820403_INSPECTIONS_20171231

NUHTH CAHOLINA
Department of Environmental Qua!
II

— -- _ �i► S 15'A 17 icy
`sion ofM Of F-23 Resources
acility Number - 0 Division of soil and Water Conservation
� Other Agency
Type of Visit: om 'ance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: &Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departurc Time: B2) ounty: Region
Farm Name: ,6 ±Iti�7i-5 _ Owner Email:
Owner Name: (A )Q�--5 Phone:
Mailing Address:
Physical Address:
Facility Contact: _gt4o (1ter Title:
Onsite Representative:
Certified Operator: L)"t.Y UJ2( of
I —
Back -up Operator:
Phone:
Integrator: 2z�
Certification Number: it 7t 0
Certification Number:
Location of Farm: Latitude: Longitude:
g
Gpo eat
Deesign
Current Y w I
Design Current
Swine Caeacn
P t3 P•
W`e t Poultry
Capacity
Paper# C a
Capacity Pop.
jY
Wean to Finish
Layer
Dai Cow
-
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
jDairy Heifer
Farrow to Wean
Dry Cow
-
o�
'` Design
Current; :
Farrow to Feeder
iD P,oult ,
Ca aci
Pao �,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
Non -Layers
Pullets
Turke s
Beef Feeder
Beef Brood Cow
�...
Qther
Turkey Poults
a I
r ^
Other F
ZM = it
10ther s
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑G � o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [:]No D'1qA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes [:)No
❑�NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes [:]No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes [� N
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
El Yes /NO
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E a—
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[]''i�A
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[D-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
E No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[]Yes
<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Lal�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
[ to
❑ 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?
l l . 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): j fit{
l 3. Soil Type(s): �� 1A oCh
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes []' to ❑ NA ❑ NE
i
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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes E No ❑ NA ❑ NE
❑ Yes [;R 3"o ❑ 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
1:21 o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
5KNo
[] NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
Inspections
[]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CyNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - O Date of Ins ection: %A
24.''Did the facility fail to calibrate waste application equipment as required by the permit? El Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
[j]__doo ❑ NA ❑ NE
E3' o ❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
t!o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
L2 l o
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ET -No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E!rNo
❑ 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
ff'No
❑ NA
❑ NE
permit`? (i.e.. discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
R10"No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [!rNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes VNo
❑ NA ❑ NE
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).
0(ajr rr
Reviewer/inspector Name: 41 I
t
'to-�o8:- l�s/
Reviewer/Inspector Signature:
Page 3 of'3
Date: . 1
21412015

Type of Visit: (R<om ance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up Q Referral 0 Emergency Q Other 0 Denied Access
Date of Visit:lns�Arrival Time: Departure Time: County:-/ Region_,r�
Farm Name: t 1b W q,44 /� � C± Owner Email:
Owner Name: L o. s Phone:
Mailing Address:
Physical Address:
Facility Contact: i�LS �a kytAAC( Title: Phone:
t
Onsite Representative: Integrator: lff� h
Certified Operator: oa_ 4 i '�'fOWw"�" Certification Number: J h 7/ V
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
ine
=GapaciPop.
WetPbultry,°
Cp.
E&&ityP'
Cattle
CapacityPop.
Wean to Finish
ILayer
I I
Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
t
"- -
Dairy Heifer
Farrow to Wean
D
esign
.:,
Current
D Cow
Farrow to Feeder
Dr. Poul s__',u,Cci
a a
PLo
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
_.
OtherI
Turkey Poults
Other
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes NA ❑ NE
[:]Yes [:]No E3-1qA ❑ NE
[:3 Yes []No [D-NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes [:]No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Qgo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Eal�o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

R 4 , I F _b
Facility 'Number: - jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [3-NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E lYo
❑ 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
g�j<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
R2114o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
5" 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
[3 o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[B'<o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Wl < ❑ 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):-1/bN/ tL 7 o
14. Do the receiving crops differ from those designated in the CA W MP?
❑ Yes-❑
NA
❑ NE
l5. Does the receiving crop and/or land application site need improvement?
❑ Yes
EINo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E2IN—o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ 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
❑'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[31 o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3'50
❑ 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 4E�No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
DNA ❑NE
Page 2 of 3 21412014 Continued

