820291_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Quaff

L
Type of Visit: O Compliance Inspection O Operation Review O Structure Evaluation O Technics! Assistance I
Reason for Visit: Grfioutine O Complaint O Follow-up O Referral O Emergencv O Other O Denied Access
Date of Visit: Arrival Time: Departure Departure Time: ; a County: w•-- Region:
Farm Name: Owner Email:
Owner Name: n ; K Phone:
Mailing Address:
Physical Address:
Facility Contact: ri„[a,%���rtrti Title: W rt w.�� Phone: y� 1
Onsite Representative: a_ Integrator:
Certified Operator: EL prytr.Lj �, GI [; I,— Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 [310 ❑ NA ❑ NE
[:]Yes 0 No
[:]Yes [] No
❑ Yes [—]No
❑ Yes Lal4o
❑ Yes [/] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued
Design Current
Design
Current
Design Current
Swine
Capacity - Pad.
Wet Poultry
Capaclty
Pop.
Cattle Capacity Pop.
Wean to Finish
ILayer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
0-2-- (p
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , I:o_altry
Ca aci
P,o
Non -Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I jl3eefl3—dC--1
Turkeys
Uther
Turkey Poults
Other
- _
Other
:. 'sfz='.�.!�.i+i.'a-'i1• —
—
- 3ilYo9tlL5—"6' 4 _ —_
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 [310 ❑ NA ❑ NE
[:]Yes 0 No
[:]Yes [] No
❑ Yes [—]No
❑ Yes Lal4o
❑ Yes [/] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection: J
4 Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E]"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: o L,�_ 9 ro "i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ErNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes �o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 -No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [3'1Go ❑ 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 [lNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [To ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [] 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): u ; J r r r
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
En"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[arl�o
❑ NA
❑ NE
acres determination?
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
021510
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[E] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[f No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
�o
❑ NA ❑ NE
the appropriate box.
❑WUP []Checklists F] Design E] Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
021510
❑ 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
F 11e
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2 -No ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: - Date of inspection:
[3'1lo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
F,_ -No
❑ NA ❑ NE
t 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
F to
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
E No
❑ NA ❑ NE
27_ Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ENo
❑ NA ❑ NE
Other issues
2$. 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 �o ❑ NA FINE
❑ Yes [D"&o ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
❑ Yes 2 -Ko ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
[3'1lo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
Eal io
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Est' o
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Ike I- 7w*",
6 1 Jr �L�� Cu i it the. maws m.3 �1�. �o S "rr�r-p 'ra lrzw &►;
J
7 y
Reviewer/inspector Name:
Reviewer/Inspector Signator
Page 3 of 3
Phone:
Date: _ * /
21412015

' ` '"io' of Water Resources
Facility Number - Division of Soil and Water Conservation
type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: tt;- !� Arrival Time: ' J Departure Time: 1 A9.' -0v I County:L Region:
Farm Name: t L ; J G�`� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: G ,` ,,t ��}Oa�a, �, Title: �t'j„ Ut x y,i Phone:
Onsite Representative: � Integrator: A/, u
Certified Operator:, ,,,� s r Certification Number:�—
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
❑ Yes EN No ❑ NA ❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes
)gn Current
❑ NA
Design
Current
Design Current
SwineCapacaty Pop.
Wet Poultry
CapacityCattle
Capacity Pop.
.-:.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
I
IDairyCalf
Feeder to Finish
Dairy Heifer
+ Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D Poul
Ga aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I 113eef Brood Cow
,_- -
Turkeys
Other .§� ,;
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
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?
❑ Yes EN No ❑ NA ❑ NE
❑ Yes
❑ No
[] NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
Page I of 3 2/4%1015 Continued

' Facility Number: - S Date of Inspection:
1
(fl — — 17
�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
[DNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 91 r<�
Observed Freeboard (in): c 3� �-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
[DNA
❑ N E
(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
Eallo
❑ 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
JZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
M No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes kw�l 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): _fir '-'- C'
13. Soil Type(s): . v � *'-
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes LS No
❑ Yes D? No
❑ Yes ff] No
❑ Yes 0 No
[:]Yes ® No
❑ Yes [y No
❑ Yes No
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes a No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield [-1120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [] Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes R] No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑N
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA [] NE
Page 2 of 3 2/4/2015 Continued

�Facility Number: - Date of Inspection: 9—
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Callo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [A No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a FOA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes .0 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [3 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? C] Yes 0 No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below_
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E } No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
q No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
UVo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinss of facility to better explain situations fuse additional pages as necessarvl.
/ `" t/,�r � L C/ ' v ' �L�P f!`'' ii �! � j "� [7'� /�'°� �i J2� O d ✓`� Gt cr7'Q-�,
Reviewer/Inspector Name:d--�—
Reviewer/Inspector Signature:
khage.3of3
Phone: t) 3c�3 -015--;/
Date: J
2/412015

