820248_INSPECTIONS_20171231

NORTH CAHOLINA
Department of Environmental Qual

of Visit: oroutine
nee Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
in for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: , aft Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: J� Z 42 Phone:
Mailing Address:
Physical Address:
Facility Contact: L ; n kz I Title: 4LLU n S. -e-' Phone:
s
Onsite Representative:„ Integrator: /�
Certified Operator: Certification Number: A., Dj(.
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dai Calf
can to Feeder
Non -La er
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
D , Pon!
Layers
Non -Layers
Pullets
HTurkeys
Turkey Poults
Other
Design
Ca ai i
Current
P,o
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Dischar es 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 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
0 No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
I o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[J �o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

[Facility Number: -�2y Dinspection: —
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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):� j 9,;Z—
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E]31<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3lo
[DNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
D o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[3N
❑ NA
D 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 Evidence of Wind Drift
❑ Application Outside of Approved Area
�Window /j❑
12. Crop Type(s): a���f�/ZE2��ttf.�e��-•S
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes [3 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes F-14/io
❑ NA
D 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 [r]No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes Q'l o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [TN'. ❑ NA ❑ NI?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E: o ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E3- o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes do ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFacifity Number: a - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Er<o [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
PN ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes6-<o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
[] No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0/Xo ❑ 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
ETINo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑-11; o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
�No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
io ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
J.
��4 ri7't GC%c�r/z QTY l' S�k Y� cG y/�/Ir
d Coe-
r�_�14rf­
0 rAn
W -:�3 `-C-o eat i
Reviewer/Inspector Name:
Phone: 03-01-4-
Reviewer/Inspector Signature:
Page 3 of 3
Date:
2141201 S

io
�Divi"lion of Water Resoetrces
FCility Number ®- L O Division of Soil and Water Conservation
t� Other Agency
Type of Visit: ompliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: �17 Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: (71-0" S � , , * aS Phone:
Mailing Address:
Physical Address:
Facility Contact:? ; .� r 5 Title: Phone:
Onsite Representative: integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Y Design Current
Design Current
Swine, Capacity Pop
f"j Wet Poui "1' Ca aci Po
.r,. trY � . p h' p
Cittle Ca aci Po
Dairy Cow
Wean to Finish
Layer
Non -La er
I
-
Wean to Feeder
I Dairy Calf
Feeder to Finish
i," ![Dairy
Design Curren
Heifer
Farrow to Wean
lDrvCow
Farrow to Feeder
D . J foul Ga aci ` P,o
-Dairy
Farrow to Finish
4�
Layers
Beef Stocker
Gilts.
Non -Lavers:
Beef Feeder
Boars
Pullets
Beef Brood Cow
«.
Turkeys
(?ther
Turkey Poults
Other
Other
—_.oe*�.+��r.zp.uweusa�. , :!�aa�n�f
�
a i.,•�,.., i i�ne�:�wixo,ru..cu..uimuie
.,'�
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 M.No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes AINo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3
21412015 Continued

Facilit y Number: ge - Date of inspection:
Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): C_
Observed Freeboard (in): 3s__ 3�
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
ZNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ID No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, 7_n, 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 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 ❑ 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 1S� No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application'?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes ,o No ❑ NA ❑ NE
❑ Yes EaNo ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes J�j No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [2 No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other-
2 1. Does record keeping need improvement? Ifyes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes -0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes &No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: S - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: / J 1)
26. Did the facility fail 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 [j 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
Ea No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[allo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
JR 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
RNo
❑ 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
allo
❑ NA
❑ NE
Reviewer/inspector Name: �+•-`--- Phone: �li`t� P_3rfU�.S
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

Type of Visit: U'Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: yS Departure Time: County: Region:
Farm Name: or Owner Email:
Owner Name: r�z-S �i� _- S _ Phone:
Mailing Address:
Physical Address:
Facility Contact: / ci; % j rf Title: J� � �� _ Phone:
Onsite Representative:Integrator: r r/
Certified Operator: �r_ Certification Number: /lv �Q
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Design Current
Capacity „ Pop;
Wet Poultry
Design
Capacity
Curren#
Pop.
Design Current
Cattle Capacity Pap.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
D
_
Non -Layer
Dai Calf
Dai Heifer
Feeder to Finish
D : P,oul#r
Design
Ca aci
Current
Po
.
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non-La�ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
.._ Turkeys
:Other - _ Turkey Poults
Other Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
Z. Is there evidence of a past discharge from any part of the operation? [:]Yes R No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes R No ❑ 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
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): 3 I_
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
[a 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
E No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[a No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[—]Yes
allo
[] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[K 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): At'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3—No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
gNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
BNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2kNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
JRNo
❑ 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 10 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes _FXLNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: Date of Inspection: /�-
�. 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes allo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ELNo ❑ 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 R No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes W[No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [�J_No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ja No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[g No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
®-.No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: /%C� �r73-tj15`l
Date:
21412015

