820699_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental W6

Type of Visit: 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0. Routine O Complaint 0 Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: /O: County: f Y1 Region:
Farm Name: f Owner Email:
Owner Name: C>LY+^-Cq Phone:
Mailing Address:
Physical Address:
Facility Contact: F1 c.4; Title: Phone:
Onsite Representative: ti Integrator: M
u
Certified Operator: Certification Number: / Q
T
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
�o° Des _
w"ign rrent Design - C.nrrept
Swine Cap ity Pop. Net Poultry Caa.city Pop.
Design Cprrent
Cattle Capacity Pnp.
Wean to Finish
[Layer
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Dai Heifer
Feeder to Finish
1) , foul
Layers
' "
Ca ` aci Po
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
HneefBroodCow
Beef Feeder
Boars
Pullets
-
Other ,., 9
E];
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
I. 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 DW R) ❑ Yes ❑ No ® NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? T
d_ Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

6acUl umber: - Date of Inspection:
$r
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
�!3 NA
❑ NE
StruTe I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): u
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
�g No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the pen -nit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�Q] 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 DriftAp lication Outside of Approved Area
12. Crop Type(s): G) a 54L Ss l I . 1Zd S t gm
13. Soil Type(s):
14. Do the receiving crops MITer from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
[P No
❑ NA
❑ NE
❑ Yes
[M No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Kyh No
❑ Waste Application. D Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste T rnsfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412015 Continued

Facili umber: 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 first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ 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 No ❑ IOTA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below_
❑ Yes No
❑ NA
❑ NE
❑ AppIication Field ❑Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes M No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Z No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: %
21412015

i ypc u, v-1i; w 4ompuance tnspecnon U uperanon Review U structure r vatuanon U t ecnnecae Assistance
Reason for Visit: (D Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 'I � Arrival Time: ro Departure Time: 10;2. County: c�L%�.SOPJ Region:
Farm Name: OM (`� Owner Email:
Owner Name: �R'r`'e S r6-5�1 Phone:
Mailing Address:
Physical Address:
Facility Contact: 7pp f �r Title: Phone:
Onsite Representative: 4 Integrator: J 0^1
Certified Operator:
Back-up Operator:
k
Location of Farm: Latitude:
Certification Number: / Vry/ %
Certification Number:
Longitude:
Design Current
Swine CapacityWet
Wean to Finish
Poultry
La er
Desiga
Capacity
Current
Pop.
Design C►►A ent
Cattle Capacity Pop.
Dai Cow
Dai Calf
Wean to FeederLL
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Qther
Other
Non-La er
D . PouI
La ers
Non -Layers
Pullets
Turkeys
Turkex Poults
Other
Design
Ca aci
Current
P,o
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Broad Caw
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [�No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ No
C] Yes No
❑ Yes No
NA ❑ NE
A ❑ NE
NA
yy
[] NE
DNA
❑NE
❑NA
❑NE
Page l of 3 21412015 Continued

FaciLity Number: Date of ns ection: 7/ b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
1� No
❑ NA
[—] NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[—]No
C�3WA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: ^�
Spillway?:
Designed Freeboard (in):
�Ts
Observed Freeboard (in): 5
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
F No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ONE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes W 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
11
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > lit%or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of ind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Czag 8�r�t''v _57CJU�-
13. Soil Type(s): ly
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
4 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
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WLTP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑ Soil Analysis ❑ Waste T sfers ❑Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall lnspectio s ❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

0
Facili Number: Date of -inspection: 'Y lv 7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes j�TTNo ❑ 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
0 Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes M No 0 NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
ments(refer to question #: Explain any YFS answers and/or any additional recommendations or;auy other cnamentsrawings
F
of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
4l2011

Type of Visit: 4D Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Teebaieal Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Foilow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L J j(e J Arrival Time: �Departure Time: County: SOt� Region: r/20
Farm Name: ��t 30 Owner Email:
Owner Name: t n V.,V S. ses'�_ Phone:
Mailing Address:
Physical Address:
Facility Contact: c{� /U► fUL oy1 Title: Phone:
L4
Onsite Representative:
4
Certified Operator:
Integrator: j VIVI
Certification Number: 1001
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
oultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
-
Dai Heifer
Farrow to Wean
Design
Current
jDry Cow
Farrow to Feeder.
D . rlPoul :'
Ca aci
P,o .
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance roan -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 [�TNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
[] No
[] Yes
No
❑ Yes
No
MNA ❑ NE
99 NA ❑ NE
NA ❑ N E
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