Fec' ' umber: - D3:1 IDate of Inspection: kC+�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 E!I<o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ 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 tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[]Yes io ❑ NA ❑ NE
❑ Yes []'No ❑ NA ❑ NE
❑ Yes E?I o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [2rl�o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes [7r No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes hI <0 ❑ 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).
mow( ;-6 �LL9Lj -�
-
S(u-
ReviewerfInspector Name-
Reviewer/Inspector Signature:
Page 3 of 3
Phone: A J
Date:
21412011

Type of Visit: QXompliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: 04outine 0 Complaint O Follow-up O Referral 0 Emergency 0 Other O Denied Access
Date of Visit: Q Arrival Time: 00 •Departure Time: County: sSLM_
Farm Name: Owner Email:
Owner Name: JL-)+ A-1 F&,V w` Phone:
Mailing Address:
Physical Address:
Region: f+p
r
Facility Contact: v i s t^A_ L 6 Title: Phone:
Onsite Representative: Li Integrator: ) AID
Certified Operator: ` Certification Number: It / /V ^
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Desrgn Current'
Ca act. � Po
, ,.
Wet Po - Destgn�Ce�rrent,
ultt, . Capactty l'op
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder I INon-LayCT I Iry
Calf
C ray.': F AWF
Feeder to Finish - a �,.;
DairyHeifer
Farrow to Wean DesigCtirrent
A �-
Farrow to Feeder D , Pa_uIt , - Ca ' act Po
D Cow
Non -Dairy
Farrow to Finish Layers
Beef Stocker
Gilts Non -La ers
Beef Feeder
Boars Pullets
Beef Brood Cow
RAV Turke s
Other ,w_ ,. p E Turkey Pouets
_ ..
;
Other 10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0,4 ❑ 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 ETNA ❑ 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 DNA ❑ 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 P l ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [D_Wcr--❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [51�A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes [�J�o ❑ NA ❑ NE
❑ Yes [D o ❑ 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 Q'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [;.4dii ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes to (DNA ❑ NE
maintenance or improvement?
Waste Application. '
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [� o ❑ NA ❑ NE
maintenance or improvement?
11 _ Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes }o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
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.
❑ WUP [:]Checklists [—]Design ❑ Maps [:]Lease Agreements
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
�o
[DNA
❑ NE
[:]Yes
E:J�o
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [3Ko_�7 ❑ NA ❑ NE
[:]Yes
io
❑ NA
❑ NE
❑ Yes
' No
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes DTNo ❑ 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 [ o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes []'�io ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

s
%cility Number: Date of Inspection:
' 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
M,K ❑ NA ❑ NE
2110�[] NA ❑ NE
❑ Yes � ❑ NA ❑ NE
❑ Yes ��o❑ NA ❑ NE
❑ Yes Er<o ❑ NA ❑ NE
❑ Yes No DNA ONE
❑ Yes ET<o ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Cay t C- 3-1 y
dLAk
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
0 - /. �' f, F, a--,
�10
❑ NA
❑ NE
[]'No
❑ NA
❑ NE
No
❑ NA
❑ NE
[�lo
❑ NA
❑ NE
Phone: J
Date:
21412014