Type of Visit: (Tompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: outine O Complaint O Follow-up O Referral Q Emergency O Other Q Denied Access
Date of Visit: j Arrival Time: Departure Time: County: �i.�fvl Region: F I'N�
Farm Name: 19 W Owner Email:
Owner Name: Y.S L f},` riCS Phone:
Mailing Address:
Physical Address:
Facility Contact: )a-; f,j )7-eS Title: { J/�_Y" Phone:
Onsite Representative: Integrator: 1W ff
Certified Operator: Jc_ Certification Number: ld 7010
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design ;Current
Swine - - Capacity Pap. Wet�Ponitry clapaci[y Pop.
= _ - Design Current
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
D
Non -La er
Dairy Calf
Da Heifer
Feeder to Finish
Dg�Current
D dPoW_Ca aci 1'0 .
La ers
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
I
113eef Stocker
Gilts
Layers
I
Beef Feeder
Boars
Pullets
I Beef Brood Cow
-
Other_ .'=
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ 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 Z No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes allo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

lFackity Number: -,7 Date -ofInspection: S /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?: _
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
LB -No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes 0 No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
[]Yes
RNo
❑ NA
D 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
Jallo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
Jallo
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
0 Yes
® No
❑ NA
❑ NE
maintenance or improvement?
I I- Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Eg-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): �1Wv_A; �?r jam- /bfPL /W//Sc i/7 G" ors
13. Soil Type(s): J,(�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes fo No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes g No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes JZ No ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
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
M%/ 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
�D No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[-]Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[allo
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - 19q 4 Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ff 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 O No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes CE[No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes ® No
❑ Yes allo
[:]Yes El No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional nasles as necessarv).
Reviewer/inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: lZJ � C'O
Date:
21417014

rk-3e> i
Type of Visit: �Co70'Utine
'nce Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: () Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: D r j` County: L_:,4e�gv— Region:i
jV
Farm Name: Owner Email:
Owner Name: '7�►�H7 �� [ Xj; rr ,r'S Phone:
Mailing Address:
Physical Address:
Facility Contact: ,� I- ; yt Title: Qom" r- tl-- Phone:
Onsite Representative: S'r.�--� Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current -
Design
Current
Design Current
Swine Capacity Pap.
_Q70 Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
I
11-ayer
iry Cow
Wean to Feeder
I
INon-Layer
I
i Calf
Feeder to Finish
-
Dairy Heifer
Farrow to Wean
77
.III
Design
Current
Cow
Farrow to Feeder
D . P,onl
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
I
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 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 allo ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes [:]No
❑ Yes [:]No
❑ Yes No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in): ct
Observed Freeboard (in): ,3*-'
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
allo [] NA ❑ NE
❑ No ❑ NA ❑ NE
Stricture 6
❑ Yes RNo ❑ NA ❑ NE
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 threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
FKJ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes SNo ❑ 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): rr-- I s l �1�1 �7 vQ7 ^- 111�i`_L/ _li
13. Soil Type(s):17
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Wo ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 0 No ❑ NA ONE
[—]Yes ®-No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes allo ❑ NA ❑ NE
the appropriate box.
❑1ArUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0—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 S No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [R-No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rNo
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [�No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2[ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWIVIP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes (5? No ❑ NA ❑ NE
❑ Yes 5jNo ❑ NA ❑ NE
fg Yes ❑ No ❑ NA ❑ NE
[:]Yes No
[:]Yes ® No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional naves as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 'J1-49--�Z33-53 M
Date:
21412014

