820240_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

S
Type of Visit: ®'Compliance Inspection U Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 0465utine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Time: ; � Departure Time: ®i County: Region:
.01
Farm Name: �,�%Q�� k u.n Je .-d Owner Email:
Owner Name: J,(ja„[� X"Ckhurn Phone:
Mailing Address:
Physical Address:
Facility Contact: 6e-Y ,— tr- Title: s�rrG Phone:
Onsite Representative: ��$--�. Integrator:
Certified Operator: _ 5 7 ae_& Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine -Capacity -Pop.
Wean to Finish
Wean to Feeder - 0
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Wet Poultry
ILayer
]Non -Layer
D . P.oul
Lavers
Design
CapacityCattle
..
Design
Ca aci
Current
Current
Po
Design Current
Capacity Pop.
airy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Da'
Beef Stocker
Gilts
Non -Lavers
Beef Feeder
Boars
Pullets
I
113eef Brood Cow
.: �.
Other .
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �o ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [—]No
❑ Yes EET1Vo
[:]Yes [ o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Ins ection: D —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Ej 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): _ f�
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
�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
[�J No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2['-No
0 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
To
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E3-&o
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes E31�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/ ❑lApplicatio`n Outside of Approved Area
12. Crop Type(s): ue+fcQ AyYrS -GY01 !-t���'!
13. Soil Type(s): 6,21AZ pylp
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [�To ❑ 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 [ o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[E[No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ 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 [ - o
❑ 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 Ea -No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes EJ'
❑ NA ❑ NE
❑ Weather Code
El Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - I Date of inspection: /D —
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C3 No
❑ NA [j NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Efr'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 fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
0<0
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
[Ergo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
3 o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[]'�lo
❑ 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
LS 1 o
❑ 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
[3'1 to
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 Yes
❑r7No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[31N' o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[]`No
❑ NA
❑ NE
�i9an.�.ans.
Tz:, 7� S'! O,,,
Ji `r.cod,5 'eUjYw, d
Reviewer/Inspector Name: ��� (;--vy�tJ''��-- Phone: g/U :3
o3-ais'/
Reviewer/Inspector Signature: Date: /-9—
Page 3 of 3 21412015

1D-c-t -17
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Q : Departure Time: D County: Region:
Farm Name: �� q y� t/iYl� - Owner Email:
Owner Name: GU 4 ,,,L Phone:
Mailing Address:
Physical Address:
Facility Contact: e f77 rrc A Title:
I Phone:
Onsite Representative: Integrator:
Certified Operator: rJ p 5 l�-G�- /yl�d� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine�VUpacira
Wean to Finish
Wean to Feeder
Designnt
Wet Pou!
on -Layer
Design Current
Ga acPo
Design Gnrrent
attle4 ° U city � ty P•
airy Cow
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D . P,ou
Design
Caaci
Current
P,o
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Farrow to Finish
Layers
i Non -Layers
Pullets
Turke s
Turkey Poults
Other
Gilts
Beef Feeder
Boars
Beef Brood Cow
Other
IrEOther
Mwim
Discharp-es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes E;�No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes J2_No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes J&No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

' Facility Number: - D Date of Inspection: 4
/—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[—]Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�.No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
(Z No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
[K No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[2�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 EQ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes yQ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ® Y/ t /l, r�/z ��' /a S.F?�i/,�� / ,�/Yl2�e /4�/�✓Srrd
13. Soil Type(s): D�
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?
,KYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
RNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[21-No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
fNo
❑ 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
E� No
❑ NA
[] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall
Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
11�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
12No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: - Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JANo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [,No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
K 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
G� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
KNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
yRNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
FNo
❑ NA
❑ NE
11
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone:lD
Date:
21412015

i ypr ui v estt: %y-t-ompuance inspection v vperanon xeview V atructure nvaivauon V i eenmcat i+sststanee I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: —7 / Arrival Time: Departure Time: County: _w� Region:1 {�
Farm Name: wode -g L&c- Owner Email:
Owner Name: (,{ j ai le 3L_Q c_ k L u e r,, Phone:
Mailing Address:
Physical Address:
Facility Contact: C / /y T- Title: r�
Onsite Representative: _ f, ._
Certified Operator: ,C�Gy!%%ay'' r-- _
Back-up Operator:
Location of Farm:
Latitude:
Phone: `
Integrator: ✓ is S,tn��r
T
Certification Number: �2
Certification Number:
Longitude:
Design Current
Design
Current
Design •nrrent
Swine Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
ILayer
Dairy Cow
Wean to Feeder CV UDI
INon-Layer
I
Dairy Calf
Feeder to Finish
-
Design
Current
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
- D , 1?oul
Layers
Ca aci
P,o
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
O#her
Turkey Poults
Other
Other
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ®-No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [] No
[—]Yes ❑ No
❑ Yes E.No
[:]Yes &jNo
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 2//412015 Continued

