
Soil type(s) 'Sn >) D�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[KNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
KYes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
M No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
�KNo
❑ 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 ss necessary): Fry
wr,,_ T `u 7—D -e-
aon , iIlvul d1��� `T�`7"a r
1►1 �� jd T� b cp ewer ��xf ins p �"
��. (i� in�vG FCCYYrud ��
lveee_ /!peo(14 I J�i -Wle Q3 For
ReviewerAnspector Name
Phone:
Reviewer/inspector Signature:
Date:
F,
Page 2 of 3 12128104 Confinued

f
r Facility Number: — Date of Inspections ' �D
{ Required Records & Documents
19. Did the facility fail to have Certificate of overage & Permit readily available? ❑ Yes RNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box. ❑ W`UP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EgNo ❑ 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 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes IN No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
JZ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
JZ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
MNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
N No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
®No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
91 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
14 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
J4 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
J No
❑ NA
❑ NE
Additional Coroinents and/or Drawings: =. d- J "a
alu
�J-W'1I t as sDY7�
Page 3 of 3 12128104

I
r�rE_;1Tj7M
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ? 7rj_pr Arrival Time: g;$O Departure Time: County: .�q�o,�,, _ Region: _?1�wO
Farm Name: ���;nSOnarK�_ --n,G Owner Email:
Owner Name: ilm.r.e hLs4 _ /Phone:
Mailing Address: 10('ea /%� /K,�I /Q� /¢v V,^lie �8ji8
Physical Address:
Facility Contact: Ae"Q1d /PO_&K -_ Title:
Onsite Representative: �PO,►e,/ _
Certified Operator: J fajq
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator V
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ 0 ❑ i ❑ « Longitude: ❑ 0 ❑ 6 ❑ «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La yet
❑ Wean to Finish
❑ Wean to Feeder
❑ Fe der to Finish
arrow to Wean
1700
1301
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
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 EK ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
El Yes
El No
❑ Yes
❑ NA
[I NE
ElL7 Yes
,ErNo
No
❑ NA
❑ NE
12128104 Continued

I b
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes [moo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
r.
Observed Freeboard (in): so
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes B'Ro
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes []1io
❑ 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 BlNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes [�lo
❑ 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 Lam! No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
,�,�
El Yes L" No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
/
❑ Yes 2 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[]Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
1-3 >/i cy's ."I C ,IV -J �3G
12. Crop type(s) 8��.w�a/ r 5m _ Al Grn.:,
— —.
13. Soil type(s) /LIB_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes �o
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
[]Yes ❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[] Yes ❑ No
❑ NA []`NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
❑ NA 2f4E
18. Is there a lack of properly operating waste application equipment?
❑ Yes D10
❑ NA ❑ NE
Commenksdw�re gtion#!j'Eap1am an, YES)ae and/or any recamra; daha s oar � attc nets
Efflt ay5��d�clitioy�n{al�Pages
tM Y
ilseddyrawwgsWif toibetteii6plarwsrtuations:(use as�aecessacv),�y
�`. .h�iJ r Y �.-:�6S�Y>ili� 'f �1:iL_ 3i5ri
"{ f4� sp•or Fa �� 4e1 cc /� �f ,�-� wtl.J " �°�/�c •r
'00/4-,s sp. , A.
WCe� GOwM�' w%en ft` 3'0r'fy".- •S )r.'j"rpl an hoe i6riAw. Ple.ese
r- cps/aeNf,,, 7,;.j
fYw/
{or A *e u04Vetc a Ole wee sf /4fan� t.r1��1�• Please st�� %.,1e
9
Sid I .G�P'
aeraie,%4j
'�
{a sa,'1 an olYS�1 ,
Reviewer/Inspector Name �%a pra.7� e scn .�ac ..�7 e '. Phone: GJjty ;/BG
_T_
-/yam/ G,e 130
Reviewer/Inspector Signature:
Date: '� -77-01"—
12128104
Continued

Facility Number: —f6' Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ©les ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 9-Y6s ❑ No ❑ NA ❑ NE
the appropirate box. ❑weir- ❑ Ch sts esign ❑ Iv>K ❑ O er
21. Does record keeping need improvement? If yes, check the ap orate ox be] w. ❑ Yes ❑ No El El NE
&_/7,'-rs---� { f /)-iv>1.3
❑ ❑ WtvIrty-Freeve ❑ ❑ ❑ ❑,�A, i tcaton
ainfall El Stocking [j�p Yield ❑ [Monthly and 1" Rain Inspections LI<eather 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
29. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes O-Tqo� ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
9-Nf
❑ Yes
❑ No
❑ NA
91-M
❑ Yes
❑ No
❑ NA
U-ME
❑ Yes
9+ <o
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA M-ME
❑ Yes
BTo
❑ NA
❑ NE
❑ Yes
L?<o
❑ NA
❑ NE
❑ Yes
E o
❑ NA
❑ NE
L'_TYes
❑ No
❑ NA
❑ NE
❑ Yes
❑'5o
❑ NA
❑ NE
❑ Yes
9-g0
❑ NA
❑ NE
AddYtiorial"Comments'and/ot'Drawu gs
; ki 5 `tyi4V M
MRI �
A e4%�er
,261
Plers,, Le��e.� sgrrz�so� I✓RG.i {o!` a �.ye7. v� /i9oa�7 ems,.
!f
P,e6SC Kfs� �[Or/j/ %,Q rd P
%iCOr�� 19 i•r2! ��" r[.Qr� /Wz
��Prevs�
�ernrS. P/eose 4eal .n �rr cede cn/d.,�
d^-�trP-I F�r,r, CIn� �i�P
a Gr�R Y.eC� r�ca►orj
Pr°d "cer S �I'Pt�o-erd rrcor�J
s�vr,...a/ Jn9 f " a/ >� rr
00+1 �e I� vr��if' F 7'•'�6�
Of SVgt. No � �cpr� s f reo�r�;
�Dir'>`
f '
' r
nep-Calrfp r�rto evr•► �o
DWQ as -*4ef res�( 7�ire
12128104