Type of Visit: t3Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: N{ Arrival Time: Departure Time: County:',o N a! 0/ Region:E�
Farm Name: roc-rVIA Owner Email:
Owner Name: �fa{�,x; n� l r o S P1.'" I- L. L Phone:
Mailing Address:
Physical Address: G
Facility Contact: Cu.+_T Title: Phone:
Onsite Representative: 1 t
r
Certified Operator: y
Back-up Operator: f
Location of Farm:
Integrator:
Certification Number:
Certification Number: 7 [O
Latitude: Longitude:
'..
�Desig�:;.:Current
Design
Current
Design Current
Sw e a Cap�ac [y:. Pop.
Wet Poultry
Capacity
Pop.
Cattle Eapacity Pop.
Dairy Cow
Wean to Finish La er
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
rJ S S
+�
'']Dairy
Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P.oult
Ca aci
P.o
Non -Da*
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
_ rt
Turkeys
Other "k'
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:
❑Yes 01f . DNA ONE
a. Was the conveyance man-made? ❑ Yes ❑ No U "'t' ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No C3 NA ❑ NE
c- What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No [B NA ❑ NE
2- Is there evidence of a past discharge from any part of the operation? ❑ Yes Go ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: 2— - Lf C jDate of inspection: 1 r1f-
_Waste Collection & Treatment
4As storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ -N`o_Ej
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
D-tOV_
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): A�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑c '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
❑1G
❑ 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
Na
❑ 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?
Application
_Waste
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
['fro
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Eafio
❑ 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
r
12. Crop Type(s): F t' S C,_C flay
13. Soil Type(s): Cr��
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [31 o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [D'-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E3<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 [ErNo [] NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
Required Records & Documents
No
19. Did the facility fait 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
[3No
❑ 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
[3 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
IN
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LJ No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Z - D 3 jDate of Inspection: ► .c
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes CL No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 1. 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
Pa -No
DNA
❑ NE
❑ Yes
Q'1\lo
❑ NA
❑ NE
❑ Yes
['Flo
❑ NA
❑ NE
❑Yes DINo ❑NA ❑NE
❑ Yes E3-No ❑ NA ❑ NE
❑ Yes [3'19'o ❑ NA ❑ NE
❑ Yes O'No
❑ Yes D-No
❑ Yes Ef'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).
e,��faf,�,— s-
e-,V gIa- 3o �-- C t 5(
Reviewer/inspector Name: ,�(_L� O UAL _
Reviewer/inspector Signature:
Page 3 of 3
Phone-jjo-q 33' 333q___ _
Date: I K
21412015

type of visit: v p4f�mv � a on�puance inspection �peratton xeview trucuure r vaivaiion U m Lcenew Assistance
Reason for Visit: ly'xoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: AWfArrival Time: Departure Timer Z0 1(] q County: C�p�w,�,-0+ - Region:)
Farm Name: ^,b (20CA-4 �(/L �! U•i-1 Owner Email:
Owner Name: Phone:
J
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: {
Certified Operator: r �a
Back-up Operator:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Cnrrenta Design Current
Swine`` ` Capactty Popes Wet Poultry» Capactty Pop * Cattle Capacity PaP.
Wean to Finish La er Dairy Cow
Wean to Feeder Non -Layer Dairy Calf
�o
Feeder to Finish ,,s �E,�, R Dai Heifer
Farrow to Wean��a�b"' .r Design CurrentDry Cow
Farrow to Feeder D . ;Foul f�`Ca aci Po Non-DaiTy
Farrow to Finish t` La ers Beef Stacker
Gilts .n, Non -La ers Beef Feeder
Boars '' PulletsBeef Brood Cow
.r=,.- -�", Turkeys .4
Otherft.0 +r," *' Turkey Poults
Other= Other
r
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)
1 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 � ❑ NA ❑ NE
0 Yes [] No ❑ NE
[:]Yes ❑ No ER-IqX ❑ NE
❑ Yes [—]No
❑ Yes �No
❑ Yes :: No
NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

,acili Number: Zk- Date of Inspection:
Waste Collection & Treatment
4. I� storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ZNp O NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Q.D�er❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [[j< ❑ 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 [3-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 [,]-ado ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Q, ❑ 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_b10 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑,kr' ❑ 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
1
12. Crop Type(s): L e-Te,-,�A
13. Soil Type(s): AL & f0 6"t4 aa44
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ja�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E ,pfo ❑ 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
[ZJ_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
Ell o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑'?,roT
❑ 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
PI
❑ 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
03<o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[jjXo_
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

14
Vacility Number: JDate of Inspection:
1.
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 [2,110 ❑ 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 io ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ 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 [3-N`87 ❑ NA ❑ NE
❑ Yes �i ❑ NA ❑ NE
❑ Yes Vo ❑ NA ❑ NE
❑ Yes To ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Ko ❑ NA ❑ NE
33. Did the Reviewer/Irispector fail to discuss review/inspection with an on -site representative? ❑ Yes L. ,11; o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [0,16 ❑ 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:
Ph/V
Date: Iq r
Page 3 of 3 1214,12011

