820726_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua!

Type of Visit: (0-C�outine
ce Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Complaint C) Follow-up Q Referral O Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: .gyp Departure Time: ego County: Region: A-- o
Farm Name: 14Y_ IXQ e Owner Email:
Owner Name: A101-f C 1 d� •�Ss''L- Phone:
Mailing Address:
Physical Address:
Facility Contact: arrk �a�S Title: 1 t 0A -ram Phone:
Onsite Representative:
Certified Operator -
Back -up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: / 76"2r---/
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet P.oultn Capacity 1'op. Cattle Capacity Pap.
Wean to Finish La er DairyCow
Wean to Feeder
Non -La er
DairyCalf
ceder to Finish
Farrow to Wean
"'.. Dai Heifer
Design Current D Cow
D . Pout Ca sci Pe . Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Non -Layers
Pullets
Beef Stocker
Gilts
Beef Feeder
Boars
Other
Beef Broad Cow
Turkeys
Turke Points
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
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<o ❑ NA NE
❑ Yes [:]No ❑ NA [:]NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes
❑No
❑NA
NE
❑Yes
[a
[DNA
❑NE
[—]Yes
�o
❑ NA
❑ NE
Page I of 3 21412015 Continued

Faeili Number: jDate of Inspection:
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.
Spillway?:
No ❑ NA ❑ NE
[]No ❑ NA ONE
Structure 6
Designed Freeboard (in):_
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes D14o ❑ 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?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements
improvement?
Yes
No
❑ NA
❑ NE
$. Do any of the structures lack adequate markers as required by the permit?
[—]Yes�a
❑ 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
0Yes
[��
❑ 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 0Heavy Metals (Cu, Zn, etc,)
❑ PAN ❑PAN > ] D% 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): y� t,c jc� l / f9+/ e/3z�r�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
[�io
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
[�'�Io
❑ 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
[�lo
❑ NA
❑ NE
18. 1s there a lack of properly operating waste application equipment?
❑Yes
[�No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental reat, notify DWR
Re uired Records &Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [3No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
7. Do any of the structures need maintenance or
[:]Other-.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E3 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [a No
❑ Yes [-10
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412013 Continued

' 1~acft Number: - Date of Inspection:
f 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E3 o [] NA ❑ NE
s
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0 ''"' ❑ NA ❑ NE
27. Did the Facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2No ❑ 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_
3Q. 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 [3-No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �!o ❑ NA ❑ NE
❑ Yes [a�o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Any
No
❑ NA
❑ NE
[�No
❑ NA
0 NE
I__I No
❑ NA
❑ NE
Reviewer/Inspector Name: ��ille 4uy%fiy~—�~ Phone
.01 _z
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412015

i-rr- � _ _. . _� . - -. . .«.w._ -ti �T. . ..-.r '- ti . �.. ti.w..�-�. ',I y fir. •-.y.hw ••• -.- __ _.]-- -�•- • - _ •y
ivision of Water Resources
Facility Number - Division'01 Soil and Water Conservation
Q Other Agency
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: ..E 11fa f( �Z-a.F� ,� I aerp-v— Owner Email:
Owner Name: Piz., k y
=:2t,.,� �� Phone:
Mailing Address:
Physical Address:
Facility Contact: /j fxf errsya-•-, Title: , J(,U�.i.i`— Phone:
Onsite Representative: Sc� Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
esign Carreet I;Iign Carrent
Design Cnrreut
Swine tin-apacity Pop. Wet Ponitr} Capa sty Pop.
0
Cattle }
Capacity Pap.
Finish Laver
DairyCow
DairyCalf
Feeder
Non -Laver
o Finish
DairyPfeifer
o Wean
Design�Current
Cow
to Feeder
Non -Dairy
D. P,opl Ca acir b
I a ers
to Finish
E
Beef Stocker
Non -La ers
Beef Feeder
Beef Brood Cow
H Pullets
Turkeys
Turke f Dolts
Other
:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes EQ No ❑ NA ❑ NE
❑ Yes
D No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [:]No
❑ Yes 4jZNo
❑ Yes WNo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
;4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
1►
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:
Spillway9:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [aNo
C] 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 JKLNo
❑ 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 M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E�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 M'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 13 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): �INa , �,, �_ r
13. Soil Type(s),
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �]t No ❑ 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 [a 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?
❑ Yes [4 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 Q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes QC , 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 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 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EgNo ❑ NA ❑ NE
Page 2 of 3 2141.1015 Continued

