820311_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

I
Type of Visit: C�Com liance Inspection
Reason for Visit: iD Routine 0 Compi
Date of Visit: Arrival Time: Departure Time: $ p County: SAPIy
Farm Name. (A,!✓. Owner Email:
Owner Name: f- W r / Phone:
Mailing Address:
Region:'i��
Physical Address: ii
Facility Contact: �� LeJ N., ,✓i Title: Phone:
Onsite Representative: /` Integrator: -r't as `t
Certified Operator: I/ Certification Number: --If P `717
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
' a
si`
Design Current
�i
Design
Current
Current
Design1rine
'
Capacity Pop.
Wet Poul#ry
Capacity
Pop.
„,,
Cattle Capacit
Wean to Finish
Ellla er
Dai Cow
Wean to Feeder`=`b
Non -La er
I
Dairy Calf
Feeder to Finish
"'
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Di , Poul
Ca` ci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boarso
Pullets
Beef Brood Cow
Alin„
li
Turkeys
�3
Other
Turke Poults
..-'
Other Other
Discha es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes No ❑ NA ❑ NE
[:]Yes ❑ No [ A ❑ NE
❑ Yes [] No C3'N_A ❑ NE
[:]Yes ❑No
[:]Yes �o
❑ Yes [-No
[TNA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: R I - 311 jDate of Inspection:
t771
dNo
❑ NA
❑ NE
WA5te Collection & Treatment
❑ Yes
Ea No
❑ NA
❑ NE
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Eg�❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[E[" SIA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
[]J' o
Identifier:
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L d No
Spillway?:
❑ NE
❑ Yes E No
❑ NA
❑ NE
Designed Freeboard (in):
❑ Yes No
❑ NA
0 NE
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[n"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
[�]`I�to
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3-1go
❑ 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
[3 -No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[l'�'o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E3"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): �Jv�_w,� S G 'i"
13. Soil Type(s): k("_�Ul `fj
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ea No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�o
❑ NA
❑ NE
acres determination?
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Other:
17. Does the facility lack adequate acreage for land application?
❑ Yes
[]J' o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L d No
0 NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ❑
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes EYNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? I f yes, check the appropriate box below.
es o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis (a S i I Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections
❑ Sludge Survey
22_ Did the facility fail to install and maintain a rain gauge?
❑ Yes E No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
0 NE
Page 2 of 3 214/2015 Continued

Facili Number: - � ( Date of Inspection: ou 7
24. -Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ff No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C],Ko ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA far 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 EDKo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 -Ko- ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Ej>o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [3-714-o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes �o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
D-11;to-
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q -<o
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[3'1�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[-]Yes
F
❑ NA
❑ NE
- k - 5 --1-7
kc&)& 0t f
Reviewer/inspector Name: Q'm ,,
Reviewer/Inspector Signature:
Page 3 of 3
S -r 1I-_15
I
Phonei10_1 _'TB
Date: RNDU
2/4/2015

Type of Visit: PI Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: QfRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:Arrival Time: IUB Departure Time: County: Region:
Farm Name: L 0y�_ qjtj 1#yvrqy Owner Email:
Owner Name: Z �4e � f �� Phone:
Mailing Address:
Physical Address:
Facility Contact: ✓ Title:
Onsite Representative: r
Certified Operator:
Phone:
Integrator: M L�E S
Certification Number: W %t
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 10 ❑ NA ❑ NE
[:]Yes ❑No
❑ Yes ❑ No
[] Yes ❑ No
❑ Yes [;�No
❑ Yes La'No
[B<A ❑ NE
�A ❑ NE
E3'N A ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/2075 Continued

