820701_INSPECTIONS_20171231

NUH I H LARULINA
Department of Environmental Qual

A
type of visit: (Compliance Inspection U Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (DIG—utine Q Complaint O Follow-up C) Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: 'iJ[1 Departure Time: l�', t� c"7 County: _'5;' Region: ef5�D
Farm Name: T z!, pt x rp� Owner Email:
Owner Name: 2 c. Rex&4 !^, Phone:
Mailing Address.
Physical Address:
Facility Contact: L�►p>vuGt.� Title: r kz_, ► r-r Phone:
Onsite Representative: r fr Integrator:
Certified Operator: Lj Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
CertiTication Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Da' Cow
Wean to Feeder
��
p
Non -La er
Da' Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Design
Current
Cow
Farrow to Feeder
Dr. P,oalt .
Ea aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non-L.a ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qther
Turkey Poults
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
[]Yes
i�o
❑NA
❑NE
El Yes
e"No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No [DNA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No [] NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):"�?')
Observed Freeboard (in): 3 y
5. Are there any immediate threats to the integrity of any of the structures observed? 'Yeses 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 [K 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 ErNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes I_J No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes MNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q"lSro
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E]-go
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E3-1<o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3-No
❑ NA
❑ NE
Required_ Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
u ryo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0'<
❑ 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
NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[D 110
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Quo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - D IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑�o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes [a-N`6" ❑ NA ONE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 0 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 E5 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ca`f�o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
E3 o
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[f 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
2ro
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
dNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E] No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[J No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E No
❑ NA D NE
Conunerits (refer to quest,on #) 1 xplaan,any YES answers and/or any Additional recommendations or any of&er�comrne©ts.
Use drawmgs,at factlitytobetter explain situations `(use additional pages as necessary},
cold e-- % s`-' 0, o rs -0 & "�. h"y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:-�lsl
Date:
21412015

Type of Visit: (fCompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: outine O Complaint 0 Follow-up 0 Referral Q Emergency O Other O Denied Access rj
Date of Visit: —/ Arrival Time: / 13 Departure Time:,i, 5 1 County:� Region:
Farm Name: A Owner Email:
Owner Name: r-ez1- l Phone:
Mailing Address:
Physical Address:
Facility Contact: ��rt r-arLg/� Title: c2G4.� f? -c Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Certification Number: �&Z-
b
Certification Number:
Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pap.
Wet Foultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
I ILayer
I
Dairy Cow
Wean to Feeder
L& O
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Curren#
Dry Cow
Farrow to Feeder
D . P,ouI
Ca aci
I;o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Turkeys
Beef Feeder
Beef Brood Cow
Boars
Other
Turkey Puults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
[:]Yes Callo [-]NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of past discharge from any part of the operation? ❑ Yes allo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes FNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

• Faciti Number: _ D [ Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E!f-No
0 NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ 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
MNo
❑ 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
[�JNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
INo
❑ 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
JNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
KNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes allo ❑ 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 El Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): K d
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
'0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
1�3,No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
[] Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
INo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
RNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[4No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[El No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
La No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Faciti Number: - 7 19 ( 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 ONo ❑ 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 structurc(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Eg] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes JS.No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes allo ❑ NA ❑ NE
❑ Yes E, No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
[:]Yes Jallo ❑ NA [D NE
❑ Yes allo
❑ Yes 0 No
❑ Yes [�[.No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: j'���/� CJ-'��- Phone:
Reviewer/]nspector Signature: Date:
Page 3 of 3 21412015

L
ri ype or visit: to•compuance inspection t> uperatton xeview a structure Evaluanon V tecnntcai Assistance
Reason for Visit: routine Q Complaint p Follow-up p Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: -- - (o Arrival Time: p !7 Departure Time: ,' 3 County: J?e z ^Region:
Farm Name: p-n `�Y�r1�p / - Owner Email:
Owner Name: Tr. Phone:
Mailing Address:
Physical Address:
Facility Contact: , 3 rt. Title: Oul-y!Y"-` Phone:
Onsite Representative: : rf1f_ - -
-o
Certified Operator.
Back-up Operator:
Location of Farm: Latitude:
Integrator: 11; f
Certification Number: a
Certification Number.
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design Current
Capacity Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
p4
Non -La er
DairyCalf
Feeder to Finish
Dr. P,oult ,
DesignIOUrrent
Ca aci Pao
Dairy Heifer
Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
3 urkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance titan -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 [� o ❑ NA ❑ NE
0 Yes No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes O'No
❑ Yes JS.No
❑ NA ❑ NE
(DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412015 Continued