Facili Number: -Z
jDate of Inspection: /7
r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Jallo ❑ NA ❑ NE
;�25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ®.No ❑ NA 0 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?
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)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
EjjNo
❑ NA
❑ NE
❑ Yes
a No
[:]NA
❑ NE
❑ Yes
a No
❑ NA
❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes [ANo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
�jNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
Eg-No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
DKI No
❑ NA
❑ NE
Comments (refer to question #i): 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:
Reviewer/Inspector Signatur
Phone: D"3Z}3
Date:
21412015
Page 3 of 3

Division of Water Resources
Facility Number - ® O Division of soiland Water Conservation
Q Other A SM
Type of Visit: O Compliance Inspection Z5 Operation Review 0 Structure Evaluation Technical Assistance
Reason for Visit: t♦ Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: / [ Departure Time: L County: o, rt so Region:
Farm Name: LL Mar,( Owner Emaii:
Owner Name: Mia 4 k Xot rso',Phone:
Mailing Address: C i 1
Physical Address:
Facility Contact: Mai, k Pec+ rs o Title: ,A7&M e r Phone:
Onsite Representative: Sc.r* e _ __ Integrator: ircu ir-0 G
Certified Operator: _ cAme Certification Number: '7ff /
Sack -up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity op.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
ceder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
!P4$Q
D . $oul
Layers
Design
Ca aci
Current
l'o
Heifer
—Dairy
Cow
Non-Dairy
Beef Stocker
Gilts
Boars
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Uttier,
Turke s
Turke Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [Ef No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes [] No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ZNo [] NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [] No [✓] NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

r %.
Facili Number: - 0 ;L to DoInspection:
1 U
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[ONo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[:]No
❑ NA
❑ NE
Structure 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
[✓rNo
❑ 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 G2rlNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes O No [] NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E! fNo ❑ 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 E! i4o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes �No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes [] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 109/6 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): d_erMV d&/Dverse Cl Ilo ah1 Aforn -
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EfNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes QNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reouired Records & Documents
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes v No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ETNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�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
[DNA ❑ 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
E�J_No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No [✓]DNA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - 07A& 113ate of Inspection: I l 1
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
E?lNo
❑ 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 docurnentation of an actively certified operator in charge?
❑ Yes
E?'*�No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
[Ro
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[2"N'o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Q'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
2'iNo
❑ 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
21No
❑ 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
[✓'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E o
❑ NA
❑ NE
Comments (refe,-, � q _ any additional -recommendations or an other roinnnents:
U.se drawtn s.of faeili to better ex Iatn.sitn Y y
r�#or nesttaa #,) FE:cplatn any ICES answers and/or
g _ ty`p ations (use additional.pages as necessary.).`
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date: 1( Z, 41 &
21417015

• ��� /�-3v—ice
Type of Visit: oroutine
nee Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: : _M County: Region:
Farm Name: /r'�r�Q rS t7 W �Q f Owner Email:
Owner Name:, �� Q ��� �� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:Phone:
Onsite Representative: S.r-*-tom Integrator: D1Y
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
SO
Swine Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Da' Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
-
Da' Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oulitr
Ca acI
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (I f 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 [ff No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [-]No
[—]Yes ja No
❑ Yes ["No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes t No ❑ NA ❑ NE
a, If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [S 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
[a 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
EK No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
5�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
JK No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
0 Yes
ER No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes MNo 0 NA
❑ Excessive Ponding 0 Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[] PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Hare Soil
❑ Outside of Acceptable Crop Window
/� ❑ Evidence off Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):Cifi u4 //E�U''✓`r't' / �!�/'1't �Ly�1'r%�yf••—`�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ®No ❑ NA ONE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes fallo ❑ NA 0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EZI No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? 1f yes, check the appropriate box below. ❑ Yes CNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" 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 ONE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facifi Number: - bate of Ins ection:
f
• 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[allo
❑ 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) bellow.
❑ 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
Dg�No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
0 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30_ Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0 No ❑ NA ❑ NE
[:]Yes 2No ❑ NA ❑ NE
❑ Yes [a No ❑ NA ❑ NE
❑ Yes [gNo ❑ NA ❑ NE
❑ Yes [allo
[—]Yes jo No
[—]Yes IMNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question #):,eEEx-'-- 'nm' ranyi'�ES answers. and/or any additionaldrecommendations,or. any other comments.
Use drawings of;, facility to better e. laut srtttatjons use additional pages as necessa
IP ( P g rY)
,.. h.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date:
.21412014
Page 3 of 3

s ,fd -
i
Date of Visit: Arrival Time: • oa Departure Time: County: j� e
Farm Name: %r'/ ge.6'_3 V -' Owner Email: �T-
Owner Name: % M11r1c In-orr`Sa,t Phone:
Mailing Address:
Physical Address:
Facility Contact: %i�%/ �z�aSB``�--� _Title: LlPubpf Phone:
Onsite Representative: rjs -� _ Integrator: y0l s&�-
Or
Certified Operator: Certification Number:
y -
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
__
Design Current
Design
C_ anent
Design
Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wean to Finish
La er
DairyCow
DairyCalf
Wean to Feeder Non -La er
Feeder to Finish
O�
DairyHeifer
Farrow to Wean
_::
Design
Current
Cow
Non -Dairy
Farrow to Feeder Dr ..P,ouI Ca aci Po
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Pullets
Beef Feeder
Boars
Beef Braod Cow
Other
Turkeys
Turkey Poults
-
.,.
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E3�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
>❑ Yes
[]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
[] NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
allo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of J 21412014 Continued

