310196_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Visit:Compliance Inspection O O eration Review Q Structure Evaluation O Tecl.:_
for Visit: p Routine O Complaint i Follow-up O Referral O Emergencv O Other
Date of Visit: i i 71 ► 1$ i
Arrival Time: 1'.
Departure Time: County:
OL4 I PW
Farm Name: $y
S I
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
i Access
Region: YV r,b
Design Current
Swine Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
I
jNon-Layer
IDai
Calf
Feeder to Finish
Farrow to Wean
DU. I P,o_ul y ]
Layers
Design
Ca aci
Current
P.o P.
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Pullets
Turkeys
Turkey Pouets
Other
Beef Feeder
Beef Brood Cow
Boazs
Qffier
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure implication Field ❑ Other:
ErYes ❑ No ❑ NA ❑ NE
a. Was the conveyance man-made?
❑ Yes gNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
—1�3D
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
La"No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
.'Yes
❑ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�lo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

r—�8� �n
Facili Number: Date of —inspection-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JD�No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1
Identifier: h
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑NA ❑NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 12-lqo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes _❑1No
❑ 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?
_ETYes [—]No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes�'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes �No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes ❑ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect Ian application? If yes, check the appropriate box below. XYes ❑ No ❑ NA ❑ NE
❑ Excessive Pond ing 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 LQ 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 [—]No
❑ Yes LEI'No
❑ Yes ❑ No
❑ Yes '[ErNo
❑ Yes qo
❑ Yes ❑ No
❑ Yes ❑ No
❑Other:
21.'Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ Nc
❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA _ONE
❑ NA ❑ NE
❑ NAEJNE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA O'F�E
❑ NA J:]-NE
❑ NA Ef'�E
❑ Weather Code
❑ Sludge Survey
❑ NA ,TNE
❑ NA,�NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ NA ja*14E
❑ NA 12-IOE
❑ 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 .0'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No e JA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [—]No ❑ NA J�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 ..�No ❑ NA ❑ NE
9Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ,fNE
32. Were any additional problems noted which cause non-compliance of the pemdt or CAWMP? ❑ Yes ❑ No
33. Did the Reviewer/Inspec[orfxil to discuss review/inspection with an on -site representative? ❑Yes
No
34. Does the facility require a follow-up visit by the same agency? [Yes ❑ No
❑ NA
ENE
❑ NA
❑ NE
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or other comments.'"
Use drawings of facility to.better explain situations (se additional pages as necessary). us
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�� ern t� r no 4'%� CKJ �nl tsnc� U
ussisc�.- c�z�e.� l�Ycl s�i� card v oa
Reviewer/Inspector Name: D V I 1 Phone:
Reviewer/Inspector Signature: Date: 3
Page 3 of 3 21412015

Visit: Q
Evaluation
Reason for Visit: 0 Routine ttr Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Den
Date of Visit: Arrival Time: 00 Departure Time: County: Vy"o 1'�1
Farm Name: „\ �"L`� �.'*�` (:� k &GKl t/' _�O J [ A. , Owner. Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: CL
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Access
Phone: / /)
Integrator: eB S M i
Certification Number:
Certification Number:
Longitude:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operat' n? Yes ❑ No ❑ NA ❑ NE
Discharge originated at: ❑ Structure I Application Field ❑Other.
a. Was the conveyance man-made? ❑ Yes [EI-No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) i(yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? T 6D
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes M-Iqo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? &Yes ❑ No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes /No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 21412015 Continued

Facility Number: JDate of Inspection: d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ea -'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No IdNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: /vo.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[D-110
❑ 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?
D-'�es
[;�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[g-lqo
❑ 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 E3 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need Q Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. Q Y s ❑ No ❑ NA ❑ NE
❑ Excessive Ponding [2"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
Lg
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 4pppplication 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.
❑ Yes ❑ No
QN ❑ Yes 'oNo
❑ NA ❑ NE
DNA ❑NE
❑ Yes
❑ No
❑ NA
[ E
❑ Yes
❑ No
❑ NA
[D.Nt
❑ Yes
L`110
❑ NA
DINE
❑ Yes
❑ No
❑ NA
ENE
❑ Yes ❑ No ❑ NA E2"NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA [IjNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA [ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA [J"'NE
Page 2 of 3 21412015 Continued

FaciMty Number: 3 1-
Date of Ins ection:
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.
❑ No ❑ NA 13'NE
❑ No ❑ NA F NE
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA [3❑ R�
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes ❑ No NA E
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
❑ No
❑ NA
❑AIE
❑ Yes
❑ No
❑ NA
M NE
❑ Yes
❑ No
❑ NA
Yes
No
NA
OXE
❑
❑
❑
❑ Yes
❑ No
❑ NA
U '��
❑ Yes
❑ No
❑ NA
❑ Yes
❑ No
❑ NA
NE
IConnnents (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
-p 1� U-j V SI �' ' pt ye4*vr'� S I3 I q , Series
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sP2I)s.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Je
li Phone: g �� f, (bpi J l 6
Date: S 3 jj D
21412015

(Type of Visit: (?rCo once Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Q S Departure Time: 1(J 4 County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: C /Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
ne
an to Finish
Design
Capacity
Current
Pop.
et Poultry
La er
Design
Capacity
Current
Pop.
Design C•nrrent
Cattle
Dai Cowan
to Feeder
0 0
Non -La er
Dai Calfder
to Finish
to Wean
I o 9
S n
2n,p
3c�o
Design
Current
Dai Heiferow
D Cowow
to Feeder
to Finish
Dr. $ouI
La ers
Ca aci
Po .
Non-Daiow
Beef StockerM
Beef Feeders
s
Non -La ers
Pullets
Beef Brood CowTurke
erTurke
IE,,a
er
s
Points
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[—]Yes [—]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [—]No ❑ NA ❑ NE
❑ Yes Now❑ NA ❑ NE
[—]Yes B<0 ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number:) - q Date of Inspection: 2 /
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?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 17� %
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
Structure 5
ITNO ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes E N ❑ NA ❑ NE
❑ Yes C31Vo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ENo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ETNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 0 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes TNoo"
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes fo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
eo
❑NA
❑ NE
W
20. Does the facility fail to have all components of the CAMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box
❑WUP El Checklists ❑Design El Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Noo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0-1Qo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: -
Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes EjNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check es ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure -to complete annual sludge survey ❑ Failure to develop a PDA for sludge levels
Eon -compliant sludge levels in any lagoon Po �1
List first indicating n
/7�
structure(s) and date of survey non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NSA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No Q'NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ONo ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes o ❑ NA
❑ Yes ffNo ❑ NA
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?
9 5/
❑ Yes
/rPG.,ova f rtI-//^ — 4
Ii0 7 7<'::-' 2/(v s-
?�1P/a/i9
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
No ❑ NA
J211—o [:]-NA
EKO ❑ NA
se �,4_419
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Phone: � to7j6 %3-y
Date: 'Z f 4 ( b'
21412015