T ype or v tsit: k_.#-[:ompuance inspection V uperanon Hevtew V Ntructure e:vatuatton V t ecmmtcal ASSistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: D Departure Time: j3— Countys� Region:
Farm Name: --L.t v Owner Email:
Owner Name: 42rJ241, g 7r—i167' Phone:
Mailing Address:
Physical Address:
Facility Contact: Z_;4'L �,}�,f ',� Title:Own--l— Phone:
Onsite Representative: S'� Integrator:
Certified Operator: /ten- Certification Number: / 2�/L,
Bach -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
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 ENo ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes ❑No
❑ Yes [—]No
❑ Yes O—No
❑ Yes fig -No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 214/2015 Continued
Design Current
Design
Current
Design Current
Swine Gapaci.ty Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish ;�'
La er
Non -La er
Dai Cow
Dai Calf
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D . Poul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Gilts
Layers
Non -Layers
Beef Stocker
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Uther
Other
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
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 ENo ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes ❑No
❑ Yes [—]No
❑ Yes O—No
❑ Yes fig -No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 214/2015 Continued

Facili Number: - Date of inspection: —
Waste Collection & Treatment
�. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway'?: 4 _
Designed Freeboard (in):
Observed Freeboard (in): q5_
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5
CE3-No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes E.No ❑ 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?
❑ Yes
r No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
N No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
MNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E5No
❑ NA
❑ NE
maintenance or improvement?
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
r] Yes
Waste Application
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[&No
❑ NA
❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): _/ V 2-,--j!- `
13. Soil Type(s): �r tl✓l lAk.,61/- / wsa/�sv`
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
r No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
r_QLNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
_Cgl No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;2�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
r] Yes
VZ
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ONo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes J,No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ®-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EZ�No ❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes S 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 g No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes M No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[a No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Eq 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
VNo
❑ 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
0,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
KNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
K No
❑ NA
[:]NE
34. Does the facility require a follow-up visit by the same agency?
0 Yes
J&No
❑ NA
❑ NE
Com ments.(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 as necessary),
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: P_ (jj—.530C
Date: 2?_1/d_ ;11--i/il.
2/4/2015

iype of visit: si:ompuance inspection V uperation Keview V structure Evacuation V i ecnnicai assistance I
Reason for Visit: Gkoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L J Arrival Time: a p Departure Time:[--= County:y*-
Farm Name:DI _jdb Owner Email:
Owner Name: / v� /7D Phone:
Mailing Address:
Physical Address:
Facility Contact: � 0'- tfpd;L-e4 ^Title: _ �C�Itt, Phone:
Onsite Representative: if Al �
Certified Operator: 0" r f „=
Back-up Operator:
Location of Farm:
Latitude:
Integrator: OF
Certification Number: /
Certification Number:
Longitude:
Region:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure 0 Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes ®No [:3 NA [D NE
❑Yes No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes allo
[:]Yes ED -No
DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2014 Continued
DesignCurrent"
Design _
Current
Cent
Design urr
Swine
;Capacity Pap.
Wet Poultry
Eapacity
Pop.
Gallie Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dairy Calf
'AEeeder to Finish
7T7—
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D , i;oul
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
1. Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_ ...
Turkeys
Other
olts
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure 0 Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes ®No [:3 NA [D NE
❑Yes No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes allo
[:]Yes ED -No
DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2/4/2014 Continued

Facili Number: r - Date of Inspection: — !
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;3�.No ❑ NA ❑ NE
' a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ! `�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® 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?
❑ Yes
allo
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
17. Does the facility lack adequate acreage for land application?
❑ Yes
9. Does any part of the waste management system other than the waste structures require
[:]Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
Re uired Records & Documents
Waste Application
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
❑ NA
❑ NE
maintenance or improvement?
❑ NA
❑ NE
the appropriate box.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN F❑ 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): ) ,c ro-�+--� 1k
14. Do the receiving crops differ from thoseesignated in the CAWMP?
❑ Yes
allo
❑ 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
❑ Yes
Z No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ZNo
❑ NA
❑ NE
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ®,No
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes W_No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes � No
❑ NA ❑ NE
❑ Weather Cade
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/412011 Continued