IFacility Number: _ Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VNo ❑ 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): IV 0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trues, 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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes W No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [gNo
❑ 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 rZ.11 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J2,No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�JNo
❑ 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, Uo the receiving crops dater trom those designated in the CAWMP?
Lj Yes
L JC No
U NA
Lj Nt;
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q 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
® 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 Callo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ .No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: _ Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
"No
❑ NA ❑ NE
r 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
MNo
❑ 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 suucture(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
SZ 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
J�gNo
❑ 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?
C] 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
g No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
jNo
❑ NA
❑ NE
-77
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/A" L W" f77 014�/s/mot �R `�J rL_�/ L/ /%T� 12 / P �i� Fyyi.
✓ U
DID — ca i 1,
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Phone:%�� �3O 0
Date: dO�'
21412015
Page 3 of 3

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: , D County: ���r�—
Farm Namur-vl L,«.1a rd( Owner Email: `�`��
Owner Name: Zer1. y'%. .dd .� r, Phone:
Mailing Address:
Physical Address:
Region: ff)�:9
Facility Contact: s-s L ,'a �,Qµd Title:Phone:
Onsite Representative: �. -4� _ Integrator: lr
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design Current Design Current
Capacity Pop.
WetPoultry Capacity Pop. Cattle Capacity Pop.
o Finish
o Feeder �a
r
La er D ' Cow
Non -La er
D ' Calf
to Finish
Dairy Heifer
Farrow to Wean
Design Current
Cow
Farrow to Feeder
D . P,oul Ca aci P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
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)?
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 L29.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Faeili Number: Date of inspection:
- / 5
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes In 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): 9`
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes KNo ❑ 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
gLNo
❑ 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
R No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Q4 No
❑ NA
❑ NE
maintenance or improvement'?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [:]Yes [gNo ❑ 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 ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
32. Crop Type(s): a ova- Al E-,-I- f -
❑ NE
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �No [DNA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes CkNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No [] NA ❑ NE
❑ Yes 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 RNo ❑ 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 K N
❑ 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 �N
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [-]Yes � N
o
o ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o ❑ NA ❑ NE
❑ NA [] NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VrNo ❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes EM-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? 0 Yes 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 19No ❑ 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
IVI No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
0 No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
®,No
[] NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
WNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[R No
0 NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Q No
❑ NA ONE
Comments (refer to question #i): Explain any YES answers and/or any additional recommendations- r any, other comments :W,
Use drawings of,facility to better explain situations (use additional pages as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

S� v
ivis'ion of Water Quality � � i-1
Facility Number ®- 701 onservation
� Other Agency
I"ype of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: _ �j �I Arrival Time: Departure Time: t7 I County : Region:✓�-�
Farm Name: E7.- O-t 2 Or Owner Email:
Owner Name: J�- �/t- ,� j7e�-Qrat Phone:
Mailing Address:
Physical Address: !
Facility Contact: �z h� eD,.V error Title: Phone:
Onsite Representative: S� _ integrator: /2:�p _
00,
Certified Operator: Certification Number: A22/ 4
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
r gn Cii�rent '2 i gn esi }� � Des
Cu-rrent,��' Desi Current
�
Swi�lnlel��Gapa&i;Pop.l Wet Poultry C p ity Pop Cattle Capacity Pop.
Weto Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
r
DairyHeifer
Farrow to Wean
W,�Des"*igner
D , Pou!act
Current Cow
Po Non -Dairy
Farrow to Feeder
Farrow to Finish
La ers
- Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
'=3r
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)?
[:]Yes KNo ❑ NA [] NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes [:]No
❑ Yes [R No
[:]Yes RNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 2.1412011 Continued