Faciti Number: 16ate of Inspection: 7.1
Waste Collectiop & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No P NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
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 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes T 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?
I I . 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 4er from those designated in the CAWMP? ❑ Yes [)a No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[VhNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
No
❑ NA
❑ NE
the appropriate box.
T
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
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 l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
P
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility l�rnber: jDate of Ins eetion: luhle=
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes No
the appropriate box(es) below.
❑ 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 [j No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes rM No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes K] No ❑ NA ❑ NE
❑.Yes P] No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
M No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
[D No
❑ NA
D NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
® No
❑ NA
❑ NE
1.1J mments (refer to�goeshon #) Explain any�YES answers and/or any -additional recommendations or any other comments
C
se draw►ngs ofyfact[ify=to betier,'eaplain situations (use.additional naees as necessarv). ,:
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412015

Ii ype or v isu: we t.ompuance inspection V uperation Keveew 1.1 structure r vaivauou CJ i ecnmcat 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: O Departure Time: 'ADo.., County: a/J
Farm Name: t %� a Owner Email:
Owner Name: Stiff. �s T - Phone:
Mailing Address:
Physical Address: f
Facility Contact: Do, 1V ��e .o�.al Title: Phone:
K
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Region: PXZV
Integrator: M ,I
Certification Number: 1 gT f %
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design
Cattle Capacity
Dairy Cow
Dairy Calf
Current
Pap.
Wean to Feeder
Non -La er
I
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D . P,oultr Ca aci P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Gilts
Boars
Utber
C?ther
Layers ers
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Turke 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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
[:]Yes
[:]No
NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No RNA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes W No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes tp No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: - 09 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [P 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): L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No [] NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
qNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P 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 lindZj
Application Outside of Approved Area
12. Crop Type(s): � l n^-jo
13. Soil Type(s):
14. Do the receiving cropYdiffer from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility tack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P
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? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection: Z(
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes T® No
the appropriate box(es) below. T
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
1� No
❑ NA
❑ NE
❑ Yes F No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
Comments (refer to gnesboni#) Explain any YES answers and/or any additional recommendations or any other commeuts�
Use d"rawmgs of facility to i after e�cplaui situatipns:,(use additional pa�es:as necessary}. '"� �
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

I. ypc v1 .,a.c: qW%.u111puance inspecilun l.J uperaaun icevocw v airucture cvaruation S.J ■ ecunicat t ssistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: /til 30 -� �t�$. Owner Email:
Owner Name: t,,�" �`Q SST' Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Y
4
Certified Operator:
Back-up Operator:
Location of Farm:
a 1_0 Title:
Phone:
Integrator:
Certification Number: !l
Certification Number:
Latitude: Longitude:
Design
Current
k Design
Currents
Design Current
Swine
Capacity
Pop.-.
Wet Poultry Capacity
I Pop..Cattle�/
Capacity P.
Wean to Finish
Wean to Feeder
La er
Nan -La er
Dairy Cow
Dairy Calf
Feeder to Finish-
Dairy Heifer
jQ
Farrow to Wean
2LO0
00
gn
Current
Dry Cow
Farrow to Feeder
—achy
Po -
Non -Dial
Farrow to Finish
La crs
Beef Stocker
Gilts
on -Layers
Beef Feeder
Boars r
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults'
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DI
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 `f" No ❑ NA [] NE
0 Yes
O No
Q NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
[:]Yes
[:]No
® NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 21412011 Continued

[FacilifyNamlSer Date of Inspection: y
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA [] NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No JR NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): & q
5. Are there any immediate threats to the integrity of any of the structures observed?. ❑ Yes `1" No [DNA ❑ 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 M No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes [$j No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes T No DNA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1P No [] NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes V] No ❑ NA
❑ 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 Q Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crap Type(s): l_D615 6:�kg4hj�,
13. Soil Type(s): Agya v' — 06&
❑ NE
14. Do the receiving crops diPer from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
kNo
0 NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
§Q No
❑ NA
❑ NE
acres determination?
17. 'Does the facility lack adequate acreage for land application?
❑ Yes
E� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
M No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
® No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes q No
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ['� No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
NA ❑ NE
Page 2 of 3 214.12011 Candnued