,11� IL
[Facility Number: YL - I Date of Inspection: Ilk
Waste Collection & Treatment
4.'ls storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes b 10 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [4 -?1r ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E to ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes ❑r'!No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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
[R Foo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
❑ NA ❑ NE
9. Does any part of the waste management system other than the waste structures
require ❑ Yes
[:PKo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E31�_o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
dNo
❑ 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): G U
13. Soil Type(s): o
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E✓ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E;?<o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes [/'No ❑ NA ❑ NE
❑ Yes -
[No
❑ NA _❑
�
❑ Yes
�' No
❑ NA ❑ NE\
] Yes
[ o
❑ NA ❑ NE
1
❑ Yes
[ 'I' o
❑ NA ❑ NE
❑ 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 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Fj"No ❑ 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
io
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L;I-Ko
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2rNo
❑ NA ❑ NE
❑ NA ❑ NE
E] NA ❑NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E2 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
❑'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
E 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
ETNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ea -No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
[]:r No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0 No
❑ NA
❑ NE
en ateoas ovr.,an other com_memv$s
rquestionent.'(refer, to ..f "^
f
Usedawu�s ofacitty to better explain ttuahons(u�sdnal�a�esasnecessarve ditio
f
Cal'11 'tr'V[' -a, - F, -'�S -14
S 1v d�4 Su vv Le7 -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3of3
C -A
glulw � %�
°ne:%3 33
Date: 1b ►ACL
21412015

Rim f�i MeU I's qL
Type of Visit: C
o
mpliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: C1 Routine 0 Complaint Q Follow-up 0 Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:'( Region:A�yL
Farm Name: U'1 Owner Email:
Owner Name: ,¢ 021&W-41 Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
/1 Location of Farm:
ct
Title: Phone:
V� 6 vzj/7
Certification Number: 0
Latitude:
Integrator:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge original d at: ❑ Structure El Application Field ❑ Other:
a. Was the onveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 2<o DNA ❑ NE
❑ Yes [:]No [BINA ❑ NE
❑ Yes ❑ No ['NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No 2rNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [3"No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [2 No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
214/2014 Continued
Swine
Wean to Finish
Design C*urrent
Capacity Pop.
Wet Pouttry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
103co f, 1W
iNon-Layer
Dry P,ouItr,
I
Design
Ca aci
Current
P.o
Dairy Calf
Dai Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La crs
113cef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge original d at: ❑ Structure El Application Field ❑ Other:
a. Was the onveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 2<o DNA ❑ NE
❑ Yes [:]No [BINA ❑ NE
❑ Yes ❑ No ['NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No 2rNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [3"No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [2 No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
214/2014 Continued

I"acili ■ mber: - Date of Inspection: 67
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [9-blo-0 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No ETWA-1❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �o ❑ NA ❑ NE
(i.e_, large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes t3"'No D 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 imprdvement?
❑ Yes
ff No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:)Yes
[ErNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q'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 1 " Rainfall Inspections ❑ Sludge Survey
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ YesNo
LJ 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 ZNo ❑ 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): au,"SV 0
13. Soil Type(s): - -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2rko ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes U 1Yo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [2<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
DIN o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[2rNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
Q 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 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
LJ 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 1/412014 Continued

Faclli Nranber: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes [3io ❑ 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 ZKo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes io ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [2r<o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 [2"N' o ❑ NA ❑ NE
❑ Yes [2(No [] NA ❑ NE
❑ Yes [2rNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [:]Yes [2rNo ❑ 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 [Xo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES:answers and/or any additional recommendations,dr any.other coinments. }^ .-
Use drawings of facility to better explain situations (use additional pages as necessary). ,
S 1 QUI g e4y
Reviewer/Inspector Name: J1 L`
Reviewer/Inspector Signature:
Page 3 of 3
Phone: i
Date:
'-a S E�0.�_
21412014