Facility Number: j Date of Inspection-
24.
Qs ection-24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rn" No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [F�No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [—]Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non -compliance -
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes � No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Z 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 [0 No ❑ NA ❑ NE
❑ Yes r1_1_2 No [—]NA [:]NE
❑ Yes [INo ❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes
P, No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
allo
❑ 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 outer comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/]nspector Signature:
Page 3 of 3
f crr� 7 22a e-,
Phone:
Date: S-- f g —
2/4/2011

t
i
e or visit: t't-ompuance inspection U operation Review U structure tvaivation U Iecnntcal Assistance
Reason for Visit: {D -Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: -I/ / Arrival Time: ; p Departure Time: t7 County: 5�..v` Region: � (]
Farm Name: ���s �; �! x U Owner Email: "o"�
Owner Name: -� 1i pi z!S lyLMi `4 Phone:
Mailing Address: 7
Physical Address: II ,t `
Facility Contact: G; cZ dig: I7�d�� Title: Phone:
Onsite Representative: ,lr�
Certified Operator: Elam suH,l�; •.•�
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: �fU_ y'4 / 7 M4, -
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
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?
Page 1 of 3
❑ Yes gNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
__
Swine
Design °Current
�.�am
Capacity Pop
fi -r
Wet;Poultry
Design Come i-
�,
Capacity Popp
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
4,'
""
E` _
Dairy Heifer
Farrow to Wean
Design Current.
Dry Cow
Farrow to Feeder
a;D , �P,oisl
Ca acitvrPo
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Page 1 of 3
❑ Yes gNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes [&No
❑ Yes [&No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
2/4/2011 Continued

Facility Number: jDate of Inspection: _4L',2
-- 1-y
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
1� Waste Collection & Treatment
No
❑ NA ❑ NE
the appropriate box.
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
LNo
❑ 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
❑ Weather Code
Identifier:
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[] Yes
Spillway?:
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
Designed Freeboard (in): / 9
Page 2 of 3
2/4/2014 Continued
Observed Freeboard (in): y ki 1,3
5. Are there any immediate threats to the integrity of any of the structures observed?
[—]Yes
0 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [Z -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): 1A47
/ uJ �/i/�► G(��r �,,.��
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop andlor land application site need improvement? ❑ Yes CR No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Cj�_No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes O No ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes E[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
[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
[&No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RNo
❑ NA ❑ NE
Page 2 of 3
2/4/2014 Continued

IFacility Number: - f Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]YesNo ❑ 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 ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31 _ Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAVROP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes ® No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes pB No ❑ NA ❑ NE
❑ Yes � No
❑ Yes ®No
[:]Yes E _lo
❑ 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 pages as necessary)..
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
LIZ P_-1 Phone: 2&—,41Z -T-5300
Ir I
Date: //- /,,7- -"-�_
2/4/2014

61NS OTs 111113
Division of Water u � - J(�!'C j
Facility Number 19.), imialhf----I O Division"01-1
f Sand Water Conservation
•0 t]ther Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: g Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ' Q County: �aW PSA Region: Fiqn
Farm Name: p� [ j vft�DC�f _ Owner Email:
Owner Name: ,?o>4�—EsiYc�-ht }Qe� Phone:
Mailing Address:
Physical Address: (lar) CA(/"- d
Facility Contact: Lh dd MW r _ Title: MQA.4 4 _ . Phone:
Onsite Representative: (] _ f� integrator: �Vj;
Certified Operator: ?Dhn "adne( Certification Number: jq-&%
Back-up Operator: Ulu Sum!wlin Certification Number:
Location of Farm:
Latitude:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Design Current,-* Des1
Current .a
Design Current
❑ NE
Swine � �=�Cag ity`�'Pop ,
w
Wet Poultry
Ca pactty
Pop.
Cattle Capacity Pop.
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
Wean to Finish
La er
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
aig Cow
Wean to Feeder
2S Feeder to FinishFarrow
Non -La er
i ...
iC'"'4 � ""'
airy Calf
Dai Heifer
❑ No
❑ NA
to Wean
it ���
Demos! n
urreat
Dry Cow
❑ NE
Farrow to Feeder
D . P,oul
Ca aci
P,o
Non -Dairy
of the State other than from a discharge?
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_..
" ,...
Turkeys
Turkey Poults
Other I I
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/2011 Continued

Facility Number: - Date of ins ection: $
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes $a 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): 19 19
ObservedFreeboard (in): 149 q(
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E] 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
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
TUJ No
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
Waste Application
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
[:]Yes
❑ No
®NA
❑ NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind, E] Application Outside of Approved Area
,Drift
12. Crop Type(s): ri) � .. 4 i11/a.1Ct'Q
_
13. Soil Type(s): pu//)m.Y'j1k
_
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
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?❑
Yes
�C] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
M 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
❑ 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
n No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
❑ No
®NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 1104jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 15a No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes W No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes I'--' No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 0 NA ❑ NE
Other Issues
2$. 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?
24. 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 N No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
])—a No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes
ro No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
XNo
❑ 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 as necessary)...
�f gea,e, rnow bliks taro. doe r- poiso, aiRaw woadlfi o i M"de Cfl ha�i �-
o3-rS51S��f e-Xe�r
14 0) `�h�0�i, ap13, Plfaf� dD SV/ I In gory.
�COrt�! !r1 share, �l
was MaiiWek ri4-� a eakcdWQ1Wd1anei�_ 0 4013 ,
Reviewer/Inspector Name: Tnm Ihh•p fa-
Reviewer/Inspector Signature: � -, 4r (
Page 3 of 3
Phone: qj o-
Date: a
2/4/2011