Facili Number: - !7 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA [] NE
a. If yes, is waste level into the structural freeboard? 0 Yes ❑ No [] NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 b
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Z 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 JZ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes � No 0 NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes IN 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 A No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 12� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Z No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑/ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s): C a rn
13. Soil Type(s): a5V1��b�ro
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes P No
[_]NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 12 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes Q_No
❑ NA
❑ NE
acres determination?
17. Does the -facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
®No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
5A 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 S No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes MNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Jallo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: �-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2.No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ;!No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes r,No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes g No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes [M No ❑ NA ❑ NE
❑Yes ®No [DNA ❑NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes EZ[No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to questio") �Eiplain any.°YES answers aad/or_any�additrona�l ommendations�or y other comments
Use drawtngsofacility�to�beiter ezpliitn.sltuations {use add�t�onalxpages' as necessary) «
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: �% " 33— .5:3D�
Date: - 7 � 46
21412015

ivision of Water Resources
Facility Number ®- �yv Division of Soil and Water Conservation
® Other Agency
Type of Visit: om�pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01 outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ? 3 D County: �j�--
Farm Name: �j(J��� ,� Ld�rn /=a i'- Owner Email: �—
Owner Name: ui��� L aljr ��,-� Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: pry J�� • Phone:
Onsite Representative: ��"�! Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design _Current
Swine Capacity.. Pop.
Wean to Finish
. -
Design
Wet Poultry, -Capacity
[Layer
Current
Pop.
Design Cnrrent
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -La er
I
Calf
Dai Heifer
Cow
Feeder to Finish
Farrow to Wean
-
- Design.Carrent
D . Point , .Ca aci Po
Layers
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turkey Pouets
Other
Beef Brood Cow
Jill
1�1111111111' !I!
Other
Other
Discharnes and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes PS -No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [:]Yes [-]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Z_ Is, there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [—]No
❑ Yes QC No
❑ Yes [a No
❑NA ❑NE
DNA ❑NE
❑NA ❑NE
Page I of 3
21412014 Continued

IFacWty Number: t2 - 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): / g
Observed Freeboard (in): its d
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[] Yes
[3 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
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CKNo ❑ 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): &ri'yn> a� �� �`�/— e
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes ® No
❑ Yes ® No
[:]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
[::]Yes [gNo ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
[:]Yes ® No
❑ Yes No
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
to
�� v I *-w-4
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes Co No ❑ NA ❑ NE
❑ Yes
[�4 No
❑ NA
❑ NE
❑ Yes
© No
❑ NA
❑ NE
❑ Yes
Pq No
❑ NA
❑ NE
Phone: Vp — L(33 -33oz)
Date:
21412014

i ype or visit: l7 c.ompnance inspection tv uperanon iceview v arructure Evaivanon V i ecnmcai Assistance
Reason for Visit: t"xoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: LC"— 17-- Arrival Time: � Departure Time: �-fD County;
Farm Name: f,�J�i�% z ]"Ai) ecru �aF�-- Owner Email:
Owner Name: b acd �e_ zla �4c�.2 Phone:
Mailing Address:
Physical Address:
Facility Contact: GY ram.." ^17'-r Title:
Onsite Representative:
s�
Certified Operator:�Ti /37Dar�
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region: V
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Cnrrent
Design Current
Swine
Capacity Pop.
Wet Poultry
Ca pacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Weanto Feeder
600
00
Non -Layer
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . P,oult .
Ca 'aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
10ther
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 Ejq_No ❑ NA ❑ NE
❑ Yes [—]No
[:]Yes ❑ No
[] Yes [:]No
[—]Yes t, No
[:]Yes 0 No
❑NA'❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facili Number: ;Z AID
Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes N'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ 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 [0 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 Ea 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?
C,Yes [:]No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 2 No
❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes R No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes ER1 No
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop/Window ❑ Evidence of Wind Drift Appliccation Outside
of Approved Area
�❑
12. Crop Type(s): /`lrZ a lover' -- 6/AO N-'t
13. Soil Type(s): anus &�IJi>
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes MNo ❑ 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 [Z No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[a No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[0 No
❑ NA
❑-NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
QC No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
®, No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes n No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers D 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 C. No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J!� No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facdi Number: - D Date of Inspection: ;7—
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes U,No
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes f& No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes allo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes CF�No ❑ NA ❑ NE
❑ Yes 64 No ❑ NA ❑ NE
❑ Yes ®.No ❑ NA ❑ NE
❑ Yes [&No
❑ Yes S No
❑ Yes E-No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
N
mments (refer; to question #): Explain, any. YES answers, and/or any additional recommendations or any other comments..
e draw mgs of.'facility to better explain situations (use additional pages as necessary).
e7 l 6- � A -- ea_ a--' -P"-7 V v ��-✓!�
r �� ik � f `'n � �' `'`-�� #mob � �a5.5 � � � � wit �La w �/'o-m Rat► -1IJ
-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: WO��(�3r-33�
Date: 9 %
21412011