6 f R 9 w-7
Type of Visit: O Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Q1foutine O Complaint�Follow-up O Referral O Emergency Other O Denied Access
Date of Visit: rival Time: g 7 i" Departure Time: County W12 Regio4t
(IV Farm Name: lUt4 T� IFUJ .�irJ Owner Email: --�—
Owner Name: VFL_� bC
Mailing Address:
Physical Address:
.A
b .^
Phone:
Facility Contact: 1" fipt_ WY 10^ ' Title: Phone:
Onsite Representative: Integrator: M E
Certified Operator: f Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
UjjjjMKj_jesx2n3&u-urrent
Swine Cac
❑ No
Design
Current
Design Current
Ca acit
y Pop.
[:]No
E44A
❑ NE
❑ Yes
._.
❑ NA
❑ NE
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish - -
Dairy Heifer
farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D.P_oul
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef 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 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 M40, ❑ NA ❑ NE
[:]Yes
❑ No
03 A
❑ NE
❑ Yes
[:]No
E44A
❑ NE
❑ Yes
❑ No
[!j"'NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
02<o
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Condnued

Facility Number:- Date of Insp ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes FyNo ❑ 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 a No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a [:]Yes [� No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E�X' ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [*<o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
Required Records & Documents
No
9. Does any pan of the waste management system other than the waste structures require
❑ Yes 6 No
❑ NA
❑ NE
maintenance or improvement?
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Eeo'
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 0Ko-
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ NA
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [❑ Application Outside of Approved Area
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
12. Crop Type(s):
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
[]Sludge Survey
13. Soil Type(s):
[:]Yes
[J'I<lo
❑ NA
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
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ��No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes [ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
D Yes [�o
❑ NA,
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[f]
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
10
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists E] Design [:]maps ❑Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
[]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
[J'I<lo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
<o
❑ NA
❑ NE
Page 2 of 3 2/412011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes AVO ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �rN'o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ 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:
❑ Yes ILK ❑ NA ❑ NE
❑ Yes E&<o ❑ NA ❑ NE
❑ Yes M401,
❑ NA ❑ NE
❑ Yes to ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes I'J' O ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑ Yes ❑ NA ❑ NE
��No
�
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ 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).
s� �a
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Ph0 jo- ` S_3S
Date: h� K4
2/412011

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: S -o 9- o Arrival Time: Departure Time: County: " Region: f"�O
Farm Name: Z0 ,4 S�� t �YYS Owner Email: 1
Owner Name: FG �ijo N Phone: ?10)
Mailing Address:
Physical Address:
Facility Contact:
'Title:
Onsite Representative: CL'� (-s ?>4 VW rz— L
r
Certified Operator: 8a Vj `` k_
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: C o L" ",
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 =
0= [� u Longitude: =0=1
="
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish 1 Fl
Laver
® Wean to Feeder OQ Non -La er
❑ Feeder -Finish I / Il
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑
Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Popuinrion .
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes MNo []NA ❑ NE
❑ Yes
% No
❑ NA
❑ NE
❑ Yes
EgNo
❑ NA
EINE
❑ NA
❑ NE
❑ Yes
N No
❑ Yes
®'No
❑ NA
❑ NE
El Yes
[ANo
[:1 NA
El NE
12/28/04 Continued

i
Facility Number: $ Z-311 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): / 5
Observed Freeboard (in): 2On ("ve'j 6 cro"L.-�
❑Yes [9No El NA El NE
❑ Yes ® No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes NNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed ❑ Yes fgNo ❑ 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
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)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
9 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
di No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Croptype(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P1 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
❑ Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA ❑ NE
1$. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA ❑ NE
Reviewer/Inspector Name . 4 »' Phone: /D A, — S
Reviewer/Inspector Signature: Date: S— O9 — Zvo
12/28104 Continued

Facility Number: $Z -31 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IN No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes MNo ❑ NA ❑ NE
the appropirate box.
❑ W1JP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Z 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?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LN No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:1 Yes
❑ No
[0 NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
a] NA
EINE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
(A NA
❑ NE
Other Issues
❑ Yes
O No
❑ NA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ,® No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
J@ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
O No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
EY No
❑ NA
❑ NE
Additional Conmenfs andla''Dx swings a :
s s p( .
y 'iFP.'�> 3 �V F r'.iY'�1" AX'S..
12/28/04

