310572_INSPECTIONS_20171231

NOHTH CAHULINA
Department of Environmental Qual

Type of Visit: Q'Co nce Inspection Q Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
�Y� ICI UI Y 1��IY�� IPII
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ' G IZ r t r
Certified Operator:
Phone:
Integrator:
Certification Number: 1�U 7 6
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Wet Poultry Capacity Pop.
Layer
Cattle
DairyCow
Design Current
Capacity Pap.
n to Feeder
Non -La er
DairyCalf
Feeder to Finish �
-�
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr. P.oultr. Ca aci P,o ..
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Caw
Other
Other
Turke s
key Poults
Other
Discharp-es and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 KNo❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: 3- Date of inspection:
Waste Collection & Treatment
'4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2' o 0 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
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [] Yes o ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑- o0 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 to❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
doNo ❑ 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
NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o A
❑ 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
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No NA
El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Po ❑ 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]" ❑ 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 [:IS ludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 6. ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 214,12015 Continued

Facili Number: - I Date of Inspection: x Y
,24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes gNo
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 ❑410 10 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o A ❑ 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
[�o Q 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
❑ell'o E] 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
No ❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0" lam' ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
to Q NA
❑ NE
Caents (recto gnestlon #} Expla�na©y t;S answers and/or-anyladdrtiooal recominendatians or any other coutments
Ise dr�wrngs:of facrliyfa better expla�u sYtuatas(use addit�unal paged as neeessar3'}1. I . , �I�I s
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: �(n 7q j 7��
Date: 7f�-31 1,
21412015

Type of Visit: Com a nspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: t7 0 Departure Time: vS County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: /� Title:
Onsite Representative: 9 t [ V L_'yl r "
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design C*urrent
Swine Capacity Pop. Wet Poultry
Wean to Finish Layer
Design Current
Capacity Pop.
Design C*urrent
Cattle Capacity Pop.
Dairy Cow
W n to Feeder
Non -La er
I
Dairy Calf
eeder to Finish
9
p
D .ry P�oultr�
La ers
Design Current
C•_apaci P.o ,
Dairy Heifer
Dg Cow
Non-Dai
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
lBeef Brood Cow
Other LrTurkey
Other
Turke s
Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 E rNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes n
IN NA ❑ NE
YesNo ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili N-nmber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ego ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
S_o
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 No ❑ NA ❑ NE
❑ Yes 0No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment I threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 �o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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 ❑ No [DNA ❑ NE
15, Does the receiving crop and/or land application site need improvement? ❑ Yes El o ❑ 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 [TNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes I�o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [TNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�rNo ❑ NA ❑ NE
the appropriate box.
❑W[1P ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L Q 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 E3�N❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes rjrNoo❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: -7,7 Date of Inspection:
24. mid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ej Now❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E3 o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ff�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
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
Ef 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:
I
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
7�'rNiNN❑ NA _
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
I/J NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Reviewer/Inspector Signature: �it� Date:
Page, 3 of 3 21412015

Type of Visit: Qom nee Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 17 o O Departure Time: 3_'County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
C+urrent
Pop.
Design Current
Wet Poul#ry C•apacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
1
jNon-Layer
Dairy Calf
eeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Farrow to Finish
Dr, P,ouItr, Ca aci. Pio
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other IMFTother
Turke s
Turkey Poults
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ❑ <o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

J icili Number: jDate of Inspection: 414)71
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ —&
❑ 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 b
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[]-K-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
0-Ko
❑ 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 ; ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes FfNo ❑ 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 EfNo ❑ 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 M.—No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ YesF:rNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
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
❑ Yes g No
❑NA ONE
❑ NA ❑ NE
❑ Yes No [] NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design [:]Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes d ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes t o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

facility Number: 1 - t 17 Date of Inspection: / 1
24. Did the facility fail to calibrate waste application equipment as required by the permit ❑Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E to ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: {�
26. Did the facility fail provide documentation of an actively certified operator in charge? es No ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No Q'NAB❑ 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 ETNo ❑ NA ❑ NE
❑ Yes No ❑ NA
[:]Yes No ❑ NA
❑ Yes No ❑ NA
❑ Yes ' No ❑ NA
❑ Yes No — NA
❑ Yes No ❑ NA
Comments (refer to question #)::Explain. any. YES answers and/or any additional recommendations or any other. comments:
Use drawings of facility to better explain. situations (use additional pages as necessary).
S % L,.e C d eQa f ry )
Reviewer/Inspector Name: 04Lt,l � R9"
Reviewer/Inspector Signature:
Page 3 of 3
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Phone:
Date:
214.12015

Type of visit: �mpliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 4DrRoutine O Complaint O Follow-up 0 Referral 0 Emergency 0 Other C-) Denied Access
Date of Visit:
I I t J Arrival Time:
/ ; pp.
Departure Time: 0 County:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
f
Region:{
Title: _ Phone: �/
RLr V- � �a �_ Integrator: �� I-IM, 1-4
J
Latitude:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design C►urrent Design Current
C+apacity Pop. Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity P.
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oult . Ca aci P,o ,
La ers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ET�4o ❑ NA ❑ NE
❑ Yes GTI�o ❑ NA ❑ NE
❑ Yes P-No ❑ NA ❑ NE
❑ Yes J I'No ❑ NA ❑ NE
❑Yes YJ1N ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued.

