820719_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

type or visit: 1p Compliance inspection V Operation Keview t,_) Structure Evaluation t;,,) "1-echnical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O D nied Access
Date of Visit: yl /�l Arrival Time: O/.` Departure Time: Z County: Region: 99V_
Farm Name: Owner Email:
Owner Name: __'Kyjytnj P L 644 1_s v-, Phone:
Mailing Address:
Physical Address:
Facility Contact: &'><a K" rl eel, - Title: Phone:
Onsite Representative: tit Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
~Desrgn Current
Design
Current
Design Current
5wioeCpaclty Pop.
Wet P©ultry
Capacity
Pap.
Cattle Ga acity Pop.
ean to Finish
La er
Dai Cow
Wean to Feeder
PW
Non -La er
Dai Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Current
1DrV Cow
Farrow to Feeder
D . 1'oult .
Ca aci
P,o P.
Non-Da'try
to Finish
La ers
Beef Stocker
lFarrow
Gilts
Non -La ers
Beef Feeder
Boars
Ptallets
Beef Brood Cow
. ..
Turke s
Other �f T }_-
Turkey PouIts
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? 0 Yes ONo ❑ NA ❑NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other'
a. Was the Conveyance man-made? ❑ Yes 0 No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [P NA 0 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 0 No ,B NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E?0o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: _ Date of Ins ection: 7 3
Wastaollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �D No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure I Structure 2 Structure 3
Identifier:
Structure 4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�t.1
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
❑ NE
❑ NA
❑ Yes
1�No
❑ Yes
Eh No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I?] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes `1J 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 f ❑ Evidence of Wind Drift %❑ Application
' OutsideofApproved Area
12. Crop Type(s):
13. Soil Type(s): rJ ,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
14 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?
IT 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
E�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [,I No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [] Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P No
❑ Waste Applicatior. ❑ 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 r U No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M] No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA 0 NE
Page 2 of 3 21412015 Continued

Facili Number: ©ate of Inspection: 71 A I
gr
"24. DicTthe facility fail to calibrate waste application equipment as required by the permit.
❑ Yes 99No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance;
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ® No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ 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 CAW MP?
❑ Yes No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary),
L
ewer/lnspectar Name:
ewer/Inspector Signature:
age 3 of 3
Phone: I fo- q ; 3 3 3n 3c
Date:431f
2/4/201 S

t 2iL
sion of Water Resources
. Facility Number L��J ---�-� 0 Division of Soil and Water Conservation
Other Ageecy
Type of visit: 9 Compliance Inspection o Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: tF Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: /Z Departure Time: Q f County: Region:
Farm Name: �1114t7 ✓A450/7 1 - .� Owner Email:
Owner Name: _ 11eV11*1.rk:
_W 4_5i, Phone:
Mailing Address:
Physical Address:
Facility Contact: 'y XarioeAgL Title:
Onsite Representative: k
Certified Operator:
Phone:
Integrator: At. -
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
V
Design .
Current"
Design
Current
Design Current
Swtne ��.
Ca aci
F ty
Pam"
p -_
Wet Poult ,
ry
Ca aci
p ty
Po F
Cattle Ca aci Po
F t3 p
Wean to Finish
A»
Layer
Dairy Cow
I INon-LaLer
Wean to Feeder
p
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
;.„'D , Poul'
Design
Ca
Current
L?o .
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
I
Beef Feeder
Boars
Pullets
12
Beef Brood Cow
'Other
�"�„�� :
Turke Poults
Other
. ..-9w.� .,.....,4:'.'.m.bJt-M�-iF.c....•.r.4w..,.:.:
..,:;.::
Other
... .Ni.', �1.4i:..: -.MVM; ....
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation'.?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Fm i No ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
[N NA
❑ NE
❑ Yes ❑ No �3 NA ❑ NE
❑ Yes 'P No ❑ NA ❑ NE
❑ Yes J0 No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili - urnber: 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 Pq NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
k
Observed Freeboard (in): 30
5. Are there any inunediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) q,
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[P No
❑ NA
❑ NE
maintenance or improvement?
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
[ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Frop Window ❑ Evide ce of Wind Dri
❑ Application Outside of Approved Area
12.CroP T Ows' r Id-
es:
yPO
13. Soil Type(s): /V L?12!
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
rM 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
QJsNo
❑ 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
0 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
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 0 No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes Q� No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes Q 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 O No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes [P No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA ❑ NE
ments (refer to question #€): l;zplain any YES answers and/or any additional recommendations or any other comments.
F
drawings of facility to better explain situations (use additional oases as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 6?'10-7w - i-
Date: 1%
21412015

iyPV vi rwu: w i.ompuance inspecnon v Lpperarton weview v atrucrure Lvatuation V iecumcai risstsrance
Reason for Visit: • Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: YJ f Arrival Timer Departure Time: .� County: egion:
` I
Farm Name: Owner Email:
Owner Name: N Y11`-P OZA4SON] i � Phone:
Mailing Address:
Physical Address:
Facility Contact: 64Title:
Onsite Representative: L/
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
_ Design Current
Design Current
Swine �' °Capacity Pop.
Wet Poultry. Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Da' Cow
Wean to Feeder
Non -La er
Da' Calf
Da' Heifer
Feeder to Finish
^�
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr 1P[►ult .. _:::,..Ci
La ers
Non -Layers
Pullets
Turkeys
P,o .
Non -Dairy
Farrow to Finish
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars
60 -'.
Other __
TurkeyPoults
Other
Other
Discharges and Stream Impacts
l . 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 0 No
❑ NA ❑ NE
❑ Yes
❑ No
NA
❑ NE
[:]Yes
[—]No
[ NA
❑ NE
[—]Yes [:]No NA ❑ NE
❑ Yes `p No NA ONE
❑ Yes PNo ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

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

Fac' Number: - inspection: Date of Ins tion: lJ
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 fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. 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?
omments (refer to question ft
se drawings of facility to better
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
any YILb answers and/or any addil
situations (use additional pages as
❑ Yes
Yes;No
No
❑ NA ❑ NE
❑NA ❑NE.
❑NA ❑NE
❑NA ❑NE
❑ Yes leNo 0 NA ❑ NE
❑ Yes T No
❑ Yes No
❑ Yes � No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
ons or any o er comments.
Phone:. 010—IB- 3300
Date: q1141h
21412015

� e of visit: W Compliance inspection t;,,) Operation Review U structure ;valuation U 'Technical Assistance
Reason for Visit: 0 Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: /'U 3o Departure Time: O! T QD County: �54� Region: 00-2D
Farm Name: V0 h h rat J o LF) 60 h 1 Owner Email:
OwnerName: f1� ,N h So., _ Phone: ._
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: L( Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Prop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
00b YOD
Non -Layer
Dairy Calf
Dairy Heifer
s.. it . „ ...
Feeder to Finish I, ,:,I ''i (i�l 7 .
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oult .
Ca aci
P,o
Non -Dal
Farrow to Finish
La ers
Beef Stocker
Beef Feeder
Gilts
Non -La ers
Beef Brood Cow
Boars
Pullets
Turkeys
Turkey Poults
ffil 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
[!PNA
❑ 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
F1 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 21412014 Continued

[facility Number: Z- Date of Ins ectio 4, Z7_5
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [3No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No �@ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:_
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes EP 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 [�3 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes jj5 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 P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P 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): n'1 t 4�, f j2 Act.
r
13. Soil Type(s): IL
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?
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 f4 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes P No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [P No ❑ 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 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 21412014 Continued

FaciliNumber: - 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 ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Otherlssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
M 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
bg 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
[W 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
`f 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 Q@ No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? [:]Yes ® No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes [� No [] NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewertinspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: 9"'9—f133-33c0
Date: t__Az'T/ j
21412014

type of visit: IP Compliance Inspection U Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Itu -r-
�,, Arrival Time: n : 00 Departure Time: %� �. County: AJ Region: �7
Farm Name: ��' Z L►iSo� Owner Email:
Owner Name: c1t�{ I11—So'-_ Phone:
Mailing Address:
Physical Address:
01
Facility Contact: C%10_ 0 9 Title: Phone:
L. {
Onsite Representative:
Certified Operator: KA- fl't, 33_�L rt(�o ti
Back-up Operator:
Location of Farm:
Latitude:
integrator: t--�
Certification Number:
Certification Number:
Longitude:
* . p cA 4 -.. ry p ty
FWean
, Desig�CDesign CurrenSwine ' Cap rty�= Po Vet Poult e @a ace Pop"" @attle Capacity Pop.
Wean to Finish La er Dai Cow
to Feeder p Non -La er DairyCalf
Feeder to Finish Dairy Heifer
Farrow to Wean Design Current ;, Cow
..
Farrow to Feeder D . P,oult . Ca aei Po Non -Dairy
Farrow to Finish La ers Beef Stocker
Gilts Non -La ers Beef Feeder
Boars Pullets Beef Brood Cow
:•,r -y Turkeys
Other,:, ` TurkeyPoults
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 P No ❑ NA ❑ NE
❑ Yes
❑ No
r%INA
`T'"
❑ 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
® NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facility it ;Mmbe : Date of Ins ectian: y
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q?No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No Pa)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 Wo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) TT
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [�j No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered ves, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA ❑ NE
$. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [�$No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste ADolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes n 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 Wir)dow ,❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
EP No
❑ NA
❑ NE
[] Yes
[�f No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste T fem
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili ,'N'bmb : Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes `P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P No DNA ❑ 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 P No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes IVI No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes P No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ 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 � No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes [�3 No
❑ NA
❑ NE
33. Dad the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes [� No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone: '9/0��
Reviewer/Inspector Signature: ' (/vl
Date:
7 fz- ly
Page 3 of 3
2/ I20II

a yp�stt: jr c omptiance inspection V uperatton lKevtew V Ntructure Evajuanon V t ecgtttcat Assestance
Reason for Visit: i Routine O Complaint O Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: I I a ! 0Departure Time: ,n0 County: Region:
Farm Name: Ot1t1 i Q o4n5on RV+M Owner Email:
Owner Name: V0 A vt ��' ��'��^S Dry Phone:
Mailing Address:
Physical Address:
Facility Contact: Q-0 flailnee Title:
Onsite Representative: f 0
Certified Operator: txK t JOLyt O
Phone:
Integrator: H
Certification Number: �.
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
f��N
�5wine �
Dest n
Current est n Cu Design Current
�Pn �Wetult ��C
Ca ac
gk
Ca acih
1?
Pow
p.,- at Capacity Pap.
Layer
DairyCow
20
ONon-Layer
DairyCalf
Dai Heifer
K
Des
re
Farrow to Feeder
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑Structure ❑ Application Field El Other:
a. Was the conveyance man-made'
b. Did the discharge reach waters of the State? (If yes, .notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 6 No ❑ NA ❑ NE
❑ Yes
❑ No
[n NA
❑ NE
❑ Yes
❑ No
[?I NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑Yes ❑ No [8 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 1 of 3 114/2011 Continued

lfacill dumber: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
MNo ❑NA ❑NE
❑No CA NA ❑NE
TO
Structure
6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 y
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
2 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
} No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [ D Yes 50 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): 1(e�•.u.E✓��o��. �t'ltH--"'/
r
13. Soil Type(s): A _
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 IM No ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes No ❑ NA ❑ NE
❑ Yes] No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
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
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections [:]Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[@No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
N No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

ifgchi lNumber: Date of Inspection: ,� 1 q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes No ❑ NA ❑ NE
the appropriate box(es) below. VIM
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
Fist 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
R9 No
❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[ No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[� No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
15g 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
(5§ 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
f &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
[D No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
§�L No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
FNo
❑ NA ❑ NI
mments (refer to question: Explain aoy YES answers andlor any additional recommendations or any other comments.
r
e drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 3
Date:
21412011

(4,),f,;t q4
Onsite Representative: rnf
Certified Operator: &,\Nxt L , -Se1V^5d A
Back-up Operator:
Location of Farm:
Type of visit: Ortompliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: 0Routine 0 Complaint O Follow-up O Referral 0 Emergency 0 Other O Denied Access
Date of visit: It (� (� Arrival Time: 1'3o PAI Departure Timed County ' _ Region: RIO
Farm Name: ReRf" E t�or� �gi�r*�5 Owner Email:
Owner Name: Rn(\:xF_ � Phone:
Mailing Address:
Physical Address:
Facility Contact: O 11 P_ Title: _ SeEc .
Integrator: niv awN
Certification Number: as iS rZ
Latitude:
Phone:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
`' Cagucity Pop.
Wet Poultry
Capacity
Po p.
Q
Cattle Capacity P.
7Feeder
nish
Layer
airy Cow
eder
(�
Non -La er
airy Calf
inish
-
-
DairyHeifer
Farrow to Wean
Design,
Current
D Cow
Farrow to Feeder
I) P,oult .
Caac
Po P.
Non-Dai
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
I
Beef Feeder
Boars
Pullets
I
Beef Brood Cow
Turke s
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify 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 Ig No ❑ NA ❑ NE
[:]Yes ❑ No
[:]Yes ❑ No
❑ Yes
❑ No
❑ Yes
(K] No
[:]Yes
n No
® NA ❑ NE
[�] NA ❑ NE
® NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

rl
1
Facili Number: Date of Ins ection: j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No jP NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: jW 3—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 13 It
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes W No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes D� 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
9. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U) No ❑ NA FINE
maintenance or improvement?
1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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): u cn Cam£ iZ A nry Al . kt e �► t c�.ss� 4
13. Soil Type(s): NO A
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes fV] 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
K] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
rLTQ 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 [K] No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑NA ❑NE
[] Weather Code
❑ Sludge Survey
❑NA ❑NE
eNA ❑ NE
Page 2 of 3 21412011 Continued

rF—aciljty Number:q Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ej No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
K] No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
M No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
V] 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 the 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? ❑ Yes [X] No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [4 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Y] No ❑ NA ❑ NE
F
mments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.e drawings of facility to better explain situations (use additional paEes as necessarv).
4- QDKV (-\h )0 Roo- p,M-l't (gr\ -V� OV tQg
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes [fl No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
Phone:
Date: -j.oA
21412011

'Biw-5 /C.'IZ-// f1 qv'-�
Visit: EffComptiance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
for Visit: 0-1 routine Q Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: 1 Region:
Farm Name: Nf� UhAJ -,r., Owner Email:
Owner Name: rw,, le— 4 1y—X aj &A^—. Phone:
Mailing Address:
Physical Address:
Facility Contact: _keAJ L 41 Title: =e�1 Phone:
Onsite Representative: e__1 Integrator: M—E)
Certified Operator: COY?/Lrj ,L. `l a`j,�.r�1y� Certification Number: 47-t;L.3`�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
''"�'
�De'sign,,,,,.Current�`�m
Design Current
Wet Poultry
CapacttyPop
Cattle Capacity Pop.
`'
DairyCow
Da' Calf
�-
., it
3
��- akr4 h
'
DairyHeifer
,-
Destgnx,Cui renter .
D Cow
,� ��€,.
D . P,oul Ca actP,o F
Non -Dairy
i
Layers
Beef Stocker
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turkeys
TurkeyPoults
Other
'
Design C�trrent��
Swine �
Capactty� Popp
Wean to Finish
Wean to Feeder
Q
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Layer
Non -La er
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑Application Field ❑Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
�TA
❑ NE
❑ Yes
❑ No
E�
❑ NE
❑ Yes
❑ No
�iA
❑ NE
❑ Yes
EKo
❑ NA
[] NE
❑ Yes
E3 No
❑ NA
❑ NE
Page 1 of 3 2/4/2011 Continued

Facili Number: jDate of Inspection: d
Waste Collection & Treatment
No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[T
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[—]No
<A
❑ 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
B<
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E N
❑ 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 to ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Q N ❑ 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 1R<0 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�o ❑ 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 A
12. Crop Type(s):
13. Soil Type(s):
❑ NE
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
Ua o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[5 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
B<o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
1 Now
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�'1�{o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the 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
g }�o
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[L[- 'o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[]Yes
/❑
[!'No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No Q4A ❑ NE
Page 2 o. f 3 21412011 Continued

Facilit Number: - Date of Inspection: ZQZ
24. Did the facility fail to calibrate waste application equipment as required by the permit? []Yes 02'No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ea o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑NA ❑NE
❑ NA ❑ NE
❑ 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 o ❑ NA ❑ NE
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No ❑ NA
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes �o ❑ NA ❑ NE
❑ Yes ©moo ❑ NA 0 NE
❑ Yes 21No ❑ NA ❑ NE
❑ Yes Imo"" ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Q, o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes �o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes Q-16 [DNA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations orjany'other7c—oii ments.
Use drawings of facility to better explain situations (use additional pages as necessary).
oa&W�c..
Reviewer/Inspector Name:
Reviewer/Inspector
Page 3 of 3
Phone: /C� '"35
Date: Q
21412011

73YAs
& IzI /z 0/0
Type of Visit &'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: `Zl /Q Arrival Time: Departure Time: /L,r County: _ SQ��-sdN _ Region:
Farm Name: c.�nnt 31 ot%A1s6,y v Owner Email:
Owner Name: I�O nr i ; C - TO i, a"/ Phone:
Mailing Address:
Physical Address:
Facility Contact: ��nr0 Ke"�~''y Title: _�D Phone No:
Onsite Representative: Integrator: �A 4, SYdklN
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: --o ED' E T Longitude: [= ° = d =
j
Design Cnrrent
Swine Capacity Population
Design Cnrren#
Wet Poul
Design C+urrent
I I ELCapacjrvmropniation
❑ Wean to Finish
❑
La er
❑ Dairy Cow
Wean to Feeder
❑Non
-La er
I
DaiLy Calf
Feeder to Finish
La ers❑
Non -La ers
❑ Dai Heifer
Farrow to Wean
Farrow to Feeder
❑ D Cow
❑ Non -Dairy
Beef Stocker
Farrow to Finish
['031
Gilts
Boars
her
❑
Beef Feeder
PulletsTurke
Brood Co
sBeef
❑
Number of Structures:
Turke PoultsOther
lIF1Other
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation'?
❑ Yes
�
B o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
--,,��
[ t<A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
[IYes
ElNo
2-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
[BA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
LT No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
EK0
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

.. -b
Facility Number: - r 9 Date of Inspection S-zS-/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
M'No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: 44
Spillway?: A/0
Designed Freeboard (in):
Observed Freeboard (in): 7
5. Are there any immediate threats to the integrity of any of the structures observed?
Ely.,
,�
C!,No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate pubUe stealth or
environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
L7 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
B o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[] Yes
to ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
D o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
,�,
L-<o ❑ 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)
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
,�,/
LJNo ElNA
[INE
15. Does the receiving crop and/or land application site need improvement?
ElYes
RINNo❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[9,--No El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
�L�<0'_0
:o LJ NA
❑ NE
Comments (refer to question #I) Eizplain any YES -answers and/or any recom�mendationS', any ots. ,f
Use drawings of facility to better eacplain situations: (use additional pages as -necessary);„ ">
Reviewer/inspector Name
Reviewer/Inspector Signature:
Phone: 9/0_ 330 0
Date: BLS"-2-610

Facility Number: 82 — 7 f G] Date of Inspection
R_eguired Records & Documents
19. Did the facility fail to have 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 LYNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design [:]Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
a o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain
Inspections ❑ Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
09<o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[� io
❑ NA
ElNE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
El NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
EL_f'N"
L�'No
El NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
ElYes
3'No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
91 o
❑ 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 LTNo ❑ 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 E)'No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes ❑ NA ❑ NE
12128104

Rr;41s //—/3 - z E70 9
Type of Visit UCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up 0 Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: 111--2-091 Arrival Time. Departure Time: County: sq ate✓ Region: Aim
Farm Name: I20A'Ni e- �o— AAf5dn1 F9 ✓ -1 Owner Email:
Owner Name: RONtii e— Z 0kAfX0AJ Phone:
Mailing Address:
Physical Address:
Facility Contact: cep_Title: �G Sp4 _ Phone No: p
Onsite Representative: Ge' ,O /CWNC-d/ Integrator: Gv ,�y O/d�s✓�c/
Certified Operator: �e�n+! S p kwlSon/ Operator Certification Number. 2 Z 39Z
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = L = 1
1 Longitude: 0 ° = 4 =
di
©esign
Current Design Current
Design Current
_
Swine .t ; Cpty
Population Wet Poultry Capacity Population
Cattle Capacity Popularion
❑ Wcan to Finish
I ❑ Layer
El -Dairy Cow
Wcan to Feeder
OO
❑ Non -Layer
El Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Farrow to Wean
❑ Dry Cow
❑ Farrow to Feeder
❑
❑ Non -Dairy
El Beef Stocker
ElLaers Farrow to Finish
❑Gilts
on -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Turke s
❑ Beef Brood Co
f-
❑ Turkey Poults
Other T
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts.
I. Is any discharge observed from any part of the operation?
❑ Yes
E 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
El No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
[3<
❑ 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: S2 -7101 Date of Inspection / / —O9
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2
Identifier: L
Spillway?:
Designed Freeboard (in): Z�
Observed Freeboard (in):
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes E o ❑ NA ❑ NE
❑ Yes loNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threa , notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Va 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 [:3 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
No ❑ NA
❑ NE
maintenance/improvement'?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
R"o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ]0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12.
Crop type(s) _Vu "rt t. A-- it/&tAj r _ 1✓i;0jy4:,� Q+4/•Vtl21
13.
Soil type(s) 11�?j¢
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
l._7<0 ❑ NA
❑ NE
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 acre determination ?
❑ Yes
0<o El NA
El NE
17.
Does the facility lack adequate acreage for land application?
Yes
El Yes
2 ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
9<0 ❑ NA
❑ NE
Reviewer/inspector Name ,����, y W Phone: 1/0. VJUr33.00
Reviewer/Inspector Signature: RA__ � Date: //—/Z— 2D4
12128104 Continued

Facility Number: c 2 -7/9 Date of Inspection
Re uired Records & Documents �,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L'.! 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. ❑ W`Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes No El NA El NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Grog Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ElNo❑
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[J No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ffNNo
❑ NA
[INE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O NNo
[INA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
ElYes
E NNoo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
Cl No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E 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
L'fNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Leo ❑ NA
❑ NE
�tk dry g.. r r� �/.•-� / a - Z / - O `) - Of�
"/t s �,l �. 9 17 - 0 9 / • S'�c/�•�/�ao�'GG'�,�
sa,/ 7-�_ a-
12128104

-
q
ion.o ate r Quality
LReinm Number g Division of Soil and Water Coanservation
Q Other Agency
Type of Visit Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: g-d(ti-OB Arrival Time: 12%40 Departure Time: B/:3a County: .rLW4-r041 Region: `/
Farm Name: &AIN-4e _ JO GtnVSOA! /x:a"__f1 Owner Email:
Owner Name: Romy�c_ Z Ausd c/ Phone:
Mailing Address:
Physical Address: _ Y
Facility Contact: 0ei►IQe1t/a/eq14 _Title: �Ze •Phone No:
Onsite Representative: _6;1_ 1Vo �nteeol" _ Integrator: A& ram , 43i-0 Jet/
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 = { = u Longitude: = o = , =
Design Current Design Current Design ,Curret
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity -.-
El Wean to Finish
Wean to Feeder
(pff
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer :::]: F��] -
❑ Non -Layer
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance than -made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy.Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Col
I
...
Number of Structures:'
b. Did the discharge reach waters of the State? (Ifyes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
Page I of 3
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes
❑ No
C] NA
❑ NE
❑ Yes
❑ No
ffNA
❑ NE
BTJA
❑ NE
❑ Yes
❑ No
El Yes
[[DN'o
[I NA
El NE
❑Yes
8<0
El NA
El NE
12128104 Continued

Facility Number: ?- 7% 9 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
E oo
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 32
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
[IYes
/
E, o
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr , notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,�/
4. Does any part of the waste management system other than the waste structures require ❑ Yes L`_f No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes O No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > lU% 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) c e.. ��cs. ! �S re� 5i"41(0,-
13. Soil type(s) No
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes NN
E No [I NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [3E Yes ,o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes L7 No ❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application? ❑ Yes E NNoo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? El Yes L�'No ❑ NA ❑ NE
�ur OT Y�l��) do �
6c-f�✓ 3oJ 4din/ Ar,-e%d6, C0 J /tl—&e_.
Slis--' d
d 4% tot ;r/3Mj dd
�a r e e, 1 ca_% q ra ,� C K� ��( w I I Lc ta k s sEe 444.4- 'Al rs c�-
� � �
Reviewer/Inspector Name Phone CIO, 53.3. 333Q
Reviewer/Inspector Signature: Date: T - to -2-a0
Page 2 of 3 12128104 Continued

Facility Number: FZ — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP El Checklists ❑Design El Mans El Other
❑ Yes B No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
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
ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
6No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ETIN
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Na
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Otlher issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes G No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
DINo
❑ 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?
ElLYes
�,
<
❑ 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
El Yes
2 o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,�,�
El
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L'SNa
NA
NE
33. Does facility require a follow-up visit by same agency?
El Yes
o
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12178104

Division of Water Quality
Facility )Humber Q Division of Soil and Water Conservation
O Other Agency 11
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit Wkoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit- p Arrivaall Time- Departure Time: � County
Farm Name: O 71 _ i e J?Yl Owner Eroail:
Owner Name: Yl 1 `e �� 1'�I'1� Vl Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Sv`rine
Wean to Finish
-Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
fl Regio
SIR
Title: Phone No:
Integrator: r
Operator Certification Num
Back-up Certification Number:
Latitude: =]o ❑' Dµ Longitude: =]Q❑f ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
AO ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkevs
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes. notify DWQ)
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Daia Heifer
❑ DEY Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ELI,
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 0No El NA ❑NE
❑ Yes
❑ No
3 NA
❑ NE
❑ Yes
[:]No A NA
❑ NE
❑Yes
❑No
DNA
❑NE
❑ Yes
`� o
(I NA
❑ NE
El Yes
(❑ No
ETA
l�Continued
ElNE
12128104

facility Number: 7— - Date of Inspection f D
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): Z
Observed Freeboard (in): Z-
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes � No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed ❑ Yes] No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes DO 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 '0h No El NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift! ❑ Application Outside of Area
12. Crop type(s) —C1i "C. i UJ�t
13. Soil type(s) ! VCIA— ._
14. Do the receiving crops differ from tue designated in the CAWMP?
❑ Yes )gNo
❑ NA
❑ NE
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 acre determination?[:] Yes
® No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
[jj1No
❑ NA
❑ NE
`Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
IUse drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name C-H Q.1 a D Qt (fiNTO M Phone: Lj jloyj5
Reviewer/Inspector Signature: Date:-DeZDv�
12128104 Continued

• Facility Number: Z — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No []NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 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 )WO
ElNA ElNE
ElWaste Application ElWeekly Freeboard ElWaste Analysis ElSoil Analysis [IWaste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29_ Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31 _ Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
-;BZNA
❑ NE
❑ Yes
�j No
❑ NA
❑ NE
❑ Yes
E)-a)No
❑ NA
❑ NE
❑ Yes
pNo
❑ NA
❑ NE
❑ Yes
❑ No
V9 NA
❑ NE
❑ Yes
10No
ElNA
❑ NE
❑ Yes
F No
❑ NA
❑ NE
❑ Yes
Wffq No
ElNA
ElNE
❑Yes
PNo
El NA
El NE
❑ Yes
Jp No
❑ NA
❑ NE
12128104

r
Facility No.
Farm Name
Owner
Operator
Back-up
COC
C
r L I Time In
�uP __So�NinSDn FC7Lr Yl^
Circle: ever or
Time Out �Date U
^
Integrator f r 1
Site Rep
No_
No.
NPDES
Desi n
ur
Design
Current
Wean Feed
Farrow — Feed
Man -- Finish
Farrow — Finish
Feed — Finish
Gilts 1 Boar
Farrow — Wean
O
FREEBOARD: Design
Sludge Survey I 1 01 O 14
Crop Yield
Rain Gauge ✓
Soil Test . � Wettable Acres
Weekly Freeboard Daily Rainfall
Spray/Freeboard Drop �q
Weather Codes 120 min I ecti
Waste Analysis:
Date Nitrogen (N)
Observed
Calibration/GPM 1
Waste Transfers
Rain Breaker
l/ PLAT
1-in Inspections
ns
Date Nitrogen (N)
e c)
►� VV
,z
,, b a

r
Type of Visit a Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency 0Other ❑Denied Access
Date of Visit: Arrival Time: /'OQ Departure Time: /: Z County: Region:
Farm Name: _ Ronre/Ie_ .S_Q_�,�rSn..i f�r� Owner Email:
Owner Name: c- To Phone:
Mailing Address:
Physical Address:
Facility Contact: CT_G�IO 4,,'eAIA/r r7 4 Title;
Of
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No. -
Integrator:
Operator
Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = { = {f Longitude: F-1 o ❑
tta
Design ZC went esign Current Design CurrendSwine Capacity Poulation Wet PoultrpacityPopuiation�attle Capacity Population
ElWean to Finish a, ❑ La er El DairyCow
09 Wean to Feeder ❑ Non -Layer ❑ Dairy Calf
a
❑ Feeder to Finish a ,:.•. _ s ❑ Dairy heifer
❑ Farrow to Wean ` s ❑ D Cow
.,4, Dry Poultry
❑ Farrow to Feeder ❑ Non -Dairy
❑ Farrow to Finish ❑ Beef Stocker
PE01
Gilts ❑ Beef Feeder
Boars ❑ Beef Brood Co
Other .,
a❑ Other Number of Structures:
,� .•,ram=:r���- - ��
❑ Layers
❑ Non -La -Layer
❑ Pullets
❑ Turkeys
❑ Turkey I'oults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
VNo
❑ NA
❑ NE
Discharge originated at. ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? -
[]Yes
9INo
❑ 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?
Page I of 3
12128104
Continued

Facility umber: Z — 7/ Date of Inspection S 08-0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes *o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
of
Designed Freeboard (in): Z4
Observed Freeboard {in}: 3S~
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 01 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes &No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes EVNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes (p 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 cP No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 60 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes [PNo ❑ 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)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[9No
❑ 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
[YNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
VNo
El NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
:,Use. drawings of facility to better explain situations (use,addittonal pages as necessary):
Reviewer/Inspector Name { _ �eJ l� Phone:
Reviewer/inspector Signature: Date: —OS-Z a0
rage.4 uJ ) 116iaaivlf Uununueu

Facility Number: gZ —7 Date of Inspection —O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2fNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 01 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 F No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
(3 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[5? No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[P No
❑ NA
[ 1 NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
`� No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
VNo
❑ 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
❑ NG
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: s' (c OS Arriv23 Time: $.' 30 Departure Time: County: Region: //PO _
Farts Name: 1?24 r 1 Jo11nTcQp ._ Fr4u Owner Email:
Owner Name: /l on_,nl' P_ ^, 3r04.7<nrt Phone:
Mailing Address: // 70q ,a k, RoseCor o _ .2 F3 S
Physical Address:
Facility Contact: !;��cz Aegn,- Title: Phone No:
Onsite Representative: Ge,,o leenrrlly _ Integrator; raQJe7 t ,ef CfaedgZ.�a 6&­,—,� �1
Certified Operator: &Wa, e__ 1244-004 _ Operator Certification Number: a3e1a
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
❑6 ❑' ❑ss g ❑O �, = i,
Latitude; Longitude:
Design . Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
6 00 ❑ Non -La et
❑ Wean to Finish
�Iean to Feeder
El Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
TurkeyPoults
Other
Discharaes & Stream Impacts
1. Is any discharge observed 1rom any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dai Cow
❑ DairyCalf
El Dairy Heifer
❑ D Cow
ElNon-Dairy
❑ Beef Stocker
❑ Beef Feeder
El Beef Brood Cowi
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c, What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 9 o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
U<o
❑ NA
❑ NE
❑ Yes
E?No
❑ NA
❑ NE
12128104 Continued

Facility Number: eq., —7/q Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Rf'es ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑Ko ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: 110
Designed Freeboard (in):
Observed Freeboard (in): ;;L S'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
Qlo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
[0lo ❑ 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
[-To ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
©< ❑ 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
RINo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
9-No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
E*6 ❑ 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
4-� 4-tv /
941 )3-31 `�� s;
] i
12. Crop type(s) /��6—r—"%_.I p��. f l►?,'//e� �-SA"e/ _
13.
Soil type(s) 0r)ro „
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNO
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
E>�6
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
❑ No
❑ NA
a4l-�E
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
Ea4iE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[allo
❑ NA
❑ NE
Comments (refer to guestiod#):.;-Explain any_YES answers and/or,any recommendations or any other comments.
Use drawings of facHity to better explain situations. (use additional pages as necessary):
wly Fare, �iu� r* Sra,� on S S' -1Ar, S-G� 04rr•<21 -6W0 C4/1 /o Q1'✓i? uu+f
// JJ
5,7P /nS��cTar r�vr, �g flr� � �rS�Nrf'ro1+ Brno /l�.,nra/]. ugi�.ti!
>to senll 100A iJwu
Reviewer/Inspector Name �/YJa��(T (�� ,�p� a Phone: 7 0
Reviewer/Inspector Signature: Date:
rci�oiv� �,vni�nueu

. 16
Facility Number: S Date of Inspection S• 7d S
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? E Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �lo ❑ NA ❑ NE
the appropirate box. ❑ t�❑ C>ts ❑ D>n ❑ Mw< ❑ Other
21. Does record keeping need improvement? If yes, check the a propriate b. x below. 9-1'es ❑ No El NA ❑ NE
3�`1ZLI 9-_.)-oS � t.q 747 -7' >��
❑ c ❑ ❑-W'aste Analysis ❑SoiiAffa�3isis- ❑ Witste-Tm-sfecs ❑
❑ %Tnf&H- ocking idd ❑ 1 ❑ atn nspec tan ❑
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or.Drtfwings:.
❑Yes
❑l�_o
El NA
El NE
❑ Yes
❑ No
❑ NA
@ 3G7
❑ Yes
❑ No
❑ NA
❑oNf
❑ Yes
9-Tl'o
❑ NA
❑ NE
❑ Yes
Lldivo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
52
❑ Yes 2*90 ❑ NA ❑ NE
❑ Yes [a'hlo ❑ NA ❑ NE
❑ Yes
[E No
❑ NA
❑ NE
a Yes
❑No
El NA
El NE
❑ Yes
[+ l fo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
PleGse
cvGiS 4 q'"v /j'S'S avYA
n9 rwards w, {/r `�ur.n recor�5, 69", ex.,/S +✓"l/ rriar� {or
S�oc�l.'ny recor�s.�
Q Cooy v{ r,4e
r'ecol-A
De 4
n be, of .2.v0 y Me {/PP�aqzr�
wa v /
s . 4 - Ae r.n errs 5 : o� �►a� �r �iud /o �+'., >�a,
�r 6o A /k°w 5�ta �% ha 6,e / Ao rC elrc l A/ P
��S,gaPc� Y�rpa6oer� 12129104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access i
Facility Number a naie of Visit: -! : 0 Time: g
Not Operational Q Below T reshold
Permitted Stertified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold:
Farm Dame: - 40P747+ 4r24641 64'rm County: So .02jOr►
Owner Name: 1sDnrr' F e TOhl,tca,ti Phone No:
Mailing Address: �' 1?0 >a%,,o -/' ,tf
Facility Contact: G 610 I-{P7dAd( Title: Phone No:
Onsite Representative: G r', o K�� e14 Integrator: Aue0514+. ' Qrkw
Certified Operator: fi dn,, e., J"'AJ. i On Operator Certification Number: _ .22 322
Location of Farm-
L!d'swiine ❑ Poultry ❑ Cattle ❑ Norse Latitude a " Longitude
Design Current ... Dasign Current "Destga - Current
Swine, Capacity Population Potihir► Ca acih• Population Cattle < : - 'Ca -aeitr Pti uiatxon -,
can to Feeder Lio 0 10 Laver 1 ❑ Dairy I-
❑ Feeder to Finish ❑ Non -Laver I I Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
Ef Farrow to Finish Total Design .CapsCh'
❑ Gilts
❑ Boars Tots}ISSLW
Number of Lagoons -. ❑Subsurface Drains Present ❑ L oon Area
HoldingTonds / Solid Traps ' ❑ No Liquid Waste Management System
Discharges && Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man-made?
b. lfdischarge is observed, did it reach Water of the State? (If yes. notify DV.'Q)
c. If discharge is observed, what is the estimated flow in gaiimin?
d. Does discharge bypass a lagoon system.? (If ves, notify D«`Q)
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?
«"ante Collection S Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure .4 Structure 5
Identifier: _ I
Freeboard (inches):�1`
05103101
L'15o
❑ Yes
❑ Yes
[3, o
❑ Yes
io-
❑ Yes
[9-50—
❑ Yes
EK0
❑ Yes
0-9"o
❑ Yes
Structure 6
Continued

•
Facility Number: 42 —
Date of Inspection
5, Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
o
Q�
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
dq-6
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
[9-Ido-
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
ag
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid. level
❑ Yes
19-M
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
OIC
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
044o
Excessive Pondiing ❑ PAN ❑ Hydraulic Overload ❑ a� Zinc
Frozen Ground Copper
pand/or
�❑
12, Crop type /� I t✓U+ T , Sln c /1 Gra r n , Qu-, e 4 L JcL� /I I'll - (_exe�
-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
UNO
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
[-Wo
b) Does the facility need a wettable acre determination?
❑ Yes
[allo
c) This facility is pended for a wettable acre determination?
❑ Yes
Q o
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
R06
Odor Issues
IT Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
aM
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
ElYes
ETNo
roads, building structure, and/or public property)
20, At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
O-No
Air Quality representative immediately.
�ssarY) � ��eld
Gvrren_� wvsle /o/an ,n records vq f-Ae Ion—
❑ Final Notes
/ leak r�,on.�a. $ram SPATS G/'o✓n laga�n fur G/o5,'rr,
/iolr on Sr'Ur O� %�caH. Aar pia✓v cf� 7topte,'/ Rwc/
ram:. 9„}
s
L PE1/is�j 9coel cpvice efos,'.�.
Rrt 10r,*Sep,14 41roce remove 464orQre A4e7 �ecdMr At
Reviewerlinspector Name
Reviewer/Inspect:or Signature:
411.441 7 4a�au�uru

Facility Number: —71 Date of Inspection - /y-o
Required Records & Document.;
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the cility fail to have all coritponents of the Certified Animal Waste Management Plan readily available?
(ie/ ch sAa4fn, zwps; etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
witcaaQu
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
{ie/ roblems, a on)
27. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
29. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes Imo
❑ Yes
LWO-
❑ Yes
❑-ice'
❑ Yes
ji Pio
❑ Yes
M446"
❑ Yes
UW
❑ Yes
Ekwo
❑ Yes
&'No
❑ Yes
MW6
❑ Yes
gwo-
13 Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form [] Crop Yield Form ❑ Rainfall ❑ Inspection After 1 " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

t
Division of Soil and Water Conservation � 0 Other Agency
:
Division of Water Quality
10 Routine O Complaint O Follow -tit) of D%V0 inspection O Follow-up of DSWC review 0 Other
Facility Number
Date of Inspection [ ff �
Time of Inspection : Gem 24 hr. (hb:mm) .
❑ Registered 0. Certified 0 Applied Permit 13 Permitted
[3 Not Opera Date Last Operated:
/for
FarmName:.......... 1......v....... ! R..e!!!��......
......... County:.../.....,.:.R ....................... ......y...............
Owner Name:........... o•''vi, ......7,a— ,...............................................
Phone No:.�•• �1� ... FK ._Ilz1..cy.....
FacilityContact ............................... Phone No:...................................................
.................r.Y!!.:��.........�.f.�� Title:.................................
Mailing Address: ........ .1f:7,1��.1.....lfeSC� ......1r..f�tf...,,1��.r
r,,r�rP,d�.....-t3Z.........
Onsite Representafire:. - s✓� _... �s. _........ .........
_. Integrator: ...... . .. . .................. . .................. . ..... . . ...... . ..... . ..
Certified O erator,..._..J.-....._ _.
. Operator Certification Number
Location of farm: l a�-__ �C� ��.l�ifYs 16l _ �l% J'W_ - ;-Al—
Latitude • =' 46 Longitude 0• 4 "
h sx wik. ww a7M,^^>• .b-•.:
v¢a +rtir � ;
Desigp�n Curren
t�-'
�
Swttte,
Ca a`cif P ` ulatr on
Y �..
��iyAN �
w� r
1Ptatutry *, Ca aci ,Po ulation Cattle'«� a ac>< o Wationy
ty: P, P p_.
P
m-
P.. ,_.. .,
<. ® Wean to Feeder
6d
Layer
❑Dairy
Feeder to Finish
❑ Non -Layer I
Nan-Dairy
EF, ❑ Farrow to Wean:yafi
;= ❑Farrow
❑ Other
to Feeder
❑ Farrow to Finish
'# '"
Total Design Capacity E2
" ❑ Giltsir"
-
❑ —Boars
�nA C ■r.-Wf;.
Ir
sm
L
cam. f�.�. .. .... , .,-mber of Lagoons l Holding Ponds / ❑ SubsurfaceDrainsPresent ❑ Lagoon Area Spray Field Area
... qm,w. + - ,; ❑ No Liquid Waste Management System
General
_ Are there any buffers that need maintenance/improvement?
❑ Yes
0 No
2. Is any discharge observed from any part of the operation?
❑ Yes
CH No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made?
❑ Yes
[V 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 gal/min?
_ A�4
-d. Does discharge bypass a lagoon system? (If yes. notify DWQ)
❑ Yes
JR No
3. is there evidence of past discharge from any part of the operation?
❑ Yes
ZNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
M No
5. Does any part of the waste management system (other than la,00ns/holding ponds) require
❑ Yes
No
maintenance/improvement'?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
P No
7/25/97
Continued
on back

Facil* Number:..
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
IR No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Structures Lan ns and/sir HoldingPonds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
�tNo
Freeboard (ft). Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
jj
10. Is seepage observed from any of the structures?
❑ Yes
V No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
�9 No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
V No
Waste_Applicatign
14. Is there physical evidence of over application?
❑ Yes
KNo
(If in excess of WMP, or runoff entering/wafters of the State, notify DWQ)
15_ Crop type—�...�'�l,/ — W....—...._� _ ...._ .._.... _..._
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
)a No
17, Does the facility have a lack of adequate acreage for land application?
❑ Yes
RNo
18. Does the receiving crop need improvement?
)RYes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
1�n No
20. Does facility require a follow-up visit by same agency?
❑ Yes
No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
[:]Yes
allo
For Certified Fagili 'es Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Ycs
X No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
,M No
24. Does record keeping need improvement?
❑ Yes
f9 No
Comments (refe to question #): Expiaiti any YES' answers' and/or°any recommendations or any other commetifs
Use drawings of facility..to better explain situations. (use additional pages as necessary): E
_,.. � .. b.
Reviewer/Inspector Name # IF �:
Reviewer/Inspector Signature: �— Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97