i ype or visit: w uompuance inspection L.1 vperatton xevtew a arrucrure r,vaivatton CJ i eenntcal Assistance
Reason for Visit: O'Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: d '3d Am Departure Time: �, p County:op
cSAT
e
Farm Name: Owner Email: �.� �Ai�n�S ^ •
Owner Name: �l`�� qRp �}h�RS F-A tisn5 1—LC Phone:
Mailing Address:
Physical Address:
Region: FRo __
Facility Contact: CUtZTsSARL�TcK Title: Phone:
Onsite Representative: o t3 >< Integrator: im ugpk,
Certified Operator: Q R (kR:j I jkpw p RtD Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
5!, Design: Current ; Design Current "'
wine � ty Po Wet Point, • C
Ca act p _ p. .. r1 specify Pop.
Wean to Finish La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish
'135
5fiQ
,.t....,D
4,Dairy
Design @urt-eht
: Moult ," Ca aci Po
Heifer
Farrow to Wean"
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
OtherI
Turkeys
Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes C3"No ❑ NA ❑ NE
Yes ❑ No EPA ❑ NE
❑ Yes ❑ No [ff"NA ❑ NE
❑ Yes [] No
❑ Yes [Ef No
[—]Yes ❑ No
Eq'*NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection: Y d7 1 A
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: 4k-.
[io ❑ NA ❑ NE
WNA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[j2 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
[g 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
[2'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�a No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
&No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[5No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ 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 ❑ Application Outside of Approved Area
12. Crop Type(s): 1 &,S C -u E ( V A .f-A U P-0-
13. SoilType(s): {ZOO-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [g�No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [�rNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [yNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[v"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
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ff 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 [ rNo
❑ 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 gNo
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
(O'NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: a77 i-2-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [fNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Eg-No
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [g"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
WNA ❑ NE
A ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [ErNo ❑ NA ❑ NE
❑ Yes [a' 4o ❑ NA ❑ NE
❑ Yes [3/No ❑ NA ❑ NE
[:]Yes [9No
❑ Yes fNo
❑ Yes [No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Reviewer/Inspector Signature: Date: V1D-1
Page 3 of 3 21412011

(Type of Visit: ejCompli ce Inspection O Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergencv O Other O Denied Access
Date of Visit: ArrivalTime.-I Departure Time: County: ui�Region:
Farm Name: 6 Owner Email:
Owner Name: LU.&ne:
Mailing Address:
Physical Address:
Facility Contact: L�� . E Title: Phone:
Onsite Representative: Integrator: M B
Certified Operator: i.cL Certification Number: Ly 'M
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
_ -
'rent "" Design Currents : Design Current Dese Cur --�� f
�
Swine
} �
N op.WetPoultry Capacity Pop Cattle Capacity Pop.
Capacity P
Finish
Layer DairyCow
Non -La er Da Calf
_ = - DairyHeifer
Feeder
o Finish
FFarrow
o Wean
Design Current: D Cow
D , P,oeiE Ca aei P,oNon-Dairy
o Feeder
Farrow to Finish
I Layers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Co -
Turkeys
Gilts
Boars
Turke Poults
r=6ther
Other
Discharges and Stream Impacts
I _ Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other.
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
❑ Yes ❑ No CE11TA ❑ NE
❑ Yes ❑ No O TA_ ❑ NE
❑ Yes
❑ No
0 lA
❑ NE
❑ Yes
E No
❑ NA
[] NE
❑ Yes
f o
❑ NA
❑ NE
Page I of 3 21412011 Continued

Facili Number: 3M- Date of Inspection:
Waste Collection & Treatment
47 Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [U]-lao ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E3 A ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):a
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes D4C6 ❑ 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 Q�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 DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Q-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E-Iro
❑ 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
F3-idii
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[]-Ko
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes k2-Io ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I 0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window Ej Evidence of ind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): f �;Geaa_ C � 'l �]
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
C3 No
[:]Yes
52r&o
❑ Yes
[R O
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes E� No ❑ NA ❑ NE
❑ Yes io ❑ NA ❑ NE
❑ Yes [tj10 ❑ NA ❑ NE
❑ Yes [j;Ko ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [t3'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 go ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 2<A ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes to ❑ 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 2<0 [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No E;KA ❑ 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 Ei o ❑ NA ❑ NE
❑ Yes [�I<o
[—]Yes Lid l"o
❑NA ❑NE
❑NA ❑NE
❑ Yes
2N0 ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
EY'No ❑ NA
❑ NE
[:]Yes
W3/No ❑ NA
❑ NE
Comments (refer to question ff): 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'dj' 1�. �z¢� , �11Gre
Reviewer/inspector
Reviewer/Inspector
Page 3 of 3
Phone: '220 "Y, 13 ��/
Date: 41,45111
4/Z011