• Facility No. Farm Name Date �� }
PermitL.,-/ COC '� OIC_ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
J
WV
WL
res uro s
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 ifs 0.45
Date out of compliance/ POA?
F2X(k'; TT�'9. C - A-0—"/ TiI�t
KM -
Actual Flow
Soil Test Date akLw ahlqk-�,
pH Fields
Lime Needed Na -_It 'f -b oli
Lime Applied
Cu -i' k/ Zn -I
Needs S (S-125)
Crop Yield
Wettable Acres
WUP
Weekly Freeboard
1 in Inspections
120 min Insp.
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
Soil .,
..
FW-aste .. - - r. r�r��r�cfcrIfm0rN60
r-:r�i�■� �■�
Day
60 Day
Njlb/100OGiE�=
'.?7C�lG'Xs;�i�7fiiG���■�■����■��
Soil .,
..
�OX�
Date last WUP at farm Lagoon #
j
CR3
App. Hardware Top Dike
6a
Stop Pump
Start Pump
g`R
ioo0
s
Conversion- Cu -I 3000= 108 Ib/ac; Zn -1 3000= 213 Iblac3t,'�
,ytt
tq'I
Verify PHONE NUMBERS and affiliations
Date last WUP FRO (divkn,, FR r Farm Records
ah1q),©�aY
3aXXkCb
�OX�
Date last WUP at farm Lagoon #
j
CR3
App. Hardware Top Dike
6a
Stop Pump
Start Pump
g`R
ioo0
�w4
Conversion- Cu -I 3000= 108 Ib/ac; Zn -1 3000= 213 Iblac3t,'�
,ytt
tq'I

Type of Visit: QfCompliance 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 0 Denied Access
Date of Visit: Arrival Timer Departure Time: County:�SQ�
Farm Name: Li y4i oc Owner Email:
Owner Name: 2oha alishy % ' adge i Phone:
Mailing Address:
Region: �P-90_
Physical Address: D 0 arisl ma r TffPe PA
Facility Contact: [,yl ,ggdq p1 Title: Co -c W-4- Phone:
Onsite Representative: 8 Q d4�1 Integrator:
Certified Operator: �6 h h A ndn p( Certification Number: 143 6
Back-up Operator: �fL� Jl}/?1�F1 �In Certification Number: 1791 _
Location of Farm: Latitude: Longitude:
S�1W.
Destgn # n Design .Current eg
m Current ar a
Design Current
wine
Cam ap ty4— OD.-
Wet,Poultry C�apae�ty Popp
Cattle Capacity Pop.
_
Wean to sh
La er
Dai Cow
Wean to Feeder
]Non -Layer
Da' Calf
Feeder to Finish
"'
Dai Heifer
Farrow to Wean
6' Design Current
D Cow
Farrow to Feeder
D . P,oult . @a aeity P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
1pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impact
I. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes 2 No ❑ NA ❑ NE
0 Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[] Yes ❑ No
[]Yes E4 No
❑ Yes to No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
Page I of 3 21412011 Continued

F11ciii Humber: - o-[ Date of Ins ection: J a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [;;�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �q
Observed Freeboard (in): yam_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [5a 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 DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
n 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
U No
[DNA
❑ NE
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance a]tematives that need
❑ Yes
Eallo
[DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
N 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): Coui)Dam yd a bio) P % i a, -. _,' nAll qav► , ✓rise
_
13. Soil Type(s): A7tvvillt Nor�Ik,�VLU10117
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[R 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
U No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
N No
❑ NA
❑ NE
the appropriate box.
❑ VV -UP ❑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 ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
�NA ❑NE
Page 2 of 3 2/4/2011 Continued

Facility Number: -
Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C' No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�JNo ❑ 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 fust survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, frceboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond 2 Other:
❑ Yes [SNo ❑ NA ❑ NE
❑ Yes ❑ No 21 NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
R Yes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ®No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ® No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [P, No ❑ 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).
a 5 . S1 t.c� e s L'�2r�x�►P-h'o, ~ 1rQu ►� &ori 1c a O t
7, Re0je. Cot" weds to �Pw) o� i-.,s,'otee n sfd� tQ`yoo� bans,
Aon
�f g�3 mare �a�, ��o mi���Ps
al. Bese .�not�-o irrl;9a�e. shad b° 's� ab �- s aila1 aCle..,
1 Y1�cl,n uM an o� n`� D h/C1�2r �! 1'i'� A�' �✓1 is 1 o v I qJ s o
ib �" ao�r -ao+a re(oldr ch��r�.
� �x c�dFd -fir
raI _I 4 �•� Q� rosy road b'. C
, A svbsv&e il UDPG{ TYE✓11 �lOtn �/a)`
Jaired-
I q1M w o r bpi H- 0, 1Th 1_
f R f� is bud' ca-� cam'' '� i� a�,d-�,`a:7 C) ,ie y op o f R -
yJ YOU do n6f ne4.'�b �flP� k b I~
n,a3 " 't-CaII b/a� C4War Gd drl rw 50'e- a il�s jmiot
WO r o,1' Of s cs WeW d fom r. p�fa ha,/ 1 , �d a�
c-'1 a CQ
6101 a --E' 1 lace,
�
Reviewer/InspectorName: o" &--%jh�eJer
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q10 `f 33 - • 3QQIA�-
Date: Dpe Do a o I
2/4/2011