Facili -Number: - Date of Inspection. ?
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes GD No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [�j 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 Iagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes E� No ❑ NA ❑ NE
❑ Yes [n No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EK No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ® No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Qg No ❑ NA ❑ NE
r
mments (refer to questiari #j: Explain any YES answers and/or any additional recommectdations or any other commentse drawings of facility to better explain situations (use additional pages as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: t tD lil �
Date: 5�h
21412011

-t�r 16 r ;4 l --
Type of Visit: fe, Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I 1IM164rival Time: Departure Time: County: _4�1--JRegion:
Farm Name: j'1(1 3 (� -- �,5.� Owner Email:
Owner Name: Q yv" (ff e� � Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design, Currentil
1111111FUesign
gfurTen
11111alDesign
Current
Capacity Pop.
Wet Poultr.}'
Capacity
Pop.
Cattle Capacity
Pop.
Finish
rFiFeeder
La er
Nan -La er
DairyCow
Dai Calf
Feeder
Finish
1 f
` '
Dairy Heifer
Farrow to Wean
Design
Dry Cow
Farrow to Feeder
D . P,ouIt .
l±a achy
P,©
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
' "
Turkeys
t]tber
Turke Points
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ App r'UVGD ❑Other:
a. Was the conveyance man-made? ❑EQIDWR
b. Did the discharge reach waters of the State? (IfyhnyltijQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste manageme81' yes, notify DWQ)
z. Is there evidence of a past discharge from any WAt�i9 r,"'l(illlA). OFFICE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 1 !
❑ Yes P<o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

r
Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes �No
////❑
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes 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?
❑ YesZ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes /No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environme
ntal threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yeso ❑ 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 o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, e .)
❑ 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): t +
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?
,,Z
❑ Yes o
❑ NA
❑ NE
lb. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
�/�
❑ Yes I/I No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [�No
❑ NA
❑ NE
Required Records & Documents
14. Did the facility fail to have the Certificate of Coverage & Permit readily available?
fT
0
❑ Yes Z"0
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes P'1
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
El Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 'o
❑ NA
❑ NE
El Waste Application ❑ Weekly Freeboard El Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ YesVNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: `{ I jDate of Inspection: 101
24. Did the facility fail to calibrate waste application equipment as required by the perm: 0 ❑ YesN ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesrNo ❑ 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 ONo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes KNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes f j'L ❑ 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 ff No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ,�No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes FNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �No
❑ NA
❑ NE
Comments (refer to question ft Explain any=YES answers and/or: any additional recommendations or any other ednimeats
Usedrawings;.of.facility to better explain: situations (use additional pages as necessary,).
i �,� o�v� 7cZccrm-a
'79(5 13 i•5V
Vac? 13 y-1- r 3 153
LJ O r] 1- 30-0 (2� it 21
Reviewer/inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: ! 7/��"'
Date:
14/Zt711

t ype ui v nit. W s-ompltance lnspeenon U Uperatron Keview U Jtrncture Evaivanon U l ecnnical Assistance
Reason for Visit:. 10 Routine Q Complaint Q Follow-up 0 Referral Q Emergencv 0 Other 0 Denied Access
Date of Visit: Arrival Time: D ; 3pctr Departure Time: � County: Region
Farm Name: I n fn 2_�'n Owner Email:
Owner Name: -M i'1i[ F6?,vjL4S Phone:
Mailing Address:
Physical Address:
Facility Contact: E641A Title:
Onsite Representative:
°f
Certified Operator:
v
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:yy M & yc
Certification Number: %gyl %
Certification Number:
Longitude:
EFIVIM
i�
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design
Wet Poultry Capacity Pop. Cattle Capacity
Layer Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er
I Dairy Calf
Feeder to Finish
Dairy Heifer
Dry Cow
$o. Ca ari P,a Nan -Da'
Layers Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other J
I 10ther
Turkeys
Turkey Poults
Dischar es and, Stream Impacts
1. Is any discharge observed from any part of the operation?
a
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 0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [-]No
❑ Yes No
❑ Yes No
NA ❑ NE
T®� NA ❑ NE
® NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection: 12
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes PO
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No NA D NE
SI 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.) i
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No ❑ NA ❑ NE
waste management or closure plan? T�
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA E] NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes T� 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 F
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes V] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes F 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): L�- " -.!;,
13. Soil Type(s): WK
14. Do the receiving cro s differ from those designated in the CAWMP?
❑ Yes
V3 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M 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?
C] Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P 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? [-]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Y
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes Ij No ❑ NA ❑ NE
the appropriate box(es) below. ii��
L] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 1p No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No
❑ Yes No
0 NA ❑ NE
❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP? ❑ Yes [�g No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewfinspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
T
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 2 No DNA ❑ NE
FComro­e,nts (refer to question #): Explain any YES.answers and/or any additional recommendations orany
raings.of facility to better explain situations (use additional pages as necessary).
�/Qwy 5�� V-� ho �_ "�'
Reviewer/inspector Name:
Reviewer/Inspector Signature: ,.
Page 3 of 3
Phone: 9l0-M -%00
Date: 6 -AF
/I Z'
21412011