{31y4s
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01 routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: L. K AOwner Email:
Owner Name: �Qo 6� e Phone:
Mailing Address:
Physical Address:
Facility Contact: NO fAo,"' Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: �& 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
❑No
Design
Current
Design Caere at
Swine Capacity Pop.
Wet Poultry
Capaci#y
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. Poul
Ca aci
P,o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feedcr
Boars
Pullets
I 1Beef Brood Cow
Turkeys
Other _OEM 1=1Turkey
Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Page 1 of 3
❑ Yes [3-N`6`__0 NA ❑ NE
[:]Yes ❑No L7 N_A U NE
[:]Yes ❑No [3-N?�­ ❑ NE
[:]Yes
❑No
[3'<A
❑ NE
❑ Yes
[�] No
❑ NA
❑ NE
❑ Yes
P NO
❑ NA
❑ NE
2/4/2014 Continued

n ch
Facili Number: J= I Date of inspection:
Waste Collection & Treatment
�E]
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?❑
Yes
Elt NA
NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No �1A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3_N16"'0 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
[ ;K0 ❑ 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
To ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
LL:' o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[-]Yes
U"'" ❑ 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
To ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift[:]Application
Outside of Approved Area
12. Crop Type(s): s-6 e-7 CL) 13
13. Soil Type(s): �Q ilk
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D ITo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[r No ❑ NA
❑ NE
lb. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[31�o ❑ NA
❑ NE
acres determination?
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
[21 o ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[rdo ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
D-go ❑ 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 IBJ 0
❑ 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 ["Flo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes [Er�o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 2/4/2014 Condnued

Facility Number: jDate of Inspection: 17, APO
f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [ET"go ❑ 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 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern? [:]Yes 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
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 2<0 ❑ NA ❑ NE
❑ Yes]�No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ETNN ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative? ❑Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [—]Yes U '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).
car
e N t-6—Iq
L 0"
1 &A--Lj
V
Reviewer/Inspector Name: �* Phone: 3 3
Reviewer/Inspector Signature: Date: I h
Page 3 of 3 2/4/2014

S.T IS 2-05--2-0I0
Type of Visit eCompliance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit WIRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -2Z O Arrival Time/: Z:00 Departure Time: 2:3aCounty: S d Region:
e °"�i 5'
Farm Name: T' /'� Q`y�o �/� �" - 0t #. O ner Email:
Owner Name: �D�'"may l Phone:
Mailing Address:
Physical Address:
Facility Contact: _L/� v -k c 1 n
(_ S 16aV-Lr11'kc-K- Title: � t . Phone No:
,
Onsite Representative: Integrator: /rI ��Aj
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e a g = H Longitude: = o = I 0
Design Current
DesiXM
turrenitry
1. Is any discharge observed from any part of the operation?
Capan
Cattle Capacity Population
❑ an to Finish
❑ La erI
❑ Dairy Cow
Wean to Feeder I d3700 I
er
I I j
❑ Dairy Calf
Feeder to Finish
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ La ers
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑Non -La
❑ Beef Feeder
❑ Boars
Elers
Pullets
ElBeef Brood Co
o NA
❑Turke s
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Other
ElTurkey Poults
❑ NE
❑ Other
❑ Other
Number of Structures: l
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
M 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 C 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 A
s
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
o ❑ NA
❑ NE
other than from a discharge?
12/28/04 Continued