Type of Visit: 16 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: GtRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Sawwi Region: 92
r
Farm Name: /jUnj%y _ Owner Email:
Owner Name: (,�r] S Phone:
Mailing Address: 1353q
Physical Address:
Facility Contact: � -�}, er _ Title: Q✓17t- Phone:
Onsite Representative: 1fnh7v y f Integrator: � 17
Certified Operator: Certification Number: 0
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
r
Design Currrent�,�esign CurrenSwine
EDegsigigt;7Current
Pop
rWet,Poultry
Capacity Pop Cattle Capacity Pa
—_ $`
Layer
DairyCow
Non -La er
DairyCalf
DairyHeifer
Cow
..'. ._ Design Current."
D . Pou1 Ca aci Po
La ers
Non -Dairy
Beef Stocker
Beef Feeder
Non -Layers
- ;
Pullets
Beef Brood Cow
Turkeys
Other
. *
TurkeyPoults
Other
Other
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑Structure ❑Application Field ❑Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 5a No ❑ NA ❑ NE
❑ Yes
❑ No
[] NA
❑ NE
[:]Yes
❑ No
[] NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑Yes []No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑Yes 10 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑Yes ®"No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 1/4/20I1 Continued

Eaci6 Number: 4A I - a Date of Inspection:
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): r� L� !t
Observed Freeboard (in): 131 50
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
U 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
[' gcNo
❑ 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
[RNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
allo
❑ NA
[] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[XNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. K7 Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
® PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Windyo�wy ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Types)
13. Soil Type(s):
I4. Do the receiving crops d
from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
❑ Yes ® No
❑ Yes [—]No
❑ Yes J�j No
❑ NA ❑ NE
❑ NA NE
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
N No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
IR No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
14 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis (5g Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
(�j NA
❑ NE
Page 2 of 3
21412011 Continued

6acili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CyNo
25. Is the facility out of compliance with permit conditions related to sludge? 1f yes, check ❑ Yes U No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
[] No
[50 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
`R No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
X Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
P No
❑ NA
0 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.
Ca Yes
❑ No
❑ NA
❑ NE
® Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMI'?
❑ Yes
15a No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
r7i No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
[] NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments-;
Use drawings of facility to better explain situations (use additional pages it's necessary).
se..&_a -
Soli �'�P.r� �Or a D is werdaie b� mis la . -Sof i ��-for ao� n/or
a j ,
rec#+t and is not back yel ,
m,il cop� of c)oja sc), 110, +P bfw3j�gf Nait )kipLettj
aaJ &;Fd; Si _vif -e 71
PA WV 11� VC a8301 iabel�4
Se*al m h a magi elm o� v1h �1j rl°e4rtr - AIV o r � are Two `eid cue Pr
als � k 4 C011�ec Vf X Q1
Wert! � s° � �s�� o�
eSulve exm -1 " , thi-o i� aop, �1&re clo fl�1n n-exfiea-'
r
C0n j ,0+ ila/Vejkd _ ,
Foilow�no-e n 01*VC rrPry1
1ke,aa� 0 f "t�yi iefdm fw received eFgoi ro laa I� a-1dC wari�y�oa[f /e,
Reviewer/Inspector Name: Z000 S714 d&
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q/o-433-3-U of-GQ4
Date: M 0 6&' 3
21412011

+ Facility No. /�13Farm Name SYCl����lYi Date i .3
Permit ✓ COC -,*"' OIC NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
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 ifs 0.45
Date out of compliance/ POA? -
Design
IF110=-------
Soil Test Date
pH Fields _
Lime Needed
Lime Applied_
Cu-I Zn-I
Needs S (S-1<25) _
Crop Yield J
Wettable Acres
WUP
Weekly Freeboard
1 in Inspections
120 min Insp.
MIESMELIM tn.
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
Can
A-+
Sr,00
12
V
CiP 'j,
+
enfy P ONE NOMBEFS and affiliations
Date last WUP FRO al(a.lo� Oy FRO or Farm Records
Date last WUP at farm
App. Hardware
.-W-
Lagoon #
Top Dike
Stop Pump
Start Pump
I
53
4q,0
S;,D
a
�ls
,• "7
'7
IWyp
I000x 133-
Conversion- Cu-I 3000= 108 Ib/ac, Zn-I
3000= 213 Iblac -7ir
l3Jr
r
�S /
Or_ig -1 I-V ►tx
rx q M01-2
'fir
13T9�"�
i°afi�Pe�
N
F6= 1,0
a 0`'� or