Facility_Number: - 701 Date of Inspection: — --!
Waste Collection & Treatment
. 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
ON E
a. If yes, is waste level into the structural freeboard?
❑ Yes
® No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L&No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
g No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
2, No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ER_No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[0) No
❑ NA
❑ NE
maintenance or improvement?
Waste AnMiication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
bg No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
CR_No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 101% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into Hare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Outside of Approved
Area
/Application
/
12. Crop Type(s):
13. Soil Type(s): /Vtl fy K_m- J'tGt]r_ K
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CR No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
RNo
❑ NA
❑ NE
acres determination?
17. Does the facility Iack adequate acreage for land application?
❑ Yes
E� No
❑ NA
❑ NE
I& Is there a lack of properly operating waste application equipment?
❑ Yes
[KNo
❑ NA
❑ NE
Rtguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E? No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E!�No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [&No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes jo No ❑ NA ❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ®No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - 7D I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes (g 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 to provide documentation of an actively certified operator in charge? ❑ Yes 2 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus toss 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 E4 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 CR 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 [?I 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 54 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 [ o ❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other, comments- # y
Use drawings of facility to better explain situations (use additional pages as necessary).,
,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: WO J!7 `jY00
Date:
21412011

1 ype or visir: kyLomppuance inspection CJ Operation Review U Ntructure Evaluation V Technical Assistance
Reason for Visit: (3'Koutine 0 Complaint Q Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: —r j Arrival Time: .' D(7 Departure Time: f County: Region: �}��
Farm Name: L. --a rd( Owner Email:
Owner Name: rl&-- Ltia
r- a"ro1(�f, Phone:
Mailing Address:
Physical Address:
Facility Contact: Ye- Title: Phone:
Onsite Representative:'_
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: /rs
Certification Number:`' 6
Certification Number:
Longitude:
Design" Current
Swine Capacity' Pop.
Wean to Finish
�D'esign Current
try ult Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
/
on -Layer
Dairy Calf
= M
l
Design Current :`
D . P�on1 Ca aci
Dairy Heifer
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars Pullets
Turkeys
Other Turkey Poults
Other Other
Beef Brood Cow
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[] Yes jo No ❑ NA ❑ NE
❑ Yes ❑ No [] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [::]No
❑ Yes No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: C- 7 c71 Date of inspection:
/ 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
® No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(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
Lrvf No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate Public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E, No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
0 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?
I L Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes � No ❑ NA 0 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable -drop /Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): ec) rn
13. Soil Type(s): �, 1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes JUI 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?
18. is there a lack of properly operating waste application equipment?
❑ 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 C& 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 D4 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C, No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 21412011 Continued

lracili !Number: - Date of Inspection: 13
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes D!� No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �Z No
the appropriate box(es) below.
D 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 to provide documentation of an actively certified operator in charge? ❑ Yes M 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)
3 L 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 t4 No ❑ NA ❑ NE
❑ Yes JZ No ❑ NA ❑ NE
❑ Yes 21 No ❑ NA ❑ NE
❑ Yes ® No
[:]Yes No
[—]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: a�,— Phone: Jp 1.f3�
Reviewer/Inspector Signature: Dater 3
Page 3 of 3 21412011

f"-j 0 v�1,2_ee-al 81.
Type of Visit: (Drtompliance 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: / / Arrival Time: Departure Time: /' ; D County: Region:
Farm Name: `, t-`p� _ Owner Email:
Owner Name: Z, e e'-, ark C_ Phone:
Mailing Address:
Physical Address:
Facility Contact: _J3T.,� L�n/!�t f�, Title: Phone:
Onsite Representative: _ 5rla s_._L_ Integrator:
Certified Operator:
Back-up Operator: Ta77�G i UL /— v-./
Location of Farm:
Latitude:
!" /�'
Certification Number: an4
Certification Number: 1�g7:a
Longitude:
Swine
Design Currents
Capacity Pap: -
Wet Poultry
Design
Capacity
Current
Pap. "'
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
P.4-0
I
iNon-Layer
I
I
I
Dairy Calf
Feeder to Finish;!
Farrow to Wean
,_�i `�
Dairy Heifer
Dr. P.oni
Layers
Design
Ca aci
Current
Po .
Dry Cow
Non -Dairy
Farrow to Feeder
Farrow to Finish
Gilts
Beef Stocker
Beef Feeder
Non -Layers
Boars
Otli—EREA
Other
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 gj No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
[:]Yes [:]No ❑ NA - ❑ NE
[:]Yes ❑ No
❑ Yes Ej No
❑ Yes Ej No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

FaciliNumber: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes M 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
Identifier:
Spillway?:
Designed Freeboard (in): 27
Observed Freeboard (in): 4&
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5 Structure 6
❑ Yes M No ❑ NA ❑ NE
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
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[�g 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
QNo
❑ NA
❑ NE
maintenance or improvement?
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
PM 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): /LhvLl'r ,
13. Soil Type(s): C
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
" No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ 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 � No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 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 0 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