i ype or v isn: w t..ompnance inspection U operation Review U structure Evaluation U I ectinical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: v Departure Time: lt`1r' County: Region: YCA
Farm Name: _30 i r� s, Owner Email:
Owner Name: il'Y1 rrl I dC,S Phone:
Mailing Address:
Physical Address:
Facility Contact: 1/pl _&q A ie-W &qj Title: Phone:
it
Onsite Representative: Integrator: t914
Certified Operator: jt Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
_. _. . :::.,
Design Current
Capa{cityPop *'_
Wet Poultry
La er
M9 v
DesignCurrent-; Design
Capaty 'P,oP- Cattle Capacity
Daia Cow
Current
Pop.
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
LY
" ''
Dairy Heifer
Farrow to Wean
�
h'=' .,
Design �,Current�
Dry Cow
Farrow to Feeder
D , P,oult .
Capac _ Po _ fi
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
-- -
Other
�` ..
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes fnNo ❑ NA ❑ NE
❑ Yes
❑ No
Y] NA
❑ NE
[-]Yes
[-]No
CONA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No 192 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes %No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

[Facility Number: - Date of Ins ection: k $
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
EP No ❑ NA ❑ NE
[]No ®NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[)� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [6 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 ofAcceptable
_Crop
�jWindow / /❑7 EvidenceofWind Drift ❑lApplicca�tion Outside of Approved Area
12. Crop TYpe(s): ��il f ,rm,uJ4v C%;7 Vtii! 5 / J JMa a�L �
13. Soil Type(s): 1,1lao��,,r `'ji the
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
IM No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
M No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
1P
❑ NA
❑ NE
I & is there a lack of properly operating waste application equipment?
❑ Yes
[r" No
❑ NA
[] NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
No
❑ NA
[] NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? I f yes, check the appropriate box below. ❑ Yes Q3 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking []Crop Yield 0 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ep No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes EANo
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
r] NA ❑ NE
[DNA ❑ NE
Page 2 of 3 .21412011 Continued

FaciLi ^umber: Date of Inspection: t
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes (.$ No
the appropriate box(es) below. T
❑ 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 fait provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [] Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
t5i 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 concerts?
❑ 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
No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
[] NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
MNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on-sitc representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
EA No
❑ NA ❑ NE
mments (refer to question'): Explain any YES;answers ad/or any additional recommend- orp_aay other comments.
Fuse
draiwinQs:of facility to better explain situadonsduse-.additional naQes as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
glo--g3 7 3
Phone:
Date: I I A/W
21412011

A_rwS R- /l- wvf)
Type of Visit a 6ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ,•.. Departure Time: County: Region: K90
Farm Name: — /71 &0 - �S iG ��s i Owner Email:
Owner Name:cu p S� Phone:
Mailing Address:
Physical Address:
Facility Contact: _ /Vet ►•1 �,., Title: JeA U. ✓ • Phone No:
Onsite Representative: ha u el �t' ��* c,.. o11 Integrator: �% Y
Certified Operator: Vo-u 44't s-_ 01 Operator CertTcation Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E] o ED, ❑ u Longitude: ❑ ° [= S =
Design Current
Design Current
Design Current
Swine C►►opacity Population
Wet Poultry (:opacity Population
Cattle Capacity Population
❑ an to Finish
❑ La er
❑ Dairy Cow
❑ Dairy Calf
❑ an to Feeder
❑Non -La er
❑ Feeder to Finish
❑ Dairy Heifer
Farrow to Wean oo -7Oa
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
u
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
ErNA
❑ NE
[]Yes
❑No
EP17C
El NE
Ej<
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
[I,—, Yes
l�o"
❑ NA
❑ NE
12128104 Continued