Facility Numher: PjZ— 3 j
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. I f yes, is waste level into the structural freeboard?
Structure I Structure 2
Identifier-
Spillway?:
dentifier:SpiIIway?:
Designed Freeboard (in):
Observed Freeboard (in): *Z
-
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes B No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ONo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes O No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LI 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 El Yes No El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes If KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ff 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) Risk u d 'a ..� oy� Si.• t� Gi ra, i� �p , s.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,f, 'No El NA El NE
15. Does the receiving crop and/or land application site need improvement? El Yes 2< ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yeso NA El
18. Is there a lack of properly operating waste application equipment? El Yes:_o ❑ NA ❑ NE
Comments refer to question # • Ex lain 6V. YE S answer' and/or any recommendatia s or. any other-fito�inents F
Use drawings of facility to better explain situations. (use additional pages"as;necessary)
Reviewer/Inspector Name R1 4C Ree V -c s Phone: �f/Q � �33. 33aa
Reviewer/Inspector Signature: Date: / —ZL — 1
12/28/04 G'ontinued

Addrhonal Comiinents�a"ndlar Drawn
12118/04
Facility Number: 2-3j/ Date of Inspection 11—ZZ — /O
Required Records & Documents
I9. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ YesNo
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 El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis, ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i"
Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes;N�❑
NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
I!7No,, ❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No ❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,,.,�
N E3 NA
[:]NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El 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
OeNo ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
<No
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
9 ❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Addrhonal Comiinents�a"ndlar Drawn
12118/04
12118/04

;IL
type of visit: Q3 Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: I&Routine O Complaint Q Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: r7 11,71 [j:j Arrival Time: 075 Departure Time: County: 50
Farm Name: A V Owner Email:
Owner Name: PQ Phone:
Mailing Address:
Region: ER—an
Physical Address: &o l Q
Facility Contact: b NQy (per - Title: � i►py�^ Phone:
Onsite Representative: R fi [xy or Integrator: H -B
Certified Operator: R0� �Qy+p- Certification Number: q8$11 17
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
~ Discharges and Stream Impacts
l . Is a.py 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)
[]Yes C -No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ 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 Cg No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes El No ❑ NA [] NE
of the State other than from a discharge?
Page l of 3 2/4/2022 Continued
_',
Swine
Wean to Finish
Design Curirent SDesign
Capacity Popes Wet Poultry ` Capacity
..._:.e...n
Layer
Current
Pop
Design Current
. . Cattle Capacity Pop.
DairyCow
Wean to Feeder
Woo 141 IRQ
INon-Layer
auyCalf
Feeder to Finish
D . 1?oultr .
Layers
""
Design
Ca aci
-..r.ren
Pio .
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Other
Pullets
Turkeys
Turkey Poults
Beef Brood Cow
Other
Other
~ Discharges and Stream Impacts
l . Is a.py 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)
[]Yes C -No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ 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 Cg No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [—]Yes El No ❑ NA [] NE
of the State other than from a discharge?
Page l of 3 2/4/2022 Continued

. ,I
Facility Number: gg Date of Inspection: '%
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5 ' No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [] NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1^
Observed Freeboard (in): :20-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes W No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed through a ❑ Yes 0 No
❑ NA
❑ NE
waste management or closure plan?
❑ NE
18. Is there a lack of properly operating waste application equipment?
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)
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
9. Does any part of the waste management system other than the waste structures require ❑ Yes No
Wi
❑ NA
❑ NE
maintenance or improvement?
❑ Yes
No
Waste Application
❑ NE
the appropriate box.
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3 No
[3 NA
❑ NE
maintenance or improvement?
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes J�d No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ Yes
❑ No
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Outside of Acceptable Crop Window ❑ Evidence++ of Wind Drift ❑ Application Outside of Approved Area
❑ Weather Code
yy
12_ Crop Type(s):-(J��.4r1U�lt 7>Gl� svjf
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes El 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
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
[R 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 l" 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
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 M No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes JA No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond p Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
CS No
❑ NA
❑ NE
❑ Yes
❑ No
[P NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes M No 0 NA [:]NE
❑ Yes [F No ❑ NA ❑ NE
❑ Yes E3 No 0 NA ❑ NE
❑ Yes ® No
❑ Yes ® No
❑ Yes D9 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments.(refer to question #): Explain any YES answers and/or any additional recommendations orsanyiotherecommenlr,
y tea.
Use drawings of facility to better explain situations {use additional pages as necessary},
7� Q j /� S"d,e �o� V j � &4' 1)ned � t� w lr 'nr !� Cl v rrlah9 -Vivo s✓im lis �A-
r Pl�� Aar so/1 1 r a>cl 1T 1' o
On r � Y J
>�s ah
IA awt% 90 1
plob, eblear s 14 e- f 1,01.
Lec-+
L a ca� wvs bra + V to a C09 SF CS
9
04yA rplo(ds.
Reviewer/Inspector Name: � Y) to'lf
Ar
Reviewer/Inspector Signature:
Page 3 of 3
Phone: I[#—q3'c33Q0iq?J
Date: 0 J
12011