u ✓ems r'C -- &353
Type of Visit: �70='t�ine
ce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: l<CLJW Arrival Time: Departure Time: County:
Farm Name W,24 .G ZII Uu/n _252/,W%-._ Owner Email:
Owner Name: 1N_ tad _ 6& u 1r%_- Phone:
Mailing Address:
Physical Address:
Facility Contact: �d G f1-1pp'� Title:
Phone:
Region: /
Onsite Representative: Integrator:
Certified Operator: !,'� /y/jprL Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Desi n Current
Ca paPo
p g ty p
D
ry C ensign
Wet Pou!# , apacity
Layer
Non -La er
__ 'i
Design
D , $oul Ca aci
Current
Pop.
Current
P.
Design Current
Cattle Capacity Pop.
Dai Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Wean to Feeder
D
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-
OtherI
Other
Turke s
Turkey Pouets
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 18!No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes No
❑ NA ❑ NE
❑NA []NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

]Facility Number: I Date of Inspection: / —%4" /3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:]Yes
0 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):T
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 property addressed and/or managed through a
❑ Yes
E[ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
F1 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes S No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ��=rm± }L
13. Soil Type(s): ���d5 �rD
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? MA [3 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes El No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I. No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
allo
❑ NA
❑ NE _
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Z 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 q No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � No
❑ NA ❑ NE
❑ Weather Code'
❑ Sludge Survey
❑ NA ❑ NE
[DNA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CZ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes V] No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [& No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes `% No ❑ NE NA ❑
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 5 No ❑ NA ❑ NE
and report mortality rates that were higher than normal? ''�
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes R No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes allo ❑ 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. C ] Yes ZLNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP? ❑ Yes fj� No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ® No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [2-No ❑ NA ❑ NE
Use drawin s of facility to better ex lain situations use additional pages as necessary).
Comments (refer to question # ) Explain any YES.answers and/or any additional recommendations or any other comments
g it3. P ( p g
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
I v 1 ��Y l�rC�t� 1id�OCs. f S 1/Giy U-�T'e�i` �GL
t4 74, 70
Phone:
Date:
21412011

6, - /;z -/,;?- -b-
Type of Visit: (D-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Q Ifoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: --/ (� Arrival Time: ; 3r7 Departure Time: ; o o County:-��
API
Farm Name: ia)-e— T "e-L u"w Fa rm. Owner Email:
Owner Name: wat r► t Phone:
Mailing Address:
Physical Address:
Facility Contact: ��r`rr-r /'yi�pr�� Title:
Onsite Representative:
Certified Operator: !, 7;�c
Phone:
Region: ,—Q
Integrator:
Certification Number:��
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current
Design Current
Swine
Capacity Pop. -
Wet Poultry
C. city " Pop.
Cattle Capacity Pop.
Wean to Finish La er
Dairy Cow
Wean to Feeder
flD lr1D
Non -La er
Dairy Calf
Feeder to Finish
-';
-
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design_Current
ci Pao P.
Cow
Non -Dairy
Farrow to Finish - Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Putlets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes RNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[j� No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[Z 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
MNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[. No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
2[ Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
KA No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CA WMP? ❑ Yes [a No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? FV1 Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes F,61 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[]Yes
O No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? []Yes [allo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes FM No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [A No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ]A No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 5kNo ❑ NA ❑ NE
❑ Yes q No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Z Yes
go "
❑ NA
❑ NE
Comments refer to question Ex lain an YES answers and/or as additional recommendations or an otlher comments:'
( 9 � � P, y Y
Use drawings,of facility to better explain,,situations fuse ,additional pages as necessary)' .. '
� �rrn.' �7rf S w�rz. ��_�-a/re�j :S' �•�� : ,� v �� cc� ��c � �'� D �
p1--r 7 '^ r,, / -, � -5s•
p
r'y
Reviewer/Inspector Name: Phone:
___� '% /
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