0-rrvrS 2-oy-20/0
Type of Visit ('Coommpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
a Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 'OAAZ .Arrival Time: , 10254.Ar, Departure Time: /�: �0 � County: S4'raPse � Region:
Farm Name: L k An� Owner Email:
Owner Name: 114 cJa "j F"We vs A� rs. j Phone:
Mailing Address:
Physical Address:
Facility Contact: �ui''Title: `` SPA Phone No:
Onsite Representative: Integrator: (" `� �'` Ra ri""S
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: [� o [= 6 ❑ Longitude: = ° = 4 =
Lf
Design Current Design Currentiiii� Design
Current
Capacity Population Wet Poultry Capacity Population Cattle Capacity
Population
inish
74eder
❑ Laver
❑Non -La er
6 ZO
❑ DairyCow
❑Dai Calf
❑ Dai Heifer
Weeder
Finish
"7-35
arrowtoWean
Dry Poultry
❑ Layers
Non -La ers
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
arrow to Feeder
arrow to Finish
ilts
❑ Beef Feeder
PE]Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
r K-
❑ TurkeyPoults
Numberof Structures:
ther
❑ Other
Discharges & Stream Impacts
I _ Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 El"No ❑ NA ❑ NE
❑ Yes
❑ No
0NA
❑ NE
❑ Yes
❑ No
0A
❑ NE
�A
El NE
❑ Yes
No
El Yes
,❑__,,
L7No
ElNA
ElNE
ElB Yes
o
❑ NA
❑ NE
12128104 Continued

A
Facility Number: 2-1jL033 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �Co❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z 6
5_ Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
B No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes
L�i' o ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes
D<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 El Yes
�
B o ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No ❑ NA
❑ NE
maintenance/improvement?
1 I _ Is there evidence of incorrect application? If yes, check the appropriate box below -El
,��Isio�
L'"[ ❑ 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) Fe-5Cc4t
13. Soil type(s) G,0 ,4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ll, NNoo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement`?
ElE Yes
o
❑ 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
ff No
❑ NA
❑ NE
18_ Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (efer to question;#): Explauo any YES answers and/or am recom`mendatror. any other coivments
ty" ns. (use additional pages as necessary,):
Use dra�vm s of facile to better explain s�tuatio -
Reviewer/inspector Name iG ew i 5 Phone: QIG,
�? iL33. 3360
Reviewer/Inspector Signature: Date: Z- OZ -Z o/0
12128104 Continued

Facility Number: — S[O,3 Date of Inspection TTz-- /D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L"J No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LY No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ETNo
❑ 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 El
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
El NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElL7 Yes
,3"NNo
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
Bivo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
B<o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
B o
❑ NA
❑ NE
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?
❑ YesL��1/vo [I NA ❑ NE
El Yes L�7 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes ❑ NA ElNE
ElYes Biro�❑ NA ❑ NE
Addition'al'Comment`s�andl„or'Drawings• `�� "
r AL
E
12128104

$Tius r',vl� /0-®z-2-649
Type of Visit
Compliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
GHwutine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: /'u���l Arrival Time: 10:349 Departure Time: County: S�`;�Sr"� Region:
Farm Name: D s r< " Owner Email:
Owner Name: /-APkAz-•'J grcrtG�s-, LL C, Phone:
Mailing Address:
Physical Address: Facility Contact: Cor1V_V �r^'G"Z-K Title: �w� • �t-• Phone No:
Onsite Representative: Integrator: �41C"' e_
Certified Operator -
Back -up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = V = 1 = w Longitude: = o ❑ { E__1 u
J
Design` °Current
Design Current
Design Current
- CapttyPopulation
Wet Poultry Capacity Population
Cattle Capacity Populion
n to Finish
r�Feeder
❑ l a er
❑ Dai Cow
n to Feeder
❑Non -La er
❑ Dai Calf
to Finish
73,6
Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
El Layers
El Beef Stocker
Gilts
❑Non -La Non -Layers
ElBeef Feeder
P11 Boars
❑ Pullets
❑ Beef Brood Co
�,
❑ Turkeys
Ottter a,
❑ Turkey Pouets
10 Other I
umber of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
ElE No
�
NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
[J 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
���
LI NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
L7 No
❑ 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?
12128104
Continued