Reason for Visit: QIRoutine 0 Complaint 0 Follow-up 0 Referral O Emergency 0 Other O Denied Access
Date of Visit: /<( Arrival Time: © Departure Time: FT4 f County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
p\' �u S �a c 1-c �—
Latitude:
Phone:
Phone:
Integrator•
Certification Number:
Certification Number:
Longitude:
Region:
Swine
Wean to Finish
Design
Caity Pop.
pac
l
III
Wet Poultry
ILayer
Design
Capacity
I
Current
I.
Design Curren t
Cattle Capacity Pop.
Dai Cow
eantoFeeder
49,0 1
lNon-Layer
I
Dairy Calf
Feeder to Finish
arrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
00-0
D
Dr. P,oultr,
Layers
Non -Layers
Design
Ca aci
Current
P,o P.
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Boars
Pullets
NJ
I Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[-]Yes
[-]No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
G-No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: -tj jg jDate of Inspection: r y
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ffNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes L G NO ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PrNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FTNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
QXo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑I o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E3<o
❑ NA
❑ NE
Required Records & Documents
���
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
LJ No
NA
❑ NE
20. Does the facility fail to have All components of the CAWMP readily available? If yes, check
❑ Yes
o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ErNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Ficili Number: Q Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 90�
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? ❑ Yes dNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
Io
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
k❑ NA ❑ NE
❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings ofTacility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
R9 - ( t,P -tJ,
Phone: t7 ��(0 77,
Date: i
21412015

Type of Visit: 0Com�pliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: (DKoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: —0 F- County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
—Title: it _
G l C"
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
ISZ
Swine
an to Finish
Design
Capacity
Current
Pop.
Wet Poultry
I Layer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity P.
Dairy Cow
an [o Feeder
9
Q
[Non -Layer
I
Dairy Calf
Feeder to Finish1
arrow to Wean
Farrow to Feeder
Farrow to Finish
o
fl
9 rJ
9
I)y P,oult .+
La ers
Design
Ca aci
Current
Pao ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Its
Non—Layers
I
Beef Feeder
Boars
Pullets -
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify D WR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes eNo ❑ NA ❑ NE
❑ Yes
[-]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑]NNo ❑ NA ❑ NE
❑ Yes E N ❑ NA ❑ NE
El Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment �--���
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C3'❑ 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): t S
Observed Freeboard (in): Z Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Fj`No ❑ NA ❑ NE
(i.e_, large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes FP o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0- l4o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement. /
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ I__I Yes ivo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground _ ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑-lqo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2""
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E],No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3"Ko
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ff No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�
VJ N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ko ❑ 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 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes r3No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili •Number: jDate of Inspection: / - /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No �A ❑ NE
Otherlssues
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?
answers and/or any
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[TNo
❑ NA
❑ NE
❑ Yes
fNo
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes [�No
❑ Yes ]jNNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
or any other comments.
.e-e y4rO�.-,
at rl � C e_ 4^ f t C,00 /s
Cic_"f— 2—r>/i
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
s" soo
Phone: l ( D 76 T�Dy
Date: 4 03 1"6
21412015

(Type of Visit: Q-Compliance Inspection V Operation Review O Structure Evaluation V -technical Assistance
Reason for Visit: O Routine 0 Complaint O Follow-up O Referral Emergency 0 Other O Denied Access
Date of Visit: l % Arrival Time: Departure Time: So County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
MC�,ei
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder I
Wet Poultry
La er
jNon-Layer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oul(,ry
Layers
Design
Ca �acity
C•unrent
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I 113eef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
i
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DW R)
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 Ej No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes'0 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: -11,9 Date of inspection: -Z f
/(!
YXaste'eollection & 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?
P1 Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes /[J'No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [�No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes L/J No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA
maintenance or improvement?
NE
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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.
❑ Yes
❑ No
❑ NA
E
❑ Yes
❑ No
❑ NA
iNE
❑ Yes
❑ No
❑ NA
NE
❑ Yes ❑ No ❑ NA dNNE
❑ Yes ❑ No ❑ NA OINE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NAP,�E
❑NA kNE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑Yes ❑ No ❑ NA �N�E
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA gE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA '❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - fR Date of Inspection: 2.
24. Did [he facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ 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?
❑ Yes No
❑ Yes No
❑ NA Pj'NE
❑ NA E
❑ NA r] NE
❑ NA ]"NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
E3 tvo
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
ErNNE
❑ Yes
Nc
❑ NA
❑ NE
❑ Yes
f No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (useadditionalpages as necessary).
0Pl Ihh-- /n
Sa r J_ wc✓cIS 6/-t-010.
/k wR
s a�Y
Reviewer/Inspector Name:
Reviewer/Inspector Signatm
Page 3 of 3
Phone: TO 71? G 73V/
11� it
Date: z
21412015

type m visa: ky com nce inspecuun V upernuou nevirw V ovrucaurc cvawauuu L/ a mun-a- naal as v
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 2 �. _ Arrival Time: Departure Time: Z 39 County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Title:
Phone:
Integrator:
Certification Number: J !�,/ .S 1
Certification Number:
Latitude: Longitude:
Swine
can to Finish
Design
Capacity
Current
P.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
goo
4
Non -La er
DairyCalf
Feeder to Finish
o00
1000
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D
g9-0
1) . r P,oultr
Layers
Design
Ga aci W
Current
P,o .
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lBeefBroodCow
Qther
El Other
Turkeys
TurkeyPoults
Other
Dischar¢es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes QNo NA Ej NE
❑ Yes
No
Ej NA
❑ NE
[]Yes
❑ No
❑ NA
NE
[:]Yes ❑ No NA NE
Yes �o ❑ NA ❑ NE
Yes FffNo NA NE
Page I of 3 21412014 Continued

Ifteiirty Number: ^/ - / 7 Date of Inspection: 2 6 is
Waste Collection & Treatment ,
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes ❑A ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `Z S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ea'No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[i]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
dNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
dNo
❑ 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
dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
tNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
ONo
❑ NA
❑ NE
❑ Excessive Pointing ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ 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
dNo
❑ 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
r:fNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ETNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ 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 E]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 dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - - Date of Inspection: Z r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes PNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA 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?
Otherlssues
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
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
['NA
❑ NE
❑ Yes
E!rNo
❑ NA
❑ NE
❑ Yes [ZfNo ❑ NA ❑ NE
❑ Yes [J No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
dNo ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Reviewer/Inspector Signature: V== _ Date:
'—1 /—r"'(
Page 3 of 3 214,12015