Facile �Number ,, L{ Q 1 l `�r � 5^®sDivr�isi'ontoff'5ot1. and W ter Conse� cvafion
0 ' g.Y
Other A enc
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: /O County•- Region:
Farm Name: a ,.r n- rzt e Owner Email:
Owner Name: W d j — LW c A_bkr,L _ Phone:
Mailing Address:
Physical Address:
Facility Contact: 6 r-z-" /`" / 100r r__ Title: 7e---,-I Phone:
Onsite Representative: D Zr— Integrator:
Certified Operator: a.,':;�i Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
esign Currenrenesign Cut
Eel
ine pact p: W,et. Poultry Cap itv��P p. Cattle Capacity Pop.
Wean to Finish La er Dai Cow
ean to Feeder
pp)
Non -La er
Da Calf
Feeder to Finish
Farrow to Wean
gn Crr9 Dai Heifer
Dest 4'' cnt Dry Cow
Farrow to Feeder
D P,oult . Ca aei Po " . Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
r „ ....
Other
;" _
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ®, No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Q 1 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): p�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes � No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ No ❑ NA ❑ NE
maintenance or improvement?
Waste 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 S No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): (C
6yl,rJ���i
13. Soil Type(s): �I_12
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? [3 Yes [] No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�No
[3 NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
nNo
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
® No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RZNo
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection: -.3 0 /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ZNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EK ,No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
g] 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
E� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Za No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
allo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E,No
[] NA
❑ NE
33_ Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2[No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer -to question #): Explain any YES answers and/or any additional recommendations or;any�other comments.
Use drawrnes.of facility to -better explain situations (use additional pales as necessary) },�WA
t ...
Reviewer/Inspector Flame:
Reviewer/inspector Signature:
Phone: o0
Date: /';2 l //
2142011
Page 3 of 3

Type of Visit Q'Gompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: / 3 i7 Departure Time: % % 3 i7 County: '5 Region: 2�Z
Farm Name: Owner Email:
Owner Name: ���' -- �F3�u/�'t— Phone:
Mailing Address:
Physical Address
Facility Contact: 1,114701e, a G k� �� Title: z9W 4 r ✓— Phone No:
Onsite Representative: �IYi��1DD/� Integrator: Fi
l'�f rrrrt .J�j��/�y
Certified Operator: z`--� 0adr-rnOperator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = tl Longitude: = ° =' =
Design Current
Design Current
Design
Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
1
❑ Dairy Cow
❑ Wean to Feeder
1 10 Non -Layer 1.
❑ Dairy Calf
Feeder to Finish v�Op
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
El urkey Poults
❑ Other
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
RNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
®.No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

.r
Facility Number: — fl Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): i
Observed Freeboard (in): 1?TJ
❑ Yes allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes O 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 19 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
,Yes
m 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ONo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s)rrrtic�
13. Soil type(s)1 5�0 rD
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ERNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
Ryes
❑ 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?
El[ Yes
r54
No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ea No
❑ NA ❑ NE
Camments (refer to queshan #) Explain any'YES` answers and/or any�ecommendations or any o`r comments.: F w
lUse drawuig of facility to better, explain situations (use additional pages as necessary
b tiJra e J ILt��I `ice 6 f `
i `e c. tNoru� W �
�
l.r�ry a r-fo' 2-Fit � P.Y CAI `To c rZ ��1 s a'"— �fo L�s u1,;k-r do rw�—pu�,4 la
�• C�'7 ! r`i ! i{ [ (.0 r
Reviewer/Inspector Name h x
Phone: / ;33 a o
/O'3�
Reviewer/Inspector Signature: Date: 1IZ-11" —a_L2 ►D
Page 2 of 3 12128104 Continued
15

N
Facility Number: 74�y Date of Inspection U
•
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
❑ Yes
[3 No
❑ NA
❑ NE
the appropriate box. ❑ WIJP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[,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
R No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
E[No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[9No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E9 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
k 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
J-No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? .
❑ Yes
[ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
BNo
❑ NA
❑ NE
Page 3 of 3 12128104