• Facility Number: - Date of Inspection: / /
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 ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): j 7
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes allo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® 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 E3 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes allo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes (a No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [0 No
❑ NA
❑ NE
maintenance or improvement?
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes R.No
❑ NA
❑ NE
0 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?
Re aired 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
allo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
a No
❑ NA
❑ NE
❑ Yes ru'r No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps 0 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 Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [] Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: r - 7 Date of Inspection: — �r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes M 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 to provide documentation of an actively certified operator in charge? ❑ Yes EN No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ®No
Other Issues
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
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
Z,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
0 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
®,No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
O-No
❑ NA
❑ NE
Comments refer ta' u P ( P l; r ry)_ mendationssor any other eomtuen'ts.
( gneshon Eapiain°any•YES answers and/or sny sy d�t,pnal
Use drawings of.facili to;hettereir explain sitnat,onsy nse.addidonal a es:as neressa
Reviewer/lnspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
[lesson for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 02m Arrival Time: I h9,'0(-j Departure Time: I I . V [7 County: Region:
Farm Name: _W- 111a6k Fa,-A-4- Owner Email:
Owner Name: _ /-/- /yid✓/t 1p1✓a1-6 Cl— Phone:
Mailing Address:
Physical Address:
Facility Contact: ��'� �Ydrs 0-- Tide: &CCAK P-, - Phone:
Onsite Representative: cam-
Certified Operator: s�-•-�--
Back-up Operator:
Location of Farm:
Latitude:
integrator: , f-f
Certification Number:
Certification Number:
Longitude:
Design Curren_ t Design Current Design Cnrreut
Swine Capacity° Pog. V4'et Poultry Capacity Pop. Cattle Capacity Pop_
Wean to Finish
La er
Dai Cow
Dai Calf
Wean to Feeder
Non -La er
Feeder to Finish
Farrow to Wean
e9q90
�
- _
Design CurrentDry
_ D , P,oul Ca acP,o P.
hy
Dai Heifer
Cow
Farrow to Feeder
Non-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
I
Non -Layers
Beef Feeder
Boars
Othe
Other
Pullets
Turke s
ITurkeyPoults
Other
Beef Brand Cow
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 RNo ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
(S No
❑ NA
❑ NE
[:]Yes
[&No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Eg No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 0 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [KNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [Z No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 54 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit'? ❑ Yes allo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E[No ❑ NA ❑ NE
maintenance or improvement?
s
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Oc No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [j�LNo ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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
JL _
12. Crop Type(s): -, /� / jW z*,V�j / 610,-*7 ,SB�.b�r' 1
❑ NE
y
13. Soil Type(s): w aQ,�a % wa -5 /AZ O 1+
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 IS -No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes RNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
KNo
❑ 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
f2[ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[S-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 [allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
[] NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - 7 Date of Inspection: / — 13
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes El No
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes RNo
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 0 No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes RNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency'?
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes [ cL No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes
RLNo
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
®.No
❑ NA
❑ NE
Comments (referrto question;#): Explain any YES answers and/or any additional recommendations or any o#tier comments G {`
Use 'drawmgs of -facility to befter explain situations (use additional pa>;es as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: J3
21412011

Type of Visit: W'CoQ ce inspection Operation Review Q Structure Evaluation (-)Technical. Assistance
C9"RoutinI
Reason for Visit: e 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: rrival Time: ; fl Departure Time: ,9; 0 iD I County: Region:
Farm Name: rnzxek 1�ot ►'S .T- Owner Email:
Owner Name: J f /W" ft - ��cx,l'� �7•�- Phone:
Mailing Address:
Physical Address:
Facility Contact: M,2.o jl� f r�� _Title: Phone:
Onsite Representative: S—Ie Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design Current
Design Current
Swine Capacity Pop.
Wet Poultry Capacity Pop.
.w ---
Cattle Capacity Pop.
Wean to Finish
FjLayCT
I
Dairy Cow
Wean to Feeder
iNon-Layer I
airy Calf
>CFeeder to Finish
airy Heifer
Farrow t0 Wean
Design Current
Dry Cow
Farrow to Feeder
Poultry Ca achy P;o
Non -Dairy
Farrow to Finish
I Lavers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
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 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 Pg.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[] Yes ❑ No ❑ NA ❑ NE
[—]Yes
❑ No
❑ Yes
KNo
❑ Yes
;jq_No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