j
Facility Number: Date of Inspection l `O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [TNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes B No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z G I
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E 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 E3'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 B Ro ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
G' Rio
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M-Po
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�,/
L7 No
❑ NA ❑ NE
maintenance/improvement?
] ] _ Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
,�,�
is No
❑ 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
Area
12. Crop type(s) Suc.e _ (G r- -� e.
13. Soil type(s) GO A 6t-a j4� --j
14. Do the receiving crops differ from those designated in the CAWMP2
❑ Yes
��,,//
LBNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
t_7 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Ekl�'o
ElNA ElNE
17. Does the facility lack adequate acreage for land application?
Yes
El[k
<
❑ El NE
18. Is there a lack of properly operating waste application equipment?
ElB yes
o
❑ NA ❑ NE
Comments (refer to question #) Explain a6 YtES,ansRers3andlor any.recommendatloos or an other comments.
Use drawings of facility :to better egplain setuahons (use additional pages as<neeessa
Reviewer/inspector Name Ki G k K"[2�V,rr,r' $ g10.433.333V
Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

� 4
Facility Number: SZ — (td3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L1 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Bl o ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ETl o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Cade
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
B'Ro
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NNoo
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
,L�'J,
t7 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
BlVo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D-N-o-
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
91To
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
�
B o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E3 o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
At the time of the inspection did the facility pose an odor or air quality concern?
ElI� Yes
tvo
BIZ
❑ 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
,.,�
Eivo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
�lo
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
ElE Yes
'o
❑ NA
❑ NE
12128104

. 3T_Ms `I-04/ --0 6 P-fL
>f
Type of Visit 9 C,`ompliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit v Koutine O Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: -ZO-Arrival Time: Departure Time: County: 54lADSea Region: F�26
Farm Name: D E FC2YM Owner Email:
Owner Name: _ //a w tvc/ Phone:
Mailing Address:
Physical Address:
Facility Contact: CU r-/r S Title: S Phone No:
Onsite Representative: ��'' S C' YL�it �-� Integrator: C-at Q V f L fca k_*" s
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =o = 1 = 1• Longitude: = ° = ' = "
't "' r � . r �i ..'_ - -. D
Design Current Design Current" �, esi n Current
Swui Capacity Population s Wet Pout#ry Capacity Population Cattle <� : Capacity Population
❑ Wean to Finish ❑ La er ❑ Dairy Cow
❑ Wean to Feeder ❑ Non -Layer El Dairy Calf
Feeder to Finish 735 7 ❑DDai Heifer
Farrow to Wean WLIW�9WOAM
Cow
Farrow to Feeder ;
❑ Layers ❑Non -Dairy
El Farrow to Finish ❑ Beef Stocker
❑ Gilts ❑ Non -Layers
El Pullets ❑Beef Feeder
❑ Boars ❑ Beef Brood Co
l . ❑ Turkeys n,
Other ❑ Turkey Poults_ °
❑ Other El Other s: ��,N b�er�ofr�S i um tru use
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
ElLJ Yes
��
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
DINNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
ETNA
❑ 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
/
B NA
ElNE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
NNo
[I NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
,O
L� No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

r
r i
Facility Number: 9 — 4,03 Date of Inspection 8-2o'D
Waste Collection & Treatment ��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes [] No ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31 ,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
0 No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes
�,/
2 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
threat,
u No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes
DIN ❑ 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
�f
Ll No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
LT No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
,.,�
L1 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) F�SGc( C— 66KA
13. Soil type(s)
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
LJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
E No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
L_ J
[INo NA
El NE
18. Is there a lack of properly operating waste application equipment?
ElYes
El' o
❑ NA
❑ NE
IComments (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/I nspector Name R -L is Kev e.l 5 Phone: 9/0. 4113, 3 330
Reviewer/]nspector Signature: Date: - z 6 - zoo o
12/16/U4 continued