B.rWS Iz-zz-2004
Type of Visit
ompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
outine 0 complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: f�-Zl-�o`J Arrival Time: !l%; QO Departure Time: O,' County: �`r Sa Region:
Farm Name: (Nlln p- el�e�Jur� tip Owner Email:
Owner Name: d2- .�;7lack-bari✓ Phone:
Mailing Address:
Physical Address:
r-
Facility Contact: C%1re�M+� lyl.5a Title: ZDGe- Phone No:
Onsite Representative: MDae—t—^ _ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm- Latitude: = o = ' = u Longitude: = o = ' = u
Design Current
DesignSpop2miation
Wet PoryCapac
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder 6,00
1
IFJ Non -Layer
I
❑ Dairy Calf
❑ Feeder to Finish I
❑ Dairy Heifer
❑ Farrow to Wean
DE:y Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non-Dai
❑ Farrow to Finish
❑ Non -La ers
❑ Beef Stocker
❑ Gilts
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cold
❑ Turkeys
Other
e Pouets
❑ Other
Fo tzr
Member 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
v
a. Was the conveyance man-made?
❑ Yes
❑ No
9NA
❑ 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)
ElYes
❑ No
�
B A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
ElYes
91 o NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: S2 Date of Inspection ►2-?�—Q
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: r,6%
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
Oel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) r
13. Soil type(s) 14.
_
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 ❑ NE
#p le �".
P r c�i'� u j /7
had
Ga rl r d rr.-�
��, p 0 � .
GfkTf�f�Ci� [�'�
pYz S`-•e !�•r C_
4K
AAD h,,15
h ouft d a-1 a,'-s
ReviewerlInspector Name Z00 O l It u_� fS Phone: 1%livi
Reviewerllnspector Signature: Date: 47
12128104 Continued

gZ —Z D tz-zl —o y
Facility Number: M — Date of Inspection 0
Rc uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes G-<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes BIT5 NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ DesignMaps
❑ ap ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes CTlTor❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L7No ❑ NA- ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L71Vo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(E<o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
oo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
,Ly.�
El NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElE1<No Yes
t? va
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑'1ro— NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
NA
NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes L__TNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes 0"No ❑ NA ❑ NE
General Permit? (iet discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes EOCEI NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes Bl�o" ❑ NA ❑ NE
Comments and/or
12128104

sion of Water Quality
I MFacility Number O Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: �: �S` County: ow V&-J Region:
Farm Name: _ Alade- Owner Email:
Owner Name: _ k�q di - _ ek c4i1 k 1xi _ Phone:
Mailing Address:
Physical Address:
Facility Contact: 6?rem /vp,,V'C_ Title: - S�� • Phone No:
Onsite Representative: Csi'GGB�— Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: F--I 6 F--I L = is Longitude: 0 o [=] ` 0 «
Design Current- Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
U Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Giits
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Curren
Cattle Capacity Populati
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Neifei
❑ 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 U�No ❑ NA ❑ NE
❑ Yes
❑ No
[P A
❑ NE
❑ Yes
❑ No
E 'NA
❑ NE
L'NA
❑ NE
❑ Yes
❑ No
❑ Yes
915'o'
❑ NA
❑ NE
❑ Yes
[3'1�'o
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier: _ 4a 9—
Spillway?: A/C
Designed Freeboard (in):
Observed Freeboard (in): Z
Structure 4
❑ Yes NNoo El NA El NE
[IYes 2 o ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
9No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElYes
L7No ❑ 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
ClTlo" ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
p tvo ❑ 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
��
[1,ivo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ErNo ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes 01vo ❑ 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) B u d -- �, . eor
l3. Soil type(s) G7 kl/to T pCc ^/•S
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,ice, oo El NA El NE
15. Does the receiving crop and/or land application site need improvement? El Yes L�,, oo ❑ NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:][
Yes �F o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 3<o ❑ NA ❑ NE
18_ Is there a lack of properly operating waste application equipment? ❑ Yes [; ^<o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name ` ��y L% Phone: 9/0• "3, 733 aO
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: ft —ZiVOI Date of Inspection
Required Records & Documents //
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes BNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes BNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
D<o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E<o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9 <o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
TKo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
Ehgo
❑ NA
❑ NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,.,/
o
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�[3"N'
I� 5o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
D1vo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

f,1_XlS /2_//2IZoe7
(vision of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit l3}<ompliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Grcoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: I: 30 County: Region:
Farm Name: „ WaAe� S [uG.-k6 u &­N _ �il'IrL Owner Email:
Owner Name: �JcAc- 3104—L �gVA/ Phone:
Mailing Address:
�.eO
Physical Address:
Facility Contact: G «Y li&orrc_ Title: %G S® Phone No:
Onsite Representative: _ 4L Ak mv-e_ Integrator:
Certified Operator: a u6414 Operator Certification Number: 1$ % Ir
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ o ❑ ' = Longitude: = ° ❑ ❑
`Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
® Wean to Feeder Z&OD
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Puliets
❑ Turkeys
❑ urkey 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 ' CUTTent'.
Cattle Capacity. Population>S�
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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 F J No ❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[�l No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