Facility Number: - [ Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes ❑ No
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 5D No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 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.
0 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 [Z No ❑ NA ❑ NE
®Yes ❑No DNA ONE
[:]Yes
JS No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any, other comments.
._ P
Use drawings of facility to betEer:explain situations (use additional pages as necessary).
pF
3tf, f LM-e�
i b �5
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: �Q , � .33 Da
Date: _22'191`__
21412011

t tviston�'iif-Water Quality , ' �`
f"acili Number�-�!�
�gDtvisiater Conservation
® Other Agency'-
- �..�
Type of Visit: ompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: �31D County: Region:
Farm Name:Ley, yl - Owner Email:
Owner Name: _�rti '-d j Phone:
Mailing Address:
Physical Address:
Facility Contact: — 2;riy / _,_ l- Title: IAfVJ _Ill — Phone:
Onsite Representative: Integrator:
Certified Operator: J,O�y®:-a11�/ Certification Number:
Back-up Operator: fA7-/rG; a 1z "a-g Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine "
Wean to Finish
Wean to Feeder
Design Current�*Design Current
Capacity Pop. Wet" PoultryCapacity Pap.
Design Current
Cattle Capacity Pap.
Dairy Cow
La er
Layer
Dairy Calf
Feeder to Finish
uDesgn Current
D = Pou) _ Ca act P,o
Layers
Dairy Heifer
Farrow to Wean
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes 5a No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes { 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

Facili Number: - Date of Inspection:
Waste Collection & Treatment
l 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
I] No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in): —
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
14 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
Q No
❑ NA
❑ NE
waste management or closure plan?
N
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
R] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[allo
❑ 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
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Q/ '�t� 5y-�-' f-
13. Soil Type(s): _.. it.Ln2t
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
[Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E[No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Reguired 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
[0 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 [Z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [R No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [Z No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faciti Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [—]Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Z 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
[DNA ❑NE
❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [B No ❑ NA ❑ NE
❑ Yes �'No ❑ NA ❑ NE
❑ Yes
jo No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
[0 No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any otherfcomlkk...
Use drawings;.of facility to better explain situations (use additional pages as necessary). �
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

vision of Water Quality �� �--11
iFaci ity Number � 70 ( 0 DiVUO of Soil and Water Conservation
Other Agency
Type of Visit Ej Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 7 Arrival Time: 17 Departure Time: D 3 a County: Region: i�Q
Farm Name: Af ex- l— a'ed Owner Email:
Owner Name: 'K—_ j, L rC - Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: 45R'�n ��` Phone No:
Onsite Representative: Ste-= Integrator: Arm
Certified Operator: Operator Certification Number: 01y7-39 6
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = ' 0 " Longitude: = ° = ' = "
riDesign ;. Current
Design Current Design C*urrent
-Cat} "Populon
Wet Poultry Capes citypopulation Catue Capacity Population❑
F
La er
❑ Dai Cow
❑ Non -La er
❑ Dai Calf
Dai Heifer
Dry PouA ❑ D Cow
❑ La ers ❑ Non-Dai❑ Beef Stocker
❑ Non -La ers❑ Beef Feeder
Pullets❑
Beef Brood Co9❑ Turke ser ❑Turke Pouets
❑ Other Humber of Structures:
❑Other
ean to Finishean
to Feedereeder
to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges &Stream impacts
1. Is any discharge observed from any part of the operation?
❑Yes
®.No
❑ NA
❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
❑Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? ([Eyes, notify DWQ}
❑yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
K No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
[KNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/28/04
Continued

Facility Number: E2 — p 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): �f Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
IM 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
LgNo
❑ 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
RNo
❑ 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
U�No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
C@.No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
J
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
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
J@ No
❑ NA
❑ NE
_ ... ,
Comments (refer to question #). Explain any YES `ans� ers and/or any recommendat! or any other com nents.r
)
Use drawings of.facility.to better explain situations (use, uadditional pages as necessarY
Reviewer/Inspector Namef Phone: p3 330 C=.
Reviewer/Inspector Signature: Date: 12 ---'Zo/D
Page 2 of 3 12128104 Continued