i,
Facility Number:
Date of Inspection 7-2 8 -10
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes B No ❑ NA ❑ NE
❑ Yes 2'No ❑ NA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): SZ
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2fo ❑ NA ❑ NE
(icl large trees, severe erosion, seepage, etc.) 6. Are there structures on -site which are not properly addressed and/or managed ❑ D Yes o ❑ 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
L
7. Do any of the structures need maintenance or improvement? ❑ Yes 1< ❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 31o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) �
9. Does any part of the waste management system other than the waste structures require El Yes Ejglo ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,�,/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LSNo ❑ NA ❑ NE
maintenance/improvement? ,
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CK01 ❑ 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
/ ,f `
12. Crop type(s) 46►0S� .5 G!/Y�• �.✓ r`� • S J
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
18. Is there a lack of properly operating waste application equipment? ❑ Yes
3No ❑ NA ❑ NE
[ to ❑ NA ❑ NE
Lj N ❑ NA El NE
[ �o[01
NA El
NNA ❑ NE
Use. drawingS�of facwty to better es `lath situations♦ (use additional ny recommendations or any otter comments.
Comments (refer to quesr,on #) Eaplain any YES answers and/or a
p pages a s nece ss�ary)
Reviewer/Inspector Name c S t Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number:©ate of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes O No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If es check the appropriate box below. ❑ Yes/No ❑ NA ❑ NE
P g P Y e appropn
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�<o_[INA
❑ NE
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?
❑ Yes7No
❑ Yes
El NA
❑ NA
El NE
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[I Yes
�No<❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ONo ❑ 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?
ElYes
No ❑ NA
❑ NE
72129104

Z. r. - .. O n C Y7 D
Jl r v o- v i
— vision of Water Quality
1gacility Number }�J (o g 9 Md
of Soil and Water Conservationgency
Type of Visit 0-6—mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q7koutine O Complaint O Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: �p `"��'`s Region: /=Xo
Farm Name: . !� M -30 — 8>cS 13YeiGS Owner Email:
Owner Name• —] + we M4 �e5 t- Phone:
Mailing Address:
Physical Address:
FacilityContact: toga /`+!«o,,► j __, Title: 9N'i! '''r r Phone No:
Onsite Representative: pu ;e- x4o,4 Integrator: F b M Aa lwS
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 00
= 6 = Longitude: 0 0 = ' E__1 "
Design Current
Design Current Design Current
Swine
Capacity Population
Wet Poultry
Capacity P.opu.lation Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑ DairyCalf
El Feeder to Finish
�, r '& ❑Dai Heifer
® Farr
.: Q. Poul try
El Layers
El Dry Cow
:sue"
ElNon-Dairy
El Beef Stocker
Farrow to Feeder
❑ Farrow to Finish
El Pullets er
El Turkeys s El Beef Feed
El Beef Brood Co
❑ Boars
Other
El Other
Humber of Structures:
ow to Wean
� !� D�
❑
❑Gilts
Discharges & Stream Imn-acts
1.
El
Non -Layers
Is any discharge observed from any part of the operation? El Yes [3 No El NA ❑ NE
Discharge originated at: ❑Structure ❑Application Field ❑Other ����iv a. Was the conveyance man-made? ❑Yes ❑ No L7 A El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El Yes ❑ No U lYA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ) ❑Yes ❑ No �A [I NE
2. Is there evidence of a past discharge from any part of the operation? El Yes [� No ❑ NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑Yes D'1�l0 ❑ NA ❑ NE
other than from a discharge?
Page 1 of 3 12/28/04 Continued