• Facility Number: $Z —2{[p 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
[!I No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: it
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): to
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
[HNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA ❑ NE
8. Do any of the stectures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
$fl No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12.
Crop type(s) c_ruj_Ajc, __ (N�.�) S , G . CeYc>,sc_,d ,.
--C°ry e,1L 1-1
13.
Soil type(s) G4
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[$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
[A No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
(M No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name ��k,� 2.V C.�S Phone: 'V0,1433. 3'300
Reviewer/Inspector Signature: Date: I Z-13 -- 2.ao -7
12128104 Continued

Facility Number: 192 —Z4[O Date of Inspection lz-/.3-07
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ VvUp ❑ Checklists ❑ Design El Maps ❑ Other
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 09 No ❑ NA ❑ NE
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes V No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Cade
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes
[A No
❑ NA
❑ NE
❑ Yes
�fl No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
El Yes
09No
El NA
[I NE
❑ Yes
[91 No
❑ NA
❑ NE
❑ Yes
[0 No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104

J1,
W
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit a Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: O IZ Arrival Time: 3;00 Departure Time: ;�D County: `R'6 Region:
Farm Name: W Owner Email:
Owner Name: kla e- Rlaz C 6u k6Z Phone:
Mailing Address:
Physical Address:
Facility Contact: C►! /U►rr _ Title: SpcG. _ Phone No:
Onsite Representative: Car✓ _im LZQI--&, Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e ❑ ` = Longitude: ❑ 0 ❑ 6 ❑
Design Current
�: ° ,_I)esigm . Current Design Current
CapacityPopulation
3."y9
Wet Poultrn Capacity PopulationCattleean
to Finish
;Feeder
❑ La er ❑ Dai Cow
ean to Feeder
2&
❑Non -La er ❑ Dai Calf
to Finish
[] DairyHeifer
❑ Farrow to Wean
Dry Po Htry ' r '" ❑ Dry Cow
❑ Farrow to Feeder
, -
❑Non -Dairy
El Farrow to Finish
.;
❑ Layers
El Stocker
❑ Gilts
❑ Non -Ls ayers ElBeef Feeder
❑ Boars
❑ Pullet
w El Beef Brood Cowl i
-
- w-.
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
b....
❑Other .. ,Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ YesOw
yrNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
9 No
❑ NA
LINE
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
EP No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
? No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
VNo
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

I Facility Number: Z—Zip
Date of Inspection y O
• 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?
El NA El NE
❑NA El NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): [9
Observed Freeboard (in): —
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [XNo ❑ 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?
❑ Yes 0No
❑ Yes [ONo
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes d No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes EKNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application ��qq
10. Are there any required buffers, setbacks, or compliance alternatives that need ElYes ICl No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes t9 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) �j P.tr144-twriL_
13.
Soil type(s) 6za A .,
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[XNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
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
R No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Wo
❑ NA
❑ NE
Gomments (refer to question #)::Explain. any YES answers and/or any recommendation's:or any other cornifi6nt.411,
Use.draAtnp of facility to better explain situations. (use additional pages as necessary):.
Ye 1
--3
_ _ _
�Reviewer/Inspector Name Z e.✓ �S
Phone: g%D
Reviewer/InspectorSignature:
Date: /O/Z:4/z a (p
Page 2 of 12128104 Continued

.I
Facility Number: 2TZ — Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [XNo ❑ NA ❑ NE
the appropriate box.
❑ Wi1P ❑Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [7No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes r No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes W No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[;�?No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
R No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�4 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
02 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
' No
El NA
El 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
W No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
&] No
ElNA
[3NE
Additional-.Comments.and/or Drawings: 1
Page 3 of 3 I2128104

�k '91stJ ti-so-OS�
Water Quality
lFacility NumberZ �/� O Division ofiSoii and Water Conservation
Other Agency
Type of Visit *Compliance Inspeption 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: oS-1Arrival Time: '(fa Departure Time: D,�„� County: Region: FRO
Farm Name: fLa,.t ]tw e k 6 a.,it Owner Email:
Owner Name: �Za� Q 47 �� 1<k r� Phone:
Mailing Address:
Physical Address:
i
Facility Contact: r e ev AFO�- e Title:
Onsite Representative:
—1—.**,,
Certified Operator: Aa ►cL e s *47 a —
Back-up Operator:
Location of Farm:
Swine
Design Current
Capacity Population
❑ Wean to Finish
C'Wean to Feeder
D O
v0
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
I
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number: -2 (p_
Back-up Certification Number:
Latitude: [ 0 0 [ 0 Longitude: ❑ o ❑ 1 ❑ "
Design Current
Wet Poultry Capacity Population
❑ Layer I
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkex 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 Heifei
❑
DEY Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: �1
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 ffNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
❑ Yes
r❑
[! No
❑ NA
❑ NE
❑ Yes
(?fNo
❑ NA
❑ NE
12128104 Continued