30�►es C fees
3g5P Pew* Chi AFTrT
aoka
�P--Sy
l 00I - Car/)
FFooa - Cpin

i ype of visit: K�P%_ompuance inspection V Llperation xeview v structure Pvatuanon V t ecnmcat Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ; js y County:MVJQI
Farm Name: sy? S f G}rp,� Njjij��►1 Owner Email:
Owner Name: �(]ryl i�l]�p� Phone:
Mailing Address:
Physical Address:
Region: 1:7l�
u �
Facility Contact: J1 M M4 ' Title: Phone:
Onsite Representative: rAj Integrator: M 13
Certified Operator: lom-e S ffihej Certification Number: 1 &70�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
WetiP;outtry _
Layer
Non -La er
__... _:_ _.., w._.� _ ..
I) . P,onl
Layers
Non -Layers
Pullets
Design
Capacity
_ _ _ _ .. _ _
Design
@a aci
Current
Pop.
- - -
Current
P,o
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Daia Heifer
Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
\' Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
WIN
Other
Other
Turkeys
Turkey Puults
Other
_Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �R No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [] NE
❑ Yes ❑ No
❑ Yes [a No
[:]Yes Eg-No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: jDateof Inspection: d a0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[,'R No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):i�
Observed Freeboard (in):`
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
CK 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 CjZ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes fg 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 CE�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [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 Crop Window ❑ Evidence of Wind Drift
[3Application Outside of Approved Area
12. Crop Type(s): �1) . S©y !rQt.5* ! 1}
13. Soil Type(s): _ R_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes �R No ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes & No ❑ NA ❑ NE
❑ Yes [,g No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [] No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes [a 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 JE 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 23 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
ff NA ❑ NE
Page 2 of 3 21412011 Continued

FaciIi Number: �, _ a1 Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes g No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [5tNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [5;NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
JR No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
R[ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[g 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.
aYes
❑ 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 ReviewerAnspector fail to discuss review/inspection with an on -site representative? ❑ Yes Cg No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes &No ❑ NA ❑ NE
aI, Mer,� -W-e sarf sa�1lej in say -flevr (JUA- havp4w) 'be re19d aJ'kD"A
a q, CaN bAcn w a u',i f- doi e and, resAf ar-e Y7o-+ hoc� y of
ay, SIU sv�ty axonffia, -For aora aid a013.
iC oaf. cc� cal-er
mood- iNemds
t'
Reviewer/Inspector Name: �`t�,an Sehn �►�� _ Phone: q/Q-i133-2000� ]
Reviewer/Inspector Signature: Date: heca.Q w a
.11
Page 3 of 3 21412011

Facility No, Sa—ao Farm Name S",flOrf- NU(Je,' Date 040
Permit COC O1C� NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
4h
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?
at
Actual Flow
Soil Test Date N�_+�(P yI� �? �I�SAla
-
Soil Yield Transfer Sheets
pH Fields Wettable Acres �� RAI GAUGE
Lime Needed WUP �— ead bo or incinerator
Lime Applied Weekly Freeboard Mortality Records
Cu-1 ✓ Zn-1 +� 1 in Inspections Check Lists
Needs S (5-1<25) _ 120 min Insp. Storm Water
Npprk P l`] Waathar (_nrlac
_FM ■ _ I -
�mmr.�■rn�r��rr����r���n���
��
111 _
ITEMS-
,
dE�u{ryff/vff.�Wi11FIR
n
WNl�---
�
.
i 1 iI
1
Verify PHONE NUMBERS and affiliations G
Date last WUP FROgkkj0 -1td ails t)V FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 lb/ac; Zn-I 3000= 213 Iblac

�iype or visit: w t_:ompuance 1nspectnon U Uperanon xevtew U brructure Lvaiuntlon U E ecnmCal Assistance
Reason for Visit: Q Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: E9�ln County: Q�fttng2saN Region: F&G
Farm Name: MC) -- n N (Z ,
Owner Name: Zit 5
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: �iAM 4 L . Hr n LS Integrator: / IU R 12Lf 6R(jwA)
Certified Operator: �A(`^� S �. Hal- fSF Certification Number: "1 Q
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
�D sign Current ' ¢ Design Current Design Current
Swine C p city Pop. Wet Poultry Capactty Pop. Cattle 4 Capacity Pap.
rFeeder
Finish La er Dai Cow
Feeder Non -La er Dai Calf
Finishai Heifer
o WeanDes�gn Current D Cow
o Feeder Dr $oul 'Ca ace Po . Non -Da'
Farrow to Finish Layers Beef Stocker
Gilts Non -La ers Beef Feeder
Boars Pullets Beef Brood Cow
..-;.. Turkeys
Turkey Poults
Other Other
L-JO
Discharges and Stream Impacts
1" Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No 7� NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes ® No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: Sa - aLl jDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
W No
T��
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
4 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
[N 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
E0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[J� No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [$] No ❑ NA 0 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): w\ S `J
13. Soil Type(s): ptiUM X>
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [-]Yes ® 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
[N No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�j No
❑ NA
❑ NE
Re uired 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
W 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 g] No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P�rNo
Page 2 of 3 .�
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA V NE
21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:]Yes
Qj No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
O 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
[t No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
0No
❑ NA VIE
Other Issues
A ,
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
M 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
[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
[ No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L 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
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Reviewer/Inspector Name: - SS6 z Phone: [phone]
c
Reviewer/Inspector Signature: Date:A67I f
Page 3 of 3 21412011