Facility No. m Name clop, Lf � Lk Date I a 3D !
Permit 1 COC OIC NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
Lagoon Name, S forspillway 1 2 3 4 5 6 7
Design Freeboard I Last Recorded in
Observed freeboard j
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume ifs 0.45
Date out of compliance/ POA?
Pv�lP07A., Un#i I a r f'i
Design Diam._(ft)
Actual Diam.
Soil Test Date 7� Q ).�m / Crop Yield�^ Transfer Sheets
pH Fields Wettable Acres RAIN GAUGE
Lime Needed O+rUlrfe WUP ✓ Dead box or incinerator
Lime Applied Weekly Freeboard Mortality Records
Cu -I v Zn -l. ✓ 1 in Inspections Check Lists
Needs S (S-1<25) 120 min Insp. Storm Water
Needs P f) / Weather Cnrlec
.. ,.
j ... '.
11 1
Verify PHONE NUMB R$ and affiliations
Date last WUP FRO lG C FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start PUMD 1J
f, T -?7
Conversion- Cu -I 3000= 108 lb/ac; Zn -I 3000= 213 Ib/ac

M
Type of Visit:om ance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Arrival Time: ,1 Departure Time: County t� a�� Region:
Farm Name: ! r z4a, , t.;y/ 5 Owner Email:
Owner Name: in F— I L 1,2 pdL HlJffr Phone:
Mailing Address:
Physical Address:
Facility Contact:e•S Title:Phone:
Onsite Representative: �6v�� Integrator: �r
Certified Operator: ,rs Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 Ea No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[—]No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes allo
❑ Yes allo
[] NA [] NE
❑ NA ❑ NE
❑ NA [] NE
Page l of 3 2/4/2011 Continued

[Facility Number: Date of Inspection:
❑ Yes
[3 -No
❑ NA
❑ NE
Waste Collection & Treatment
❑ Yes
n No
❑ NA
ONE
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
0 NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
❑ NA
Identifier:
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z No
❑ NA
Spillway?:
Required Records & Documents
Designed Freeboard (in): 1 9 -
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EgNo
❑ NA
Observed Freeboard (in): —
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
r-1 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
6. Are there structures on-site which are not properly addressed and/or managed through a
❑ Yes
PA No
❑ NA
❑ NE
waste management or closure plan?
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield [:1120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
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?
0.1yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
rNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
21412011 Continued
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Ej No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Eallo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [Eg-No [DNA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence/of Wind Drift p Application Outside of Approved Area
12. Crop Type(s): I p{C,-13. Soil Type(s): O r F (,LJaL
14. Do the receiving crops diner from those designated in the CAWMP?V
❑ Yes
[3 -No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
n No
❑ NA
ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Z No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EgNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�j No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield [:1120 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
® No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

[Facility Number: -A09 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
• 25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes � No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 [4 No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
S: Yes ❑ No ❑ NA ❑ NE
[:]Yes No
❑ Yes ® No
❑ Yes 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 pages as necessary).
r NC-rcu Low yon
�/ a - Surw ;_5�u� 1�� �� 1,-9- -3
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/2011

Type of Visit compliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit (046utine Q Complaint Q Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit:I �11�Ia Arrival Time:1:9:057 Departure Time: County: Region:
Farm Name: 116 a 14 ��i ,,,k Owner Email:
Owner Name: Ohm.._ I1S tu0 fl�- D(scs Phone:
Mailing Address:
Physical Address:
Facility Contact: Dt�- 4Q�2e6 Title: f t_A_Jn if `� Phone No:
Onsite Representative: I ntegrator: %n u 1Q
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: =0
=,
= « Longitude: = o = t =u
Design Current
Swine Capacity Populatiiin
❑ an to Finish
Design C*urrent
Wet Ppultry Capacity Population
❑ Layer
Design Current
Cattle Capacity Population
❑Dai Cow
❑ NE
❑ an to Feeder
❑ Non -Layer
❑ NA
❑Dai Calf
eeder to Finish 3{0
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Yes
❑ Non -Dairy
Farrow to Finish
El Farrow
❑ ers
❑Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑Turke s
Other
❑ Other
❑ Turkey Poults
❑
Number of Structures:
Other
Discharees & Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
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 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 14 -No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
PjNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
Page ! of 3 12128/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 19 ! �-
Observed Freeboard (in): G f
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes P No ❑ NA ❑ NE
❑ Yes ER No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? UYes o ❑ NA ❑ NE
S. 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 10 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑-No ❑ NA ❑ NE
mai ntenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2 -No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12_ Crop type(s)��
13. Soil type(s)/r-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes MNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes a No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 4 No
❑ Yes S -No
El NA El NE
❑ 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):
• t"rsr�-.� �� � � ate- ��
•
Reviewer/Inspector Name Phone: WO—(3 —3�5O o
Reviewer/Inspector Signature: Date: // dg—ate/0
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes UNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E.No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes bio ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes KNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 64 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27_ Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
KNo
❑ 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
KNo
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
D& No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
DI 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
q No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
,®,bio
❑ NA ❑ NE
Page 3 of 3 12128/04