Facility Number: 3 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
4
a. If yes, is waste level into the structural freeboard?
[:]Yes
�, o
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 21
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2T�4o
❑ 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
;Z'—No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes �o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes PJ''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 � o
❑ NA
❑ NE
maintenance or improvement?
j"
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 2po
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Zj"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 Ino ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �To ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reouired Records & Documents
❑ Yes �No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �' o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ fNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E3rNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ,[!fNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ONo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: 2 SL Date of Inspection: Z'
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 P'No ❑ NA ❑ NE
the appropriate box(es) below. TT
❑ 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 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes 0No ❑ 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 .0 No ❑ NA ❑ NE
❑ Yes 6No ❑ NA ❑ NE
❑ Yes ;ffNo ❑ NA ❑ NE
0 Yes ��o ❑ NA ❑ NE
❑ Yes No
❑ Yes WNo
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: ! Date: % Z/_X
Page 3 of 3 /4/24

it ype or visit: .►o compnance inspection V uperatnon iceview u structure r,vaEuanon lJ i ecnnicai Assistance
Reason for Visit: Of Routine 0 Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: �-� ,j Arrival Time:I.L)dl Departure Time: County: Region: Nf
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone.
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
1!Feeder
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Cattle
Da Cow
Design Current
Capacity Pop.
Wean to Feeder
on -Layer
Da Calf
to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C&arrant
D , P,oultr.. C►_a aci r
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
JillOther
Turke s
Turkey Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �' No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes jeNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

4
r
Facilidumber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
❑ NA ❑ NE
❑ NA 0 NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
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?
❑ YesNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes K,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 KNo ❑ 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 KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ . Frozen Ground ❑ Heavy Metals (Cu, Zn, etc))
❑ PAN ❑ PAN > 10% or 101bs. ❑ 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 Cd'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Z�No
No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes t� ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes �No
18. Is there a lack of properly operating waste application equipment? ❑ Yes 0 No
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes n/ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" 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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number :4$ jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes K,No [DNA ❑ NE
permit
25. Is the facility out of compliance with conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes PTNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ONo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ;21 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 VrNo [DNA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes Wo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes KNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Ff No ❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: o_62L x 225D
Date: I �'���j
21412011

Type of Visit: Compliance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit": . outine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time:® Departure Time: CountyRegion:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: V—i aL U (C IL Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current Design Current
wine SCapacity Pap. Wet Poultry Capacity Pop.
Wean to Finish La er
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Design Current
Dr.. P,ouI C:a a�i P,o ,
La ers
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes ❑ No ❑ NA ❑ NE
a What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [:]No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

1
'Facili Number: - ' [Date of Inspection: f(> J y//
Waste Collection & Treatment T
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XN o
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1
Identifier:
�6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
_
❑ NA ❑ NE
❑ NA ❑ NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
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 No ❑ NA ❑ NE
❑ Yes �LNo ❑ 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 F 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 I 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? 0
O11.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): � � W 47 S .� S6 �
13. Soil Type(s): &qCQMm
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes kNo ❑ NA ❑ NE
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.
QWUP ❑Checklists ❑Design Q Maps ❑ Lease Agreements
❑ Yes
VTo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
tRfNo
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
0 Waste Application Q Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑,�&o Transfers
Q Rainfall ❑Stocking Q Crop Yield 0120 Minute Inspections Q Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1 N
❑NA ❑NE
Q Weather Code
Q Sludge Survey
o ❑NA ❑NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Oncility Number: - Date 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 fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ) No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 ❑ NE
❑NA ❑NE
❑ Yes
RNo
❑ NA
❑ Yes
1No
❑ NA
❑ Yes XNo ❑ NA
❑ Yes M�No ❑ NA
❑ Yes _C3d ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Comments (refer to question ##): Explain "any YES answers and/or any; additional orecommendations orFany other comments: N
�v
Use drawings of facility to better explain situations (use additional pages as necessary).
90471dm�
� �C O Q
A U7rL&
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C? M
Date: 4) L_/
21412011

type of visit: W, t.ompuance inspeciwn v uperation Keview V atructure r.vaivaiwn l.J 1 ecnnicai PLssisrance
Reason for Visit: (kyoutinc O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: uon � Arrival Time: ® Departure Time: —1 County: U /t/ Region:
Farm Name:
Owner Email:
Owner Name: R . 1Z . L Phone: 9 j () ` Q% - L ! d'"
Mailing Address: 8 PO FOun► rigov T oL.-,w & u cA Ul LLE , A C eQgS � d
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Zl C.aG (_4/Vl EAz­ Integrator:
Certified Operator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
We to Finish
Design Current
Capacity Pop.
Design C=urrent
Wet Poultry C►opacity Pop':
La er
Design Current
Cattle Capacity Pop.
D Cow
We to Feeder
Non -La er
DairyCalf
DairyHeifer
Feeder to Finish
�&U
Design Current
I) , Pfoul_ . C•_a aci_ Pio
Layers
Farrow to Wean
Farrow to Feeder
D Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke 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?
❑ Yes N No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
No
❑ YesjNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Fpcili Number: —31 - jDate of inspection: 10 1 Q
/
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: LA GooM
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
14No
❑ 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 F� 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? 9
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ 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 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
0 WUP ❑ Checklists 0 Design E] Maps ❑ Lease Agreements
❑ Yes No
❑ Yes No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis Q Soil Analysis ❑ Kaste Transfers
0 Rainfall ❑ Stocking ❑ Crop Yield Q 120 Minute Inspections QMonthly and V RainfallInspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0
No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Q Weather Code
Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: -
Date of Inspection: I Cj I q /
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 ❑ NE
No ❑ NA ❑ 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 ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No XNA ❑ 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? 0
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
❑ Yes No
❑ Yes No
❑ Yes XO
o
ElYes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or "any other comments ` ,
Use drawings of facility to better explain situations (use additional pages as necessary).
dG. P-,,. F_T Cgu,4 F- O JC C_MrU l Y q'T U4"ccADS — Lc[) GI MS 0IC AC-i 1 uF.L
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: T PG' }9 G-_q_5a1
Date: lot 19 // 1
V412011
i1

Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit i36Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: f Arrival Time: Od Departure Time: County: U N Region:
Farm Name: n1Lt~� w���l Am LAN, ECZ FAQ m Owner Email: t�
Owner Name 'I� i�-iLP� ��u/�� JQ. Phone:a�ci��g'yoa�3
Mailing Address: R(P(2) r-G)L.N TCX,.-)N U QEI�AC-A0/LLC—
Physical Address:
Facility Contact: Title:
Onsite Representative: aL,,i I cK
Phone No:
Integrator• �AoL--wQ-b
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 0 0 0, Longitude: a o=` 0"
Design Current
Design
Current
n Current
DesigNA
$wine Capacity Population Wet Poultry
Capacity
Population
C*attle Capacity Population
❑ Wean to Finish ❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer I
I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
Non -Layers
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Turke s
❑ Beef Brood Co
Other
❑ Turkey Poults
❑ Other
Nunn a of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 )tNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
�No
El NA
❑ NE
El Yes.
*o
❑ NA
❑ NE
12128104 Continued

"l
Facility,Number: 3 — a Date of Inspection FM/0:1
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: L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes] No
[INA
ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are.not properly addressed and/or managed
❑ Yes ONo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes kNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes M No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 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) ca q-1t/ C-3 t+64-1 S r � S <�) 9 (=
13. Soil type(s) f—CX7_a5 i 0"y
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
Cl NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
A No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ NA
❑ NE
I & Is there a lack of properly operating waste application equipment?
❑ Yes
J?�No
❑ NA
❑ NE
dor anyecomdaonsoanyhommentsComments(referto question -#):.Explain any YES-answersaner
Use drawtn s of facffi to better.ex lain situations use additional a esras necessary ,M
g tY a.< P.. P g
Reviewerllnspector Name „� N S ;. � b � Phone: 9 r 0 " 1f a "� 4
Reviewer/Inspector Signature: Date: �_7! AO
Page 2 of 3 12128104 Continued

�FacilitpNumber: "3 j — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Per � readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. 0 WUP ❑ Checklists
0 Design 0 Maps ❑Other
_�,`
1
❑ Yes KNo ❑ NA ❑ NE
❑ Yes ANo ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑.W/aste Transfers ❑ f rnual Certification
Rainfall [] Stocking 0 Crop Yield 0 120 Minute Inspections El Monthly and V Rain Inspections '❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes 9No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
ElYesiNo
No ❑ NA ❑ NE
El Yes ❑ NA ❑ NE
❑ Yes INNo ❑ NA ❑ NE
❑ Yes ❑ No )p NA , ❑ NE
❑ Yes
KNo
❑ NA
❑ NE
[]Yes
PfNo
❑ NA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
5(No
❑ NA
❑ NE
❑ Yes
jNo
❑ NA
❑ NE
Additional Comments and/or Drawings: 3
�coP� S
Page 3 of 3 12128104

._4
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: u A/Region:
Farm Name: ZI C.4. of-U_")lul Qfn LANIE2 � Pt2ML Owner Email:
Owner Name: lL 1�i� Ae � � • L M I E P, n Phone: � J9) one
Mailing Address: g� FOUNT P/)q TO��N ?-6 _ �E(ILP U r L , _� Ye, Q ES) .
Physical Address:
Facility Contact: (� Title:
C
Onsite Representative: a 15 '�4 Cr— Lr4,yiER
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 c = . = Longitude: [� o = s =
Designn C•urreat
Swine Capacity Population Wet Poultry
Design
@apathy
Current Design Current
Population Cattle Capacity Population
❑ Dairy Cow
I Dairy Calf
❑ Wean to Finish 10 Layer
❑ Wean to Feeder ILI Non -Layer
Feeder to Finish WO $ S C�
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
El Farrow to Finish ❑ La ers
Gilts ❑Non -La Non -Layers
pBoars El Pullets
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑Other
I
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes )� No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes 0 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes �No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection 09
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes} No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 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
0No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
*o
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
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 Driiftt ❑ Application Outside of Area
12.
Crop type(s) Coq A( WH-CAT S 1J 1>E `I-
13.
Soil type(s) C-Cx_es' TC�-AI
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
A No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
gNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
Kul No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
ANo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
*o
❑ NA
❑ NE
COmmentS refer t0 ElestlOn i EX lam an ' YES'anSWe[S and/or an recomm � � �� �
( q } p y y , endahons or anv othVer comments
' .9 P p g;: � ry)- '�
Use drawin s offacih to better ex lam s�tuahons use:addthonal a es as necessa
��T GaP 0 rr C_1g(Zl� 7lox/ lot 4 pu-r W f R.F_c�c iLb S
Reviewer/inspector Name o / e Phone: q /d 396 4'Ka3
Reviewer/Inspector Signature: Date: 3/3010q
Page 2 of 3 12128104 Continued

Facility Number:3) Date of Inspection o9
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes .6-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ) ] No ❑ NA ❑ NE
the appropirate box. [D WUP 0 Checklists ❑ Design ❑Maps ❑Other �
21. Does record keeping need improvement? if yes, check the appropriate box below. Yes KNo ❑ NA ❑ NE
,0 Waste Application KIA;
eekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑/aste Transfers ❑xnual Certification
fA Rainfall ❑ Stocking 0 Crop Yield 0 120 Minute Inspections Monthly and I" Rain Inspections 0 Weather Code
Al
22. Did the facility fail to install and maintain a rain gauge?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to property 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?
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
X NA
❑ NE
❑ Yes
'4 No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
PfNo
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes NJ No ❑ NA ❑ NE
Page 3 of 3 12128104