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: /,j Arrival Time: 04•'c�4'" Departure Time: County: � 561)_ Region: FT
Farm Name: Y 5 i Owner Email:
Owner Name: I-0-mr-9 Phone:
Mailing Address:
Physical Address:
C
Facility Contact: J ai%" 5 Title:
C(
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: MUOLY-6.)hAc
Operator Certification Number: 16706
Back-up Certification Number:
Location of Farm: Latitude: = e = 4 = `+ Longitude: 0 ° Q 4 Q
Swine
Design
Capacity
Current Design C•urreat Design Current
...� attle Capacity Population
Population Wet Poultry Capacity PopulatiofrED311IDairy
❑ Wean to Finish
D11L]Non-Layer
❑ Layer
a' Cow
® Wean to Feeder
5D0
Calf
❑ Feeder to Finish
El Dairy Heifer
Dry Poultry ❑ D Cow
❑ Non -Dairy
❑ La ers
❑ Beef Stocker
❑ Non -Layers
❑ Pullets ❑ Beef Feeder
❑ Beef Brood Cowl
❑ Turke s
El Turkey Poults
❑ Other Dumber of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
® NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
® NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
fo No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
O No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: Date of Inspection 1 D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[TNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
P NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: O�
Spillway?:
Designed Freeboard (in):
u Observed Freeboard (in): 14
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[A 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
§a No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[P No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[9No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
PNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers. setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
IL . 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 > l0% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops
Iffer from those designated in the CAWMP?
❑ Yes
MNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
SNo
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
y No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ea No
❑ NA
❑ NE
Comments (re6er to .question ft Explain any YES answers and/or: any recommendations or anv�otite� eo[nments
Use drawin sf'p -- _ .
g ;of facility to better explain situations (use`additraiiaE pages as necessary)
Reviewer/Inspector Name — — - - Phone• `1/0'M- 33DD
Reviewer/Inspector Signature: Date: �� Q
12/2 /04 Continued

Facility Number: a Date of Inspection O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [WNo ❑ 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 P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 15a NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E3No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
5 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
q 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
1p No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
� No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
QKJNo
❑ NA
❑ NE
12128104

Division of Water Quality
===Faci1ity_NMUjM"rjj2 HE 0 Division of SoianC ! d Water onservation
Q Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referr4L 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Arrival Time:
Departure Time:
'00i
County: -S41-C&1 Region: PRO
Farm Name: SifCQnlorC
P% !y
09,0D Owner Email:
Owner Name: dam
�_Si4
L. !'i 1�s
Phone:
Mailing Address:
Physical Address:
Facility Contact: 5a'—S OL�Y5 I Title: Phone No:
Onsite Representative: tt Integrator:
Certified Operator: h Operator Certification Number: 6706
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = I = 44 Longitude: = ° = C Q f4
Design Curren#-.
DesignCurrent Design Current
Swine
Capacity Population Wet Qaultry .Ga ace 1? p lattan Cattle =,;' Ca aci Po ulation
p.� " p p
w k-
❑ La er
❑ DairyCow
❑ Non-Layer-1
El Dairy Calf
t�MANElDai
Heifer
❑D Cow
❑
El Layers`;�
❑ Beef Stocker
x ElNon-La ers
-
❑
ElPullets
❑ Beef Brood Cow
.' ❑ Turke s
' �.�-��
e
Othr
��
r ❑ TurkeyPouets
,
❑ Other
"El Other
er o fractures•
❑ Wean to Finish
Wean to Feeder
ADO
0
❑ Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
Discharlres &Stream Impacts_
FINE
1. Is any discharge observed from any part of the operation?
El Yes
O.No
❑ NA
❑ NE
Discharge originated at: ❑Structure ❑Application Field ❑Other
a. Was the conveyance man-made?
El Yes
❑ No
IO NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El 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
[�
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
$No