Facility No.F rm Name C)t N Date
Permit - COC O1C_ NPDES (Rainbreaker PLAT Annual Cert)
M. f► PISM
La oon 1 2 3 4 5 6 7
Spillway
Design freeboard
Observed freeboard in -7
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Calibration Date
Design F�---�--�
Actual •Design Width
��■��������r
Soil Test Date
Wettable Acres Jam_ RAIN GAUGE
H Fields Grp
WUP Dead box or incinerator
Lime NeededWeekly
f7��C- `fit
Freeboard �� Mortality Records
Lime Applied,
rte/
1 in Inspections
Cu -I Zn
120 min Insp.
Needs P 4-14
Weather Code
Crop Yield
Transfer Sheets oL--
Waste Analysis . - OmmWinrinclmrrOMMrr
• o p
Puffield Soil Crop
Acres
PAN Window Max Rate Max Amt
S'
3q'
50 ro
a�
Verify PHONE NUMBERS and affiliations
Date last WUP FRO to iS ( DY Date last WUU,,PIl __at farm
FRO or f=arm Records Ch+�C {I'T� 1 qo&
Lagoon #
Top Dike ' Z,3
Stop Pump''x11-q
Start Pump ►AVVi'A- '
Conversion- Cu -I 3000= 108 lb/ac; Zn -I 3000= 213 lb/ac
ilon
App. Hardware

U
1BJ4g5 10-07- Zoo i
0 -Division of Water Quality
Facility Number ] p 4 ^ j j j 1 O Division of Soil and Water Conservation
O Other Agency�1
Type of Visit Compliance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit "Routine O Complaint O Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: lq-15-4071 Arrival Time: .%S �,, Departure Time: 3.35 County:'4 Soi✓
Farm Name: 0. Ar SGt 0 0 �` /1�uYscF Owner Email:
Owner Name: rk. a / rQ r Phone:
Mailing Address:
Physical Address:
Region: /CW
Facility Contact: Ci[r�+S g� r i c.. ie Title: l ��- • �D p [ (rPhone No:
Onsite Representative: Cu -VAI -S Integrator: C44►4�r� e_ �4YpN�S
Certified Operator: robe_,- Operator Certification Number: I SS�I7
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: =0 =6
=5 Longitude: =0=1 = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
�g 3Qr7 1_570(,,o ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity;: Population
❑
Daia Cow
❑
Daia Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
e. 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 ONNo [-INA ❑ NE
❑ Yes
❑ No
LEJ, NSA
❑ NE
El Yes
El No
Lt'NA
❑ NE
❑ Yes
❑ No
LINA
❑ NE
❑ Yes
N/o
[_1 NA
❑ NE
❑ Yes
,�,
LJ'No
❑ NA
EINE
12128104 Continued

f �
Facility Number: — 3 It
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -3 S �r_
❑ Yes 0 <No❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
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?
El Yes B o El NA El NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr 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 If rNo ❑ 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 ffNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) /yG
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. is there a lack of properly operating waste application equipment? ❑ Yes
L'J N ❑ NA
No ❑ NA
No ❑ NA
[31N. ❑ NA
fo ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Name '. ¢ V { S — - Phone: 4710, 'Y33 J3.3 y
Reviewer/Inspector Signature: Date: 9-/5-206
Page 2 of 3 12/28/04 Continued