F
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: . &de_r Owner Email: of
Owner Name: _ /�sixIa Hi d a'..r Phone:
tl
Mailing Address:
Physical Address: �
Facility Contact: l �-a` rt Z:� n 1_4 r- -6 Title: n Phone No:
Onsite Representative:6—Integrator: //
Certified Operator: - Operator Certificati Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [--]' ❑ ' =] Longitude: =0=' = "
Design Current
Design Current
Design Current
Swinc Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish F❑
La er
❑ Dairy Cow
❑ Wean to Feeder I
-Laver
❑ No
❑ Dairy Calf
Feeder to Finish �(p /p'ZI /
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
D9,No
❑ Turke s
❑ NE
Other
❑ Other
❑ Turkey Poults
❑ Other I I
Number of Structures:
❑ NA
❑ NE
other than from a discharge?
Discharp_es & Stream Impacts
1 _ Is any discharge observed from any part of the operation?
❑ Yes
PINo
❑ 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 past discharge from any part of the operation?
❑ Yes
D9,No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
UNo
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

Facility Number: — Date of Inspection
( Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /9 /
Observed Freeboard (in): `%D
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes 0 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? RLYes ❑ 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
[Z No
❑ NA ❑ NE
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
IgNo
❑ NA ❑ NE
maintenance/improvement'?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ EvidenceofWind Drift ❑ Application Outside of
Area
12. Crop rype(s)
a
13_ Soil type(s) t�— � r� Z A"tJ a101
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ NNo
❑ 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
[9 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA ❑ NE
IS. Is there a lack of properly operating waste application equipment?
❑ Yes
V -No
❑ NA ❑ NE
C- ~moi + — 2,-L-cOs "Jn o 1— /7to 0 •%­
f elm,, -C �/%�hrn f 7rr"rSl d'r� (� C �[ls'y� C/1d l%- O"l LJ�*�l
IReviewer/inspector Name-- Phone:
Reviewer/Inspector Signature: L 7/a-� Date:

Facility Number: Date of Inspection
' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [&No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5ENo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists
❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes YNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E,No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes R No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
UNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
R1 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[3a No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29_
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
E] Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
12/28/04

ti
Type of Visit ]rT,)-�ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 4901foutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 60-3-iwf Arrival Time:►� C7 , �D.eparture Time: County: Region: J�
Farm Name: t �► ve.S221, Owner Email:
Owner Name: �P'16- _Madgai _ _ _ Phone:
61
Mailing Address:
Physical Address: / /�
Facility Contact: h,� /1; nTitle:
Onsite Representative: Sd*-•��
Certified Operator:
Back-up Operator:
Phone No:
Integrator
Operator Certification Number -
Back -up Certification Number:
Location of Farm: Latitude: [� e [� C [� l{ Longitude: E:J o =1
Current
N Design Current
ry
Swipe qt Population
out
Wet Poultry Ca acs Po ulation
111�10@Design�Gu�rrent
Ca#Ue Capacity Population
❑Wean to Finish
❑ La er
❑ Dairy Cow
❑ No
❑ Wean to Feeder
on -Layer
❑ Dairy Calf
❑ Yes
IR Feeder to Finish OEl
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Yes
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
2. Is there evidence of a past discharge from any part of the operation?
❑ Gilts
❑ Non -La ers
El Beef Feeder
❑ NE
❑ Boars
❑Pullets
❑ Beef Brood Cow
❑ NA
-,, w
e
❑ Turke s
❑ Turkey Poults
«.
❑ Other FE
El Other
Num tser of Structures:ELI
12/28/04
Continued
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
CRNo
❑ 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
PZNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
RNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: — Date of Inspection /
1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural Freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
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 J9 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ® No ❑ NA ❑ NE
El Yes DoNo El NA El NE
If any of questions 4fi 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 RINo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 54 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 C4 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 5d No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ., ZeMMJA / 9vf-e2s��•
13. Soil type(s) / t&t` 71-yp,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P4.No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;.No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
5LNo
❑ NA
EINE
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
R[No
❑ NA
❑ NE
Co ent�s�(refer to question #J" Ezplaxn any YES answers and/or any recomm ndatians or any other com11:ments ,
-.ye p"''"yh. *.'A` _ ��i C
"Use drawings vttacihty,.to betterrexplain situations. (use additional pages asnecessary) ,
Reviewer/Inspector Name Phone:jp�y33 33�a
Reviewer/Inspector Signature: Date:
Page 2 of 3 '- 'V 12/28/04 Continued