Facility Number: $'a —
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: I A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes '"gNo ❑ NA ❑ NE
❑ Yes ❑ No j] NA ❑ NE
Structure 5 Structure 6
❑ Yes �j No ❑ NA ❑ NE
❑ Yes "'No ElNA ElNE
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 KANo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [�)No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes F9'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
qNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind El Application Outside of Area
12.
ADrift
Crop type(s) Cov-n (kr r k So r,..rntr A SrK Grct;r, CevQi
13.
Soil type(s) �1; (�� � An
_
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
hNo
❑ 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
MNo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
KNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
No
❑ NA ❑ NE
lJ fp �1 t,-)
bXAr1-Wn:-n I ocok 9X
Reviewer/Inspector Name Phone: !D--1.33 3300
Reviewer/Inspector Signature: fqaJ4 Date: / i�0$
Page 2 of 3 12128104 Continued

Facility Number: ELA Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes j)�'No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
6No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ElWeather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
bko
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
IsNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
t&No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
R9 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
bdNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
LA No
❑ NA
❑ NE
Other Tissues
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
1,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
17�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
t§No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
[:]Yes
'$No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number O Division of Soil and Water Conservation
C1 Other Agency J
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: l /� .'f(,jV/" I Departure Time: ; County: SA'1f600
Farm Name: S-a Or1 `VLP� _ Owner Email:
Owner Name: _ J Q me S t i I s Phone:
Mailing Address:
Physical Address:
Facility Contact: I'fVxr—li !j i'rj t'S Title: Phone No:
Onsite Representative: integrator: [,LY p►1 N _
�I
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Sack -up Certification Number:
Region: FAO
Latitude: = e [::] ' ="
Longitude: = ° ='
=
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
Wean to Feeder a-00
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes O-No ❑ NA ❑ NE
❑ Yes
❑ No
P§NA
❑ NE
❑ Yes
[]No
Q NA
❑ NE
MNA
❑ NE
❑ Yes
❑ No
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
19 No
❑ NA
❑ NE
J
12128104 Continued

Facility Number: - 2 Date of Inspection ll
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �fNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No N NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
3 ,t
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
6No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
$No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
JANo ❑ 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
(5 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ANo El NA ❑ NE
maintenance/improvement?
I _
11. Is there evidence of incorrect 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 > I0% or ]0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wind Drift ❑ Application Outside of Area
❑I
``Window{
12. Crop type(s) C. - N Ggymh) t 5o
-E_videncerof
laws , 5uk^v%g r �'"t� t S�pM
grg,, Cave,,,
13. Soil type(s) va
1
14. Do the receiving crops differ from those designated in the CAWMP?
ElYes
Lit No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E? No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
X�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
14 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
N 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):
AL
I
T
Reviewer/Inspector Name Phone: �1 Q Lf33--33co
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: 039, Date of Inspection U p
Required 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 09 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes fj No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ANo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[$No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
6�No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[?•No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EgNo
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�INo
ElNA
ElNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[� No
ElNA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
[
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
rpNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ffNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit i Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
I.
Date of Visit: to /6 ZQ7 Arrival Time: 0 IM Departure Time: �,��� County: 5���N Region:
Farm Name: Or % N Owner
l !'!1IOwner Email: l !-
Owner Name: anus L+ ►t'�nes Phone: 6"0 533 —34La 7
Mailing Address: 670 A At • .wK-P.; /fir o9393
Physical Address: t -
Facility Contact: _ �Q S �' �Q �_ _ Title:
Onsite Representative: ldy4S
Certified Operator: J Q s
Back-up Operator:
�1f1 Phone No:
Integrator: In 1L�1rD h�
Operator Certification Number:
Back-up Certification Number:
Location of Farm: � o = ` =6 g = 0. � ` = "
Latitude: Longitude:
Design Current
Design Current
Design Current
Swine
Capacity Populations., . Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
Wean to Feeder
260 ❑ Non -Layer
❑Dai Calf
ElFeeder to Finish
❑Dai Heifer
❑ Farrow to Wean
Y`
° ` "`
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
❑ Pullets
El Beef Feeder
❑ Boars
❑ Beef Brood Co
Other .R
LiTurke s
❑ Turke Poults
.
tiw
❑ Other
El other
�
Dumber of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
W No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
N 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
[ANA
❑ NE
2. Is there evidence of a past discharge from any pan of the operation?
❑ Yes
91 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[g No
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