Facility Number: 2 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ YesNo NA [INE
20. Does the facility fail to have all components of the CAWM[P readily available? if yes, check ElYes 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 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ETNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EjeNo ❑ NA ❑ NE
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
❑ Yes
[E No
❑ NA
❑ NE
❑ YesNo
❑ NA
El NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
B"No
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
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?
Comments and/or
❑ Yes LS No
❑ Yes ErNo
[I NA El NE
❑ NA ❑ NE
❑ Yes
LENo
❑ NA
❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
❑ Yes
B"No
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
122/28/04

,� B194 S 61291-08 rr- -
Type of Visit Q'Compliance Inspection Q Operation Review O 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: Z 300", Departure Time: 3: OS County: Region:
Farm Name: L SLra�7 �V�1�'-sc�' Owner Email:
Owner Name: Rob er f Na:� far' Phone:
Mailing Address:
Physical Address:
Facility Contact: ce'1 r S Title: �`� Sem Phone No:
Onsite Representative: cw''ks��r�i c''�-- Integrator: COI e ki'L -/!i;)AfS_
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: E:] e [—] ' F--] Longitude: [—]0[—]' [_] u
VII
f
WIP'le*Uxii., �-_,.kir -rent-Design
pa-
CurrentCurrent
wine Ca aatt©n`"
�_ p.
Wet PoultryCapacity Po�ulatty+on ` Gattle Ca aci Po elation
atr p p ty p
<
Wean to Finish,
❑ La er
❑ Dai Cow
EWean to Feeder (0300
S9D 7 ❑ Non -Layer
❑ Dai Calf
❑ Feeder to Finish
"'
�"'
❑ Dai Heifer
❑ Farrow to Wean
�'�
DryxPoultry
- �° ❑ D Cow
❑ Farrow to Feeder
p°
❑ Layers
_ ❑ Non -Dairy
❑ Farrow to Finish
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
y,,
10 Beef Feeder
❑ Boars
t El Pullets
❑ Beef Brood Co
2. Is there evidence of a past discharge from any part of the operation?
❑ Turke s
–
Other lawUN
o
�r ; ❑ Turkey Poults
❑Other
❑Other
Number of Structures:
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
C No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
El Yes
ElE No
�/
NNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
A
❑ 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)
El Yes
El No
�,/
L� NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
B lvo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

J*'
Facility Number: SZ - 31-1
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes [3 No
❑ Yes O No
Structure 5
❑ NA ❑ NE
Ll NA ONE
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '� g
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [t' No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on-site which are not properly addressed and/or managed El�,
Yes f� No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ffNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes No [I 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 ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
mai ntenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes BNo ❑ 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) Renu vd o_ (Xy) e v, s .
13. Soil type(s) lVo A
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ 'No
[:INA
❑ NE
ET'No
❑ NA
❑ NE
L'� No
❑ NA
❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Reviewer/Inspector Name A51, l��.v� �$ Phone: �%/DX33.3330
Reviewer/inspector Signature: Of Date: g-12 - Zoog
Page 2 of 3 12/28104 Continued

Facility Number: IrZ —jjf 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 LJ 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
[T No
❑ NA
❑ NE
❑ Yes
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ NE
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections El
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L'J, NNo
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P� o
E] NA
EJ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
L'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L3No
❑ NA
❑ NE
27_
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Ej<o
❑ NA
❑ NE
Other Issues
2$. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
[INA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
, _,
131Yo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ffN.
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
❑ Yes
BNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12/2$/04

f
l
CnfyceP-ed 9 -zS-o7 Rz
1
0 Division of Water Quality
Facility Number 8Z ] J 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 9'Z7 -O i Arrival Time: 2:3d Departure Time: 3= p0 ,,,, County: SQiNAS"e J Region: 17'0
Farm Name: L- Dv Slt6 �-I / Vw'SU"y Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: C4l4�- S S4-VLJtieK Title: Phone No:
Onsite Representative: cg " S 9gLjC.Jr t k.. Integrator: Ctika-,'i C_ �al,lr>ti15
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0
=g
=16 Longitude: =o=&
o=& =
di
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
Wean to Feeder lsU 510
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑
Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design,, Current
Capacity Population
❑ Dain Cow
❑ Dairy Calf
❑ I-
EWry Heifer
❑
Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes INo ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ 1 No
❑ NA
❑ NE
12/28/04 Continued