Facility Number: — O Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ER No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall [:)Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EZNo
❑ 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
Q No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
to No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E4 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31,
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
99 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
BNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ER No
❑ NA
❑ NE
12128104

n
F.
Type of Visit 9-Co-mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason €or Visit ty`rcoutine 0 complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: {7 Departure Time: i 3 v County:
Farm Name: d r• Owner Email:
Owner Name: 13 e- r'1 ' L,pg�6avf d 7—r. Phone:
Mailing Address:
Physical Address:
Facility Contact: &_- _ Lgej rd _V i^ . Title: _ C,t 9 n e if- Phone No:
Onsite Representative: Integrator: , i�r'S %e$ -.
le
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Region: FRD
Location of Farm: Latitude: 0 0 = = Longitude: = ° 0 [ = "
Design Current
Design urrent
C
Design Current
Swine
Capacity Population
Wet PnWtry Capacity Population
Cattle Capacity PopWation
❑ Wean to Finish
❑ Layer
❑ Daia Cow
® Wean to Feeder
Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
Non -Layers ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
El Turkeys
Outer
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
4. Is any discharge observed from any part of the operation?
❑ Yes
R No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
[!.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?
12128104
Continued

' Facility Number: 0 ( Date of Inspection I vt 13
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JANo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Stnicture I Stnreture 2 Structure 1 Structure: 4 Structure ; StructurL b
Identifier:
Spillway?:
Designed Freeboard (in): -
Observed Freeboard (iny 33
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CRNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes P .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 X No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(Not applicable to roofed pits, dry stacks and/or wet stacks) ❑Yes (� No ❑ NA ❑ NE
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement? ©Yes [ No El NA ❑ NE
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PQ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes O 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 Drill [:]Application Outside of Area
12. Crop type(s)
0. Soil type(s) &�, 4 eoe k % Na A , ��A / e5- x a . _
—
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L@.No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
A No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes
N No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
N No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O No
❑ NA
❑ NE
Comments (refer to question #): Explain nay 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 Phone:
Reviewer/Inspector Signature: Date:
121291" continued

Facility ]Number: —L_7V1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [9 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes A No ❑ NA- ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[XNo
❑ 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
4 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[,No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Pff No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LgNo
❑ 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
Q 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
ERNo
❑ 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
EgNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
El NE
Comments and/or
12129104

ivision of Water Quality
Faei6ty Number 0 Division of Soil and Water Conservation S '
O Other Agency
Type of Visit ompii ce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: , MP Departure Time- County:, Region:
Farm Name: ;&rn ar"�f Irl. Owner Email:
Owner Name: ^ram„, , fie /7 r- Phone:
Mailing Address:
Physical Address: /
Facility Contact: Rrn �COi�p✓bf _ Title:
Onsite Representative: faz�,
Certified Operator -
Back -up Operator:
Location of Farm-
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone
hone No:
Integrator:�7`_:_ /�-L
1
Operator Certification Number: d;X3�141
Back-up Certification Number:
Latitude: [=1 o = I = u Longitude: = ° = g = w
Design Current Design Current
Capacity Population Wet poultry Capacity Population
❑ La er
4j f�D , �g0I ❑ Non -Layer
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges & Stream Impacts
I _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ NOD -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b, Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
1. 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 1KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NF
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
%.No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of inspection
i
Renuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Perinit readily available? ❑ Yes [3No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IS No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Other
❑ Design El Maps
21. Does record keeping need improvement? If yes, check the appropriate box below. C9 Yes ❑ No ❑ NA ❑ NE
D§ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes JRNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
A No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
tRNo
❑ NA
❑ NE
2& Did the facility fail to have an actively certified operator in charge?
❑ Yes
10 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CK No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EN No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E9 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
[KNo
❑ 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
U(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
CRNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
IN No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

r
Facility Number: X�Z — 7Di Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NNo ❑ 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): S
5_ Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes allo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes X 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 C.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 ro No ElNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes lo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift []Application Outside of Area
12. Crop type(s) T>z- ,
13.
Soil type(s)�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Da 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
M No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
JO No
❑ NA
❑ NE
18,
Is there a lack of properly operating waste application equipment?
❑ Yes
A No
❑ NA
❑ NE
Comments (refer.to-question ##): Explain any YES answers andlor�any,Irecommendations or any other court tents ,
Use drawings of facility to better explain situations. (use addthonal,pages-as necessary):
3 /.amp/�/�/ �f}� �D�'i" •
Reviewer/inspector Name �o ?.� — Phone: t7e7
Reviewer/inspector Signature: Date: —
rage i of i ]VIMIu4 t onnnuea