­_ S
Facility Number: S2 - G99
Date of Inspection
Waste Collection & Treatment �/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 2'1lO ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L a 5 I
Spillway?: ICI D
Designed Freeboard (in): 2 (a ff
Observed Freeboard (in): ?7 �
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
L3<
❑ 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
340
❑ 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 I1'1Qo ❑ 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 Cropt Window ElEvidence of Wind Drift ElApplication Outside of Area
12. Crop type(s) _8 e.rktiV'dc` f%� Grs �1+ti4 G� (gi?,i,•! K0 S
13. Soil type(s)�
t4. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes C�Io El NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [I Yes ,El//NNNo El NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ L7 Yes 6 ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑-Io ❑ NA ❑ NE
Camrnents referueshon#) "Egplatn any�YES answers and/or any recommeudations air any other comments.
9
Use drawings of fact,. y to,better exptam situations. (use additional pages�as nec ses ary).,
K'z., ,i r -,.F Y_.?, 1. ;!,` r� ''-wia"i F.�r".='�r'•.;,Y. .
Reviewer/Inspector Name FIZ cD � _zq- e Phone: Vo. l/ , 3330
Reviewer/Inspector Signature: P, e,-,_l Date: Z - 19 - Z 00 6
Page 2 of 3 12128104 Continued

__ . 1b
Facility Number: $2 — 601
Q9 Date of Inspection /g-D
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IJ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [],�jo ❑ NA ❑ NE
the appropirate box. ❑ W`Up ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes
o
El NA
❑ NE
ElIr Yes
,[TN
No
❑ NA
❑ NE
❑ Yes
B<o
❑ NA
❑ NE
❑ Yes
NNo
❑ NA
❑ NE
El Yes
ET
El NA
❑ NE
El yes
,ET1voNo
Cl No
❑ NA
❑ NE
❑ Yes
3'No
❑ NA
❑ NE
El0Yes
o
❑ NA
❑ NE
❑ Yes C o ❑ NA ❑ NE
❑ Yes 0No ❑ NA ❑ NE
❑ Yes
oo
El NA
El NE
El Yes
,�
B<O
❑ NA
❑ NE
12128104

R i ief S ::, k- -cd / z/ar/zao7
Division of Water Quality
Facility Number z (v9 O Division of Soil and Water Conservation
O Other Agency
Type of Visit * Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit O Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Q 31'' �7 Arrival Time: // 30 Departure Time: County: SG�� Region: /5&
Farm Name: . I bi�i 3� L_?.n9yz_ Bi_295_ Owner Email:
Owner Name: + mt►eSq Blef� Phone:
Mailing Address:
Physical Address:
Facility Contact: D641 ji di�E ed l _ Title: A6�iV Phone No:
Onsite Representative: I-c"o n/ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
Farrow to Feede
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' [7] Longitude: [—] o = ' 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer 11
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Puults
❑ Other
Discharges & Stream Impacts
. 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 Fleifei
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: UJ
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 P No ❑ NA ❑ NE
❑Yes
No
El NA
[I NE
❑ Yes
No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[A No
❑ Yes
[)9 No
❑ NA
❑ NE
❑ Yes
PM No
❑ NA
❑ NE
12128104 Continued

i.
Facility Number: S�
Date of Inspection V& 31-0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes `ram No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [2fNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): & 7 '
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No
ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
Q 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
[�FNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
l I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
WNo
❑ 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 S) 13P�-.��a1Q ee,, /�� -t -e ) _ 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
IM No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
RNo
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
[] Yes
Q9No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PR No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary).
Reviewer/Inspector Name KjL Re Phone: 9/O, 33.330 +fl
Reviewer/Inspector Signature: Date:
I Z129104 ConUnueu