t
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 40 Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access t
Facility Number ? Date of Visit- Time:
0 Not Operational 0 Below Threshold
S ermitted SKer ifted [] Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: county: ...SQL Sect! .»............. ....
Owner Name: .._....... if ........ Phone No:.....
Mailing Address: • -. �Qlc%t----...t,............ .............. ��/,,ti l�� ��� ,,� �L� _ �.S,�l� __. _ ...._ ...........
Facility Contact: l�n. .t? .._..... c.� ............. .R.k;ti.RGi.........—.. Title:Phone Na:...... . ........ -••-... -•...... - .....
Onsite Representative: ..... ..... �Pr .. �i Q�x�,rn .�r�.............._ ...._...... Integrator: •.,
Certified Operator:.---_ �&'z._ S. ����!livci. ..... Operator Certification Number.
Location of Farm:
�I
T
©-Swine ❑ Poultry ❑ Cattle ❑ horse Latitude Longitude �• �< �«
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes S'Ko-
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 2-N-o
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes C -Ko-
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes QNa
2. Is there evidence of past discharge from any part of the operation? ❑ Yes G-K-o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes QAIo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes B-No'
Structure 1 Structure 2 Structure ; Structure 4 Structure 5 Structure 6
Identifier: .......... L....................... ............... ....... ..... ...---------..-............-........ .............................. ..... ..... -._..._........ __ . _.._...... .......
Freeboard (inches): �p
12112103 Continued

Facility Number: 9.2 — /S Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 0'Ko-
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes DlZo
8. Does any part of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes [aiqo
9. Do any stuct:ures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes M-No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes B No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes G-No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [RNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes &No
b) Does the facility need a wettable acre determination? ❑ Yes D-No
c) This facility is pended for a wettable acre determination? ❑ Yes &No
15. Does the receiving crop need improvement? ❑ Yes PNO
16. Is there a lack of adequate waste application equipment? ❑ Yes ®-No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes '\❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes NNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [Flo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes S-No
Air Quality representative immediately.
[3-Fl"eld Copy ❑ Final Notes
P19 weJ ,s
1 -14e
sr.a�, ><:a�� '01",
0070m,41-
q..o�
spFy �flr
�✓lP�S.
Plea SP r�rrtv►re
woad•
VOn 7/�e /011 " L""1(
C/O"
Ta
arc fob
of �c
Reviewer/Inspector Name r'lafl( - _Qra
Reviewer/Inspector Signature: Date:
12112103 Continued

Facility Number: 0.2 -- j S Date of Inspection 1 $ •-)a-d
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
des
❑ No
22. Does the f ility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie! ,cats, di*i . p , etc.)
❑ Yes
Q.NO
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑Fwaebearr—❑ Waste is- ❑ SeH-Sam ng •'"'w
G -.71 a / . T- - Nwc rn4, 2;416-A, ,rpm i
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
RNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
GNho
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
MJ90
27. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
[:]Yes
EWo
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑.ado
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
G- o
NPDES Permitted FacRities
30. is the facility covered under a NPDES Permit? (If no, slip questions 31-35)
❑ Yes
Q-Mb
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted during this visit. You wf7I receive no further correspondence about this visit
of 7AC 9enel-sl ins or, -s:fe �vf >%-r v/' eovr..y*I ,`s ild';
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12112103

Site Requires Immediate Attention: uo
Facility No. z-lS
DIVISION OF ENVIRONMENTAL UANAGEUEN7
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: &J K%j'tiSk , 1995
Time: IV�.b -._
Farm NamelOwner:.RO M Ms 1) N lrwumc- Uc- .
Mailing Address: 1 D(o(n _ Avk 4-y WAV 'lL 4k
County:
Integrator: `Mu
On Site Representative.
Physical Address/l
Type of Operation:
n vi� 1�01�'� t,S aYV
Swine _X_'
Design Capacity: j Z S s�
Phone: -2b0' 7_% Zll i _
Phone: a in - Slo`ir-- ion 13
Poultry Cattle 'a`"""" " T" ''
Number of Animals on Site: —12-5
DEM Certification Number: ACE DEM Certification Number: ACNEW_
Latitude: Longitude: ,
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) or No A Mual Freeboard: -fit. Inches
Was any seepage observed from the d ovn(s)? Yes of Was any erosion observed? Yes or vo
Is adequate land available for spray Yes or No Is the cover crop adequate? (i�)or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings:l,YO or No
100 Feet from Wells? .'e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or to
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or _O_)
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o6i� If Yes, please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes o 0
Additional Comments: -1 CAW k. 1� vo v1 �t �_t{��o ►S,
cc: Facility Assessment Unit Use Attachments if Needed.