III 1
Division of Water Quality
Facility Number O Division of Soil and Water Conservation
- - Q Other Agency
Type of Visit Alcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1370C Arrival Time: ® Departure Time: County: �c�N Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: J Title: Phone No:
Onsite Representative: 64yi lS CjafLuu l UC / I cr- „ LA,"o;(— Integrator•
Certified Operator: Y`-lIaQ.� T� �tN� �� Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = g = Longitude: = ° = d
1. Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
----
Other
❑ Other - -
.Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design , Current
Cattle Capacity Population
❑ Daity Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[:]Yes
ZNo
❑ NA
❑ NE
❑ Yes
jallo
❑ NA
❑ NE
12128104 Continued

e
Facility Number: Date of Inspection �t1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes _KNo ❑ 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: 6<00/J
Spillway?:
Designed Freeboard (in): I7,
Observed Freeboard (in): IA
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 VNo ❑ 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 TNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ro ❑ 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 V No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
KNo
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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 CA WMP? ❑ Yes
10 No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
4'No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
$d4No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
G �
Reviewer/Inspector Name A MA&D (X&S Phone:�1'%�-!
Reviewer/Inspector Signature: Date: Was
12128104 Continued

Facility Number: 31 Date of Inspection n�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes allo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the approprrate box. ❑ W"Up ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ON.
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KNo
❑ 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
EjNo
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
fg""o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
JKNA
❑ 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
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
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

I
Facility
Qf Division of Water Quality
0 Division of Soil and Water Conservation
Q Other Agency
Facility Number
of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Acce/ss/�'
Date of Visit: (� Arrival Time: S Departure Time: ounty: G Z Region: `� —, �U
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 'Title: ,1 Phone No-
Onsite Representative: �C �!�" ' `C�d11'4 tegrator: _ "eo�
Certified Operator:
Back-up Operator:
Location of Farm:
F
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = f Longitude: = ° = 4
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Feeder
Feeder to Finish
LJ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
I IL I Boars
Other
❑ Other — - -
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
ElNon-Layers
El Pullets
ElTurkeys
❑ Turke Poults
❑ Other
Design Current,
Cattle Capacity- :Population "
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
Beef Feeder
Beef Brood Cowl
is
i
Number of Structures:.,,,
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [I Structure El Application Field El 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 � No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes fi�No ❑ NA ❑ NE
❑ Yes Z(No ❑ NA ❑ NE
I2/28/04 Continued

1
Facility Number: —
Date of Inspection ZZ D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ 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?: / ►/O
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA [3NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �XNo El 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 ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ff 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes ,19No ❑ 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
JZ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
y 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
eNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or'any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
r Lf �Z/V�. ����11'� �i✓ ��Qr�i
Reviewer/Inspector Name Z2 Q Phone:
Reviewer/Inspector Signature: Date: 5 .2
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection 2 O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWW readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONO ❑ 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
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
JZNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RfNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
'ONO
/ONO
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
❑ No
ElNA
[3NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
//
❑ Yes
VNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
XNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
�f
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
/� No
❑ NA
❑ NE
Additional Comments and/or Drawings:
AR c/�S-� �7�OSi 4'V/_v'
"/�� f� �ofz �i✓ZD .�oD��- ��.�I-�C�'.e/}-zi✓ Cror�,� C/1O� (3��/�✓
e
a
Page 3 of 3 12128104

■
Facility Number s ti
G Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit ,Conmpliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit cD Routine Q Complaint 0 Follow up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit:
Arrival Time:
Departure Time: County: �+'V Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ,, �]] Title:
Onsite Representative: fl� ��}}
_� AI&911
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: e= 6 0 Longitude: = 0 0 6=
Design Current Design Currents;
Swine Capacity Population " Wet Poultry Capacity Pop
ulation°
❑ Wean to Finish 10 Layer I[
❑ Wean to Feeder ❑ Non -Layer
_Weeder to Finish
1 8 G
❑ Farrow to Wean
❑ Farrow to Feeder
❑ barrow to Finish
❑ Gilts
i
Dry Poultry
�❑ Boars
Other r ;�
�11
❑ Other
Non-L
Pullets
Turkey Pouets
Other
attle 'Cad
Dairy Cow
Dairy Calf
Dairy Heifer ^
Dry Cow
u r4un-Lai
❑ Beef Stocker
_ ❑ Beef Feeder
❑ Beef Brood Co
rNumber 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 dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
Cl Yes
,❑l
VN
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
12128104 Condnued

Facility Number: — 1. Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �..�
Observed Freeboard (in):3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
XNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑/Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
'❑ No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
[] Yes
0No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
['lo
❑ NA
❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) CLJS 6 6 R440*-(4) S 6 Z)
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?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
19. Is there a lack of properly operating waste application equipment?
❑ Yes
[0 No
❑ NA
❑ NE
�No
❑ NA
❑ NE
ErNo
❑ NA
❑ NE
E/❑
NA
❑ NE
WNo
El NA
[I NE
Comments (refer to question #): Explain any YES answers and/or.any recommendations or any otheucomments
Use drawings of facility to better explain situations. (use additional pages as necessary):
7,) Pugy, ►Ve6p D oA/ ,( XASS CoVOL �'f AL
w
Reviewer/Inspector Name f �df� to L Phone: t) S • 7r
Reviewer/Inspector Signature: Date: Z.
Page 2 of 12128104 Continued

•I
Facility Number: —'157y Date of Inspection EV/ t
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 CAW -MP readily available? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21,
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
U(No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain
Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
IdNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
� No
❑ A
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
ElNo
NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
IyJ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
1� NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
WNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
[INo
❑ 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?
El Yes
o
❑ 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
O�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
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ElYes
No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