Type of Visit: .0 Compliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: Routine Q Complaint 0 Follow-up O Referral Q Emergency Q Other O Denied Access
Date of Visit: ( Arrival Time: parture Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number: 1154 9 o/
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Ghent
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dy P,oultrV
Layers
Design
Ca acit
Current
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Other
El Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes oETNo ❑ NA ❑ NE
❑ Yes [a —No
❑ Yes 2'No
❑ Yes PrNo
❑ Yes ff No
❑ Yes 'Z"No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Pagel of 21412011 Continued

Facility -Amber: Wit, - Date of Inspection:
/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
LNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
�No
TT
❑ NA
❑ NE
Structure_ 1 Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
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
VNo
❑ 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
L2"No
❑ NA
❑ NE
waste management or closure plan?
T
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 structures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ONo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ YesZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E21'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
3No
r-
❑ NA
❑ NE
Required Records & Documents
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
[No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑.No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [� No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility- Number: - Date of Ins ection-
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes
[2No
❑ NA ❑ NE
2-5. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
qNo
❑ 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
[2,No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[�J'No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
;] No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
;' No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
0 No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑'No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[—]Yes
�rNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use•drawings of facility to better explain situations (use additional pages as necessary).
r 1...) C-S� ��� C-,-,moo( �, fYt 111.e,� o�Br feed.
gc�cic mid fflQ rcln pa�mpl'k"'�
z'3
71--3 lecerlwy SuSM)
Ha
Fo-1-rn rc c-ofA i06lC Y" J.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
M
-7 39 c7
Phone: /
Date: a
214120111

rl�l
for Visit:
0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: EiVDepartnre Time: County:. Regio�j
Farm Name: Q f lqA Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 'W1114
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
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)?
Phone:
Integrator: 123
Certification Number:
Certification Number:
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?
Longitude:
❑ Yes jZrNo ❑ NA ❑ NE
[—]Yes
El —No
❑ NA
❑ NE
❑ Yes
J�!rNo
❑ NA
❑ NE
[:]Yes Z No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
[:]Yes �No ❑ NA ❑ NE
Page I of 21412011 Continued

.Facility Number: 2r_ Date of Ins ection:
-o
Waste Collection & Treatment
4.*Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes T/�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes ZfNo
❑ NA
❑ NE
Stmcjure 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 ZNo
❑ 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 ff No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes jiT�'j' No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
jo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes VrNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes rj/ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes J21No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes J2 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes L'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 ONo
❑ 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 Z No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of Inspection:
JF
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes F] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Z No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality 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)
❑ Yes
,U No
❑ NA
❑ NE
❑ Yes
Pj No
❑ NA
❑ NE
❑ Yes Pn No ❑ NA ❑ NE
❑ Yes J2 No ❑ NA ❑ NE
❑ Yes P No ❑ 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
PNo
❑ NA
❑ NE
CJ No
❑ NA
❑ NE
No
❑ NA
❑ NE
[� No
❑ NA
❑ NE
comments (refer to question P#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
s Wed callbrg4-tan �,.//�oo a� (42CCPP�, S��« uSe
A � CGr tPL�icoN • A'(to .elv_r s�ao �11t rdec,
V111" r / 9 7 Fafm �1- re cod s 1 ook 5acd,
/'
/eg 7
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7 — 7
Date: 5 r /C A7
21412011

r II `;_- '.-•_ -- -
IType of Visit—Qf,C.,00mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit _ Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
N Farm Name:
Arrival Time: �LI Iparture Time: County:
Owner Name:
O�
Mining. Address:
•
Physical Address:
Facility Contact: G/ Title:
Onsite Representative: r S/ G Clef
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator: Ik
Operator Certification Number -
Back -up Certification Number:
Region:444
Latitude: [ --- 10FMT n Longitude: n o n n
a
Design bCurrent _ De§tgu Current D stgn Current
W Swme
Capacity Population ' Wet Poultry Capacity Population 'Cattle` CEap �tyy,.Plopula
•.
-on
a
❑
Wean to Finish
❑ Layer
❑ Dairy Cow
❑
Wean to Feeder
`: ❑ Non -Layer
❑ Dairy Calf
., ❑
_ Feeder to Finish
-;^.'�=a..-.fie
,.
- ;� _
`, ❑ Dairy Heifer
❑ Farrow to Wean
Dry Potiltry,t'"`�"-fs' ❑ D Cow
❑ Farrow to Feeder
''
`';: ❑Non- Dai
[ ElFarrow to Finish
❑ Layers ��
' ❑Beef Stocker
s ❑ Gilts
El Non -La ers
F. ElBeef Feeder
❑ Boars
ElPullets
El Beef Brood Co
.. .w. El Turkeys
Other "�' ❑Turke Pouets
,..-
�"`
❑ Other
❑Other
�-°,•
Number,oStru Mures
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �]i No ❑ NA ❑ NE
❑ Yes P'No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ANo
❑ Yes ON.
❑ NA
❑ NE
❑ Yes � No
❑ NA
❑ NE
Page 1 of 12128104 Continued

Facility Number: 3— Date of Inspection
Waste Collection & Treatment
4. Is ,Storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
❑ Yes
ZNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ONo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
0 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ,,O('No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El/LI 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 El Yes iJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes W6 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V�No ❑ NA ❑ NE
❑ Excessive Pending ❑ 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 )ZNo
. ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes PrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes 01, No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes PNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �No
❑ NA
❑ NE
Comments (refer to question #):' Explain any YES answers and/or.any recommendations or any other comtneiits
Use drawings of facility to better, explain situations. (use,`additioual' 'ages as necessary): F ,
t� .>
715 on , •
Reviewer/inspector Name J/ ;�. � Phone:
Reviewer/Inspector Signature: Date: 2Z
1..,,,, 1 _r 2 1 /2R/Od , Cnndnuad

Facility Number: — Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes'zNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes yJ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ 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 FerNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes �TNo
❑ 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 H No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes 0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes O No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ,0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes Z No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes �No
El 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)
VoNo
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes,UNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes OfNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
k41 leeen.-Ily Sevc'� ACT '
zrJ�J% Sc<r.��it5
' /�4%H/
nll/ r4�i/rS �!//12�1/7��G`1 ✓�G?I�CCQ/y fC
G/vf
Page 3 of 3 12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 'Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: � Departure Time: County: Region:
Farm Name: �CO vY�s Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude: = o =
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle
Capacity Population
❑ Wean to Finish
10 Layer I
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer I
❑ Dairy Calf
❑ Dairy Heifer
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrowtoto Finish
❑
❑ Non -Layers
[I Beef Stocker
❑ Gilts
❑Beef Feeder
El Pullets
❑ Boars
❑ Beef Brood Co
ElTurkeys
Other
❑ Turkev Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes gNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[I NA
❑ NE
El Yes
,V(No
I/J No
❑ NA
❑ NE
12128104
Continued