n
MR-1 vision of Water Quality a G -A--7
Facility Number p O Division of Soil and Water Conservation
- Q Other Agency
type of Visit QKmpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0"�outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date or visit: Arrival Time: ; �--�—Departure Time: County: Region: E<10
Farm Name: ;I ,—,-4H,7,// U_ �. Owner Email:
Owner Name: 5 P-jq 14C_j2�Phone:
Mailing Address:
Physical Address:
Facility Contact: ki 0,ugrejT'• Title:
Onsite Representative: _s
Certified Operator: _ _-:5
Phone No:
Integrator:
Operator Certification Number: zole-H-39 b
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = a= i 04i Longitude: 0 0 0 6 0
As
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
e. D z 5e& 00 1U Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pou Its
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
l
❑ Beef Feeder
❑ Beef Brood Cu
i
Number of Structures:ED
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 UTNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
�&No
❑ NA
❑ NE
12128104 Continued

.y
Facility Numher: — Date of Inspection v
-17
i Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
[9 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): _ vZ
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
R 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
Da 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
[4 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
K No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[) Yes
0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
U No ❑ NA ❑ NE
maintenance/improvement?
1 I . is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop Type(s)
f
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5d No
❑ NA
❑ NE.
IS- Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[3 No
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
U[No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: 210— I.U3 3ya
Reviewer/Inspector Signature: Date: f�y9-002

f Facility Number: — Date of Inspection rk, ` /—a
t
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 0 Yes 10 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P9 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E,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
5d No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
14 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
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0,No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
KNo
❑ 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
[Z No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R[No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

11
Type of VisitS�—M✓piiance
Inspection
O operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
Grf outine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: Arrival Time:/ � D Departure Time: I �, i7 f7 County ��' Region:
harm Name: �1��-rt t�1�2a�d�+ Owner Email:
Owner Name: J�^i1 . h-8`t add d r� _.__. _ Phone: I
Mailing Address: L _D/X1►',e ��C
Physical Address:
Facility Contact: ztel A Title:
Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number: 1:9d23 9 (0
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o F-] f F-I u Longitude: ❑ a ❑
Design'...'`Design
Carrent Design Current
Ss+ a
Capacity? Pogufatiou
Wet Poultry Capacity; Poguht io_n- Catite Capacity Population
❑ Wean to Finish
10 Laver
i
Wean to Feeder
9S
• ❑ Non -Layer
^; r
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other4
_"
`�`i ftlumber of Structures: FLI
❑ Other
. 1Dry Poultry.
' _ '
❑ Layen
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Points
❑ Other
Discharges & Stream Impacts
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
1. Is any discharge observed from any part of the operation?
❑ Yes
U(No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
KNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
❑ Yes
� No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)`?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
KNo
❑ NA
❑ NE
2. 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
EQ No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — 1 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 P(No ❑ NA ❑ NE
Structure I` Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
;jNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
El No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
No
❑ NA ❑ NE
8_ Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
2No
❑ 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
R No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�No
El NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
A 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 Drib ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LRNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
LK No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
W No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
QfNo
ElNA
❑ NE
ry _.
tam s'ituattons (us
93VJ I=a,-rn
Reviewer/Inspector Name Phone:`
Reviewer/Inspector Signature: Date:
12/2VO4 Continued

Facility Number: — Date of InspectionI�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [2(No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,Q No ❑ NA ❑ NE
the appropirate box. ❑ W'UP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 5f 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 Cade
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 P No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(Q No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[4 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
QjNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
& No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Z No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
®No
❑ NA
❑ NE
Ad�houal Cgtnments�and/orDrawings4t
12128✓04

■<
fi hh,
Di+rision of Water,-Quality.utxiber Sa '�O ( D Division of Soil and Water Conservation r. —J Q Other Agency
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: Arrival Time: I� 1S Departure Time: County: _ S a+no.S*A ] Region: FOLD
Farm Name: Iseeg L!gc, aina► j_R . Owner Email:
Owner Name: 0 � a 4�,i'a . n/ Phone:
Mailing Address: 13414 01,94 tr�� 1'So�� io�r�, NC _ 09-382
Physical Address:
Facility Contact:
Title:
Phone No:
Oasite Representative: I< r r L. tl Integrator: ` , e .6
Certified Operator: IR a, 1 JAL. �Gar%ar._CnOperator Certification number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
❑0 E' ❑` g ❑O=t ❑46
Latitude: Longitude:
Design Current Design Current
Swine Capacity Population Wet Poultry- Capacity Population Cattle
❑ Wean to Finish
IN Wean to Feeder 020 Y D9 S
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer _
❑ Non -La ct
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkevs
❑ Turkey Poults
❑ Other
Discharees & Stream impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Call'
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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)?
Dumber of Structures: U3
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part ofthe operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[A No
❑ NA
❑ NE
12128104 Continued