Facility Number: Date of Inspection 6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 0 No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes ❑ No F&I NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?: po
Designed Freeboard (in): 19
Observed Freeboard (in): ` 8 32`'
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �Q 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 N No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 50 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes Wo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes W No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes allo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes MNo ❑ 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 Elof
❑ Application,
OOutside
12. Crop type(s) corn ll�+'a�t . 5,ry,n �4 l�L^ O"u �[ , M � 14 i s�
fA�rea _
k&te&
13.
Soil type(s) Au —Akl!�j Vr r{
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
W No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
E�No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E� No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
C� No
❑ NA
❑ NE
I &
Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
Reviewer/Inspector Name I u Phone: 1
Reviewer/inspector Signature: Date:
Page 2 of 3 1212810d Continued

Facility Number: Date of Inspection /
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check
the appropriate box_
❑ WUP El Checklists ❑Design El Maps ❑Other
❑ Yes 5a No ❑ NA ❑ NE '
❑ Yes E�.No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes to No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
Qw/a
� sI�(>r�mpJ�� /ar, r>s
5 �
c "I e.W aytd
NWMP
1:Qi��/� s
r��� lie, NG
/►�r� �r�teS fJ `rv� proce55 01(
S
❑ Yes
[9 No
[:1 NA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
E ] No
❑ NA
❑ NE
❑ Yes
[A No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
®NA
❑ NE
❑ Yes [j9 No ❑ NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
[]Yes
PNo
❑NA
❑NE
❑ Yes
[5jNo
❑ NA
❑ NE
S/ua�e 1'eiha► �44
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: : 00 Departure Time: County: Srs ftI Region: 6a �
Farm Name: .5 Sfa AI c opy Owner Email:
Owner Name: _ Tat..,[Ss Phone: O- 3 -»i
Mailing Address: Lit? 70 Ale He-,e GAur-eA, /?4aJ 71, ,kv- &t_ Z ,acp3
Physical Address:
Facility Contact: T Title:
Onsite Representative: 7-- m0s H"
Certified Operator: T —
Back-up Operator:
Phone No:
Integrator: At.,,ok
Operator Certification Number: /d 70L
Back-up Certification Number:
Location of Farm: Latitude: F—] o = ' [::] Longitude: = o = , =
it
Design Current Design Current, k Desiga Current
PEI
neWept Pouapacityn to Finish ❑ La er ❑ Dai Cow
to Feeder S' oo ❑Nan -La et ❑ Dai Calfer to Finish ❑ Dairy Heifei
SY t
w to Wean L ° ❑ D Cow
w to FeederNon-Dairyw to Finish ❑ Beef Stocker
❑Beef Feeder
s ❑ Beef Brood Cowl
Number pf Structures:
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑-No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
OIo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: $, —?y Date of Inspection 3 0�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes B'IVo ❑ 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?: „a no
Designed Freeboard (in): ` _74
Observed Freeboard (in): 3j
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑"No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E?No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
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
BNO ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Eallo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside
of Area
'7 S : 3.4r'7 y cr t Ou /--> U
12. Crop type(s) -J. Gam, 1�14 S-,Lear s In, IIle- 4
13. Soil type(s) vA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[allo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[]-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
❑ No ❑ NA Ea" NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No ❑ NA [2'NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
--0'&o ❑ NA ❑ NE
titter egpi
r-
ReviewerlInspector Name /1'1�� �/{� w
Reviewer/Inspector Signature:
ft/
Phone:
Date:
9/a-
3 -.2 ey - d S

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes D-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �M4K ❑ NA ❑ NE
the appropirate box. ❑ W�❑ C>pk-hsts [I De5igrf ❑ ]Jars ❑ 0
21. Does record keeping nee improvement? If yes, check the appropriate�ox be,ow. El Yes 9 o ❑ NA ❑ NE
❑• n ❑ tlV sbetsrd—❑ ❑4&&AAwy&% Owaste Trwtsfers ❑ n
❑-fall— ❑­&� ❑p-� field ❑ ❑
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
[moo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
D-NE
❑ Yes
❑ No
❑ NA
63,KIS
❑ Yes
❑ No
❑ NA
PlgF
❑ Yes
B'Flo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
[+ <E
❑ Yes
Rfio
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
2-No
❑ NA
❑ NE
❑ Yes
2 nio
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
12128104