`Facility Number: SZ - -311 I Date of Inspection -27-07
Soil type(s) �lpA
Waste Collection & Treatment
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
QW. No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
1� No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[A No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
❑ Yes
�] No
❑ NA
❑ NE
Spillway?-
pilTway?:Designed
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
DesignedFreeboard (in):
Observed Freeboard (in): (y 0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
INo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-site which are not properly addressed and/or managed
❑ Yes
Vj No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 1A No [:INA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [ANo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes O No [INA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes oNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [$ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 3 e -,,-j„ t.ud O. -
i e V4'j (p. S.
13.
Soil type(s) �lpA
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
QW. No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
V No
❑ NA
❑ NE
IT
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
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Ki QcL,, Ke.V i Phone:/D. 33 . 3300
Reviewer/Inspector Signature: Date: 9 -27- ZOO -7
12/28/04 Continued

Facility Number: SZ -31! Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No [INA [:1NE
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 [__1 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 I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[P No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1)2 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
[� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[A No
❑ 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
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
W 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
V 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
[P 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
0 No
❑ NA
❑ NE
12/28/04
E

lk
(Type of Visit: GrCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: VRoutiae 0 Complaint O Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: p S Arrival Time: Departure Time: County: q�l�Al�St71� Region: f�
Farm Name: TAUQ's t Owner Email:
Owner Name: IA"' O(Z_ Phone:
Mailing Address:
Physical Address:
Facility Contact: wob&yk i MN }dp— Title:
Onsite Representative: C'4� P^r,
Certified Operator: RO)D.R-C 0-A"o z
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: MuR0--i Claw A
Certification Number: CV8$5 41 1
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Cgrrent
Pop.
Wet PoWtry
La er
Design
Capacity
Current
Pop,
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
6p 00
a.
Non -La er
D . Poul
Design
Ca acit
Current
1;0 -
Da' Calf
Da' Heifer
D Cow
Non -Dairy
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ No
❑ NA
La ers
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
Beef Stocker
Gilts
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
Non -La ers
Beef Feeder
Boars
❑ Yes
❑ No
Pullets
Turke s
Turkey Poults
10ther
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
Beef Brood Cow
Other
11 Other
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
dNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
F(No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/412011 Continued

V %
Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ji I
ff No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in): CA
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
[�rNo
❑ NA
ONE
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
gNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E3 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
[glNo
❑ NA
❑ NE
maintenance or improvement?
Waste Aoylication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[v7No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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 [D Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): L+?UkjrCzUp$, vs. C-1.
13. Soil Type(s): �`1oR�o1K 7 J
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2/No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ["No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes E�fNo ❑ NA ❑ NE
❑ Yes YNo ❑ NA ❑ NE
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 [fNo ❑ 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 dNo ❑ 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 [ZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑No []w NA ❑ NE
Page 2 of 3 2/412011 Continued

r
IFaciRty Number: L- Date o(inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNo
25. Is the, facility out of compliance with permit conditions related to sludge? If yes, check E]Yes E6No
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 [3"'No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [—]No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on-site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
03'NA ❑ NE
[]Yes gNo ❑ NA ❑ NE
❑ Yes ERNo ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
❑ Yes [;�No ❑ NA ❑ NE
❑ Yes dNo
[:]Yes EvrNo
❑ Yes [grNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: w Date: J b
Page 3 of 3 2/4/2011