Facility Number: SZ -GPI Date of Inspection /O 3i-o7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [NNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropriate box. ❑ y1UP 0 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 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes W No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
J9 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[M No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
`>c' No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
P 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
WNo
❑ 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
PgNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
217No
❑ NA
❑ NE
Additional Comments and/or Drawings:
AL
ki
12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit • Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
(late of Visit: Arrival Time: /Z:Q Departure Time: County: sfjwoSc-.1 Region: -'�Xo
Farm Name: / zr3p C&SI e�,O.T) Owner Email:
Owner Name: S i wt �ob;,J Bc ,,� Phone:
5.
MaflingAddress: E0._aa)C 300 Ak— ZS36
Physical Address:
Facility Contact: �bdk iLtian! _Title:
Onsite Representative: b2l:14 � CWtoNCL
Certified Operator: QLtq4/► GlKeNc�L
Back-up Operator:
Phone No:
Integrator: b
Operator Certification Number: /'K1V 7
Back-up Certification Number:
Location of Farm: Latitude: [--1 o Imo, 0 N Longitude: El ° =I =
r,.
Design` Current ' "�., Design Current Uesign C•nrrent
Swine Capa tty iliapon Wet Paultr,I Capacity Popu`fatFon Cattle Capacity Population
❑ Wean to Finish ❑ La er ❑ Dairy Cow
❑ Wean to Feeder ❑Non -La er ❑ Dairy Calf
❑ Feeder to Finish t cr� ❑ Dairy Heifer
Farrow to Wean Q Dry Poiltry �n �'i ❑Dry Cow
❑ Farrow to Feeder ❑
Layers Non -Dairy
❑ Farrow to Finish ❑
❑ Beef Stocker
❑ Gilts ❑ N Nets ers r] Beef Feeder
❑ Boars ❑Pullets
r
- ❑ ❑Beef Brood Cow
Turkeys
Other 0 Turkey Poults
Q Other ❑ Other Number of Structures: El
Jill FJK*q.,­
Discharges & Stream Impacts
1 _ is any discharge observed from any part of the operation?
❑ Yes
[9 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
59 No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
❑ Yes
M 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
1 is there evidence of a past discharge from any part of the operation?
❑ Yes
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 1 of 3
12128104
Continued

Facility Number: g2 —(a Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [A No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [--]Yes [N No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
I denti Fier:
Spillway?:
Designed Freeboard (in): Z 7
Observed Freeboard (in): 411/
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 0 No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [PNo ❑ 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
I0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ No ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes [Y 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) �erx.�a%�/YCl.. �erzr i.• �i�[tl� Gi;
13.
Soil type(s) .
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement'?
❑ Yes
b4 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
DT No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
(:1 NE
;Commeats(refer'to question #): Explain any YESanswers and/or any recommendations or any1othercom eats'
�.
i7se: drawings of facility to better explain situations (use additional pages as necessary):
Reviewer/Inspector Name , � G � Q� S Phone: L�. V�0, 3- 0
Reviewer/Inspector Signature: Date: $—ZZ—ZOO
Page 2 of-3 12128104 Continued

Facility Number: SZ —G 9 Date of Inspection
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [)g 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 10 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis Cl Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes CONo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes $1 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
09 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
WNo
❑ 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
R No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
V9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
59 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
[9 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
53 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Additional,:Coimerits and/or Drawings:
Page 3 of 3 12128104

t
r
Type of Visit *Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit *Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of visit: -Q- 45 Arrival Time: Q. S5774+% Departure Time: County: kn ro Region: fed!
Farm Name: _ a0 %�-f Drd3 Q_ Owner Email:
Owner Name: 110_T 6jpvt 5i ta%kg 1� a L, 6 Q r, Phone: 9/
1�
Mailing Address: atc IQ D Alif w 7 e&
Physical Address:
Facility Contact: 126k s s C AL,, s. _ Title: Phone No: Ito — tx 1d — $ /31
Onsite Representative: _;%HC%�J�-+*oM __ Integrator: _ TDA
Certifies! Operator: o A&LOA Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm; Latitude: = = ' E--] u Longitude: 0 o [=] , =
Swine
Wean. to Finish
Wean. to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gifts
Boars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
�; ❑ Non -Layer
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke 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
QDairy Cow
❑ Dairy Calf
❑ Dairy Heifei
DDry Cow
DNon-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Ca
Number of Structums:
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?
M
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
MNo
❑ NA
❑ NE
Cl Yes
[9 No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Spillway?:
N
Designed Freeboard (in): a 7
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
m 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 46 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
5d No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Waste Anolication
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.
El 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
Z4?- .202-- S'Ciir
12_ Crop type(s) BrCet w .� .t} Lget».
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 acre determination[] Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
MNo
❑ NA ❑ NE
tasK Wlou td� I.:a� t ' $r •A j. itror�.•
e- p� j Oa h .
Reviewer/Ins ector Name °� '� ''� "4 Phone: /a p F �h0� "1: r ' .
Reviewer/Inspector Signature: —Xj Date: 2 - Gi
12128104 Continued

FaMi6 Number: $� — 141 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [jQ No ❑ NA Cl NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑Yes [ENO ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Dzsutn ❑ MTps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [&No ❑ NA ❑ NE
❑ ❑ ❑ 1afs�is ❑ ❑ ❑ Annual Certification
❑ Rninfai❑ Stet-� ❑ ale ❑ �1- ❑ : specttons ❑ 1V ez Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
®No
❑ NA
❑ NE
23.
If selected, did the :facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
N No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
M No
❑ NA
❑ NE
Other lssues
28.
Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP?
❑ Yes
© No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern'?
❑ Yes
M No
❑ NA
❑ NE
Ifyes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerlInspector 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
[29 No
❑ NA
❑ NE
Additional Comments and/or Drawinbs:
x t.,
12128104

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ate; 4K;"'v.�'�ev�' :iv x.<..,: .......: .v.� ::�:�..o �'^�•c ,. .�y d �"+r°,.`+�r�x V
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Division of Soil and Water Conservation ❑Other Agency
Division of Water Quality
Facility Number '
](Registered E3 Certified 13
Applied f r Permit Permitted
Farm Name:.....(.�a T.....�� ...............
Owner Name:
Date of Inspection
Time of Inspection �J 24 hr. (hh:mrrt)
10 Not Operational I Date Last Operated: ..........................
....... County: ...... /C7^ tj� lid! ....................................
....... Phone No:..........` ��. V.-L..a(.. ....................... _.......
c.
Facility Contact:..... f Y!?............ � Title:... CL(k ...................... Phone No:................................................... �C ................. ...... / y� / �. / /
Mailing Address: _....2..._......fj�k......_�`...._lCdr......................................L.[.i.11%.�f..r..�,�.,...................... 2?
Onsite Representative: .... bn�y.....'...."... .f!'I..LI. .................j Integrator:........................ ...Ll............................................
Certified Operator* ..._ (.. ....................... ./. tLLQ..3! Q..................... Operator Certification Number :.........................................
Location of Farm:
Latitude 0•=r=11 Longitude =9=,=11
Destgn „Current Design— Current '° -Design Current
Somme, Z ,,,, . ,Capacity xPopulation a Poukry Capacity: Population ;Cattle Capacity Poptilahon
`
,
Wean to Feeder
V
❑ Layer
;.;'.
❑ Dairy
"'.
-
❑ Feeder to Finish
-.
❑ Non -Layer
p'
❑Non-Dairy
r
❑ Farrow to Feeder
% ❑ Other q„
'.Total Capac ty�...
❑Farrow to Finish
3w;Design Z4Qv
❑ Gilts
»�.
x 4 2,.,
?
SL❑Boars
FW
Number of Lagoons / Holding Po ❑ nd Subsurface Drains Present 1111LagoonAres JE1 Spray Eteld Area „
L —!J
to ; ❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes N0
❑ Yes No
❑ Yes o
❑ Yes o
❑ Yes No

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be property closed? ❑ Yes No
Structures lLaQoons.Holding Ponds, Flush Pits, etc.} L
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes A No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft): .. ................._....... ............. .................
.................. ...
10. Is seepage observed from any of the structures? ❑ Yes No
IL Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12. Do any of the structures need maintenance/improvement? ❑ Yes ONO
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
ANo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
(If in excess of WMP, or runoff entering wa rs the State notify DWQ)
15.
Crop type ........................ .
16.
Do the receiving crops differ with those esignated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
o
18.
Does the receiving crop need improvement?
❑ Yes
No
19,
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
®No
�Ej
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22. Does record keeping need improvement? ❑ Yes RNo
For Certified or Permitted Facilities Only,
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ANo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes KNo
25. j�7ere any additional problems noted which cause noncompliance of the Permit? ❑ Yes
No.violitions:or deiteieneie's.rver'enoted-during this:visit. YodW.ili i&e' ive.no furtliei,::
Orrespi}ndehce al oiit this'. visit'.
! !Zr 5 i5 c-- rt �ar- �`} Lks� J--" � c� — lio i rr i 3,J! r i
j9e
e II r (�
7/25/97
Reviewer/Inspector Name b . ` a, W.. r ..* t
Reviewer/Inspector Signature: Yw l `f Date: �Q--3C)—r//