H S7z-
Type of Visit 6
,C.,olmpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit tdRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: �, Title:
_,�
Onsite Representative: R�
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o ='
= Longitude: = o =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
�� ❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes MNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
El No
❑ Yes
L'-t'N0 NA
❑ NE
El Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
c
Waste Collection & Treatment
4. Is storage capacity (structural plus storm 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: L66w nJ
Spillway?.
Designed Freeboard (in): ltf.
Observed Freeboard (in): .36
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ff No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[:I o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
LI No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
��
EI No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s) QV-R-m V O X C 6) C, ,,5 S GO
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes El No ❑ NA ❑ NE
l5. Does the receiving crop and/or land application site need improvement? ❑ Yes l _J No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination', El Yes 23'No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 2-go ❑ NA ElNE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 10 ❑ NA ❑ NE
at.J L-PJDA T ( Y2R-fl F4R,&jS-
w ki -LS-Mt WAS (�,ce:0 CkQ'JC ANP f-j-C-c_
Reviewer/Inspector Name L}o N Atzrl6L:. - .I Phone: L9�a .T�6 7a /�'
Reviewer/Inspector Signature: Date:
12128104 Continued

FacUity Number: 31—,� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ENo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L"I No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
IJ Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Wee y Freeboard El Waste Analysis ❑ Soil Analysis
El Waste Transfers
El Annual Certification
❑ Rainfall ElStockin— Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ YesdN`o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ld No
NA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ElNo
,❑l
ETNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
DINA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
E NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 1�o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�2No ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
D o ❑ 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
ONo ❑ 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?
El,No Yes
❑ NA
❑ NE
Addition$I Comments:and/or Drawings_
12128104

Type of Visit Mompliance Inspection O Operation Review O lagoon Evaluation I
Reason for Visit Orl�outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number S -z Date of Visit: t d + a K Time: �
Q Not Operational Q Below Threshold
dPermiitted Certified Q Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: _W M—MU-M II? ...9 - 50 Lq —Eqk . County: 0 ups
Owner Name: _ . RIMA" i.pNAf F-, .... _ , , 'Phone No: 21Q Z9 8 - 92 37 . _.-. . .
.Viailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: �►�� SF2 • Integrator. CAMio(,4',S
Certified Operator:
Location of Farm:
Operator Certification Number:
a
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • « Longitude • < «
Desrgn ,+....1..t 3 k s ri�....
Li.ILLsB
i Cut i+eut .' Dew C eat
Swine — -Y. 4 youPouitry , Po ; Po tioa
Wean to Feeder
Layer
Dairy
Non -Layer
- Non -Dairy
EffFeeder to Finish
gj 1)
8
Farrow to Wean
OthFarrow
t
to Feeder
r
T4tSX Ii eSl��,.
Farrow to Finish
Gilts
T6W �LW
Boars
, w
z.—e r
'.a�,�F`"11
.
Discharges &Stream Imp its
1 _ Is any discharge observed from any part of the operation? ❑ Yes dNo
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 dNo
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 LTNo
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: — 1
Freeboard (inches): 2 d
12112103 Continued

Facility Number: 3 } — Z Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? �(ie/'trees, severe erosion,
❑ yes
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑yes
[To
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 maintenanceJimprovement?
❑ Yes
1?1�0
8. Does any part of the waste management system other than waste structures require maintenanct!unprovement?
❑ Yes
B<O
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
Elo
elevation markings?
_Waste application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
B o
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
l.�o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type bQl SG(O
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ETNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
0140
b) Does the facility need a wettable acre determination?
❑ Yes
[QNo
c) This facility is pended for a wettable acre determination?
❑ Yes
PNo
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
EJ-No
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes JnZNo
liquid level of lagoon or storage pond with no agitation?
IS. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 1314o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 6 o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ yes [ rio
Air Quality representative immediately.
;--^--a-�- —---•..W ��� r ��"-s� �_.�..=�r��-',_.- � � ^ems ..�= -- � .i .�.x, a, - ��„�
'-
E[be �3ravvmgs of fari�ty to better acplam sstaatnms.�{:�drhi� l � r3' ❑Field Copy ❑ FfnaI N ores
vsEwC� C. C,,>Pa 2P POe LA01:61-,
n1 & J . wv J2 _T rn 1GzN G �14C,Y i t T r g rC' �,�r�,? fin! Gr §Te �a-r �Z'%q,�6�
YETI 1,Ed�E AGR-Erg, EN r Zs1 �i.Ac ,
SeN �.rf i�f►P a�n.K -1'd dt7n-T-'�j w6l'j P6P-WIXT APJ I' QUESTEWS Cba
r./�u ti w► (A LL °I1 p 3 S 39700 eD&►. V 3Hv
1;
w ,�-
Reviewer/Inspector Name,tL?O��
Reviewer(Inspector Signature: Date: /a }
12112103 Con2Ynued

Facility Nu&ber: —5 7 Date of Inspection t b
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [�io
22. 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
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [3/No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes dNo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes O No
25. FaiI to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑Yes o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [` o
28. Does facility require a follow-up visit by same agency? ❑ Yes o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑Yes IJ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes E No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
l2/l2/03

ision of Wa#er Quality
y Division -of Soil and Water Conservation
H rY O.Other AgeRCy } �n
Type of Visit 0 Compliance tnspection 0 Operation Review O Lagoon Evaluation
Reason for Visit eRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: 2 Time- 0019 Printed on: 7/21/2000
Facility Number
O Not Operational O Below Threshold
[] Permitted [] Certified (3 Conditionally Certified © Registered DVa5t Operated or Above Threshold: ..................
Farm Name: .. T� ._,%.�.`..._.... �%�/. F Q.� %ti!,�..LI 'j. County:. L �jv ......................... f�..
Owner Name: i'1 �L�/..11..........�yt°11?�Q................ Phone No:............................. ..
Facility Contact:
Title... ...............-.......
Phone No:
Mailing Address: ..................�/'
.........................._...........................----...............--•• .------.---.-------•--........................... ..........................
�OnsiteRepresentative::................ .�/ .._.. Integrator:.... ..(.!/5 .......................................
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� ��
�« Longitude
Design Current
Design
Current Dcstgn Current
She Ca ci Po ulation
,-�..
Poultry Ca aci
Po ulation Cattle . , Po uiatioitz
Wean to Feeder
❑ Layer
❑Dairy
sip
r
eerier to Finish 000
❑ Non -Layer
10 Non -Dairy
Farrow to Wean
' "
Farrow to Feeder
❑ Other
`
Farrow to Finish
Total Design Capacity
?+
:;. ----------------------
Gilts
Boars
Total'skW -
_ umbers" of%agoaiis Subsurface Drains Present ❑ Lag-= Area
_okl�ag:Ponds/Soltd Tsags . No Liquid Waste Management System
I0 Spray Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes AO
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 ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes "R<o
SCrUC:ture i Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .................................... ............... .................... ................................ .... ............. ..................._...................
..... .... .
Freeboard (inches): 35
5100
Continued on back