' Facility Number: - Date of Inspection:
Waste Collection & Treatment
4 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
allo
❑ 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): Li _
Observed Freeboard (in):�_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
PRI 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
t9nLNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2g No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Z, No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,Ln, 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): /i}yey_15-' j // Q/n'l /GlJlt r•✓ �.J�f3�
❑NE
13. Soil Type(s): Q
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 MNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2LNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[M No
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
rNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
;gNo
❑ 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 D3 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 N No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C,No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �gNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes RNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e_, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
[] Yes Z No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 5D No ❑ NA ❑ NE
[:]Yes ® No
❑ Yes ® No
[:]Yes E-No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to questtdwX) Explain ah YES answers and/or any additional recotrimendations or'any otlter F fii 'tom'
Use drawings of facility ti better expl`atn.sifuations (use additional pages:as necessary) .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
214/1011

t
Date of Visit: Arrival Time: ; OD Departure Time: I i ;t70 Coun
Farm Name: r r Owner Email:
Owner Name: 111aeA jam/, -- �,�� Phone:
Mailing Address:
Physical Address:
Facility Contact: y06����SD Title: Phone:
Onsite Representative: �� y
Certified Operator:
integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Region:
Design Current
Design
Current
- Design Curren#
Swine
Capacity Pap.
Wet Poultry=
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
_:
Dairy Heifer
Farrow to Wean
_
Desi
Current -
Dry Cow
Farrow to Feeder
D . Poult
Ca aei
Pia
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qther {
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
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 N No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes P!� No
[:]Yes t5No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - 71 Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes g[ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [:]No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes � No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes � No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
ER Yes o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ZI 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 jo No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes 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): t�dP�►7 fICJ/t -.V�
13. Soil Type(s):..
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes PLNo [DNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes K No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 14 No ❑ NA ❑ NE
acres determination?
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
� No
❑ 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
99 No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ 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 I& No
23_ If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J&No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes WNo ❑ NA ❑ NE
25. is the facility out of compliance with permii conditions related to sludge? If yes, check [::]Yes E&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 [S No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 5�[No ❑ NA ❑ NE
❑ Yes CKNo ❑ NA ❑ NE
[—]Yes [allo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
[::]Yes JR No
❑ Yes � No
❑ Yes .a No
❑ NA ❑ NE
❑'NA ❑ NE
❑NA ❑NE
Comments Use drawings of facilztyeto belt) �Explam anyYESWanswers and/or any additional, recommendations or any other�com:.mets:
( 4
er R Iam�sitiiattons+.(use additional pages as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 6 —,-Z.ose
21412011

Type of Visit ®'Lfompliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit QM outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: r �j ! �! Arrival Time: ' Q� Departure Time: t�J County: Region: F-0
Farm [Name: /L Re-dZ� c3w pz��/" 't Owner Email:
Owner Name: /71-. i�'iet✓�R P_`ee -jtr --f Phone:
Mailing Address:
Physical Address:
Facility Contact: _ I& PrTOK4t7'^' Title:
Onsite Representative: �S".,r Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = ' = " Longitude: 0 0 = ' = "
Design Current
Seine C►apacity Population
Design
L1'et Paultr.�° Capacity
Current Design Current
Papulaiiosl Cattle Capacity Pep€rlation
❑ Wean to Finish
❑ Wean to Feeder
10 Layer
❑ Dairy Cow
IQ Non -Layer
I
I
❑ Dairy Calf
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Gilts
❑ Boars
Other
❑ Cither
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Beef Brood Co
Number of Structures:
Discharges Si 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 -[Wade?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes .No ❑ NA ❑ NE
El Yes
❑No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
j] No
❑ NA
❑ NE
❑ Yes
5.No
❑ NA
❑ NE
PgGe 1 of 3 12128104 Continued

Facility Number: — Date of Inspection
r
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Ctnirt,ire I Structure 2 Structure 3 Structure 4
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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
E[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
RNo ❑ 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
W No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
J,No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
5 .No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buf 6rs, setbacks, or compliance alternatives that need ❑ Yes
S No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
I --No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I O% 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
10L.,e /W/
12. Crop type(s) j5ey- ,,J / enr-n rl`�/-` "/'�
13.
Soil type(s) J"3co Zwa_ff 1 %VBA
'
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ZNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
ERNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
FL No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[RNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[�*o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings a! facility to better explain situations. (use additional pages as necessary):
GlPu+m we ��= 1 T72 -r-zA
U
a
Reviewer/InSpector Name -, �8 Phone:
Reviewer/Inspector Signature: Date:. 271- b/ O
Page. 2 of 3 12/28/04 Continued

Facility Number: ga—,7,24 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C9,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 151 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [$No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5jNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
C,No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CgNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
® No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
19 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
P 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
[ `rNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
t] No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
MNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ANo
❑ NA
❑ NE
Page 3 of 3 12128104

N
Type of Visit Q;<ornpliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit e-110-utine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: . O Departure Time: County: Region: J LO
Farm Name: #11744 IQ5" t" 5 Owner Email:
Owner Name: ,,A._ __ df ai 7, _F'e Gt'r, Z'-� Phone:
Mailing Address:
Physical Address: yy�
Facility Contact: j&,fk f Gar-.S 0 `-' Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator: _,l2.E�s%
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [—] o = i = Longitude: [=] ° = ' 0
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Design Current
Wet Poaltry Capacity Populatn
io
❑ Layer
10 Non -Layer 1
Design Current
Cattle apacity Population
C
❑ Dairy Cow
❑ Dai Calf
Feeder to Finish
❑ Dai Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turke Poults
❑ Other
Nunttser of Structures:
Discharp-es & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
WNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
J4 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[„No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

4
Facility Number: e — W Date of Inspection 9
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 9
Observed Freeboard (in): 3 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes Le N
❑ Yes ❑ No
Structure i
El NA El NE
❑ NA ❑ NE
Structure 6
❑ Yes KNo ❑ NA ❑ NE
❑ Yes (R No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes EK No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;4 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 RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes XNo ❑ NA ❑ NE
maintenance/imgrovement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ®.No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate ManurelSludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) /li�� ii'/e-Y-_
13, Soil type(s) n X f--(d1a�_...---
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes RNo ❑ NA ❑ NE
IS. Does the receiving crop and/or land application site need improvement? ❑ Yes IR 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
1KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
9No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
I
rw
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: /49
r IZr25104 Continued

r
Facility Number: — 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 appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑Yes ®No ❑NA ❑NE
❑ Yes JO No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [A No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall [:]stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26_ Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
�9 No
❑ NA
❑ NE
❑ Yes
CRNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
El No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes
[9 No
❑ NA
❑ NE
❑ Yes
t@ No
❑ NA
❑ NE
❑ Yes C9 No ❑ NA ❑ NE
12128104

Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 4G��outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: Gib County: Region: f�a
Farm Name: Pe!" iSD P4— i E__�/K Owner Email:
Owner Name:, �t2,-- & f� Phone:
Mailing Address:
Physical Address: /-
Facility Contact: ��/'/�dLi7J'"'�Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator• _ Q
Operator Certification Number: Z225 f
Back-up Certification Number:
Latitude: = o = ' = N Longitude:
Design
C urrent
Design Current Design Current
Swine Capacity
Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
Feeder to Finish
❑ Dai Heifer
D . Poultry" ❑ D Cow
ry y
El Farrow to Wean
❑ Farrow to Feeder
"„` °"
❑ La ers ❑ Non -Dairy
❑ Beef Stocker
❑ Non -Layers
❑ Pullets ❑ Beef Feeder
El Beef Brood Cqyd
❑ Farrow to Finish
❑Gilts
❑ Boars
❑ Turkeys
Other
❑ Other
❑Turke Poults
IEJOther
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ELNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
C&No
❑ NA
❑ NE
❑ Yes
L&No
❑ NA
❑ NE
12128104 Continued

Facility Number. fflvgb pate of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes RLNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J4 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 RNo ❑ 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 [ZNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 11 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 JX No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes R No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Q4.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 Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
(X[ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
(A No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
RLNc
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
R.No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E-No
❑ NA
❑ NE
I',rs` "} 3ro •1 "�'fi YES answers andlarMan r �T r~ 1Cuianments,(referp "�questton�#) rEgplatn apy + � y ecommepdations or'an-other comments.
llse dra�rngs offac ty,ter�extuations. (use additi^paags necessary.):
r
Reviewer/Inspector Name 1. Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 112128104 Continued

Facility Number: Date of Inspection IT
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes §4No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 53 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge'?
❑ Yes
® 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
9No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
t@ No
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
tkNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Q No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JXNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/lnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[9No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Additional`Comm atsandlor"�Draw�ggs; t
Page 3 of 3 12128104

F"I
i«sion of Water Quality JHG . 4"
Facility Number rr O Division of Soil and Water Conservation /,9_Jq "a7
O Other Agency
Type of Visit ompliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: / �� Arrival Time: )O O Departure Time: County
Farm Name: �} a&rk . t-Q �' V., � r"I.— Owner Email:
Owner Name: . %y%Gri'k Pad /—,- ''� Phnne:
Mailing Address:
Physical Address:
ad �-
Facility Contact: �� r"� Title:
Onsite Representative: •rl?1a1k _tea f'"--� _
Certified Operator:
Back-up Operator:
Location of Farm:
Region: -S�
Phone
�No:
Integrator: rl r1/�
Operator Certification Number: yr{
Back-up Certification Number:
Latitude: = o = , 0 « Longitude: 0 o F—T =
Design Current Design Current
Swine Capacity. Population Wet Poultry Capacity Population Cattle
I❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
1 ❑ Layer
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design _ Current
Capacity Popnlation.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
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 21 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[.No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — --o
Date of Inspection D�
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[]No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .3 (p
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
J4 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?
CR Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
XNo
❑ 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
A No
❑ NA
❑ NE
maintenance/improvement?
1 1 . is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12_ Crop type(s) . Ayy 02:Se_ d &� ,ear dlJ; rr ��t7 f�
13. Soil type(s) ffa ! LUa �l" D 74`
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes J, No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes C,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'?[] Yes
0 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
gNo
❑ NA
❑ NE
Comments (refer to question ff): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional^ pages as necessary):
FT
Reviewer/inspector Name �' �� Phone: �a—y33r33oe�
Reviewer/Inspector Signature: Date:
12128104 Continued

' Facility Number: — Date of Inspection12t7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 19 No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22_ Did the facility fail to install and maintain a rain gauge?
❑ Yes
E.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
9.No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ANo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[:]Yes
XNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
,,��++
F�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
9 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
K_No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

1
M
vision of Water Quality
iFNor acility Number 7 — Division of Soil and Water Conservation
Other Agency
Type of Visit o—mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �"J Koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: DG Arrival Time: , Departure Time: .3 County: �Region:
Farm Name: �� Q/ ,��QrS$-`-� Qr'_ Owner Email:
Owner Name: /y%4�' fC ,��a /—_-5D L�� Phone:
e /
Mailing Address: + �° W/t� � G1� re-'s
Physical Address:
Facility Contact: Alal'k T /iis/Si1Title:
Onsite Representative: ah_
Certified Operator: 5zx --
Back-up Operator:
Phone No:
Integrator: Xs z_j__e
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 6 0 1 = " Longitude: 0 ° = f
Design Current
Design Current
Design Current
Swine
C►apacity Population
Wet Poultry
,Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Daia Cow
❑ Wean to Feeder
❑Non -La er
❑ Da"y Calf
Feeder to Finish
D D
„r K "`"
El Dai Heifer
❑ Farrow to Weans
Dry Poultry '2x ; ..
❑ Da Cow
❑ Farrow to Feeder
_ _,.,.
_.
o- _. ,,_s._.;rW
El Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowj
❑ Turkeys
.
Other
❑ Other
.__..,
r ❑ Turkey Poults
❑ Other
Number of Stivctures:
s...:�:'J�i'.W�.':e t '-x�'aa`F
..ii'
k 1 �A•..: i SfTr-.n
�,.
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
&No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
O,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
KNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
q No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
MNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: —% Date of Inspection --D
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NrNo
❑ NA
El NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
ONo
❑ NA
❑ NE
- Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in): �j
5. Are there any immediate threats to the integrity of any of the structures observed?
[] Yes
Z 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
Z 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?
0 Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes q 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 allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EgNo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. [:]Yes JKNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > I0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ElJ Evidence of Wind Drift ❑ Application Outside of Area A
12. Crop h'Pe(s) ./�Yrmdd &ra tzY /min G�ot� 04 err ! ge,,L d,��frm,,22 r
13. Soil type(s)
At A-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes W No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes
17. Does the facility lack adequate acreage for land application'? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
[4 No El NA ❑NE
[&No ❑ NA ❑ NE
Comments'(refer to'goestion #): Explain any YES answers and/or any recommendations or -any other comments.,,-, s
Use drawings+of facility to better explain situations. {use additional pages as necessary) .
<.=
U/?
Reviewer/Inspector Name-r/`�r- V
Phone:
Reviewer/lospector Signature:
Date: D©tio
Page 2 of 3 12128104 Continued

t
Facility Number: Z;19 Date of Inspection to
# Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C,No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes El No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ,KNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 29 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
KNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
E4 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
29 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;XNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
5U No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[Z No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
DqNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
M No
❑ NA
❑ NE
Additional .Comments and/or Drawings
Page 3 of 3 12128104

Type of Visit It Compliance Inspection O Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: fof�?�ps' Arrival 'rime: .a = O Departure Time: County: S�r� �.re.✓ Region: rk-j
Farm Name:Owner Email:
Owner Name: o-/ Phone:
Mailing Address:
Physical Address: Ave_
Facility° Contact:
Title:
Onsite Representative:
Certified Operator: �8 • k ___-,_,e_ 0'se4-
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
=O =' ❑" =O ❑, ❑ a
Latitude:Lon Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
II JE1 Non -Lave[
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkevs
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Populatiom
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ DEY Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State`? (if yes. notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: /�'
d. Does discharge bypass the waste ntanagilement 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 M No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑Yes
®No
El NA
El NE
12128104 Continued

FIX51[ity Number: If.2 — 11G Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
U 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?: 1/ -- I ?,- 9D
Designed Freeboard (in): d "
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[A 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
[9 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 [P No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [g No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) �. �. �� C r z� Za L eAJ - PA: I -SA . C3 S -- S Q -
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA"P?
❑ Yes
$j No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
W No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[W No
❑ NA
❑ NE
Reviewer/inspector Name . 4.,:: 1.; �/ - Phone:
Reviewer/inspector Signature: Date:
12/2&04 Continued

Fa`cility'rlumber: Date of Inspection 67 az
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 approprrate box.
❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
R No
❑ NA
❑ NE
23_
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
91 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the pennit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
(R) No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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/)nspector fail to discuss reviewlinspeetion with an on -site representative?
❑ Yes
M No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[y No
❑ NA
❑ NE
A�ddttioisalt,C4annents andlor'Drawings:
ic-
Gt M fxJ�- �" h
i
Cc t.r C
12128104

IType of Visit 0 Compliance Inspection Q Operation Review Q Lagoon Evaluation
for Visit 0 Routine Q Complaint Q Follow up 0 Emergency Notification O Other ❑ Denied Access
Date of Visit: S %b-�} Time. : C1
Facility Number
O Not O rational O Below Threshold
M,Pe-rmitted MCerified © Conditionally Certified © Registered Date Last Operated or Above Threshold: ----..-----
Farm Nance: /7a/-M ».._...W�....__._........ County:
OwnerName: » _% .Gr.%� ..._...._..... f'e Ac._s!:.2........,...................................... Phone No:......................................... _.......................... .
Mailing Address:..i1.._.��'.//i'�:z� ... ?1: �sv _.....rC c.�............ .. .... _
Facility Contact: .._G r I(.. 1 . �.s"s c?•� _.__... _ Title
Onsite Representative: -___ � A• S�t2 _._ _ _._ ._..
Phone No:
Integrator: _ _Pr �.5
Certified Operator: ��ra-.-son.- __. ww_.._... Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude 0 ` "
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes 0-No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes O'go
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c_ If discharge is observed, what is the estimated flow in galhnin'?
d. Does discharge bypass a lagoon system? (If yes, notifv DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure S
Identifier: ..... ..--..... i............................................... »... .....».............................. ......---------_-------- --..._..... ..._........ ................. .......
Freeboard (inches): 3 �r
❑ Yes [3No
❑ Yes ['No
❑ Yes ETNo
❑ Yes []NO
❑ Yes ONo
Structure 6
12112103 Continued

s
Facility Number: ;� — 7aL, Date of Inspection �a-n
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes aNb
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ yes H`No
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 M-M
S. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes D.No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑ No
elevation marldngs?
Waste Apphcation
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑-No
1 I . Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 1-?e m �+++o// En,: , Svis+,rr�r /if.,,,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
9 No
b) Does the facility need a wettable acre determination?
❑ Yes
E340
c) This facility is pended for a wettable acre determination?
❑ Yes
2140
15. Does the receiving crop need improvement?
❑ Yes
0,No
16. Is there a lack of adequate waste application equipment?
❑ Yes
QNo
Odor Issues
17. 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 UNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONO
roads, building structure, and/or public property)
24. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ONO
Air Quality representative immediately.
❑ Final Notes
�4s 40'e tv"/w cn"Oo -a5 �hc� �1(J� I ^'��1
/ ff 5 •ks5 r s t5 tlnp� f
I'Y1o.7, Jur cn
j r// �f' Ma L✓Lnf /v f'o//C
60 'e/`Prys,�dh q9
✓ "�•GP Un how lea Gam„ 0"P f/F
Reviewer/Inspector Name
Reviewer/InspectorSignature: Date: y•ay
12112103 Corttvtned

+� Facility Number: $ — 7a Date of Inspection S r3 v L
Renuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
UNo
22. Does the f ility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie!WUP, Ockifffis, dent, ups, etc.)
❑Yes
❑ lw#6
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ Waste Application QFreebawT—O ' ❑Seil-Sampiing-
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
�o
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
Q.Xo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
O-N"o
27. Did Reviewer/Inspector fail to discuss reviewfwspeetion with on -site representative?
❑ Yes
ONO
28. Does facility require a follow-up visit by same agency?
❑ Yes
&W
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
EIKo
NPDES Pemdtted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) S-Ws ❑ No
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ©-No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes Lts
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes [go
34. Did the facility fail to calibrate waste application equipment? ❑ Yes c❑. NC
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes EIINo-
❑ Stac�orm ❑Crop Y' ❑ ❑ Inspecti r "Rain
❑ 120,MinlIf Inspections ❑ Annual on Form
12112103

_,L,+M �. cj,, "v ''i"Y-X'.. .r- ..:e - y.�sa.-•�'y�c'", +s., 7'::7i-s.:r -Y- - -
Type of Visit 10 Compliance inspection Q Operation Review O Lagoon Evaluation
Reason for Visit a Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Batc of N'kit: ib'a `0 Timc: = �D
Facility Number �
•• -ro Not Operational 0 Below Threshold
Permitted 14 Certified O Conditionally Certified ©R
egis'tered Date Last Operated or Above Threshold:
Farm Name: /edeO tSPN a rMf + County: AL'a #.1
Mark- Owner Name: _ pGO-r3 O N Phone No: DO .] 5 1P
Mailing address: 904. %ia W n o <-f' i C_ -- _-i . re- ; _ I
Facility Contact: Title: Phone No:
Onsite Representative: /Y%ar // � ru Integrator: _ _ / r e s
Certified Operator: �7G �¢ar fa /-� Operator Certification Number: # /78 S
Location of Farm:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 0 " Longitude '
Design Current
Design Current
Design Current
Swine Ca acity Population
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
I
I
IEJ Laver
❑ Dairy
® Feeder to Finish
294YO
❑ Non -Laver
1
10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts••••■�
❑ Boars
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 11EIL290on Area 10 S rav Field Ji rea
Holding Ponds / Solid Traps 10 No Liquid waste Management System
Discharges S Stream Impacts
I. Is anv discharge observed from any pan of the operation?
[-I Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
+++
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is obsen-ed, did it reach Water of the State? (if yes, notify DWQ)
❑ yes
ElNo
c. if discharge is observed, what is the estimated flow in gal/min?
J' A
d. Does discharge bypass a lagoon system? (If yes. notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
Qj No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
(P No
Waste Collection 8- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
I No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier f
r.
Freeboard (inches):
05103101
Continued

7 de
-
[Facility Dumber: —pRW
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage. etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? (if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do anv of the structures need maintenance/improvement?
8. Does any pan of the waste management system other than waste structures require maintenance/improvement?
9. Do anv stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes M No
❑ Yes t No
❑ Yes (3 No
❑ Yes [P No
❑ Yes $ No
XVactt_AD}rlication
10. Are there ant buffers that need maintenance/improvement? ❑ Yes FO No
11. Is there evidences of over application? ❑ Excessive Ponding El PAN ❑ Hydraulic Overload ❑ Yes [ No
I3. Crop type C. a o � �c 1 ge r .xgyL CQ a4 r a'�' — .i& r � 1* 0 a - 0 V C-f -0 �i
33. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAVI'MP)?T ❑ Yes � No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes MNo
b) Does the facilirm need a wettable acre determination? [] Yes %I No
c) This facility is pended for a wettable acre determination? ❑ Yes 09 No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? 0 Yes � No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(it/ WUP. checklists. design. maps. etc.) ❑ Yes [h No
19. Does record keeping need improvement? (ie! irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility- fail to have a actively certified operator in charge? ❑ Yes No
22. rail to notify regional DWQ of emergency situations as required by General Permit?
Ot discharge. freeboard problems, over application) ❑ Yes $5 No
23. Did Reviewer. -Inspector fail to discuss reviewrinspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? L] Yes No
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
COmatents (refer t6e4nesti6n ft-Tiplain b saswe3s aud(dr_46} recommeudattOtts Or anvarther.commestts,= y
.YES
Use drawings of factity to better ezphten sitnations. (use additional pages as necessary) ti . ❑MField CopNotes
—Final Not
- -
�CQC
tU P acc
5 a-S a r..- p,c.3 Vo , - 0.3 ' u
F,elaC.! f �o4J ev;alr�c[ e-� ?� Season . fir- Pc�rJo� i�
hla' �Ci+�q +C 1 ►4►�raJ a lnnu'�eiv�Q.
Reviewer/Insstrut Nam
; ,. p e
Reviewer/Inspector Signature: Date: %d - .27-e3
05103101 Condnued