Facility Number: —,ZrfO Date of Inspection
Waste Collection & Treatment �'N�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes L90 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l 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 E o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,�_ ,,��
6. Are there structures on -site which are not properly addressed and/or managed El Yes 1_2 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 3 tvo ❑ NA ❑ NE
8. Do any of the stuctures 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
L3<o
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
VNo
❑ NA ❑ NE
maintenance/improvement?
I E Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
ONo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Ev``idence of Wind Drill ❑ Application Outside of Area
12. Crop type(s) �� // �o
f-�@ r Ilt.l�.�t ✓ J n� .r r .ti ,`h r
13. Soil type(s) G,o��� ��� 11,6 e-,
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
ONo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes
[21 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
ONo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
E/ No
❑ NA ❑ NE
�%fi S +/i 5 d e i • rt wa' � Gt�dn � �f+ � � ��� e lis/ �.r:.sa � / ..[ /12s✓ 4 cer
eli�1' 3 +i. �� . ` %f+�o� a � .�ie -•+ [ /�'j/ �✓ y ��!. �t �r %Yy�urP
ReviewerlInspector Name * %1 '� Phone• 0/!1 �d'�
ReviewerlInspector Signature: Date: D Jyd 5�
12128104 Continued

Facility Number: 2— Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & 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 [YVo ❑ NA ❑ NE
the appropirate box. ❑ WTJp ❑ Checklists ❑ Design
g El maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑*&infaif ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ WenOterEede
a/it—z3
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
["NNA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[2(NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
E�rNA
❑ 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
ffNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
YNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
YNo
❑ 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
Q"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
EZNo
❑ 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
[ZNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[!(No
❑ NA
❑ NE
Additional Comments a d/orDrawings `" ' ''
.'
12128104

(Type of Visit • Compliance Inspection O Operation Review O lagoon Evaluation
for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 8Z O Date of Visit: f o E 1 Tune: ob
Not erational O Below Threshold
13 Permitted E3 Certified 0 Conditionally Certified eTh
d 13 Registered Date Last Operated or Above reshold:
Farm Name: e 196&k6Vr-^ Q _ County: ! C--cog-%, ...... —
Owner Name- . _5 -- � � - Phone No: _ ` to — S 3-2, — 2- � 3t)
NU ing Address: __._Zqqq Y ._ . WS ACAP+ _ U- liy
Facility Contact: _y" � -964e- /+rw4 Title: Phone No:
Onsite Representative: .' ..�J" `o&rr, ---- - - •• Integrator:
Certified Operator:— , !V Lcan r^t Operator Certification Number: u ass
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' Longitude •
Swine G
Desga ; Cntre�t,: _
;Capacity =Po> illation -.GatHle
Wean to Feeder
= Layer
Feeder to Finish
Non -Layer
Farrow to Wean
S^z60
s Other
s
Farrow to Feeder
to Finish
Deny
Y :h -
... 7
/F',a�rrow
Gilts
Boars
Discharges - Streamhnpa
1. Is any discharge observed from any put of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Feld ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaymin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4- Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: -_-
Freeboard (inches): _
12112103
x_y _
❑ Yes ®,No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Q No
❑ Yes MNo
❑ Yes KNo
Structure 6
Continued

Facility Number: —
Date of Inspection IO p
5. Are there any immediate threats to the integrity of any of the structures observed? Cie/ trees, severe erosion,
seepage, etc.)
6. Are. there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require mamtenancelunprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenanoerinprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Capper and/or Zinc
❑ Yes $LNo
❑ Yes MNo
❑ Yes tMNo
❑ Yes ® No
❑ Yes MNo
❑ Yes ®No
❑ Yes fallo
12. Crop type &--r-P --u_eL, 40 a tI t—a i K- Lai Lce± - Sri v �, _�a e�.�S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 10 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes jg No
b) Does the facility need a wettable acre determination? ❑ Yes Mj No
c) This facility is pended for a wettable acre determination? ❑ Yes R[No
15. Does the receiving crop need improvement? ❑ Yes Wo
16. Is there a lack of adequate waste application equipment? ❑ Yes ANo
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 EffNo
19_ Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes J3 No
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 KNo
Air Quality representative immediately.
�. Keel wvlrlc.; �g
Reviewer:& pector Name
ReviewerAkspector Signature:
4o Lek vege4-�-It4vim.. cow on
❑ Field Copy ❑ Final Notes
"&L SPos GLA-br`�
Date:
I2/l2/03
Condnaed

Facility Number: SZ Date of Inspection �Q 0
f
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
Yes
❑ No
22. Does the facility fail to have all co eats of the Certified Animal Waste Management Plan readily available?
c ecklistYdesi96, , etc.)
❑Yes
RNo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
KNo
❑ Waste Apphcati.*'-'[j Freeboard"❑ Waste Analysi✓b Soil Sampling
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
OjNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application)
❑ Yes
[%No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Iffl No
28. Does facility require a follow-up visit by same agency?
❑ Yes
® No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JQNo
NPDES Permitted Fatuities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes &(No
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 V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

❑ Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
PO Routine O Complaint O Follow-up of DWQ inspection O Follow-up of USWC review O Other
Date of Inspection
Facility Number � S/d
Time of Inspection t vp 24 hr. (hh:mm)
[3 Registered 13 Certified E3 Applied for Permit 13 Permitted 113 Not Opera Date Last Operated:.........
Farm Name:.. .............. .-.. � r�....1I r....._............... County:.............�........J.......... .....
..................
Ommer Name: ............. e.4... .......................................... Phone No: �9fai �� '�.734
................ ........................ ......
Facility Cantact:........,r......... Title: ... Phone No: ...................................................
Mailing Address:...........�. .............................. 1... ......-' -
OnsiteRepresentative:................................................................. ......................-----•--............ Integrator•....., i
G
Certified Operator ................---.......................................................---. Operator Certification Number:.......................
Location of Farm: zrRe,
....................
......_.•...•................................
_.........................................
I ...........................................
...................__...._................-............._......................._.... ........
Latitude Longitude �• ��
f Design.' Current ; DesignACurrent u D
` aCurreitt
r
Somme "i Capacitp Population Poultry Capaetty, ._.p ilatian Cattle Casa ty Population"'
to Feeder Z�drJ A-ACOLo ❑ Layer ❑Dairy,::
M.Wean
..
❑ Feeder to Finish" ❑ Non -Layer ❑Non -Dairy
*k,
Z_ ❑ Farrow to Wean
❑ Farrow to Feeder ❑Other "� ';
; .
❑�
Farrow to Finish Total DesigtivCapactty
❑ Gilts
❑ Boars .~.Total=SSI W T
_..-' s
Es
� u
:Number of,Lagiwns / Holding:Ponds-, ❑ Subsurface Drains Present ❑Lagoon Area
❑ Spray Field Area
❑ No Liquid Waste Management System«
Y'Lii1..�a ,saae+^ +•S..E a_ R �-;f" --
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes X No
2. Is any discharge observed from any part of the operation? ❑ Yes M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes J No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ['No
c. If discharge is observed, what is the estimated flow in gal/min?
A. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes MNo
3, is there evidence of past discharge from any part of the operation? ❑ Yes I!$'lvlo
'
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes JRNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes Wo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes KNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes n No
7/25/97
Continued or: back

i•ic
Facility Number: —;ZgWl
8. Are there lagoons or storage ponds on site which need to be properly closed'!
Structures (LaEoons.Holding Ponds. Flush Pit. eta
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes .) No
❑ Yes 91 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard tft): ... 2..f! ....... 1 ............... ......................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement!
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application`!
(If in excess of WLMP, or runoff/entering waters of the State, notify DWQ)
E15. Crop type .........,, ..- .. 1....................... ................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/lnspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[j No.violations•or. deficiencies. were` noted duri ng this.visit.- .You "Will receive no further
correspondence 2ihout this. visit: :
❑ Yes WNo
❑ Yes Wo
r—)RrYes ❑ No
❑ Yes P'No
❑ Yes IVNo
................................
❑ Yes 0 No
❑ Yes CjNo
'Yes ❑ No
❑ Yes V No
❑ Yes R9 No
❑ Yes 1KNo
❑ Yes AD No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
It mnt(eetoqusionEYSwers ndo}omtoaamhoungnCs;,
Use drawings of facility to better e4iain`sttuattgns (use additional •pages asFtnecessary} a r ter. I
9f-"/' .<'7 �i �� /may /� i✓.�CiESf/i .
7/25/97
Reviewer/Inspector Name/-
Reviewer/Inspector Signature: .+T��
,y,_�
Date:
//�-7.