Faci tty Number: = Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes JZNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): [Y f/
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes FZMo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes PNo
❑ 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?
ElYes f No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes VNo
❑ 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
/
ElL4 Yes No
❑ NA
❑ NE
maintenance or improvement?
T
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 PKNo , ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ANo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
LI No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Z No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
L-I'No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
Comments (refer to queition #): Explain any YES answers and/or any recommendahons or any lot her commentsIF
Use drawings of facility to better explainsituations (useadditional' pagesas n-e -ssry.t
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: 3 Ci
12128104 Continued

Facility Number: 3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�No El NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I] 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 PrNo ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RrNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
� No
El NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
7No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ 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
„YJ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
,t
f LI No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[2rNo
❑ NA
❑ NE
G�. /ve/2eGP/ lb- <Se%c Cp,rrr�
4
' /Ylls� 3G �
Gt/6 ��� iadrocPu�l�
cro� on
Cry
is !n- /l o �.✓
12128104

Type of Visit 0-COmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit JQ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑Denied Access
LA,Date of Visit: ' Arrival Tfine: ��) _ eparture Time: County: Region: Z_
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:./LG /
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator: 1217 //�
Operator Certification Number:
Back-up Certification Number:
Latitude: [n [=, = Longitude: =e=, =«
';Design ;current ESDestgn �un't
::
'Swine Capacity Population Wet Poultry Capacrty..,P,,opulahon
❑ Wean to Finish J❑ Layer I i I
' Design Current
Cattle„ .,, rCapacity .Population
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer I j
❑ Dairy Calf
*"
"Other
❑ Feeder to Finish
- 11, '--. , .a
❑ La ers
ElNon-Layers
El Pullets
❑ Turkeys
❑Turkey Points
,,,;x 1. �.;�•
-•
El Dairy Heifer
❑D Cow
❑Farrow to Wean
El Farrow to Feeder
❑Non -Dairy
❑ Farrow to Finish
El Gilts
❑ Beef Stocker
•• El Beef Feeder
❑ Boars
-- ❑ Beef Brood Co
gilil
Number oFStr`uctures:
❑ Other �' ❑ Other
-�—ter---, --
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes oNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes PNo
❑ Yes
;'No
❑ NA
❑ NE
❑ Yes
j2No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Stmctule I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes � No El NA El NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes A No ❑ NA ❑ NE
❑ Yes jZrNo ❑ 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 10No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes 7No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) rrrryyyy 9. Does any part of the waste management system other than the waste structures require ❑ Yes VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Aoolication
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 "o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10%0 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 ONo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
X No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
R(No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recomm'endahoso nny Mmeats
,Use drawings of facility to better explain situations., (use additional pages as necessary) ref ,4 a�
a
Reviewer/Inspector Name Phone: S' O
Reviewer/Inspector Signature: Date:
IX28101 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [;?No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ' I No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes p')qo ❑ 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?
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes VfNo
❑ Yes [VNo
❑ Yes *110
❑ Yes y"o
❑ Yes RNo
❑ Yes PrNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA El NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
;?rNo
❑ NA
❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes TTP�No ❑ NA ❑ NE
❑ Yes
VrNo
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
leee,�� Cresu/fs nJ14-
o ,P>t
12128✓04

Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑Denied Access
Date of Visit: 1• )7 Arrival Time: ) Departure Time: County:Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title.. Phone No:
Onsite Representative: !��i�P o/" Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = ' = « Longitude: = o = 1 u
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer I❑Dai
Cow
❑ Wean to Feeder
❑ Non -Layer
❑Dai Calf
❑ Feeder to Finish
❑Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
El Farrow to Feeder
on- airy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Pullets
❑ Beef Feeder
❑ Boars
❑Beef Brood Cowl
El Turkeys
Other
❑ TurkeyPoults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes Z No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes , /ZNo []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]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 1;�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 PNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 9'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 ;ZNo
❑ NA ❑ NE
maintenance or improvement?
Waste Aoolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes )?I No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 'VNo
❑ NA El NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.) JJJJTT
❑ PAN ❑ PAN > 10% or ] 0 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
.[_I No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[:]Yes
k] 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
No
❑ NA
❑ NE
Comments (refer to question ff): 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):,
If
Reviewer/InspectorName I / _.; 1Phone: /O— / — L
Reviewer/Inspector Signature: /e_77 "_� Io'Date: 3, 9 ii-7
Pnoo 2 of i

Tacility,Number:. — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [2No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JA No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
;D 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
O'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�2rNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�allo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;TNo
❑ 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
r�
IGI No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[2rNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E;KNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
l" C l l r �'� (�✓6✓/Cl�z-r Glut. ICI fi ✓Clti. �.!/H-t �
y/l7lo? Fccev.a vs�.,. at o (fists Fo ( 1'V�
Ca. 5Q ba c Ic. d(Ite-
a00 ro Puvnf l v"5
(l)�J 6^I t)sts'
CtOvl jInUA PFlo�
Fa.Jccce �
12128104

(Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit O Routine o Complaint O Follow up O Referral O Emergency 0 Other ❑Denied Access
Date of Visit: I.I1471d V I Arrival
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Departure Time: County:
Facility Contact: Title:
Onsite Representative: ' i /"'
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone No:
Integrator:
— Operator Certification Number:
Back-up Certification Number:
" Longitude:
0
Discharges & Stream Facts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes �YNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
,-NO
❑ NA
❑ NE
❑ Yes
[fNo
❑ NA
❑ NE
12128104 Continued

Facility Number:'31 — 96 Date of Inspection /T
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes J2'No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 4EI'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 A No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes -ETNo ❑ 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 fE-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes D'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EMo []NA ❑ NE
❑ Excessive Pending ❑ 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 Ev' eencce/of Wind Drift ❑ Application/Outside of Area
12. Crop type(s) ` �( /GQ�/'✓� > G �i12 T%��S
13. Soil type(s) lj
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes „0No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
[--]Yes -ETNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes 0 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes JNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes ErNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
IReviewer/inspectorName ( GGi�-t„fT/ Phone: �CU�!`l'lp �lOs6�l
Reviewer/Inspector Signature: Date: l
Pao' 2 nP 7 12/2R/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,ErNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ YesZ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other r-�
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes G 5o ❑ 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 j2f-4o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FerNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes DNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ONo
❑ 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 ❑ No
❑ NAx]'NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ZNo
❑ 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 PNo
❑ 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 E]No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes .0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes p "o
❑ NA
❑ NE
Comments and/or
Amemr, Cav/ CGIQi'l/li�v2 �r /l/�/eryl�e
� 0 a6l
Page 3 of 3 12128104