Type of Visit Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit 4P Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
��
Facility Number Iraie of Visit: rime:
Q Not rational Q Below Threshold
0*ermitted aCertified © Conditional�lly Certified [3 Registered Date Last Operated or Above Threshold: -
Farm Name: -5 �!Cl C MGW-..:51A? T�0%1...----. &KC--St•L County: FPO
Owner Name:
�R,��,�........�.....hl 2� 5.-----,,................ .... Phone No: W0...33 7 7)']
Mailing Address:....... 229......., &!±!.......... Hiso2e............
C�y![_�� cell
Facility Contact:
--•- ............ Title: Tale• Prone No:
Onsite Representative:......_ ........... .................. . Integrator:
Certified Operator:._...........; Tah7�..................a,e4................. ................ . Operator Certification Number:...... /L 7t7[9
Location of Farm:
19'"wine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude • ` Du
-Swine-.,
,Curmnt Dmga �=Cnrreat
"Po - uiataan Pouitr3' : • acc Po nla6an . .Cattle _
ean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Nu
aQnnnc "'
-: ❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
V-:❑ Other
_TotaLD Ca� aq '
Tota[SSLW
Disci & 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?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ......... I................ -7-
------ . ...............
Freeboard (inches): AI Z y, "
12112103
❑ Yes allo
❑ Yes [T'No
❑ Yes [3-No—
Yes Q'No
❑ Yes RNo
❑ Yes EIN-0
❑ Yes [3-No`
Structure 6
Continued

Facility Number: —)14 p Date of Inspection O+
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Apolication
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
I2. Crop type &rn - 1�v,.�Pen9 z /1ii��e�, S// 6fp n
❑ Yes moo'
❑ Yes O-Ko
❑ Yes B-Nob
❑ Yes aM
❑ Yes 9qb
❑ Yes B-trio
❑ Yes D No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes UNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Qfio
b) Does the facility need a wettable acre determination? ❑ Yes dNo
c) This facility is pended for a wettable acre determination? ❑ Yes dNo
15. Does the receiving crop need improvement? ❑ Yes ��
16. Is there a lack of adequate waste application equipment? ❑ Yes 3<0
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
IS. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes DA�O
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �To
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 ETI o
Air Quality representative immediately.
ICO-- (refer to quesiton #) F�phtm a� YES answers ant#!or any recommendations or any othsr,commeats.- _
Use draflf�aclto .b_tteer jM{ose � oiPaas oecesar9) ield Copy nal WNotes
ToI �I�fj a
e we#ej acres �ivs 6rtn rer�PrR'p�(
T
azHFRev"diewer/Inspector
erAmpector Name
-
Signature: .tiq Date: d
I21I2103 Continued

• Facility Number: 8a Date of Inspection $ 0
Required Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ielXWP fists, desio,mnps etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Wa ❑ Freabaw ❑ -Au*sta- ❑ Seff-s fiag
�>> 1, a '�7 A3
24, facility not inlcompliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Farm ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes 21�o
❑ Yes Swo
❑ Yes 9-Ko
❑ Yes ❑<
❑ Yes M-W
❑ Yes 2-5o
❑ Yes 8,90-
❑ Yes 21�o
❑ Yes 9-N6
❑ Yes gWo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Site Requires Immediate Attention:
Facility No. S% - W4 8
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: !�tek•} ft , 1995
Time: kZ` �-5
Farm Name/Owner: 51C«*%.1VY, kknA
Mailing Address: "l1 Ro 6twe-tk FIA _TZIASU tJc.-Xg-s4t
County: S a s e VJ _
Integrator: n't,.rQt. G�..._�-�,�_ Phone: q�e - Z84 - �.�► t
On Site Representative: Phone: 4Uy - 5; - Z
Physical Address/Location: lu, t ; L V h- .%L%.kg_ CW% (foe^ 5AI-1 tacz -_l
Type of Operation: Swine X Poultry Cattle
Design Capacity: Zceo o Number of Animals on Site: M& a o
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° ' " Longitude: ° ' "
Circle Yes or No
Does the Animal Waste Lagoon sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes r No Actual Freeboard: 3 Ft. Inches
Was any seepage observed from the n(s)? Yes or No Was any erosion ob ed? Yes or No
Is adequate land available for spray? es or No Is the cover crop adequate? Yes r No
Crop(s) being utilized: M%ALh
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin te or No
100 Feet from Wells? Yor o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o NN
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line: Yes or F
Is animal waste discharged into water ofe state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management recpr#s (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?or No
Additional Comments: C34. n - 0"'s %.,
aC_
W ck�r
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.