` Facility Number: — Date of Inspection L.L
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes QNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Desi
gn El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ( No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ®,No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[R No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[.No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CQNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
QkNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[R No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Z No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
allo
❑ 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
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
CJ No
❑ NA
❑ NE
Page 3 of 3 12128104

ivisiou of Water Quality Sze -,-
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 'lam v n Arrival Time: '3 0 1
/Departure Time- 177, County:
Farm Name: 5 L iV��SctT _ Owner Email:
Owner Name: _( �'L- ' r.„ Phone:
Mailing Address:
Region:/` 2r
�/
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: /
Certified Operator: _ � - Operator Certification Number: ,Z9'34Z t0
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: = o
Back-up Certification Number:
❑ Longitude: = ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La ei
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkev Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl I
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes. notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 9No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
[j Yes
0 N
❑ Yes Zl No ❑ NA ❑ NE
❑ Yes DkNo ❑ NA ❑ NE
12128/04 Continued

Facility Number: Date of Inspection
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
KNo
❑ NA ❑ NE
Waste Collection & Treatment
Re-viewer/Inspector Name �— Phone: y 63{ZQ
Reviewer/inspector Signature: Date: --
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N -No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
RNo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
Spillway?:
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
,PS�No
Designed Freeboard (in):
IT
Does the facility lack adequate acreage for land application? ❑ Yes
.qNo
❑ NA ❑ NE
Observed Freeboard (in):
Is there a lack of properly operating waste application equipment'? ❑ Yes
J No
❑ NA ❑ NE
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ YesNo
VK
ElNA
❑ 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
R No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
J@ 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?
J�R
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
KNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
Re-viewer/Inspector Name �— Phone: y 63{ZQ
Reviewer/inspector Signature: Date: --
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s)
13.
Soil type(s)---
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
RNo
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
®-No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
,PS�No
❑ NA ❑ NE
IT
Does the facility lack adequate acreage for land application? ❑ Yes
.qNo
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment'? ❑ Yes
J 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):
0 1pabo 4e Z�--4 V-1'e'M9C' _5M.Ij
Re-viewer/Inspector Name �— Phone: y 63{ZQ
Reviewer/inspector Signature: Date: --
12/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes j4No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [& No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
R No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
®No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;K No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PQNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
yMNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,&No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
a® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EgNo
❑ 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
R 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
ELNo
❑ 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
LgNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

ivision of Water Quality
Facility Nllmbelr.Q Division of Soil and Water Conservation'
.:..,
- OOther. :Agency
Type of Visit 06ompliance
Inspection
O Operation Review Q Structure Evaluation
O Technical Assistance
Reason for Visit
0 Routine O Complaint
O Follow up O Referral Q Emergency
Q Other ❑ Denied Access
Date of Visit: Arrival Time: .�(� Q Departure Time: r County: Region:
Farm Name: ST Owner Email:
AK
Owner Name: T2�... 1,144,44 r—j Phone:
AV
Mailing Address:
Physical Address:
Facility Contact:Title:
Onsite Representative: S _
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:_�4�$
Operator Certification Number:
Back-up Certification Number:
�0 0 0„ e D0
=1
Latitude: Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
I1 10Non-Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes. notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
54No
❑ NA
❑ NE
❑ Yes
5&No
❑ NA
❑ NE
11/18/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes DrNo ❑ NA ❑ NE
a. If yes, is waste level into the structural Freeboard? ❑ Yes Q1 No ❑ NA EINE
Structure I . Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): L1 9'
Observed Freeboard (in):
5. Are Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No ❑ NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes [KNo ❑ 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 [V1 No ❑ NA El 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 L4No [INA ❑NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes (a No ❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application'? If yes, check the appropriate box below. M Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
0 PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ Application Outside of Area
12. Crop type(s) `P7 yr w. ..�.. s !lr" syez -
iY l Le,;
13. Soil type(s) ki&r—V L" � /� �n r fo ZA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9 No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
RNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
51No
❑ NA
❑ NE
Comments (refer to question#}: Explain any YES answers'and/orany recommendations of any other comments.
Use drawings of facility to better explain situations. (nse additional pages as necessary):
apra p L: cc s a •1- ����., o- !� ��" s s T4, &D
Reviewer/Inspector Name I ? ,� Phone:
Reviewer/Inspector Signature: Date:.r—r�O�o
12/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings: V
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
E.No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
CK No
❑ NA
❑ NE
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes
LKNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
f, No
❑ NA
❑ NE
12/28/04