Type of Visit ,coompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit XJ Routine o Complaint O Follow up 0 Referral O Emergency 0 Other [I Denied Access
Date of Visit:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Arrival Time: Depa
v C�P�J7 <
Facility Contact: �% Title:
Onsite Representative: /�l�/l,C ACC'
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Time: County:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification
Back-up Certification Number:
Region:
Latitude: [ o �� = Longitude: =o=.
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
6Q ❑ Non -La et
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
0�0 /0
Farrow to Wean
U
ElFarrow to Feeder
ElFarrow to Finish
ElGilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
El Pallets
LiTurke s
El Turkey Poults
ElOther
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ DrV Cow
❑ Non -Dairy
ElBeef Stocker
ElBeef 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 ffNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes ZTNo
❑ NA
❑ NE
❑ Yes )2'FIo
❑ NA
❑ NE
12128104 Continued

i Faculty Number: — 9
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):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes XJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ET�No ❑ NA ❑ NE
❑ Yes ErNo ❑ 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 ,❑ No ❑ NA ❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes EINo ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9.
Does any part of the waste management system other than the waste structures require
❑ Yes �Z No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes B No ❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ;2'No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Ou de of Area
r C C
12.
Crop type(s) C 2Y
13.
Soil type(s) Q
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes _�ffNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes JZNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'![] Yes ZNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [r No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes PrNo ❑ NA ❑ NE
Reviewer/Inspector Name t /94 la r<; 5 Phone-
Reviewer/Inspector Signature: Date:
12,28/04 Continued

'F"acility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes oNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Z No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ 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 min gauge?
❑ Yes E No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes ,ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes BNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes 2 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ;3-No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes ETNo
❑ 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 ffNo
❑ 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 Z No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes O'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes J2�No
❑ NA
❑ NE
.`ifi'2•: T s .. e. L i 4t L, ;S?F a3
AddihonalcComments:and%or,Draw�ings� �:s �';w?a.. _ ._mt ��& ��" sk
(e Co rok s n ecAd-
0 rdor�� .
12128104

Type of Visit (9-Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit F-Routine O Complaint Q Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of visit: l! G Time: �Q�/>'-
Facility Number
_ ' Not Operational Below Threshold
MPermitted ®•Certified 0 Co `ditionally Certified 0 Registered Date Last Operated or Abgve Threshold:
� Farm Name: / County:
Owner Name: �&6&e/ ,7n%� d Phone No:
Mailing Address:
Facility Contact: Tide:
Onsite Representative: Iny_AR/--
Certified Operator:
//PPh�hone No:
Integrator: i/!l4�1
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• 0. 0- Longitude 0' =, =`
Design _-Current `"Destgn" r .Current =- =Design "Cui•reot
Swine- Ga pacih• Po dlstion 'Pouitrt•" , Ca achy "sPo ulation �Cattlew =Ca acitv�Po ulaLon
t� Wean to Feeder P ` ❑ La er -
r� , ❑ Da' , Feeder to Finish❑Non-Laver ❑ Non -Dairy 7
Farrow to Wean -' _ - -
❑ Farrow to Feeder �' ❑Other
❑ Farrow to Finish Totai DesignfCapacity
❑ Gilts
❑ Boars Total SSLW
Number of Lsg000s _ "© _• ❑Subsurface Drains Present ❑ La ooa Area ❑ S ray Eteld Area L
Haldirig Ponds lSolyd Traps r: ❑ No Liquid Waste Management System] _
Dischar-es & Stream Facts
1. Is any discharge observed from any part of the operation? ❑ Yes [9-M
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
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 ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes B-5-o-
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [it>—
Strucmre I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: !
Freeboard (inches): 3"3
05103101 Continued

Facility Number: 3 Date of Inspection IT
5. Are there any immediate Am, to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes S-No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes S-Ko
(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 [g-No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes QN-o
9. Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [[].No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes M.No
11. Is there evidence of over application? �/ ❑�l Excessive Pending/ ❑ PAN ❑ Hydraulic Overload _ ❑ Yes [` -N-5
12. Crop type 5;4" /7lLAVa f r/ —/ [ M411 (�2h, Ab'1tY/ii 41 e— Ines
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ®'No
❑ Yes 8-No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes El -No
❑ Yes [Sfo
❑ Yes E3-NO
❑ Yes nru
❑ Yes [9#o
❑ Yes ZINo
❑ Yes M-Ne-
❑ Yes BWo
❑ Yes ®'lam
❑ Yes ❑-No
❑ Yes C2176­
IM
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
Comments'(refer to :ques4on #)r.:Explam auy:YES ansttien androi any reeommendations or-eov othereomments.."
Use drawings of facility to better exphun situations. (use addttional.pages as petessary),.❑Field Copv _�. v.: _ -� ..
_ �,. - ❑ Final Notes n
/Atf WO
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 s y
Continued
05103101 s y
Continued

Facilih \umber: 3 — Date of Inspection
Odor Issues 3/ , Q
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
[g'50
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? -
❑Yes
D"Qo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
R2,io
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
6'9%
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
El Yes
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
,,..LTNo
.._7�A�,
I..vo0
32. Do the flush tanks lack a submerged.fill pipe or a permanent/temporary cover?
❑ Yes
R-10
Additional'Comments:-and/or.Drawings::
05103101

V
Type of Visit to Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification J6 Other ❑ Denied Access
Facility Number Date of Visit Time:
10 Not Operational 0 Below Threshold
Permitted 13Certified O Conditionally Certified [3Re tstered Date Last Operat or Above Threshold:
Farm Name: rOS�S7S1 �SO[!J� County: li�L2!✓
/ J
Owner Name: -S'y5-F_m Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No: /
Integrator:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude F--70 =` =a Longitude =' =` =`
Design
I'llCurrent
_< Design',. Current "-�. Design Current
Swine Ca city
Eo ulation�
Poultry Ca aciri P,o ulation Cattle Ca aci P,o ulation
❑ Wean to Feeder
11 ❑ Layer I❑ Da
❑ Feeder to Finish
11 ❑ Non -Layer
I❑Non-Doi
❑ Farrow to Wean
�`-
❑ Other
❑ Farrow to Feeder
Farrow to Finish
Total Design Capacity
LJ Gilts
Total SSLW
❑ Boars
Number of Lagoons
❑Subsurface Drains Present ❑ La oon Area ❑ Spray Field Area
Holding Ponds/Soolid Traps
❑ No Li uid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
- b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑Yes 0No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
ONo
❑ Yes
$No
Yes ❑ No
Structure 6
Continued

Facility Number: — �p Date of Inspection I �7%6�031
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? -
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
[I No
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9.
Do any stucmres lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Aonlication
10.
Are there any buffers that need maintenance/improvement? _
❑ Yes
❑ No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
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
❑ No
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
yrNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
EgNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
tcl eats"(refer to'!question #)E'xplam any YES answers and/or any. ecommeodationsror any other=comments 3�w, ! _-"Otll
Use drawingsof faeility to better`explatn'situations (useadditional pages as necessary) -: ❑ Field Couv ❑ Final N
,.+
%r/ES-; rNSP�T�dn7 Oon1E �CA�1s6 Pie v55Z�� oatlD G
�F 1��S7E i�O7•z�EO Fom �W� F�ov�e�
No F✓2zoE,jC45 LOF -gljy %�SCNA,F«5 40R /'4s7 Vzz502,4 ESQ
F4695619
Reviewer/Inspector Name /�-' ° x • 4
Reviewer/Inspector Signature: Date:
05103101 Condnued

C
Facility Number: Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
Cl Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
❑ No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
❑ No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
❑ No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Il) �� ��F/G ��Y� l!%/15<G RPPG�GR�1TzanYa SOR➢���Pa-
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LE}5 �Fp 7 f�ouRst IJO W
Puy op� ucC-
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,✓
PROatFMi %Fl r m��N c aP0jFpL
— TPRNK5 f-�OR 12�Fr00C, 000PF9f-TZ--I/F_,
05103101

Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
M Permitted M Certified 13 Conditionally Certified 13 Registered 10 Not Operational Date Last Operated:
Farm Name:.Eco.Systems.L(Sows).................................................................................. County: Duplin WIRO
OwnerName: ................................................... Ecasyslem.Farms..Ine.........................
Phone No: 293-36.07 ...................................................................
FacilityContact; ...............................................................................Title:...............................................................
Phone No:....................................................
MgilingAddress: 444.Sammy..Gudwin..Lane..............................................................
Warsaw..NC ........................................................... z8a9R ..............
Onsite Representative: ..........................................................................................................
Integritor:MLirplhy..Family.Farms......................................
Certified Operator:................................................................................................................
Operator Certification Number:.........................................
Location of Farm:
Latitude =, =, 0" Longitude =• 0, ="
"Design-- ,r urrent <:­- Jpipsign., .-Current-,
Swme� Poultr Cattle
Capacity Population` Y Capacity Population_ ;Capacity Population
® WeantolFeederLayer ip airy `
® ee er to ims = p on- ayer [:I on- airy
® Farrow to Wean _
p Farrow to Fee er ❑Other
Farrow ro Finish - Total Dest nCa act 4,900
p Gilts g _ P tY
❑ Boars Total SSLW' 1,662,500
_ �Nuinber of Lagoons W� ®Subsurface Drains Present JIM Lagoon Area p Spray ie tea '_'
_ Holding _Ponds/SolidTra`psy0 =p No Liquid Waste Management System
Discharzes & Stream Impacts
1. Is any discharge observed from any part of the operation? Yes p No
Discharee originated at: p Lagoon p Spray Field p Other
a. If discharge is observed, was the conveyance man-made? []Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) Yes p No
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 p No
2. Is there evidence of past discharge from any part of the operation? p Yes p No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? Yes p No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? p Spillway Yes p No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ............... 2-4...............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, Yes []No
seepage, etc.)
3/23/99 Continued on back

acility Number: 31-196 Date of Inspection
6. Are there structures on -site which are not properly. addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application -
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding p PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
1' iro.vloranons or. uenewircres.were,nntea -auring.!gts visit. • x ou wiu -receive na turtner. - .
............................... .... ........ ......
i tirresboudence aboirf this :visit:
freeboard available. No problems detected.
p Yes []No
p Yes p No
p Yes p No
p Yes p No
p Yes p No
p Yes ❑ No
p Yes p No
p Yes p No
p Yes p No
Yes p No
p Yes p No
p Yes p No
[:]Yes p No
p Yes p No
p Yes p No
p Yes []No
[]Yes p No
p Yes p No
[]Yes []No
[]Yes p No
p Yes [:]No
Reviewer/Inspector Name
Reviewer/Inspector Signature. Date: )

(Type of Visit ;5 Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: [
'Permitted ❑ Certified E3 Conditionally Certified ❑ Registered
Farm Name: G LO SyS��3)
.................... i.......... .......
rr............... ...... ..........................................
Owner Name:......C..`7 S�ev'�.,_F"A ✓""�l{ rn i
Facility Contact:
Title:
i
Not
Date Last Operated or Above Threshold: ..
County: D.V. '.11. a .............................
Phone No:
Phone No:
MailingAddress: ............................................................./.�............................................................................................................../...........y.�............... ..........................
Onsite Representative: .... !.L...STO..G.1�..✓................................................. Integrator:.....�.U`r�"�'-'..f_�.�.J.........................
.......................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
,O swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =* =1 =« Longitude =0 =- =,-
Design Current
Swine - Canarifv Ponnlntinn
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
❑ Other
Total Design Capacity C
Total SSL_W'- C
No Liquid Waste
Area J❑ Spray
vtsenarees & Ntream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes 36No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other -
a. If discharge is observed, was the conveyance man-made? ❑ Yes 5YNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 'ONo
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 ONo
2. Is there evidence of past discharge from any part of the operation?
[]Yes fi3TIo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................ I./ .................. .................................... ................................... .................................... .................................... ....................................
Freeboard (inches): , Z(
5/00 Continued on back

Facility, NumbeDate of Inspection $Qp Printed on: 7/21/2000
5.�Are
there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes WNo
seepage, etc.)
-
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
1
closure plan?
El Yes IYI No
(If any of questions 4-6 was answered yes, and the situation poses an
777���
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes >d No
8.
Does any part of the waste management system other than waste structures require maintenance improvement?
❑ Yes JgNo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes 0 No
elevation markings?
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes ONO
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes ONO
12.
Crop type > eSLUGI/)/G1,ti✓ ljru55 eeY-iVAt� rq LC
pine --rror-d
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Manag4ent Plan (CAWMP)?
❑ Yes z9fNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes ;ETNo
b) Does the facility need a wettable acre determination?
❑ Yes ;O'No
c) This facility is pended for a wettable acre determination?
❑ Yes)z No
15.
Does the receiving crop need improvement?
❑ Yes ONO
16.
Is there a lack of adequate waste application equipment?
❑ Yes'XNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available? -
❑ YesXNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes o
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes _V,,,,!!(!
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
,,,--No
❑ Yes /0No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes 9mo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes/21"No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes,ffNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes j No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
[]Yes ,� No
..
did viblatipt....... e.... •were ...... ing this:visit; Yoit will i eceipe do fui thgr
comes oridence: abotif this :visit
Comments (refer to question#): Explain any YES answers and/or any recommendations;or any other comments
_
",drawings of facility to better explain situations. (use, additioriatpages as _ueces saty)Q- ,
'
.`
rviA
re to r0( 3 Are Vere We// Ae .
Reviewer/Inspector Name - vl¢ ti✓�.l!
Reviewer/Inspector Signature: Date: .�1'17 1 5/00

Facilitg Number: — Date of Inspection
ddor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes XNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes P?No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes );�No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes ;eNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes F,�'No
/❑
32.
Do the flush tanks lack.a submerged fill pipe or a permanent/temporary cover?
❑ Yes No

Routine Q Com laint O Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection 6 G
Time of Inspection 24 hr. (hh:mm)
Permitted E3 Certified [3 Conditionally Certified 0 Registered JE3 Not Operational Date Last Operated;
FarmName: ........... L lS.......................................................................... County: .................... ..._11,
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
Mailing Address:
................... . ...................................................................................... ..
OnsiteRepresentative: 1C\ h���Q ...Integrator..........................................................................
.............................................................................................................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude =•=` =« Longitude =•=' =14
Design --`' :.Current Desi _ gn ;Current .'Design .Current
Swine - Capacity- Population Poultry Canacitv.Ponulatian "Cattle
❑ Wean to Feeder
Lt66
❑ Feeder to Finish
OC1 6
❑ Farrow to Wean
6
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
❑ Layer
1
❑ Dairy
❑ Non -Layer
1
❑ Non -Dairy
Total SSLW
❑ Subsurface Drains Present ❑ Lagoon Area JoSprayFieldArea '
❑ No Liquid Waste Management System
Inscaarges dr Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes 19No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes D�No
❑Yes [$No
[]Yes '14 No
Structure 6
Identifier:
Freeboard (inches): ............3 ..............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONO
seepage, etc.)
3/23/99 Continued on back

1\.
FaciliWNumber: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over
12. Crop type
❑ Excessive Ponding ❑ PAN
13. Do the receiving crops difT'er with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
yiola{igris:ojr- di f cien6t,9 were hOfed d. (WMg 4.hjs;visit. • Yoit will-receipe yid fuilher
coriesporidence:ab66fthis visit:"' :.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:•:•:::::::: :
❑ Yes WNo
Oyes ❑ No
CE(Yes ❑ No
❑ Yes �dNo
❑ Yes RNo
❑ Yes X No
❑ Yes KNo
❑ Yes No
I
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 5(No
❑ Yes J( No
❑ Yes JWNo
[]Yes XNo
❑Yes NjNo
❑ Yes N$ No
❑ Yes t�No
❑ Yes %No
❑ Yes Wo
❑ Yes No
❑ Yes ® No
I� ` e" _'.2 F-ab <4 8tL_t3 4._� T. WAS /m'C.�1�tti `Tw4-. 1 a'LG kiv
ca L_ Z - a t•_,2 \`--* e l..Vj\ Q�c51 c ,, �✓�tlR f leV2 I + C✓Qhi`Jr�1 Ct�
W 16'
fit J fit:.-eq
Reviewer/Inspector Name `_
Reviewer/Inspector Signature: wO (_ A N" -, 'ZZ7� Date:

Facility Number:,( Date of Inspection �o
Odor Issues
26. 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?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Q�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0�`No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes j�'No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes VNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes J�(No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes M No
AdditionahComments and/or Drawings.
`^"�jjc.,
I V:� ,
3/23/99

E
r Division of Soil and W-atereonservahon - Operatiovicet ew
iDivsion of Soil and-Water•Coaservation -.Compliance Inspection , r':-
Division of Water Quality Compliance Inspection r
Other Agency -Operation Rewew
11PRoutine OComplaint 0 Followup offDDWQ
Q inspection 0 Follow-u of DSWC review 0 Other
Facility Number Date of inspection
Time of Inspection 630 24 hr. (hh:mm)
Permitted 0 Certified 13 Conditionally Certified Q Registered 113 Not Operational I Date Last Operated: ..........................
FarmName: ..................................................................... County:...... .......:....�........................................ tlr�
OwnerName: ................................................... ............................................... Phone No:.......................................................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress: ................................ .............................
Onsite Representative:.,.._\.`\)F���e� Integrator: %%��JJ��
.......................................................................................... ......I_CyL`.�.... ( .................................................
.. .
Certified Operator: ................................................... ............................................................. Operator Certification Nunrber:..........................................
Latitude =•=' =•. Longitude =• =' ="
Swine
Current - Design - Current
Population .Poultry' Capacity. Population' -Cattle
Wean [o Feeder
I LfOO
Feeder to Finish
I COO
Farrow to Wean
1Scto
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons- .-
_Holdiiig Ponds_ / Solid Traps
❑ Other
Total Design Capacity
Total' SSLW
J0 Subsurface Drains Present �2 Lagoon Area
❑ No Liquid Waste Management System
Current+
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ((No
Discharge originated aC ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
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 ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes N�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes M No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ...............................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? fie/ trees, severe erosion, - ❑ Yes KNo
seepage, etc.)
3/23/99 Continued on back

• Faciliy Number: �j t — 6 Date of hrspection
O
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
No
(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
No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
IVI No
Xy
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
O No
11.
Is there evidence of over application? ❑ Excessive onding ❑ PAN
❑ Yes
4 No
12.
1
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination? -
MYes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
[9 No
15.
Does the receiving crop need improvement?
❑ Yes
NINo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
O(No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ff No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes r','No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes [X'No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes JNfNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes M No
24. Does facility require a follow-up visit by same agency? ❑ Yes VNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ZNo
0' iVq violatititis or deficiencies were itgfet7• ditg this'visit: • Yoit :wiii-tebeipe ti6 further '' :
corres ondei tie'about.thfs visit
- m. _.
Comments (iefei to gteshon.#):Explain any YES -answers and/or.any recommendation's orany other coments -- -•�
`Use drawings:of facility to better:. -explain situations e(use.additional pages a's necessary):.� - _
s= _
AriU2 �' S cl P4j
IReviewer/Inspector Name
Reviewer/Inspector Signature `'1 Date: 4 15-A 9
3/23/99

• Facility Number: — ,6 Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
Yes
ElNo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
,< No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. brokenlan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
X No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Oyes
❑ No
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
Q Division of Water Quality
Follow-utiof
Date of Inspection d Z 9
Facility Number �_-�-�—•��
11 Time of Inspection 1 24 hr. (hh:mm)
U Registered 1P Certified 0 Applied for Permit ;Q Permitted 113 Not Operational Date Last Operated:. ..........................
FarmName:......... .0..... C}SA.......:k.�.......: l[x�................._. Sy..................................................................... County: ...........................................
Owner Name: .............. E." Gar.Lk i............................................................. Phone No:.....�R.l�� 7SI3 -_36p 7
.............................................................
Facility Contact: .... ;ai4....S.6tku.................................... Title: ...... Mttr,n4
p� __ JkL.:• ................................ Phone No: ...................................................
Mailing Address: ...........NCtC�k3.....iy[4�k...... :..kja..................................................................................... .:��.3�Q.......
Onsite Representative: ........ MOLL ... ..]tB.Lttaet.................._........................................ Integrator: ....
'.�N}...............................................................
Certified Operator: ............................... :........._,.................................
................................ Operator Certification Number:..: . _.............
Location of Farm:
1U Subsurface Drains Present jj❑ Lagoon Area
❑ No Liquid Waste Manaeement Svstem
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is.observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gatlmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes [3No
❑ Yes P No
❑ Yes 1$ No
❑ Yes
W No
—KIIA,--
❑ Yes
eANo
❑ Yes
'QNo
❑ Yes MNo
(AYes ❑ No
❑ Yes [A No
❑ Yes CANo
Continued on back

Facility Number
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
[A No
Structures (Lagoons,tlolding Ponds, Flush Pits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
0 No
Structure I Sim cture 2 Structure 3 Structure 4
Structure 5 Structure
6
Identifier:................y............................................................................................................................
......................................................................
Freeboard(ft): ............`.`..5....................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
® No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12.
Do any of the structures need maintenance/improvement?
(Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
pa No
Waste ADDlication
14. Is there physical evidence of over application? ❑ Yes 0 No
(If in excess of WMP, or runoff entering
nt�e ing� ,w}�aters of the State, notify DWQ)
15. Crop type ........... cSGUG.............. C ux..'. A ....................swo., 1......1!rkn...............�.1:!s SJrcss............................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 0 No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.vioWions•or deficiencies were noted during this.visit. You'wiU receive ito further.
................. .......................
eorrespWtdehu about this:visit: '
❑ Yes X] No
Pes ❑ No
❑ Yes [%No
1P Yes ❑ No
❑ Yes Q9 No
® Yes ❑ No
❑ Yes q No
Yes ❑ No
Yes ❑ No
S. uvasscc) Wk W ways ivy Eftld tf�'t Slnot)ld btM cd c1ctY�
lz. Fveyiorr aar tt0r `i(-, auvl - At'i,.`Jk '5'61d 6e (111tf1 aj r%eaw. Bart- att" Sly 16 L4-
YtSt�e.(j
to 4 <eparuFt IRR � Z 6_ each f-n(c� eeeG crop. (� �oon dcsi9
skGOW fie. Pr, plow.. pu 14
Z4./,,C, tjtkv j« oru-.aO.A In 44* t31 �011 18 + fidd;f4, P�(1 z . 3tKA — 11551601�
1# 4, 2 — I oa 16 s%ao ove< oce1- 7/25/97 _

Facility Number
Farm Status: ❑ Registered ❑ Applied for Permit
Eff Certified ❑Permitted
❑ Not Operational Date Last Operated:
Farm Name: 9 5 �.5�^ }..5`. �..........._...._._....__....__....__.......
Land Owner Name:
Facility Conetact:..�.t_�t Title:
Mailing Address:............. __.
Onsite Representative:..$ _..... ....__....__......_...._.
Certified Operator: .... _...
L�O��. {..SCi.j� ...._.
Location of Farm:
county:
Phone No:
Phone No:..�
Integrator: __�}_.�... .._._...._...._....__.
Operator Certification Number:Q �..1
Latitude ©• 02 Zo u Longitude ®• 5q m�
szenerat
1. Are there any buffers that need maintenance/improvement? ®,Yes ❑ No
2. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray field []Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes E No
❑ Yes
19 No
❑ Yes
Rf No
a1A
❑ Yes
19 No
❑ Yes
19 No
❑ Yes
(B No
N Yes
❑ No
Continued on back

Facility Number: .&&...... —.1q..ix._
y 6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Ctructures (Lagoons and/or Holdina Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
CK No
❑ Yes
E[No
❑ Yes
® No
❑ Yes
&No
Structure 5 Structure 6
❑ Yes
19 No
❑ Yes
IN No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type _.b.&.x t:sLA-k..... ..... C.......... ..... Lsa—a..Ll.._yr3i............. ............. __..... ._.....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
® Yes ❑ No
❑ Yes I'No
❑ Yes ErNo
❑ Yes � No
❑ Yes 9 No
IN Yes ❑ No
❑ Yes 19 No
❑ Yes ® No
❑ Yes KNo
❑ Yes ® No
❑ Yes CKNo
❑ Yes ® No
1, s-eto w btttw 12.t}c�- betwee� kizva a;(t1-`i o r.l wrew S ed to 4
p r" C^-x t- r v ,,. o{ f• p
5. =t w o V l d- b e a o c tl r A e-a a +0 e -z (C ,5 i �y � e ;�4k s ✓v�.o V-e of
ti%en^ iv
Y� G.V vk 4, (.e v p c� I e % b ca- E+t 4. I
Iz_ Q'jc k- ro11a.CL e. I a 0.` q)o ov W a L 1 C o-�^-a °-^^'� a tl•�e"i L
a r'f-a V, I.a �-�1 W P. t) . rr t'ct £W S 1 0 VA 4 V-0
O c� t
if. GarTr rj (�ee c( PwLL i. Sr
I�G C b I a D v" el, e-s_.I tic V. n
Reviewer/Inspector Name
Reviewer/Inspector Signature:
cc: Division of Water Quality, Water Quality Section. Facility Assessment
Date:
d/1n/07

0
Site Requires Immediate Attention:
Facility No. 3 1— 19 1,
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: I<V 1995 -
Time:
Farm
Mails
s 53 Ci
County: Ij in l i 0
Integrator. ��U F21" M 6 Phone: T09 — Z I
On Site Representative: /IlitP 2foc U-' Phone: Z93-3(op_�
Physical Address/Location: 2 Z 5 opeo—OCA
5 1 -3DI A�' 1'/�Z wt, %iron, sK 130+ , fc,rm an Krnh-'
Type of Operation: Swine _� Poultry _ Cattle IS5Go5 v
Design Capacity: 34CO 5C US Number of Animals on Site: -�;4&0
DEM Certification Number: ACE_ DEM Certification Number:. ACNEW
Latitude: 35 - O2' lciy'. Longitude: _7? ' 9q_' 5NXr' Elevation: Feet
Circle Yes or No
pal
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard: 2 Ft. (P Inches
Was any seepage observed from the lagoon(s)? Yes o IVo)Was any erosion observed? es es( t
Is adequate land available for spray? Yes r No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o](9
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es r No
Additional Comments:
Inspector Name
/ ' ,Gf" A
Signature
cc: Facility Assessment Unit Use Attachments if Needed.