acility Number: $ 2 — 7at
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 I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ;as,26 u y / /G/97
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[A No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement'?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) �.r d. 1-•d,� 1_ 5 G — —
13. Soil type(s) 9,4
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
[A No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ yes
® No
❑ NA
❑ NE
Reviewer/inspector Name Phone:
Reviewer/Inspector Signature: Date:

Facility Number: a — o Date of Inspection S//p
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2( No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes m No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ® NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
55 NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ 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
[j 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
FKI 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
[�L] No
El 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
V No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
® No
❑ NA
❑ NE
i; " 'ie�s. zf „ - ..+ d 7 lb:,.; L. a,"'-... w 5 i c l c4- �v*• . X�
AddlhonalComments:andlorDrawings
12128104

4.
Type of Visit a Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine C) Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 8 Date of Vhdt: Time: A
ME
Kot Q .rational 0 Below Threshold
Permitted 13tertified 0 Conditionally Certified ❑ Registered bate Last Operated or Above Threshold
Farm ;tame: _ Bey Leonard County: _.-S'7=4ADr7Owner Name: tie,, Leonar6Z Phone No: %0•97297- 9S72�
Mailing Address: - 196y Old-Sa%e,.L�e al Rose 6 rd
FacHity Contact: &12 L�CQf Title: Phone No: 1`0 - 06 - 7z/g
Onsite Representative: dell L�P( eCA)VIIntegrator: -Pxi=j *a r_ / -
Certified Operator: &17 Lev ,a Operator Certification Number: 2� 3 �1 tO
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �r �• ��
M& Design Current
Design Current Design Current
Swine capacity Population
Poultry
Capacity Population Cattle Capacity Population
MRr-ean to Feeder
I &0IW 0
G ovO
Q Laver
I
I
Dairy
❑ Feeder to Finish
10 Non -Laver
❑Non -Dairy
Other
❑ Farrow to Feeder
Farrow to Finish
Total Design Capacity
Gilts
Bow
Total SSLW
Number of Lagoons l 1 I ILI Subsurface Drains PreseeLJILJ Lagoon Area 1LJSprzvFieldArea
Holding Ponds I Solid Traps No Liquid Waste Management Svstem
D35eh8rwe5 & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sorav Field ❑ Other
a. If discharge is observe(, was the conveyance man-made?
b. If discharge is obsenvd, did it reach Water of the State? (If yes, notif}' DWQ)
c. If discharge is obsen'ed, what is the estimated flow in galimin?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Wa a Collection S Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: Z
Freeboard (inches): 4y'7 /I
❑ Yes vlJ tvo
❑ Yes 2fio
❑ Yes Q No
❑ Yes BNO
❑ Yes QNo
❑ Yes ago
❑ Yes Elwo-
Smtcture 5
05103101
Conte aed

t
3 /I -ate--1
Facility Number:g — p Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes D1,10
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes U-NO
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental tbreat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [t <0
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
[ o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
/
elevation markings?
❑ Yes
o
Waste Application
10. Are there any buffers that need maintenance/improvement?
ElYes
�
Ef <o
It. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
U-No
12. Crop type _(Oaal
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑" o
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑-WO
b) Does the facility need a wettable acre determination?
❑ Yes
E�jVo
c) This facility is pended for a wettable acre determination?
❑ Yes
ONO
15. Does the receiving crop need improvement?
❑ Yes
[3'1�o
16. Is there a lack of adequate waste application equipment?
❑ Yes
[a'1Go
RRe uired Records & Documents
17. Fait to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes M'No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ,EWoo
19. Does record keeping need improvement? ie/ irri ation frecboa d aste analysis & soil sa arc orts E
P� g P (� S Y P ) El o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑'No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 9no
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes [L 0
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 9No
24. Does facility require a follow-up visit by same agency? ❑ Yes Po
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes D-Ko
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
use°wrawuigs or ""curry "o taetter,,exptatosituations: tuse addtt"onal pages as necessary): field Copy ❑Final Notes
s % ".O w
77 '3
H- 1q, or. Jeaharrr/ USej Gt 7�[rn�o�� ��A�. f( P�c� ,.. Avyysf f,
layao level, 6Vt,7n 610.,-, (�htcti y«,) [v/'v e ftie loklm /PoPPo-Wer/( 1o0lee4l
9oa d
Fan,-, l o.les 9
/sec vrJ5 are we // leePo4
Reviewer/Inspector Name
Q/ rLin►7t°'_'�_�
ReviewertInspector Signature: Date:
05103101 Continued