11
.d . L
Facility Number: 51 — Date of Inspection f
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Anulication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? Excessive Ponding ❑PAN ❑ H
12. Crop type /)')///1i4— 4� /L
i /�_L l r� Aw
13, Do the receiving crops differ with those desigSated in the Certified Animal Waste Mana;
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?
Overload
Plan (CA
16. Is there a lack of adequate waste application equipment?
Required 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/ WL1P, 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?
❑ Yes /INo
❑ Yes �No
❑ Yes U(No
❑ Yes 'VNo
❑ Yes )YNo
❑ Yes ,No
❑ Yes No
❑ Yes �No
El Yes )dNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ENo
Cl Yes YNo
❑ Yes ff No
El Yes 03o
El Yes
No
❑ Yes No
PYes ❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑Yes IdNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? El Yes XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
r.eM6_m,'fi"inA(refer to question: Etrpla'ui any YESanswersandlor any recommendattousor any other comments
a,..`
Use drawings of facilitto better explain situations: (use additional pages as necessary).;
_ Field Copy ❑Final Notes
IV) luteD 70 &P
G'Ff � � �Fz�D 12-oqA��2
Norf; /C���Ltgs o>J Go KF'o Gam.
I�ICCWQ 5
Reviewer/Inspector Name �d
Reviewer/inspector Signature: Date: D
05103101 Continued

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 []Yes I�INO
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 VNO
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 XNO
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 RNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 70
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes zP No
I'AdditionaU Comments andlorr mwings:
�.m .
0,
2,2,',-
5100

Type of Visit AGompliance Inspection O Operation Review O Lagoon Evaluation
Reason for VisitArRoutine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 1
Date of Visit: I
0 Permitted © Certified 13 Conditionally Certif�i�ed�,t [3 Registered
Farm Name: ' � � SO "�L erjOt' w� F rvn
_..........................+'1................h.......................... ...................
}.... I
Owner Name: ............... .M i ........fi..................................................✓ � .........O
EllTime:
Not Onerational O Below Threshold
Date Last Operated or Above Threshold: .................. ....
County: „ V�-r..........................
Phone No:
FacilityContact: ............................................................................... Title:................................................................ Phone No:
Mailing Address:
. ..................................•-------......--•-------------•---............_..........._.....................................................................................................................--- _.....
Onsite Representative: .... 11arS6 IIntegrator: �` ................................ .......�.....Y
Certified Operator:
Location of Farm:
Operator Certification Number: ..........................................
❑ Swine ❑ Poultry []Cattle []Horse Latitude * 4 " Longitude �' �4
-.Swine -
Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
I _ Gilts .
❑Boars
Design . Current De_si& Cuih-int
Capacity population. Poultry .. -•• .ai aci -- Po ulation. Cattle .4
❑ Layer ❑ Dairy
❑ Non -Layer 10 Non -Dairy
❑ Other
Total Design Capapift
Total SSLW
Number oflagoons s '; I ❑ Subsurface Drains Present ❑Lagoon Area ©Spray Field Area
Holding Ponds / SoGd Traps'. ❑ No Liquid Waste Management System
Discharaes & 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 gallmin?
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 l Structure 2 Structure 3 Structure 4 Structure 5
Identil;er:................ 1.................. .................................... ...............
Freeboard (inches): 2-9
sioa
❑ Yes gfNo
❑ Yes PNo
❑ Yes JdNo
�1a
❑ Yes jZfNo
❑ Yes 0.No
❑ Yes No
❑ Yes No
re Structu
Continued on back

2lQ
Facility N ber: 3t'O12
f —� Z Date of Inspection
7-400
5. Aie 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? ❑ Yes � No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
'I. 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/improvemcnt? ❑ Yes JR�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ANo
Waste Applicatin
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 96 0-^W4 Gi y
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes IoNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ONO
b) Does the facility need a wettable acre determination? ❑ Yes_P'No
c) This facility is pended for a wettable acre determination? ❑ Yes 'P'No
15. Does the receiving crop need improvement? ❑ Yes P'No
16. Is there a lack of adequate waste application equipment? ❑ Yes EfNo
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ATNo
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 'pl"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 '1 No
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes O'No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes JZNo
24. Does facility require a follow-up visit by same agency? ❑ Yes —ErNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes &No
vii lntiq�js;or d�fc�e ctes ry re noted d�rrMg �b s;vjsjt; Yo> wig ....V...... no fu4-thgr
eoraresnonc#ence atbauf this visit:......... ........................ .

Facility lUumber: ,3j—J`"r%2 Date of Inspection 22 0
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 ',EfNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes -[XNo
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 /UNO
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
Additional omments and/or ravings::
5100

Ve
Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency ..
(Type of Visit 19 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason fo'r Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 S' 7 Date of visit:
13 Permitted ® Certified © Conditionalflfy Certified [3 Registered
Farm Name: iyi , �40.v t�: o ti7,h '' /.I nd Fm- -' ''...............
.......................rr................... p J
Owner Name:....... KV ); .............................. h u a l -, In +'1 O{
.I...................................................................
DO 'ri,ne: 3S Printed on: 7/21/2000
O Not Operational O Below Threshold
Date Last Operated or Above Threshold:
County:...up [ I''\
Phone No:
Facility Contact: .............................................................................. Title: . Phone No:
MailingAddress:................................................................................................................................................................................................ ..........................
Onsite Representative:.... r Sp uT c t' �� integrator:...., .................... f
............................................................................................._.................................................
Certified Operator:
Location of Farm:
.. Operator Certification Number:
A,
Swine ❑ Poultry ❑ Cattle ❑ Florse Latitude • C�' i Longitude • ` Os�
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer ❑ Dairy
® Feeder to Finish d PRO 10 Non -Layer JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons JS Subsurface Drains Present ❑ Lagoon Area Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid 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 llow in gathnin?
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 , Structure 4 Structure 5
Identifier:..............I.................... .................................... ................................... ........._..................
Freeboard (inches):
5100
❑ Yes X No
[I Yes No
❑ Yes No
[:]Yes E] No -
El Yes allo
❑ Yes ® No
❑ Yes 10 No
Structure 6
Continued on back

Facility t umber: .31 ­5721 Date of Inspection d Printed (in: 7/21/2000
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
KNo
closure plan?
❑ Yes
(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
tNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
& No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
Vj No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑Hydraulic Overload
❑ Yes
No
12. Crop type S eY r"i V 4 ,g M"ov, JS ,Z It 111
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
ONo
c) This facility is pended for a wettable acre determination?
❑ Yes
VNo
15. Does the receiving crop need improvement?
❑ Yes
CRNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
�TNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
®'No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
No
(ie/ WUP, checklists, design, maps, etc.)
❑Yes
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
VNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
fZNo
21. Did the facility fail to have a actively certified operator in charge'?
❑ Yes
JS No
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application) ❑ Yes 0 No
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative'? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes] No
i
25, Were any additional problems noted which cause noncompliance of the Certified AWMP? El Yes �No
0: o yiolafiQ ...deficiencies were . . . . it .. ... t. . .. s.. . . . �v.. receive Rio further
' corres oridence: abaati this visit. :::..... ... ' . ' ..... ' .. ' ... ' : ' ::...:: ' : ' :.: :
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
TA k e -, se I sa—tool ee aYtd hc,ve- qevil� zed -Ear je,Id _t ber•►, udu
Reviewer/Inspector Name ��o'n 2wh� Z� ;�
Reviewer/Inspector Signature: Date: _ _ ___ 5/00

r
Facility Number: 3 / — s rf Z Date of Inspection GQ
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 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes JR 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 J9 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 �5 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 13 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 14 No
nail -onxnt�en a�.a. ar: rawtngs Y '._ Via. ,:- �t� _-� �.

W. . ,
[] Division of Soil and Water Conservation ❑ Other Agency
El Division of Water Quality
LO.Routine O Complaint O Follow-up of DWO inspection O Fallow -up of DSWC review O Other
Date of Inspection jI Z
Facility Number Z
Time of Inspectiou / 24 hr. (hh:mm)
E3 Registered WCertirted [3 Applied for
Permit 0 Permitted 10 Not -Operational Date Last/Operated:
Farm Name.?...1�pv 1 vfi�/G=v? County: ..........
(�s,,.,/,'.Y..t.r.......................................
// ..f%........................ > _....................
Owner Name* ... '12�.(.l`'i................... './�f?—�r�....... Photze\To:.. 31...................................................
.... ..... � Z
Facility Contact:.. .A .` ... ............��.rt., .�..i-.'�+�itle:.....AM.AIV...rt..�' :2 ...... ... Phone No: ...................................................
..... ..........
Cd
Mailing Address:. � ..{................ G....... .(........ ............I...................... ... ..5.........
�......—
Onsite Representative:....., .. . .s.� + y 0-
8?.............................................. Integrator:..................._.._............................
...{ 'tom... I
Certified Operator-,._.-.;L.-YTY............................ ..................... Operator Certification Number.................
Location of Farm:
Drains Present
No Liouid Waste ManaQen
General
1. Are there any buffers that need maintenancelimprovement?
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 gat/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?
C
Lagoon Area i❑ Spray Field Area 7
System.
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?
7/25147
❑ Yes 0 No
❑ Yes ZI No
❑ Yes ® No
❑.Yes WNo
❑ Yes
jP No
❑ Yes
JO No
❑ Yes
,ISM No
❑ Yes
Z1 No
❑ Yes
® No
❑ Yes
Z No
Continued
on back

04
Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3
Identifier:
Freeboard (ft): - J
10. Is seepage observed from any of the structures?
Structure 4 Structure 5
❑ Yes [allo
❑ Yes 0 No
Structure G
.................................................................................................................
❑ Yes EqNo
11. is erosion, or any other threats to the integrity of any of the structures observed?
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..................................................................................................................................................................................
lb. 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?
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.vio'lations• of de'rciencies. were- noted- during' this: visit. - You .W' ill receive, no -further- : -
correspo6dence. about lhis:visit::
❑ Yes W No
❑ Yes 91 No
❑ Yes 9. No
❑ Yes ,0 No
❑ Yes 9 No
❑ Yes k] No
❑ Yes El No
❑ Yes E9 No
❑ Yes Ef No
❑ Yes a No
9Yes ❑ No
❑ Yes El No
Yes ❑ No
❑ Yes ® No
te
jet-t.•ie� f.-I ..-:. is- � � s -*� � r r. eY-�%�'".t.
,ap t G (,•�t.g } t a w'�' S ��c Gr G�JL`"
�.zci{,.•d�Iaj�r�
Achi o /,r .��1 i�A r� S . Grope r-Jit 7125197 -W
I Reviewer/Inspector Name
Reviewer/Inspector Signature: _ Date: ! 2 YfZjf

DSWC Animal Feedlot Operation Review��'°'
DWQ Animal Feedlot Operation Site Inspection �
QkRoutine O Complaint O Follow-up of DWO inspection O Follow-up of DMVC review O Other
Facility Number
Date of Inspection _cl Iq 1q? -
31 `IZ
Time of Inspection DL�= 24 hr. (hh:mm)
[] Registered 91 Certified © Applied for Permit © Permitted [3 Not Operational I Date Last Operated:
Farm Name: ........ a -I ._...��L11 r(nitt(t..._...54h................. County :......n iL. A ....................................... ............
OwnerName:........ n1.1........SaAdj ....................................... I...................... Phone No:....011A.M1:311.1.............................................
Facility Contact: ......MA.l +1......... �2. Ukj................ Title* ........ O..Wkut.tr..................................... Phone No:..��LQ�.-qQ'�3% ..........
Mailing Address: ...... 11r+.1.1........ �.C.........111...... ?4G!- i!hp..V�G-�kh.l..l1�L................................... i?4rZr4...........
Onsite Representative: ....... L"�4.�.��.....��............................................. Integrator: .......... C".Y.1kit1.S.......................... I-- ........ I..............
Certified Operator; .................................................. ............................................................. Operator Certification Number;.
Location of Farm:
Q1... .... ........ ,i..... X An ...., .. 7fiG X+ i .,.....IAr.... .l ors iti11BU G lC►?� J 3 ...... s. .....t�.f.......�- .x► wr4.._...��n.....hbr.. ._............(ii- _}............................................................................................................. .
Latitude ' =° 41 Longitude ' 4 .4
Design Current
Swine . Capacity Population
❑ Wean to Feeder
Feeder to Finish
'99D
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design C, urrent.
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number' of Lagoons 1 Holding Ponds I�.� [A Subsurface Drains Present ❑Lagoon Area Spray Field Area
❑ No Liquid Waste :Management System
General
1. Are there any buffers that need maintenance/improvement? - ❑ Yes C3 Nlo
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
DischanTe originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [;JNo
b. If discharge; is observed. did it reach Surface Water? (If yes. notify DWQ) ❑ Yes M No
c. If discharge is observed, what is the estimated flow in
NIA
d. Dees discharge bypass a lagoon syswm`? (If yes, notify DWQ)
El Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
JM No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
I] No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
® Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑Yes
M No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
ER No
7/25/97
Continued on hack

Facility Number:
S. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.Holding Ponds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure t Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(ft): .......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
50 No
❑ Yes
ER No
Structure 5 Structure 6
........................................................ I......
.................................................................
❑ Yes
T4NT0
❑ Yes
®,No
t2. 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. ory runoff entering waters of the State, notify DWQ)
15. Crop type raii.......... Clttu�.A............................. ................................ ................ 'Y►j..... YL.i[�...._..............
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 ReviewerAnspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement'?
For Certified or Permitted Facilities_Qnll
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?
❑ Yes 10 No
❑ Yes V No
❑ Yes U-No
❑ Yes R.No
❑ Yes
bq No
❑ Yes
& No
❑ Yes
M No
❑ Yes
® No
❑ Yes
i( No
'Yes
No
0- No.violations or deficiencie's. were noted• during this.visit. - .Yoit.will receive no ftirtlier
coerespondehce about this.visit:..
❑ Yes RNO
❑ Yes tff No
❑ Yes Wo
c_..ents (refer to question #): Explain any YES answers and/or any recommn xadattons or ant}.other camrnents
Use drawxns of facility to'betteir explaiii,situations. (use additional pages as'necessary)T
g W
S, ps be.ri. Skould 'v t lao-4 Q."A . 61avunt1 toca W her,-,- aG ee�F j d -
0 S SGr-rouha i 7
Fsel� �` J } L f,
2Z. lQVMbeV tY\ tnr��aro� record% S�oUjj � eonsisttihl �,t t+j% rJCL.5t . U4fl�IA4vn �cn.
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature
Date:

Site Requires Immediate Attention: AlJ
Facility No.. 31-,'T7 _-L
DIVISION OF ENVIRONMENTAL MANAGE?VIENT
A.aNB4AL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: / L , 1995
Time: I 0
$. N
. �vC
Farm Name/Owner: U ^� 1�4 r1A
Mailing Address:
County: _Q.ral,-A-
Integrator: . CA-r_r,) f 1 _ _ _ Phone: 5 Y - 3l L( _1
On Site Representative. Phone:
Physical Address/Location:. N C 1 P R 1 • 1 e �= l ► A �-
V- A4 vn u iv. S �r `7 v 1� N e k F +y ��7(Lprl n
Type of Operation: Swine Poultry Cattle
Design Capacity: Ho. - Number of Animals on Site:
' a' w
DEM Certification Number: ACE DETM Certification Number: ACNEW
Latitude: > `� ° / cl Longitude: 7 -7 `// Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) )�e r No Actual Freeboard: _LtFt. 6 Inches
Was any seepage observed from the laQoon(s)? Yes or No Was any erosion observed? Yes or
Is adequate land available for spray? 9 or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: _ n n tK l —P�'^� �.d'� _ _ _
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Y�es� or No
100 Feet from Wells? (E2or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters
�oxf-the state by man-made ditch, Bushing system, or other
similar man-made devices? Yes ork�5 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)? Yes or No
Additional Comments:
Inspector Name
Signature
cc: Facility Assessment Unit 1 s.: Attcchrnents if Needed.