Type of Visit 49 Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit O Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
I:acilityNumber�crf [tate of Visit: � Time: �Qiab
! =Not Operational Below Threshold
Permitted Certified Q Conditionally Certified ©Registered Date Last Operated or Above Threshold:
Farm Name: HQ61ge.SLI te,,�]�ecl! _ County: SGr.+1X
Owner Name: O -A., Had"frS Phone No: 9/,O` g f.2
Mailing Address: _' SD tj ,IaPS &ggy 4(
Facility Contact: _ T0407 H "AP 5 Title: Phone No:
Onsite Representative: To hn HBA e Integrator: 1i11 vf�� 8J^dW!3
Certified Operator: IQA4 Haat/ S Operator Certification Number: /42.942�f
Location of Farm:
2/S'Wine ❑ Poultry ❑ Cattle ❑Horse Latitude 0' 0 0" Longitude 0 0"
Design Current
Swine rvingeity Pnnzah%tinn
❑ Wean to Feeder
eederto Finish P7 _2
❑ Farrow to Wean
[] Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current -:Design Current
1.
PoultrN Ca achy. Population Cattle ;CRpacity Population
❑ La er ❑ Dairy
�] Non -Laver ❑ Non -Dairy
❑ Other
Total Design Capacity 41
TotaI:SSLW :• -
dumber of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ID No Liquid Waste Management System
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ La2oon ❑ Spray Field ❑ Other
a. If discharee 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 eal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DN Q)
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 CQUection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 1.2
.2
rr
Freeboard (inchcs): �5
05/03/01
Structure 5
❑ Yes L3Y140
El Yes QNo
❑ Yes B<o
❑ Yes
13-5o
❑ Yes
D-9-0
Cl Yes
0 _ o
❑ Yes
E3 o
Structure 6
Continued

Facility Number:
Date of Inspection
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 maintenancehimprovement?
❑ Yes [31go
❑ Yes ❑Vo
❑ Yes [moo
❑ Yes ❑<
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes EgKb
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [g -No -
11. is there evidence of over application? If yes, check the appropriate box below. ❑ Yes UINO
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
I2. Crop type Bermuda. SA it �,w.n, Win -6 A-nukk . 6W tl
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑-N-o—
14, a) Does the facility lack adequate acreage for land application? ❑ Yes RIG
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. is there a lack of adequate waste application equipment? ❑ Yes [],No
Odor Issues
IT Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes E11<0
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [54�o
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 344
Air Quality representative immediately.
Comments (refer to gnesttoni #)Fxplaui any YES answers and/or any reeommeaons or any other comm -
_Use drawings:of ia�cihtyto better explam sEtuattoas. (use additional pages as necessary) �,lr eld Capy ❑ Final Notes i
-1
A�
I7Ddyes S A1Dr1.�0/,.+c� c1 y7cL 5P/'ar,n? �dr ct/Pe�%S �+S n�pdPe�r
TAGee- A fP[i WOCdy Saf,/i•'g5 1,r 0117 la�oc:Y Qx,7n &a� e"(
T
Reviewer/Inspector Name a
ReviewerAnspector Signature: A &MAL Date: - p
12/12/03 r Continued

Facility Number: q.2 —. 7 Date of .Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑lq'o
22. Does the f cility fail to' have all components of the Certified Animal Waste Management Plan readily available?
fV)+AG61'2
44P V(f 1'/47 - /V Ai if 4-A ff 011117 O C n 4
(ie/ tsts, dear , etc.)
❑ Yes
E}iq_O'
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[N6
❑ plicationF �3'❑ [Ifi g
24. Is facility design?
El Yes
[.] bier
not to compliance with any applicable setback criterfa in effect at un
the time of
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Q -No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
(ie4.iaeitT7g—e,
❑
011-6�'
27_ Did Reviewer/Inspector fail to discuss review/inspection with on-site representative?
❑ Yes
EgNcr-
28. Does facility require a follow-up visit by sante agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
PMo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
fires
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O -Ko
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ W
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
0 No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑-Yes
❑ No
❑ Skmki vg m m ❑ Crop Yield Form ❑ Rairdffi1 ❑ ec
❑ ❑
Q No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddrUoiial Comments and/or Drawrrtts -'
x_ .1."��„_: _
EQ
J � �� lac/t��`vn2�j/u�p�+r.-r kcrs %ica rte, P � � f v/Y
fV)+AG61'2
44P V(f 1'/47 - /V Ai if 4-A ff 011117 O C n 4
Rev,cwtd �rGl° K, Id F I'^I , Re,,,`cwr/
4v Aft, No ages
12112103