I
0 Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
10 Routine O Complaint O Follow-uD of DWO inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
D
Time of Inspection
O; 02? 24 hr. (hh:mru)
13 Registered IX Certified
0 Applied for Permit IQ Permitted
113 Not Operational I
Date LastOperated:
FarmName: ...............eCl.......n,�..._...('.•
.............. ..............
County: ...............................
IJ......................................
Owner Name: ...... .... e!1............................. ort ctro[�........... ' •
........... ...............
Phone No:
' ..-........�.......
9I ., �� S=la. ....
Facility Contact: ................6&&b ....... 9'i..; F &.0!V Title:
Mailing Address: ................. /Y M.
aj R�nelta tt'-a lYt.
Onsite Representative: ............ I7elh...........
earn+ ............... I.........................
Certified Operator:...............l1A'f?.t.
' ......... ell�?Ql .............
Location of Farm:
............................ Phone No:...................................................
...................... .............a83 a
Integrator: ............... _ A96-f &�........�.......
Operator Certification Number :....... A113q...............
Latitude ' =' 66 Longitude =' 0` ="
: ".i-DmtV z ` Current Design Current a .. DesEgII •` CiLTlent
Swvrrte _ �" Gapacity;'#'opulatEon Poultry �, .., Capacity „Pnpulatton Cattle dapacEty JPopulaUon
❑ Layer
❑ Non -Layer
... .
LEI Other
Total Destgn Capacity. g-v
v
F. f
T€►tal'SSLW
Nurtabec of Lagoons I Holding Ponds ❑ Subsurfaent ce Drains Pres❑ Lagoon Area ❑ Spray Field Area
�fx. Su.A^"ir., •a'' ,h,...� at ,�. --, _ .-- .... ... ....... .... .......
3 ❑ No Liquid Waste Mana
x ement S stem t F
Wean to Feeder
��`
Fe
❑ Dairy
❑ Non -Dairy
General
1. Are there any buffers that need maintenanceJimprovement? ❑Yes � No
2. Is any discharge observed from any part of the operation? [I Yes (� No
Discharge originated at: [I Lagoon El Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made? ❑Yes � No
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑Yes � No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑Yes ONo
3. is there evidence of past discharge from any part of the operation? ❑Yes [#No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes 0 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require [j Yes ONo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? El Yes 14No
7. Did the facility fail to have a certified operator in responsible charge? ❑Yes �No
7/25/97

Facility Number: — .701
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons: Holding Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes OfNo
❑ Yes XNo
Structure 6
Identifier:
Freeboard(ft): .......»Y.'S5 f� _.... ...»......»__ ......... _.......... ...... » .- ...__�.._........ .... _...,,..W...�,..... --- .................._ .............
10. is seepage observed from any of the structures? ❑ Yes VU No
11. Is erosion, or any other threats to the integrity of any of the structures observed? Q Yes [K No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
,Yes ❑ No
13. Do any of the structures lack adequate ininimum or maximum liquid level markers? [] Yes No
Waste Application
14. Is there physical evidence of over application? ❑ Yes No
(If in excess of WMP, or runoff entering waters of the State, notify DW Q
15. Crop type ....... .......... ... .............-----..-- - - » �tK/Z. Seems ....................... _---------------
-J ti
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 0 No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes dNo
18, Does the receiving crop need improvement? ❑ Yes 19fNo
19. is there a lack of available waste application equipment? ❑ Yes 0 No
20. Does facility require a follow-up visit by same agency? ❑ Yes E ] No
21. Did Reviewer/laspector fail to discuss reviewlinspection with on -site representative? ❑ Yes qNo
22. Does record keeping need improvement? ❑ Yes ( No
Fgrertifeed or Permtittted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes E6 No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes gNo
[] No.vitilations or deficiencies. were noted.iltiring this:visit+ You:will i-eeei�e:no ft%rtlier
CO& pofidence. aboat this:visit: ;
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: