820243_INSPECTIONS_20171231

IMF-
-.A=
NORTH CAHULiNA
Department of Environmental Qual
II

ivision of Water Resources
Facility Numl)er - ® 0 Division of Soil and Water Conservation
O Other AgeUcy
Type of Visit: 42FICompliance 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: /� Departure Time: County: p*�- Region:
Farm Name: ,f"/yyt Owner Email: 4
Owner Name: Phone: �/y —9 I o (p
Mailing Address:
Physical Address:
Facility Contact: p Title:Phone:
Onsite Representative:Integrator:jZ`A
Certified Operator: 'e f I--, r, Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
DesignF ;:current
_
Design
Current
Design Current
Swine
CapacEtyPo
� `. P•
Wet Poui...
�'y
Ca aci
P h'
Po P
Cattle Ca aci Po .
P h' P
Wean to Finish
Wean to Feeder
ii0�
La er
Non -La er
DairyCow
DairyCalf
Feeder to Finish
' "" `
_
DairyHeifer
Farrow to Wean
__ : -- :, Design
Current
D Cow
Farrow to Feeder
D 1Peiult"rt
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
"{
Turke Poults
Other
Other
............ .._.
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
[::]Yes 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
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 21412015 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ETNo
[] NA
❑ NE
a. If yes, is waste level into the'structurai freeboard?
[—]Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[!(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
0"No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
EjrYes
❑ 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
EYNo
❑ 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 El"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): A,-W71,fI4 10z, - ey1j'
13. Soil Type(s): ,;Iq— aj-5
_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ff 'es
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[D 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
[allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [3 o ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
` 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [fNo ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ENo ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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?
/'ram: r-- ba--'c Lt ✓ z-a �� L ��'�1
r fir%
�
jV-` 8d�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes �io
❑ Yes ETNo
❑ Yes [. No
❑ [y Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
[—]Yes [] No ❑ NA ❑ NE
❑ Yes <o ❑ NA ❑ NE
❑ Yes [3i No
❑ Yes [I No
❑ Yes e"�io
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone:
Date:
21412015

Type of Visit: UCompliance Inspection U Operation Review U Structure Evaluation U 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: ; p'(J Departure Time: ^!!.' 3y County: 4141, Region:
Farm Name: L"?'Wy Gf/ /i'L� Owner Email:
Owner Name: Gl%r•�yje_ Phone:
Mailing Address:
Physical Address:
Facility Contact: rlr1,` S�/�rht— Title: 995��V•Z_ Phone:
Onsite Representative:Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Cnrrent
Design Current
Swine
Gapatity Prop.
Wet.Povltry
Gapaity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
er
Daia Calf
Feeder to Finish
"`'
Design
Cnrrent
Daia Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
D , P.©ult ,
La ers
Ca aei
P,o
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discha es and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
D NE
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 ;R_No ❑ NA D NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes J24-No 0 NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JR No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes allo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
[—]Yes allo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
2,No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
hreat, notify DWR
7. Do any of the structures need maintenance or improvement?
Yes
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E�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 CAWMP? ❑ Yes L�LNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ELNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 0 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
allo
❑ NA
❑ NE
_Required Records & Documents
19. Did the facility fail to have the 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
allo
❑ 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. 0—yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis 0Soil 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 E�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [!�No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

' Facility Number: DateofInspection: I—/ Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes DffNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 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 J29 No ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes jM No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
10 No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
[A -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
jo No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
}-No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JjNo
❑ 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
C! f No
❑ NA
❑ NE
dtons.ar nyatnherComnens(refertoigndon EX fain any YESansweaid/or, any,:'additms'�lru7k
[)se:.drawuis of facilitvto better egolasn situations
n:se add�honai,naes as necessarv�. ;
7w�
�1. ,vbs��rs
'0A 7 4
Reviewer/inspector Name:
��
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

Type of Visit: QM;z=utine
ce inspection U Operation Review IL) Structure Evaluation U Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ' a County: Region:L7�� r
Ferro Name: _ l/ix.V X 4 1� j anti Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ^ z-nh1S/�/7� `t Title:n Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
(,.E
Non -Layer
Da' Calf
Da' Heifer
Feeder to Finish
Dry Cow
Farrow to Wean Design Current
Farrow to Feeder
D , P,oul Ea aci
Pao
Non -Dairy
Farrow to Finish
Layers
I
113eef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars Pullets
Other
Turkex 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 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 [RNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:
3— L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 32=
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ 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
allo
❑ 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 tY reat, notify DWR
7. Do any of the structures need maintenance or improvement?
® Yes
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
R No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Callo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CR 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): _L
13. Soil Type(s): a —W
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes (2 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Z 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
E2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
10-.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.
❑ W UP [:]Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
.Yes
❑ No
❑ NA
❑ NE
O-Waste Application [Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes " No ❑ NA ❑ NE
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes JZ 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 [RNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 1R No ❑ NA ❑ NE
Other Issues
28. Did the facility fail.to properly dispose of dead animals with 24 hours and/or document
❑ Yes
2§ 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
Jallo
❑ 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
CNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
J4 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
allo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
0 Yes
EZ�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[N-No
❑ NA
❑ NE
y 4z"
J, zrV -7-J-5 7
l
121
Reviewer/Inspector Name:
Reviewer/Inspector Signatta
;/a
Phone:
Date: Z1 _";U 1Z_1
21412015
Page 3 of 3

.777—&—
' i�ision o! Water Resources
Facility Nu[nber 9� z - 0 Division of Soil and Water Conservation
� Other Agency
Type of Visit:C��omm�pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: rrxoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ® —Arrival Time: Departure Time: ; County S Region:
Farm Name: 17 Zf l�V J��'+'L� Owner Email:
Owner Name: '7� C�uc�l + Phone:
Mailing Address:
Physical Address:
Facility Contact:
!^— Title: ^G►'" Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: /,;/ fj
Certification Number:
Certification Number:
Longitude:
Design
C_ urrent
Design Current
PEDesign-swur—r-i1nt
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
El Wean to Finish
La er
Dairy Cow
Wean to Feeder
aO
Non -La er
I
Dairy Calf
01 Feeder to Finish
' `
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D . P,oul . -
Ca aci
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a, Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
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 F& No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes S No
❑ Yes Wo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

ZO-3
Facili Number: - Date of Inspection: -�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
'
❑ Yes
Callo
❑ 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): 7
Observed Freeboard (in): �G
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
J2�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
[a No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Eg 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
KNo
❑ 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 M.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):�yyUDfs�
13. Soil Type(s): _ JA
a
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ONo ❑ 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 j. No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ta No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [g No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No
❑.Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes N
o
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
❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�o
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast 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
M No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[! - No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[2[.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
[31Vo
❑ 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
Jallo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[RNo
❑ 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 gueshon,-#: Explain, arty. YES answers and/or any additional recommendations or_anyAothe Cr ommeiits.-
Use drawings of facility to better eaaiatn. situations (use additional pages as neeessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7� `'.�
Date:
21412014

Type of Visit: !Tmoiance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up O Referral O Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Q; D-0 I Departure Time: .'D a County: Region:
Farm Name: Owner Email:
Owner Name: j/ Phone:
Mailing Address:
Physical Address:
Facility Contact: � � �`� Title: _ AUsi L-r Phone:
Onsite Representative: <1:7� - Integrator:
Certified Operator: �f. Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Design
Current
Capacity _Pop. Wet Poultry Capacity Pop.
Swine FI
Cattle Capacity
Pop.
Wean to Finish La er
Dairy Cow
Wean to Feeder
2LOO
on -La er
Dairy Calf
Feeder to Finish
&
Dairy Heifer
Farrow to Wean 1
esign- Current
Dry Cow
Farrow to Feeder
1) P,oul Ca stir Pop.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
Other Turkey Poults
OtherI 10ther
Discharges and 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 the discharge bypass the waste management system? (If yes, notify DWQ)
[]Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: Date of lns ection: r /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
5 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
0 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
g 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
jo 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
ja No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
JZ 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 AD lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
7� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes a 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes IK No ❑ NA ❑ NE
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_
❑ WUP ❑Checklists [:]Design [—]Maps ❑ Lease Agreements
[:]Yes ® No ❑ NA ❑ NE
❑ Yes CaNo ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
[] Yes No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 5aYes [—]No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard SWaste 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 M No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes 54-No ❑ 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 S1 No ❑ 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 to provide documentation of an actively certified operator in charge? ❑ Yes allo ❑ 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 property dispose of dead animals with 24 hours and/or document ❑ Yes [A 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
[SNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately-
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below-
❑ Yes
M 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
[3 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
®,No
❑ NA
❑ NE
Comments (refer to question #l) Explain -any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explainsituations {use additional pages as necessary}.
js
r 1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

?1w
o01n
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason f0iYY ..isit: 19 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Q' ! Departure Time: j��H� County: S/pf� Region: - FRA
Farm Name: WaS/ a& �/Ar
Owner Name:Q
Mailing Address:
Owner Email:
Phone:
Facility Contact: hemp'. " AjohlbTitle: Phone:
Onsite Representative: n 9 Integrator: —
Certified Operator: �%_ '0 W f /b, nlN j Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Cnrrent Design Current Design Current
Swine '' . ',Ca aci Po VVet Poul Ca aci Po Cattle Ca aci Po .
P ty P• � R . ty - P• P h' P
Wean to Finish
La er
DairyCow
Wean to Feeder
Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design @urrent
Cow
Farrow to Feeder
Dr, Po_nit . 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
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)?
❑ Yes 1' No ❑ NA ❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [] No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: ,
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
r-
fir.. .
❑ Yes U No []NA ❑ NEk
[:]Yes Callo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
21 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 J�TNo
❑ NA ,
❑ NE
maintenance or improvement?
Waste Application
_
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Q No
❑ NA
❑ NE
maintenance or improvement?
. +
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes f�j 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): 13 &dQ _ Hayq- �P/f- - Sma I t &-,a 19Lej
r- F-mC
_
13. Soil Type(s): Ls
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
N No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
ER No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
r
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CR No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[2 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes
Dg 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 [5� 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 N 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
® NA ❑ NE
Page 2 of 3 21412011 Continued

r '
Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Co No ❑ NA ❑ NE
25. Is the facility out of compliance with -permit conditions related to sludge? If yes, check ® Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
® Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concem?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No CR NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes f)_� No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes a No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes $j] No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Z No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Rj No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional -recommendations or:any other camtuents ' ,
Use drawings of facility to better explain situations (use additional pages as necessary):' _ y,
Plme, c)ea, +�of-h ou�fee 1�100)
�s. R4 WM I (mom
a I, �'+►� ancttrsel argML, ?1k1 cr M%14 40 Sys , �I eUpda e 1Rk a_-r irh0\y0"9e-fa� e�
tiNo�� soyl�l �P , 4s a NQhtCUf-DpPlc'
rah
al M0P1t
►� (ssved . Edico^ ckam f Pia,, ha,, bee, &e_ wirh+ ty4G ivece e1
CkOWfi CIS 'FQr{, ► fkPkile � e CwK `etraoL3 NM ao�-fC-O F3) n
d� I ra t o 7 ,
6� C.L1br�. -fiIJ yavgnde&d heiv4/PIS. � pr
aq
*le
'AW
� eV�aC a, �e� Pq Ua s n o d C�vr
,Dla &eexq %, hal- a- var hi h z��c. °� o>�� U MI, V t o ;
ye#l�v) I " r z&tQT 0 rWe-
+, �S C�r ►sf- St�E�e� t•y Fkwx oreA p`"ycym s
Denn4 j Alf
Ile Pc as3ol - s'o�- hsb - W4 a+� ar Yn*o ao1
� a, Plfr w'
FM. 4►0 - 486-07 o
Reviewer/Inspector Name
Reviewer/inspector Signature:
Page 3 of 3
Phone: lk—t�
Date: t�june a4clo f3
21412011

1
Facility No.q)*'1,3g3 Farm Name Date (� a
Permit COC IC_ NPDES (Rainbreaker PLAT
FB Droll s
.y.
Annual Cert Daily Pipe)
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
r
Soil Test Date Crop Yield �� Transfer Sheets
pH Fields Wettable Acres ✓ RAIN GAUGE
Lime Needed WUP ✓ { Dead box or incinerator
Lime Applied Weekly Freeboard b611Z Mortality'Records
Cu-I Zn-1 1 in Inspections Check Lists
Needs S (S-1<25) 120 min Insp. Storm Water
J
Needs P Weather Codes TI
rWaste Date TGlaalh le 141010. 1 �T f) 0 1 1.& k-6W � gi41d -TAWAL to hVI IS
- 60 Da
f 60 Day _
N flb/1000 Gal
Verify PHONE NUMBERS and affiliations
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon # 4 (j
App. Hardware Top Dike
Stop Pump 4w0
Start Pump q,i avyt S"1
Conversion- Cu-I 3000= 108 lblac; Zn-I 3000= 213 Iblac a
R*(3 -33 cs
kt ot�
175-11_0F,i3

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1101pliij Arrival Time: ,QQ Departure Time: County:
Farm Name: �►%Q4 R°� 1 fo4s fiih Owner Email:
Owner Name: Wdnv4e- I Q& Phone:
Mailing Address:
Physical Address:
Region: FRQ
Facility Contact: Wayne- /V(x41f Title: nwier Phone:
OnsiteRepresentative: WaVHP_ „�a [Ts Integrator:
Certified Operator: WQynP Vyot*s Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design C•urrentDesign� Current w Design Current
ity Pop. Cattle Capacity Pop. Swine Ca aci Po Wet Paul Ca ac
AuP
Finish La er Da Cow
Feeder
Layer
Da' Calf
o Finish
` airyHeifer
o Wean
DesrgnCurrent D Cow
Earrow
o FeederD
Finish
„ Point Ca �cio Po Non -Dairy
La ers Beef Stocker
Non -La ers
Beef Feeder
Beef Brood Cow
_ _
Pullets
,•-
Turkeys
Other
Turke Points
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E[ 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 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
[S 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

acility1Number: 1; - p�lgi! 3 Date of lnspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CR 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): a
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
f 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
U No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
F�gj 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
[VNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
ONE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
2 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [D 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 CAWMP?
❑ Yes
❑ No
❑ NA
ONE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
C3 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
(RNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
CKrNE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
❑ No
❑ NA
�@ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
[RNE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [—]No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ No
❑ NA NNE
❑ Weather Code
❑ Sludge Survey
❑ NA [gNE
[ZFNA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number a, - a
Date of Inspection: 1011q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA CR NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA n] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e_, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
[—]Yes
❑ No
❑ NA
r'NE
❑ Yes
❑ No
[RNA
❑ NE
I] Yes ❑ No ❑ NA f5a NE
❑ Yes &I No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA _'NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
to No
❑ NA
❑ NE
3�, �OIOwL� �'p i 1nS �v13 rfJl�d�a� r�mn�af froyl )a oral b�rfis, srydye ►�ar
r� b7e rema-�
r o t a-�l s � i���^ anc- �d w h
O��r TOW A b off- 10 s9COC � W-0-e- rP1n o�d f��I � t �t j -} }, �s �o��,
01 bleyek at ab0,f 1 scoop off h o9 slued e -truck- 0`0 11,
�,m.
fh -�r��� lbad is aVo 3 ieadr-Ioodra, per �dvc�r Jl,,t
�. s��ev� ®� -b ohs Ic�� o� a t l � �a t�►.� � 11r
s��� �1a«J a,, -�-�� � cad y
was � '��o�(a bad- 3-y �nchi'o
poi If co be fo s, ry � �
r 1t�dr ►� mix mark �'� Co[0" b'� nef 0b�io✓J1 1 l3-100ki�J. the sc�o�P
D 9a, r c chic. 7 h;c�rl` rh �a of h a
oteas wfie✓ reeled Per rod ucfl', rnvlch�ea� W r Q y y
P SC I A?X 1%f�t� `�a�+ia*0_ sCan` ,SCOO( wo,4d be- l�esrfihr.,i ! Cvb/c_
m�d� u Pe�._'� � 1
A re��•`�Or inf�rntd�l C� I��er hear rna I $r m � � e.
( res tdta is aice- -h,ey Leff-fhe `Fu«1 onc-h �S inS fec c� n7alk� 40 fhVrle-
Kff
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: [phone]
Date: Oct a a, a o I d
V4/2011

Facility Number � g � - a 3��, . ®Division of Water Quality
�visio
n of Soil and Wa#er Conservative
•Q Other Agency
Type of Visit: rQComphance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral Q Emergency Q Other O Denied Access
aI
Date of Visit: Arrival Time: Departure Time: County:.56'trfS� Region:
Farm Name:
W(4 nO
�(� �F&A-1
Owner Name:
We7Ynp
�U
R�
Mailing Address:
Owner Email:
Phone:
Physical Address: fto 611 Lh QWhka)
Facility Contact: {k L , 1 r Title: jy(} Phone:
Onsite Representative: f UQ y A Integrator: M�
Certified Operator: a Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
—1110— Design
� Current -
Desi
gn
Current
Design Current
_
SwineCapacity
Pop K_ -&Wet Poultry
Capacity
Pap.
Cattle Capacity 1'op.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
i �!.
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
- _ Di P■oul
CaPat i
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
I
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
I
10ther
Discharges and Stream Imaacts
1. Is any discharge observed from any part of the operation? ❑ Yes [3 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 the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters 'R Yes ® No ❑ NA ❑ NE
of the State other than from a discharge? 7V-5
Page 1 of 3 21412011 Continued

Facili Number: - Date of Ins ection: 00
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ®' No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats totheintegrity of any of the structures observed? ❑ Yes [R 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
r No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7_ Do any of the structures need maintenance or improvement?
❑ Yes
Ig No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
rallo
❑ 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
CR 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?
--y V
�J*No
11. Is there evidence of incorrect land application'? If yes, check the appropriate box below.
� Yes
[DNA
❑ 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 fR Application Outside of Approved
Area
�j %)
12. Crop Type(s): (jM'�(1 1 6t�vr� 1 LY q-- ollvf'o S r47' vlrif �
13. Soil Type(s): M(ki 1,
14. Do the receiving crops di er from those designated in the CAWMP?
❑ Yes
[5jNo
❑ 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
allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
CR'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
JR No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
n 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. [RYes ❑ No
❑ Waste Application ❑ Weekly Freeboard N Waste Analysis [:]Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [S 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
MNA ❑ NE
Page 2 of 3 21412011 Continued

IFacility dumber: - 07 3
Date of Inspection: $ a
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes W 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 fRNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No E';2-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:
❑ Yes &�No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes fo No ❑ NA ❑ NE
❑ Yes 15a No ❑ NA ❑ NE
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
t" No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? L9Yes
[:]No
❑ NA
❑ NE
Comments (refer to question #) Eipiain'any YES answers and/or anv addrttonalrrecommendations or.'any other comments.
Use drawings of facility to better `explain situations (use pages as necessary):: w,:,`
II, Wva1
V-01 M jojorj 10� U1o� S�l��dd�, b�r�. Thy Sr age
remoihd-6- 00), 4° i �� 1 a oo-, has not e+ bee,) o It IMd
c aiL�b be- ,d tp� c. � k►a
() �f °1
1, pl�ore Cyr aid log 01f0,) i�e�d o) lnr� de Df �a Dare a gar. �xt "oAp'*9ro�JL'c�
� .9 y
ls,fie(dr were- ` h
i�1y a011a+d i`(az�, ao �
r _9 �� all
he rye u,P war el-p0b1e a d Sh hail Ye, ?f4bt Olt, please e� cLnew wa.�Za (l r e gel, 3� y m s
rr � y �Q fdc
3 (j V0 t -uneeded_ � be s,,Ie. s 1 Ld e la��n I �va,s` Y' na f�oti,
I+ n y- l
Th 1n5ic�es��te bermr Gv'e O� as` IS
e 1 Zn keA jojf sof h'`Be�P1C�rPnC� i
Iaq, 1p)1e.S xe- be1i baI` r i MO'�'oa,al>+ t ijll� 6 lj Q/l�
jc n&Vpy Cre i bye. s��d I>~e �'`I�lc ,( c� npx`F so (j � y
Irn ioued . Ple&e f"t� �Owrl r11( FAkl "'P. [ ,
1 ea, e �r 1isl u 1 sv�v� ' �-��r
��o �/� a� na�ea , nofo� �adu�rcgr�C7,
I�a plrlr�uc�� i c '2 �t11t,iSPri�'��o�A,v�vdr,� �►PwsR�LtyQ`CfP4Qo 11/�y., �C fl/i�l�` i�i ��dl
Reviewer/Inspector Name: a 9A n e,
Reviewer/inspector Signature: �. �+.QyyL"
Page 3 of 3
Phone:
Date: a Q -z
2/4/2011

&I
11
Facility No. 43 Farm Name Wa r)1 �`I'AIiJ Date {ol
Permit ✓ COC OIC `✓ C1htQcd61 NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
�-Ae,
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume ih 0.45
Date out of corn liancel POA?
Cn154
Flow (qp
ActualDesign
. - . . _
; 0
-197-►iTi���T�'������
Soil Test Date
Crop Yield 04 . yfjl�'d.
Transfer Sheets
pH Fields
Wettable Acres V
RAIN GAUGE
Lime Needed
WUP ✓
Dead box or incinerator
Lime Appliedoilr.2-
Weekly Freeboard ✓
Mortality Records
Cu-I
Zn-1
1 in Inspections
Check Lists
Needs S (S-1<25)
120 min Insp. ✓
Storm Water
Needs P
Weather Codes
-
ice. �
_'
U� •:-
��
,r
l
j
r
Verify PHONE NUMBERS and affiliations �t
Date last WUP FRO 1,5 f 00-0fi FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike �(p
Stop Pump 4
Start Pump
'D, a
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac
l LaA,Sa ird Sef -

{
MiVobl
10
67
Aq

Qhur TI1i I
yof Water 4472-1 fiy
Dwision.
Facility Number a a LJ3 1�10ARvisian of Soil and Water Consersvation
f�Other Agency
Type of Visit: 1153t Compliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: 1$r Routine p Complaint Q Follow-up O Referral O Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: Region:
Farm Name: W11q ne w/a �iL1% ! Owner Email: � �+
Owner Name: Y a** _ Phone:
Mailing Address:
Physical Address: 1060 HO Rfr ,
J �
Facility Contact: WAS Title: Phone:
Onsite Representative: Q ws Integrator: M'-13
Certified Operator: ` L yfj Y yQ Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
DgnK Current Design Current
Swore C pacity Pop. Wet PoultryCapacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dai Calf
o Finish
Farrow to Wean
Design Current
D , P,ouIt ;.. �Ca `sei P,o
Layers
Dai Heifer
Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non-Lff ers
Beef Feeder
Boars
Other K-
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
10ther
Discharses 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 RNo E) NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
CR No
❑ NA
❑ NE
❑ Yes
R' No
❑ NA
❑ NE
Page 1 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
QWNo
❑ 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): 24
Observed Freeboard (in): a
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 environm5 tal threat,
5
notify DWQ
7. Do any of the structures need maintenance or improvement?
®Yes
QW No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Rj 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
(qNo
❑ 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 [RNo ❑ 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
[C�r jop Window 1❑� Evidence of Wind Drift
l ❑ Application Outside of Approved Area
12. Crop Type(s): Cog I a 1 6e,-- 7 [�t1� l'1l_ti�i- kA&e_,S (f Eli?t� 6yejH �
13. Soil Type(s):Iyvr'�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
W No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CR No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[a -No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
CR 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. r'Yes [—]No
❑ Waste Application ❑ Weekly Freeboard '5jjNVaste 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 5 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
RNA ❑ NE
Page 2 of 3 21412011 Continued

Facili� Number: - v Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 5g 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
CRNon-compliant sludge levels in any lagoon
List date first indicating S
j
V
� a
structure(s) and of survey non-compliance: ✓
f
26. Did the facility fail provide documentation of an actively certified operator in cha
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
® 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
N No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
® No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Ej No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
2 Yes
❑ No ❑ NA ❑ NE
omments (refer to question ft E
se drawings of facility to better. e
�� a� a,d_ 3 4. SI��9� war rakta� vpon�0 b�r�-, l �a�r, r� �'�vcryf'oFdew �7,y
s,eozje J p jr b-em mai 1V- dd-a i 1 i� wark -� b•e do;e -d a-64Me
oC a1/0,
l1Fd- , ' t l ow, nwpd4 -1-o ch�k -alai- 4?
-� ��--��r �rn�r y Ia, P 6 wf a�
e_ hvr bed °� lop o� beio, r pok- rv� needs -fo P
if1Sl e: bGh kS d n pWff, , P-k&ej-a7f1e_
a , Sewer sfra 'et;OA S }v$e dAe- dwI a l lva�eqf � � � ``�`�Gtrn pia r�Qnd �cxe- r af1 , PAA/ rva.r of Ve err�dd_ �beQ�fe- s f 1
� r �
m�
y
it�.s vs S/3lpG�
the aeyla la,
0Vrr 0Ad_ need- '�W
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Jo& �.1C111?'P�� Phone:
Date: Q$ Do
1 /2011
Rev 4qui-F / 11

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [R No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [5�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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
1p No
❑ NA
❑ NE
❑ Yes
[:]No
[5�NA
❑ NE
❑ Yes
PNo
❑ NA
❑.NE
❑ Yes [5�No ❑ NA ❑ NE
❑ Yes 51 No ❑ NA ❑ NE
❑ Yes PU-No ❑ NA ❑ NE
❑ Yes PNo
❑ Yes 9 No
[:]Yes Og No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
: Ex lam an YES answers and/or an additional recommendations organ pother comments.
Comments (refer to.question #)' P: Y. y Y
Use drawings of facility to better explain�mtuatiom (use,addihonal pages as
n 1
© v�co Of 4 0 V a40 bptm 0-f 41 06h SM t(
a �o ry nth bcv 1 le?c
aI, clever+ s�ra -even w e dc�e <l�r�. a. )" a array fu
P- /2 U y p 1�Son le. ��'' j s �111 1'�as n9� 11" �2 � c
v /
ReviewerlInspector Name:
Phone: y,3tr3333 L0�J
Reviewer/Inspector Signature:
Page 3 of 3
Date: �©
Cf 4/20II

.(�Iw 114
0
Type of Visit WCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit V Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: ' S Departure Time: County:
Farm Name: �p Owner Email:
Owner Name: t Yne y Phone:
Mailing Address:
Physical Address:
Region:
4_1
Facility Contact: -e, Title. Phone No:
Onsite Representative: n)1 S Integrator:_
Certified Operator: WhynQ`G YVGt'f> C Operator Certification Number: O�glgq
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ e = I = " Longitude: = o = 6 =
Ai
Design
Current Design Current Design Current
Swine Capacity
Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Layer_ I 1i❑ Dairy Cow
-�fIE:l Non -La er 1 ❑ Dairy Calf
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Qaky Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
Elai Non-D
El Farrow to Finish❑Beef
❑ Layers
Stocker
❑ Gilts
❑ Non -La era
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Turke s
❑Beef Brood Co
Other
❑ Other
❑Turke Poults
❑ Other
Nunn of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑'NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes "B No ❑ NA ❑ NE
❑ Yes t2ZVo ❑ NA ❑ NE
12128104 Continued

t
Facility Number. —3
Date of Inspection (l r
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.
❑ Yes P No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
El NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes C! '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 MNo ❑ 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? 12:yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes bwo ❑ NA ❑ NE.
❑ Yes [No ❑ NA ElNE
❑ Yes —97No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu., Zn, etc.)
[]PAN [-IPAN > 10% or ] O 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) Colh W) fit►m ic& flay 4 Pos1 e, Smol l Ain,A ones-o4
13. Soiltype(s) Ayb is I v
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes fXNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
EjNo ❑ NA ❑ NE
1G No ❑ NA ❑ NE
B No ❑ NA ❑ NE
KNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES anss•ers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
n n jrow� ra
-hwa! A
N4_ Ma itItTitb and C&4 l*k 6 4,s�jA*AoSoij anatys , :qq�
-4C-1b�
(0IC bOCcv&M 4d- St idje Pm lef w [4h Oehas ��[
ft rYi/'nt7
0wit has been hoop hPal4-h lsse',
g 5l
Reviewer/Inspector Name ; 1. �'�. , , f Phone:
Reviewer/Inspector Signature: Date:
✓ j (3
Page 2 of 3 U 12/2&04 Continued

lk
Facility Number:"-6— — Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
[:]Yes
$;No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
5? No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design El Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
W Waste Application ❑ Weekly Freeboard ❑ Waste Analysis KSoilAnalysis []Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[:%No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[R NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Sallo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes CR No ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
CR NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[8,No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
&No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Dallo
❑ 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
RNo
❑ 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
Q-No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
5irNo
❑ NA
❑ NE
Pfe ivYk-of � 0 o b cry S �i- - ' .s;c�� ` i a� Cyr}' Vi �" 1I
ve+4 . Goat ivte)f . o, �Wfr
1 h4 I a 0 ,� L 11A+ tAlAik o7a7 T
u -4o dad , vv o)4e_ cha�Ses,
�� i ill✓ -ram j C L*
' j j i�fi v 1- Qvfr- Dr 3-0) f p� -
- � hsrld � s�vb ��� �Lrj.
�5 t o k. ►v � I� i , r� � M 9 a c aye . Yv 01 ha s yc
r✓ � w
.� c �a, s (YTer
�'I 1 b e. cl��rf I� ' t l��rhfSa�trt `f�
v�rh 14_ghqfe Cr
e dale
ri�._p-► j �� gyp-+
hr �.
?ih i a\ r.e CD^ t �� D �a
o � ��m h ��� �- •
(see f ,e -A)
Page 3 of 3 V C x4_ YV r k �ckd i� *h'li ivbee ow 5 he-'ri ; 12128104

Facility No. 4n) 4 Farm Name �Q _ ----,Date
Permit L% COC (—i OIC NPDES (Rainbreaker
Pop.
Type
Design
Current
a�
�... =_
ir�YiliiVl)y-��
r
PLAT Annual Cert )
La oon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
-y
Ratio Sludge to Treatment Volume
F�alkbration Date
li Design Flow
WTIMM,Design
Width
Actual Width
�r Soil Test Datet,dll� �GP�
pH Fields
Lime Needed
Lime Applied
Cu-1 Zn-I
Needs P
Crnn Yield
Wettable Acres _
WUP _
Weekly Freeboard
1 in Inspections
120 min Insp.
Weather Codes _
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Waste Analysis Date
!
o '
r .
Amt r r r Gal
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
D:
0
f
-p
r
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #�`�
Top Dike
Stop Pumpw
Start Pump qoo
Conversion- Cu-1 3000= 108 Iblac; Zn-I 3000= 213 Iblac
�r bn�41,3T-7
App. Hardware
%ri? 6
Cr

y
i ASS it 1(4 10 9
R.
Type of Visit B Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: y,," Arrival Time: i Departure Time: � ; p County: SRegion:
Farm Name: rV�r t/ �'l1A , Owner Email:
Owner Name: ty r � 1 Vo-k � Phone:
Mailing Address: —01 s�, Pooch a C�1'1T� c-)s3a9
Physical Address:
Facility Contact: Yvaf 11 P Ka
, Title: ��C)?/` Phone No:
i,,
Onsite Representative:&,(Ap ]'►Lb Integrator: 1'Tytyh /— 13own__
Certified Operator: l 46'e- Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = ` 0 u Longitude: = o E l = a
Design
Current
Design Current
Design Current
Swine Capacity
Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Daia Cow
Wean to Feeder
R
❑ Non -Layer
❑ Da Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry-
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
Beef Feeder
❑ Beef
PGilts
Boars
❑ Pullets
El Brood Co
❑ Turke s
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 1RJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[:]Yes _1TNo
❑ Yes YNo
❑ NA ❑ NE
❑ NA ❑ NE
12128104 Continued

FacilityNumber: —a Date of Inspection-7--
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes WNo ❑ 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): o�
Observed Freeboard (in): a�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
N No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
P 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? JR Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
PNo ❑ 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
P No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. M-Yes
❑ No El NA ❑ NE
❑ Excessive Ponding Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 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)
emo tea 4 PigAlle S
13. Soil type(s)
1
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
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
RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�kNo
❑ NA
❑ NE
Comments refer to `aesttoo Expliffi1ifiyNES'ans«°ers and/or an recomneendattons or an other comments.
Use drawings of facility to better explain situations. (use additional pages:as neeessarv): L
Reviewer/Inspector Name Phone:
(Q110 � —�s� ��
Reviewer/Inspector Signature y� f �„ 0-4 p t Date: `VnC� � Q ca f)Q Q

i
Facility Number: Date of Inspection t or 1qi p�
Reduired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check_ ❑Yes UNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists fz.
❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
P 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
CkNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
P NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ERNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No t9NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ®"No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
&No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
U"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
ErNo
❑ 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
197No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
lff No
❑ NA
❑ NE
Pleyard � b"Of5 61 40f Of-
J oc�
a-3t- ►
W05Erna ys>°J J000t d ays pi,e4e_ , ej- YV�lat� s►�'e el7d0�1eafa
dvrs��� flay
I (P1f6'e1Vr* s rQ� rtir/L5+0 5h&cr , Pz* 1i' Yv �� �i��d, �vllpc_a[U �
u r -gyp D^�s ►n bovf ao Coo Lqlla�
�>vf S h 0ks h yh val UHF �sI �� . w� l l wa f v�
bC-eet s 7001,0 ?Et`�m�,�f"YDl � i0kftqj
e eotia, vti h i� a
fill", now n&-(0) F0j&'Cfr ion ;ic•e a7u� 1�i- hr4 n� kaf�SQid M �
Twos uharb�e-� h�Or "� s�''�,lL 't� d �`b �� 1 o�! -Fo� b�, -f�r�rr�1 ��, a or o,
�fa�►l� -� � �' a7 �
IM8104

Facility No.
a `tom
Farm Name wig �iAS Date
10 It c(l o l
Permit
COC
OIC_ NPDES (Rainbreaker
FB
Props
PLAT Annual Cert )
me -'sign ireiib—oard
Observed freeboard (in)
Sludge qumeyMite
.Ratio Sludge to Treatment Volume
Design
1rI,�+�------
Actual Width
N67L4"(q"
Soil Test Date
Wettable Acres RAIN GAUGE
pH Fields
WUP Dead box or incinerator
Lime deeded
Weekly Freeboard Mortality Records
Lime Applied
s i I aq�g �I��(
�JY17aD1D
1 in Inspections
Cu-I
Zn-I
120 min Insp.
Needs P
Weather Codes
Crop Yield
Transfer Sheets
Waste Analysis Date
1
- 60 Day
F
+ 60 Da
N Amt Ib/1000 Gal
r
,
H
_7e.'
f
Pull/Field Soil Crop RYE PAN Window Max Rate Max Amt
1-91 &15r
� r
Verify PHONE NUMBERS and affiliations
Date last WUP FRO (A-30l6� Date last WUP at farm
FRO or Farm Recordsip(Qy0 A)l `rO-1-eA
Lagoon#
Top Dike
Stop Pump q4,00
Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 lb/ac
App. Hardware
.3o �fj g�X�'t7 1,
[-e 1- e0jiw�e J
J

I
41% -444 sCors+, -Ja{ VvS
Y 4,N �C�
.
3yois 1 C.
'
(�-4vov
Ah
-"h'o�S
0'C j
�h
�� J�� tL

w5 qq IalEsloB -
Type of Visit U Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit (Br Routine O Complaint Q Fallow up Q Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: F8__1 Arrival Time: li''Ql1 Departure Time: County: '5G40101 Region: !_WO
__ O
Farm Name: A_ lV—& Owner Email:
Owner Name: i►t11 ne �Uil] _ Phone:
Mailing Address:
Physical Address:
Facility Contact: �/.y111?�� Title: Dwn'Pr Phone No: -3j77IS-0
Onsite Representative: Integrator: i"t�/fh r+�G► tj�y PP/M-j
Certified Operator: WAOR C Operator Certification Number: z" e�yly�
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = , 0 « Longitude: = ° = , = "
_ - -
Destgn r Current De Current Design Current
Swine CapacWity Popuis on Wet Poultry C Pacity Population Cattle Capacity Population
❑ Wean to Finish ❑ La er ❑Dai Cow
Wean to Feeder a 0 ❑Non -Layer ❑Dai Calf
❑ Feeder to Finish -g ❑ Dairy Heifer
❑ Farrow to Wean"` ❑ Dry Cow
El Farrow to Feeder ry Poultryr«: aq'
El Layers El Non -Dairy
El Farrow to Finish ❑ Beef Stocker
❑ Gilts ❑ Non -La ers
- El Pullets ❑ Beef Feeder
Ot6e y_; „ . ❑ TurkeysP ❑ B Boars eef Brood C°
r ❑ Turk oults
❑ Other❑Other ' �Numbe�:of $treictures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
C'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
CRNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
j:jkNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number:
Date of Inspection Llsll I1tILf V6 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): atj
Observed Freeboard (in): oZ
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes & No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes W No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CgNo ❑ 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 t8'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 5�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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) C.owkl 0"40L lt'U�ig?), SGQS
13. Soil type(s) Av$ k
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 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 9[No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? -MYes -IRNo ❑ NA ❑ NE
Reviewer/Inspector Name jpm 'SCA NEIr— PL „ „ „ Wy _ I Phone: q/0'4a3-33CVXJ337
Reviewer/Inspector Signature: Date: a 008
Page 2 of 3 U 12128104 Continued

Facility Number: $a — Date of Inspection UIR lot
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes CRNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CRNo ❑ NA ❑ NE
the appropirate box.
❑ WLTP ❑Checklists [I Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. JRYes ❑ No ❑ NA ❑ NE
® Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking laCropYield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
C8 No
❑ NA
❑ NE
❑ Yes
❑ No
J�j NA
❑ NE
IRYes
❑ No
❑ NA
❑ NE
❑ Yes
ER No
❑ NA
❑ NE
❑ Yes
CR No
❑ NA
❑ NE
❑ Yes
❑ No
CR NA
❑ NE
❑ Yes
CgNo
❑ NA
❑ NE
❑ Yes
NrNo
❑ NA
❑ NE
❑ Yes
RrNo
❑ NA
❑ NE
❑ Yes
®'No
❑ NA
❑ NE
❑ Yes
Ej No
❑ NA
❑ NE
[—I Yes ®No El NA ❑NE
Additional Comments and/or Drawings �� - ��; �_ „ _.. - - `' . _ �,��,•x�.- - x _
�14. N66L40 r,ecal[Wie,reet-cif&fjmnmef 4laCflown►2%-, Mofrhoi 10010 fhd?r,
air Wedr fvM ffl, sly e r✓rve but 14 was clv,Q aoo8,
IS, L" e w Q lied a* 1171, �� 4A s f1n Hn ar �� /a e_ �r
al, �vos�e a�n ys� 90� le ►min, hvasie awl sy,,yox( o a�ajs,
it Ieg� C(erm i,h ov+ ©f I jock ,
Rye w4r 61 jed e) Oc o her,
n
Is. H-iyh Zinc_ IRveis th se,,&aj -f efdr d v-e io ea,+ �i��ry De—lv��c�ey ��� (Aevei�a r000),
born 9 Sone new sef07 -effIds ) f', ILyre,
slualyes �-fom MOML tecrs)
C
Page 3 of 3 12128104

Facility No. �a-ay3 Farm Name 1rv0 n-a Date
Permit COC OIC_ NPDES (Rainbreaker
Pop.Type Desi n Current
PLAT Annual Cert )
---_--
Sludge Survey Date
Sludgr - .
��'�----�
Liquid Trt. Zone (ft)
� eMh10
Calibration Date
Design width—'
Actual Width-
CvA
c�o�r• -o j
Soil Test Datep . �- r
pH Fields
Lime Needed
60l
i V
Lime Applied
1 S�rty�
Cu
Zn Sw ,IoOD,
Needs P
Crop Yield`�0�
Wettable Acres ✓
WUP T_
Weekly Freeboard
Rainfall >1"
soap talta-alb
1 in Inspections
120 min Inspections `T—
Weather Codes
Transfer Sheets Yl74C--
RAIN GAUGE
000
JIM
Pull/Field
Sail
Crop
RYE
PAN
Window
Max Rate
Max Amt
DRM UJI 6pe
Q,3y
WAT
S
F
o,
Verify PHONE NUMBERS and affiliations
Date last WUP FRO 610Date last WUP at farm
FRO or Farm Records3���
Lagoon #
Top Dike t0l)
Stop Pump 4a.ay
Start Pump YyOo
SolJd.k�--,38
App. Hardware t &�. l

MA
4 MW la-4-0-1
1 Division of Water Quality
Facility Number gj a p1 y3 Q Division of Soil and Water Conservation
Other Agency
Type of Visit ?& Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit QfRoutine 0 Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �a� Arrival Time: Departure Time: Fir, q5_7 County: 5 Gin Region: Ego
Farm Name: wayne. W4ffS Fat Owner Email:
Owner Name: 1"1160_ �V4*5 Phone: cfj0 590 3�lsb d
Mailing Address: .311 CAb&.p 1gTU7
Physical Address: c agam
Facility Contact: Title: Phone No:
Onsite Representative:61e.,Wq* Integrator: 14L/V& amp"
Certified Operator: Ng � Operator Certification Number: .�
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e 0 '' ="
Longitude: = ° = I = u
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Currenf
Cattle Capacity Population
❑ Dairy Cow
❑ Daky Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes &No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes C'No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
12128104 Continued

"' Fac1lity Number: ,.. Q
8a - a 3 Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): a
Observed Freeboard (in): 3 } !1
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes tZ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Q] No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
NrNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
-,TVs WYes
56No
❑ 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
t5fNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CgNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
YNo
❑ 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) C I 4 P as
13. Soil type(s) AV q
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
1-91 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1K No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
w
Reviewer/Inspector Name ~ aAsPhone: 31n y,33-3300
Reviewerllnspector Signature: Date: IA- 4-Q3
V 12128104 Continued

Facility Number: g a —a1 Date of Inspection la`
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other moils 705 -jI5
21. Does record keeping need improvement? If yes, check the appropriate box below. ITM IYes AINo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard EKWaste Analysis ❑ Soit 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
C'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
5d NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
.K No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
WNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
EWNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
U No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
D?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
CWNo
❑ 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
R No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
WNo
❑ NA
❑ NE
Comments and/or Drawings:
a� Plea rfmthnber`�'hdf-- rvAqe, a, fi;af
is (j efiA-_ 4jPq4Y.
bekmerl Noe, a;d*, 7 6107 4-rc-
al�lo� _
4S lvdie, Surv-e, 4o be, d o>, W&r& yea, en& ,
Ji, aan Sall Salele. `6k-m 4-n be rnai W vf- -
u c4li brarfl01 sq�i-aoo — p k
a1. P I ewe, I~ & year at le&+ 0nce- po_oe., eremdl
g , Marker s hog fie. +�pq� ..~ o a'l n - N-ebaveL (freva wa 19
D4 xwia� rec,ads V)&Aio read 1� SCMe.cAM . PpW herder, ©n carba, C%y
7= Pi-esse seed(t,mv16 boreffob &) )°9 walls, LejoDn most) harjood C&ep.
12128104

31*7 J_Vs
=yM[j
0Z Y Z 3 O Division of Soil and Water Conservation
ji � Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review ®Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: -aS'O Arrival Time: Departure Time: County: Qa.r SQn/ Region: F2y
Farm Name: _ __ ��LbNG _1✓ 4!1>� f4r.✓l Owner Email:
Owner Name: _�C� "A S Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = i [� " Longitude: = o = I = "
Design Current
Design Current Design Current
Swine
C►►specify Population Wet Poultry
Capacity Population Cattle Capacity Population
❑ Wean to Finish
JEJ Layer
❑ Dairy Cow
❑ Wean to Feeder
1110 Non -Layer
I
I
Dairy Calf
❑ Feeder to Finish
ult
Dry Pory
❑ Dairy Heifer
El Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
' El Beef Feeder
❑ Beef Brood Co
-
❑ Gilts
❑ Non -La ers
❑ Boars
❑ Pullets
❑ Turkeys
Other
❑ Turkey Poults
r
❑ Other
❑
,Other Numbe�aof�Struetures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
Q4NE
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
51 NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system`? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
® NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
R NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
P NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: gZ --2�15 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VjNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes M No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z g'f/
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Pd No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes VNo ❑ 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 NNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA 4NE
(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 JO NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA 01 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ONE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
33NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
50 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No ❑ NA
10 NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
tZNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
® NE
`Comments (refer;to question #): Explain ap YES answers and/or any recommendation or any other comments" t r
Use drawings offacility to better explain'situations. (use additional pages as necessary):
(-1o) $U3-333 0
Reviewer/Inspector Name R; C-CV Icr [s Phone:
Reviewertinspector Signature: Date: 3 -- 0 $ — ZO07
Page 2 of"4 12128104 Continued

Facility Number: gZ —Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA Qf�NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes ❑ No ❑ NA 0 NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA t4NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
[NNE
25. Did the facility fail to conduct a sludge survey as required by the permit`?
❑ Yes
❑ No
❑ NA
[kNE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[]No
❑ NA
PNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
,® NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
[9NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
ONE
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
[ONE
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
29 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
JP NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
f NE
Additional. Comments and/or Drawings:
Page 3 of 3 12128104

1 Z-/z -Z-/z -a u 6
Type of visit y Compliance Inspection Q Operation Review U structure Evaluation Q Technical Assistance
Reason for Visit ®Routine 0 Complaint 0 Follow up 0 Referral Q Emergency 0 Other El Denied Access
Date of Visit: %Z-I 9 _0 G Arrival Time: O �%: DD Departure Time: /Z: O,Q County: s4wL0520-1 Region:
Farm Name: wau nJe. &A #_5 Cwk-P^ Owner Email:
Owner Name: i/a Phone:
If
Mailing Address:
Physical Address:
Facility Contact: w wj<- in�'lj4S _ Title: Phone No:
Onsite Representative: i.1•4 Integrator: MA 1,,2 �� SILO -J ^j
Certified Operator: WG 4 ^/<. �%'�f �s Operator Certification Number: 2 V/ f" 9
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I ="
Longitude: = ° = I ❑
Design
Current
Design Current
Design Current
Swine
Capacity
rMlauulation
Wet Poultry Capacity Population
Cat#le Capacity Population
❑ Layer
❑ Non -Layer
Dairy Cow
Dairy Calf
119
,k
t"
El Dairy Heifer
Dry P tltry s
:, -
❑ D Cow
❑ Non -Dairy
❑ Layers
❑Beef Stocker
❑ Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Beef Brood Cowl
.ra
Other
e;,- m;��,-
=z,,.,aF
❑Turke s
❑ urke Points
F=O her
❑Other 1MMUMMerf
Structures:
u.-.
❑ Wean to Finish
Wean to Feeder Z le b U
� 4
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow !o Finish
❑ Gilts
❑ Boars
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
OfNo
❑ NA
❑ NE
Discharge originated at: ❑structure El Application Field El Other
a. Was the conveyance man-made?
❑Yes
[YNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
[;PVo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the state (gallons)?
d. Does discharge bypass the waste management system? ([f yes, notify DWQ)
El Yes
F No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
Wo
❑ NA
❑ NE
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
[)(No
❑ NA
❑ NE
other than from a discharge'?
Page 1 of 3
11/28/04
Continued

t
Facility Number: $2_—Z
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Wo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E;rNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes U& ❑ 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 [XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Pro ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes PNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes E�No ❑ NA ❑ NE
I 1 _ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes QfNo ❑ 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) St ens c c d G Yr. Z 7�sf.6 jV e 0. S.
13. Soil type(s) 4 8
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? El Yes MA ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 9 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [VNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes dNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or, anyrecomtmendations or�any other comments �� �'
Clse drawings;of facilityto better explain situations. (use addition aUpages as necessary): a
Reviewer/Inspector Name KG VL� S � Phone: (9/0)S<3,_3 — 3.33 O
Reviewer/Inspector Signature: l e—AJ.—I Date: i z —
rage z of s IZ/ZdIU4 uonnnued

. tt
FacilityNumber: r2-21V41 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3No ❑ NA [:]NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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 M 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
ENNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[A No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EIFNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[N'No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[14 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[gNo
❑ 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
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[9No
❑ NA
❑ NE
Additiianal :Comments and/or Drawings: }
Page 3 of 3 12128104

. _ r
Type of Visit 9 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S'rfd dr Arrival Time: !D. Departure Time: County: ar! Region:
Farm Name: Lr/ /��in Owner Email:
� 3y
Owner Name: W12 Vj7 f
II Phone: ci��' - -mil
Mailing Address: 221 C al 6ae a PG " C4 of 0a.1_ C IinT�7 _....---/C_ a 93-Z8
Physical Address: 11��
Facility Contact: �✓_py.rL 14/ex Title:
Onsite Representative: _ 4✓6yn:le-
Certified Operator: ,.. Lt/OTC L✓a
Back-up Operator:
Location of Farm:
Swine
wn)"q. c041 Is -
Phone No: 17412 2 4761
Integrator &iCs, l Far 6
Operator Certification Number: 2?4/ I/q
Back-up Certification Number:
Latitude: ❑ o ❑ 1 ❑ Longitude: ❑ ° ❑ =
O
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
G ❑ Non-Layet
❑ Wean to Finish
10-wean to Feeder
.2ij
Other
❑ Other
Dry Poultry
ElLayers
❑ Non -Layers
❑ Pullets
❑ Turkeys
El Turkey Poults
❑ Other
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ❑ Other
a. Was the conveyance man-made?
'Design Cur
Cattle capacity'`:Popu
❑ Dairy Cow
Ela Dai Calf
El Dairy Heifer
E]Dry Cow
ElNon-Dairy
ElBeef Stocker
ElBeef Feeder
ElBeef Brood Cowl
Number of Structures: ❑s
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 D<o ❑ NA ❑ NE
❑ Yes
Discharp_es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ❑ Other
a. Was the conveyance man-made?
'Design Cur
Cattle capacity'`:Popu
❑ Dairy Cow
Ela Dai Calf
El Dairy Heifer
E]Dry Cow
ElNon-Dairy
ElBeef Stocker
ElBeef Feeder
ElBeef Brood Cowl
Number of Structures: ❑s
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 D<o ❑ NA ❑ NE
❑ Yes
Number of Structures: ❑s
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 D<o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E o
❑ NA
❑ NE
❑ Yes
QKo
❑ NA
❑ NE
12128104 Continued

i
Facility Number: —
Date of Inspection
Waste Collection & Treatment
!!
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
R o
❑ 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
a
identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ENo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
EllGo
❑ 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
2'�o
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ERfiO
❑ 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
[fVo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
�,—,,!!
L;'wo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
2Tes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
N ❑ PAN > 10% or 10 Ibs El Total Phosphorus [I Failure to Incorporate Manure/Sludge
into
Bare Soil
VEl
tside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
n V3//� So
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[,fo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination '�❑ Yes
❑ No
❑ NA
17. Does the facility lack adequate acreage for land application?
❑ Yes
El No
,[a'11�E
El NA U tvE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[]-<o
❑ NA ❑ NE
Pit
7lrrre
lovllS were
rhuo% On dr,,14
lejt
dt{obrr 00V'I} , d✓4a14- PI&P7
,gsqo5
Gllows
jaee,vj/I[
b 6{ sPrur�� an
/�cVt�i a1
�,�►� Se' -I, 30, A Oc41-e,
a/'P oeto.
chaa<ts wera
10 �]l 10 d3r /a _74'•
Q � Ni /f�9Pn wr1'� moekell
ec.0
f.
On/'y /6,3 /S3 ran be qe/OI:Pj
{o fl,c
AYk C✓ Gl 6
ersr� , ecuv4e i-Ae
RS/
lna, .ij& % /Q.
3 ILc
IV_
Reviewer/Inspector Name ram, r: �� Phone: q/O-if Lela-�� yi P�f 73
Reviewer/Inspector Signature: Date: S7-_j_0-05-
12128104 Continued

. . , s
Facility Number: 9 �L/ Date of Inspection p -vim
_Required Records & Documents /�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes B No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes E o ❑ NA ❑ NE
the appropirate box. ❑ P ❑ Che lists ❑ Dp4n ❑ ElO er
21. Does record keeping need improvement? If yes, check the �appr9priatepoxb io' . S a �, 'es ❑ No El NA El NE
❑ W e�#� ti ❑ -- L� ll (�(i ❑l SSA ❑ ❑
❑�• �L�Stee6nz c:rop Yield E�M20 Minute Inspections ElMe ❑ *4_-adjrn eod�-
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit'?
25, Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
P �o
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
[.-}AGE
❑ Yes
❑ No
❑ NA
9-11-E
❑ Yes
❑ No
❑ NA
Q�
❑ Yes
[�J
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
g'NE
❑ Yes 0-1�o ❑ NA ❑ NE
❑ Yes 2'No ❑ NA ❑ NE
❑ Yes RfL ❑ NA ❑ NE
❑ Yes ❑'Io ❑ NA ❑ NE
❑ Yes
BIL
❑ NA
❑ NE
❑ Yes
044o
❑ NA
❑ NE
Additiopal Cbmments:and/or_Dr$win F� fie I CJ rn in✓/e i, rred'vn S,
I°IZas� beep et e ran r(e /o/ Fof`r+l,
6
A NvV mcy be
"55uep,
{dr 1Ae
wade
aPO CAV-h
ov151'Je o7c 6.1"0rlvw3
6ncrlvragecl A-.
WA#S /o
ralie
tv0Sl-e
-5ar„p/ps
MOfe 0R"'n,
PrIO/Ler ,s /`Cmov,.ry COv&,- e/o�.
12128104

Type of Visit & Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number gate of Visit: Time: I clo
0 Not Operational C Below Threshold
Mermitted 12-[,erdfied [3 Conditionally Certified © Registered Date Last Operated or Above Threshold: _
Farm Name: -... W-A�'.a-C- .-..i✓I d2............... County:...... ,
Owner Name • Phone No: y 117 - �G%? - / y--_-.........
mailing Address. ........... a�...- . Ca13G�_.5.` C l,'T Al . _ _ ."�
Facilitv Contact: ................. —. _ Phone No:. .
Onsite Representative:.. _-_ !✓� _—•--j�� .. Integrator: -.-. !Mr.�
Certified Operator: ................. ------WAA-...... .-.... .................... Operator Certification Number: 2-A)A- 1-.,,,••__.
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 46 Longitude • 4 «
- Desi Current - Deign
gn n Current Desigo tCrirrent
•
SWiDe Ca Po elation PoWtry'
Ca ci Po "Watior ac>E Po nlabon..M
ean to Feeder
..
Layer
:.Cat#le
: ❑Dairy `=
eder to Finish
❑ Non -Layer
❑ Non -Dairy Y
FFarrow
to Weanrrow
Other
to Feeder
_
Farrow to Finish
_
TdtilDesign,Ca Clt
pad
El Gilts
El Boars'-
Total SSLW
' ,Nmaber Qf Lagoons
Y,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes [ -N-5
❑ Yes EIM
❑ Yes [g4W
❑ Yes ❑.No
❑ Yes G-No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes EFo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes EPio
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _._.1............... ..._ _ ....._-_._.._- _
Freeboard (inches): �a
12112103 Continued

Facility Number: S 'j -- 943 Date of Inspection Jy o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
92'110
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
❑No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
9,9o.
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
BVo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
PNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[,Ado
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ yes
[moo
❑ Excessive ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground El Copper and/or Zinc
/Pionding
12. Crop type LlFrM✓�Q �lf� (r....'n (& A _-Grazd )
B. Do the receiving crops differ with those designated in the Certified Animal Waste Management PIan (CAWNIP)?
❑ Yes
g4fo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
RN O
b) Does the facility need a wettable acre determination?
❑ Yes
9-No
c) This facility is pended for a wettable acre determination?
❑ Yes
KWO
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
0,14(0-
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 S 1Ko
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 9-Ko-
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 Q'K0
Air Quality representative immediately.
Comnients'(refei to quest<on°#) Explain any YFS answcts and/or and rec�pmther�abons o_r'any atl:er comments. � �=
:Use drawrngs oifacritty tosbetter explain sttuatioas {,ase adthhanal pages as necessary) _ -
r �-Feld Copy ❑Final Notes
lc3i1kQ/ 4.r�*VS ;y 4•1 S ot'u ' Hvs P
41;14 Dan 160./P 4b�,.f w{Qf fo 5 ry a,c10110jrce ii.,fj
l �1 4 e
5 n vPdPat !7s°�
�
P°^s �o .►,vw
Reviewer/Impector Name B _
� r
Reviewer/Inspector Signature: Date: 7
12/l2AU Continued

Facility Number: 2y 3 Date of Inspection J -o
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes M-N-6
22. Does the (facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ y�. o- ch�5ts. pos etc.) ❑Yes
23_ Does record keeping need improvement? If yes, check the appropriate *box below. ❑ Yes C -No
❑ on ❑ ❑Andysm
s-29> .2. S a.f
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes g-Ko
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ®Wo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes [moo
27_ Did Reviewerlfnspector fail to discuss reviewlinspection with on -site representative? ❑ Yes JR�So
28. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [-No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, slip questions 31-35) ❑ Yes 0140
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 1" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
12(12103

Site Requires Immediate Attention:
Facility No. S z—
DMSION OF ENVIRONMENTAL MANAGEMENT
ANDAAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm NamelOwner• • i A.
Mailing Address:
County; S'D
Integrator:
On Site Representative:
Physical Addrtss/I.ocation:
DATE: v vS�, 1995
Time:
*I
UP — Phone: �
Y ,l �- t u,n,+t.. 1 mkt b-, k ,--i� k di
Type of Operation: Swine Poultry Cattle A mku "u
Design Capacity: V- o Number of Animals on Site: Z D
DEM Certification Number: ACE DEM Certification Number:
Latitude: e • w L.ongitude: O w
Circle Yes or No
Does the Animal Waste Lagoon
(approximately I Foot + 7 inches
Was any seepage observed
Is adequate land available
Crop(s) being utilized:
Does the facility meet SCS
from
":3 - Z-11 r
k U7 o �J Vex
yM �� A V�[��
T l
ACNEW
sufficient freeboard of I Foot + 25 year 24 hour storm event
or No Freeboard: � Ft. Inches
on(s)? Yes or o auras any erosion observed? Yes o
sir No Is the cover crop adequate? Yes or No
minimum setback criteria? 200 Feet from Dwelli '!LYy� or No
100 Feet from Wells Yes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue e: Yes o ;�F
Is animal waste discharged into waterstate by man-made ditch, flushing system, or other
similar man-made devices? Yes 4,No If Yes, Please Explain.
Does the facility maintain adequate waste management records (vokKnes of manure, land applied,
spray irrigated on specif ace a with cover r )' es or(No
Additional Comments: +� 5 _y++-- -
ils�4�
Inspector
cc: Facility Assessment Unit Use Attachments if Needed.