Facility Number: n — Q3 Date of Inspection I $'Zd-O8
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El�
Yes No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L3 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
[:]Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ 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
El NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? Yes
El0
��o
Iw�o
El NA
NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
�,,
o
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes LEj,'N/NNo El NA [I NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes Eo ElNA ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ElE Yes No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33_ Does facility require a follow-up visit by same agency?
❑ Yes B No ❑ NA ❑ NE
❑ Yes L7 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes l_TNo ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
Additional'Comments and/or Drawings: • r _ , . i
Neda 4%p Cuf ys�ss a�, !4Jndo.vs
Page 3 of 3 12128104

ir
*Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 45__ Departure Time: /0,` County: .T&� SA oA1
Farm Name: K r-z?kiid _ Owner Email:
Owner Name: It KY-1 Phone:
Mailing Address:
Physical Address
Region:
Facility Contact: QjLALTitle: Phone No:
Onsite Representative: - iCt"li �4Yl.�.i1`z!� - Integrator: L_ o kA-y Cr
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.
Operator Certification Number:
Back-up Certification Number:
Latitude: = o [= F--T Longitude: = ° =' = u
Design Current Design Current Design Current f
Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy Cow
❑ Non -La yes
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dairyj
❑ Beef Stocker
❑ Beef Feeder
IL I Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
�, I
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 4 No ❑ NA ❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
[a No
❑ NA
❑ NE
❑ Yes
[P] No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
IM No
❑ NA
❑ NE
12128104 Continued

f A
Facility Number:
Date of Inspection O �d
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 l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 37
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 ANo ❑ NA ❑ NE
❑ Yes JNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes QfNo ❑ 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 WNo ❑ NA ❑ 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 P4 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Pd No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes. check the appropriate box below. ❑ Yes � No El NA El NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
4 a
13. Soil type(s) 6 pA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EgNo ❑ NA Cl 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 ? ❑ Yes [9 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application'? ❑ Yes [;gNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes R1 No ❑ NA ❑ NE
Comments (refer to question #f): Explain any YES answers and/or any recommendations oraoy otfier comments.
Use drawings of facility to better explain situations. (use additional pages as necessary).
A,
�
Reviewer/Inspector Name
p 330 0
Phone:�.3.3.
Reviewer/Inspector Signature:
Date: /O —O s 7
Page 2 oj"3 12128104 Continued

4' . ,
_Facility Number: $Z —4LfJ3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [9No ❑ NA ❑ NE
the appropiate box.
❑ WUP El Checklists ❑Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EiNo ❑ 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]
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
LM No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[N'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
El No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
0No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;4 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ 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
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
1WNo
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
14No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[,XTlo
❑ NA
❑ NE
Additional Comments and/or Drawins=_s:
12128104

Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: QZ- O(p Arrival Time: Q Departure Time: County: �Or.! Region: FAO
Farm Name:- K r lrv-.., Owner Email:
Owner Name: }ekv B-ycS, air h1 L L L Phone:
Mailing Address:
Physical Address:
Faciliry Contact: ] U6 c & O.V-A Title:
Onsite Representative: CUW-1S Bat-W;ck balrrM j i3ayjs4'Ck
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
Other
❑ Other
Phone No:
Integrator: C fno.kc i t.
Operator Certification Number:
Back-up Certification Number:
Latitude: [ 4 =.
[=
Longitude: 0 0 = = N
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I0 Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges $ Stream Impacts
1. Is any discharge obsen ed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity, Population.',,-
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ 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? (1 f 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 lal No ❑ NA ❑ NE
❑ Yes
rA No
❑ NA
❑ NE
❑ Yes
[A No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
50 No
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
IX No
❑ NA
❑ NF
12128104 Continued

Facility Number: — Q3 Date of Inspection15;-02--OZA
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?
Stnimire 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes '59 No ❑ NA ❑ NE
El Yes ®No El NA [I NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes [N 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 $5 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes CA No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [X No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [INo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) C_
13, Soil type(s) 1 6 vu q N
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[9 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[N No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
[9No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Qj No
❑ NA
❑ NE
18. is them a lack of properly operating waste application equipment?
❑ Yes
CRrNo
❑ 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 R� S Phone: /O
Reviewer/Inspector Signature: Date: 5 — d Z— Z Q (p
T 121281W Continued

Facility Number: Date of inspection S OZ-ofa
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design 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 V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
(WNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ER No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
[N NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[9 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ 3 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
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
ER 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
ER No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
U No
❑ NA
❑ NE
Additional Comments and/or Drawings: "
12128104

x2 H A O3
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 49 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: FP —a
(� f
Farm Name: r.— a Owner Email:
Owner Name: �bwQ -r� Q ro ��cr� _ f ar r we S �,� C Phone: 9 1 --,— -54 7 — T / I
Mailing Address: 3 9 t S3 G
Physical Address:
Facility Contact: Title: ' t Phone No:
Onsite Representative: 0— -.kiss integrator: Co��ar�, e—
Certified Operator: a.- 34 IAo wCr Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [=0 0 ` �" Longitude: =o =, = u
Design: '!.,...Current Design Current
Swine Capacity.,.Population Wet Poultry Capacity Population
10 Wean to Finish
❑ Wean to Feeder
ETFeeder to Finish 7 S
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Fa er
on -La yet
Dry Poultry
❑ Layers
❑ 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 Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: 5'1 — L4 03 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): hair I e c9 s
Observed Freeboard (in): 3.5- "
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 [0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes RC No ❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ® Yes W No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[-]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [1a No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination;❑ Yes [ d No []NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ® No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes rT No ❑ NA ❑ NE
Comments (refer to question # ):' Explain any YES aflswers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
i C .S C4%.,-G a 1 j o r�� r O o ln/ ► A- i .� �' h 0 e "j, C ,
�1
t �
%1 9, 1 Ck L'i a i +
Reviewer/inspectorName n % Phone:
Reviewer/Inspector Signature: Date: 3 f'/� /a.S
12128104 Continued

Facility Number: �a — 5I03 Date of Inspection /� e
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps
p ®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
[A 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
❑ 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
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No El NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:.
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12128104

of Visit • Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit • Routine Q Complaint Q Follow up Q Emergency Notification O Other ❑ Denied Access
Date of Visit: b7 •o y Time: 8: d
FFacility Number
Not Operational O Below Threshold
M-14ermitted GZIt ertified © Conditionally
Certified [3 Registered Date Last Operated or Above Threshold: ........... ..........
Farm Name .0. ..................... County:.... 4ejr�.t,r--•_._.� .�'2 a.» ..
Owner Name:.... 6 arrd f as...... Fkt._!K� L.�..G ............................. Phone No: . �t rv� _ �G 7 :..� �`f.�............ _................ ...
y... �......_.
Mailing Address:-...........Ha.,.a�rc�.....�t�------------------
Facility Contact: .. Qcar '(Qfir�.. .�rl ... �r.��•.�...�rw�rtitle:..��..�.�.�....�.-.-.......�.�.........�.�...w.�. Phone No: -.-.r.r--,.,.------------••-
OnsiteRepresentative:Q �,j_/yds.�a,m,[-- -� �_ ,aiu�,�.� . Iategrator:--
Certified Operator: ............... ... _ 1:46.eaz,�-------------------------- Operator Certification
Location of Farm:
wine �oultry ❑ Cattle ❑ Horse Latitude Longitude �• �� ���
Disc es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑-Ko-
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes 2'lqo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ yes ❑mo-
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes D'I o
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ET9
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑Yes Q1Q'o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑•Wo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......... -.I ..... -............ _..............
Freeboard (inches):s
12112103 Continued

Facility Number: .9? —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 9'No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes LSD
closure plan? -
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes
8. Does any part of the waste management system other than waste structures require maintenanc erunprovement? ❑ Yes alq
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 01�o
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelumprovement? ❑ Yes EYTl o
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes awo
❑ Ex es essiv1317
Ponding
© PAN n[] xydrmilic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. crop type Fri za
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes EKO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
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 B' o
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [}moo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes G-Ro
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 0#o
Air Quality representative immediately.
Final Notes
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ReviewerAnspector Name
Reviewer/Inspector Signature:
Date: /a - 7 - v
11/11JU3 LonZMUW

• 1 Facility Number: I;? — p3 Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ , c s, d%i►gti-Wej etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did ReviewevInspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NMES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes 04 KO
❑ Yes EINcr
❑ Yes M-ble
❑ Yes G—Ko
❑ Yes G-No
❑ Yes 0"Ko'
❑ Yes ❑Wo
❑ Yes aNO
❑ Yes O-No
❑ Yes O-Na
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
I2(12/03