970033_INSPECTIONS_20171231

>ck. Melissa • •
From: Rosebrock, Melissa
Sent: Wednesday, August 01, 2018 3:39 PM
To: Claude Shew
Subject: REVISED Inspection Form
Attachments: Shew-Critcher Brothers Produce #97-33.pdf
Claude,
Thanks again for your time this morning. Attached is a revised inspection report for your records. I clarified some things a little
better. This is the copy that is in our database and open to public record. I also send to Wilkes SWCD/NRCS for their records. IF
we receive a change of ownership form, I can update the report to reflect this. The database wouldn't let me change the
physical address yet.
Hollar if you have questions.
Melissa
Melissa Rosebrock
Environmental Specialist 11
NC Division of Water Resources
NC Department of Environmental Quality
Office: 336-776-9699, Mobile: [phone]; Email: melissa.rosebrock(o)ncdenr.gov
Winston-Salem Regional Office
450 W. Hanes Mill Road, Suite 300
Winston-Salem, NC 27105
If you need to report an emergency after normal business hours, please call the Emerengcy Response Center Hotline at 1-800-
858-0368.
Email correspondence to and from this address is subject to the North Carolina Public Records Law and may be disclosed to third
parties.

■ Division of Water Resources
❑
Division of Soil and Water Conservation
❑ Other Agency
Facility Number: 970033 Facility Status: Active Permit: AWC970033 ❑ Denied Access
Inpsection Type: Compliance Inspection Inactive Or Closed Date:
Reason for Visit: Routine - County: Wilkes Region: Winston-Salem
Date of Visit: 08101/2018 Entry Time: 10:00 am Exit Time: 10:05 am Incident 0
Farm Name: Jay's Farm Owner Email:
Owner: Roger Critcher Phone:
Mailing Address: 7467 Old 421 S
Physical Address: 955 Dellaplane Rd
Facility Status:
❑ Compliant Not Compliant Integrator:
Location of Farm:
On Hwy US 268, 0.3 miles east of SR200.
Deep Gap NC 28618
Roaring River NC 28669
Latitude: 36" 12' 05"
Longitude: 80' 59' 23"
Question Areas:
Dischrge & Stream Impacts Waste Col, Stor, & Treat Waste Application
Records and Documents Other Issues
Certified Operator: Claude E Shaw Operator Certification Number: 21436
Secondary OIC(s):
On -Site Representative(s):
24 hour contact name
On -site representative
Primary Inspector:
Inspector Signature:
Secondary Inspector(s):
Inspection Summary:
Name Title
Claude Shaw, Jr.
Claude Shaw, Jr.
Melissa Rosebrock
Rebecca D Chandler
Phone:
Phone:
Phone
Phone:
Date:
page: 1

Permit: Permit: AWC970033 Owner - Facility : Roger Critcher Facility Number: 970033
Inspection Date: 08/01/18 Inpsecion Type: Compliance Inspection Reason for Visit: Routine
4. Dry stack is empty and apprears to only be used for hay or equipment storage.
19. Permit was originally issued to Claude Shaw, Jr. Permit needs to be issued to Critcher Brothers Produce, Inc. since they
became the new owners in August 2014, however, Critcher Brothers Produce, Inc. has not yet submitted a change of ownership
form. Mr. Shaw has been serving as manager for Roger Critcher and maintaining custody of waste management records,
including the current permit and waste management plan. Someone else is reportedly leasing the property from Critcher Brothers
Produce, Inc. and grazing just a few cattle on pasture on the hill. There are no confined rattle and none come onto the existing lot.
Farm is used primarily for row cropping. NOV to Critcher Brothers Produce, Inc. for failing to apply for a permit.
21. Need to obtain rainfall records. Mr. Shaw has been using records kept by operator of landfill located next door but had no
rainfall records for this inspection.
24. No waste applied since 2014. No calibration records required until waste is applied.
"No environmental or animal waste issues observed. Pasture was well vegetated.
page: 2

Permit: AWC970033 Owner - Facility : Roger Critcher Facility Number: 970033
Inspection Date: 08/01/18 Inppection Type: Compliance Inspection Reason for Visit: Routine
Regulated Operations
Cattle
Design Capacity
Current promotions
Cattle - Beef Stocker Calf 250 0
Total Design Capacity: 250
Total SSLW: 137,500
Waste Structures
Disignated Observed
Type Identifier Closed Date Start Date Freeboard Freeboard
Dry Stack DRY STACK
page: 3

• •
Permit: AWC970033 Owner- Facility : Roger Critcher Facility Number: 970033
Inspection Date: 08/01/18 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Discharges & Stream Impacts
Yes No No No
1. Is any discharge observed from any part of the operation?
❑
0 ❑
❑
Discharge originated at:
Structure
❑
Application Field
❑
Other
❑
a. Was conveyance man-made? i
❑
M ❑
❑
b. Did discharge reach Waters of the State? (if yes, notify DWQ)
❑
0 ❑
❑
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)
❑
0 ❑
❑
2. Is there evidence of a past discharge from any part of the operation?
❑
M ❑
❑
3. Were there any observable adverse impacts or potential adverse impacts to Waters of the
❑
M ❑
❑
State other than from a discharge?
Waste Collection. Storage & Treatment
Yes
No No No
4. Is storage capacity less than adequate? _ _ _ _ _
_ ❑
0 ❑
❑.
If yes, is waste level into structural freeboard?
❑
5. Are there any immediate threats to the integrity of any of the structures observed (Le./ large
❑
0 ❑
❑
trees, severe erosion, seepage, etc.)?
6. Are there structures on -site that are not properly addressed and/or managed through a
❑
0 ❑
❑
waste management or closure plan?
7. Do any of the structures need maintenance or improvement?
❑
0 ❑
❑
8. Do any of the structures lack adequate markers as required by the permit? (Not applicable
❑
❑ 0
❑
to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑
0 ❑
❑
maintenance or improvement?
Waste Application
Yea
No No No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑
0 ❑
❑
maintenance or improvement?
11. Is there evidence of incorrect application?
❑
M ❑
❑
If yes, check the appropriate box below.
Excessive Ponding?
❑
Hydraulic Overload?
❑
Frozen Ground?
❑
Heavy metals (Cu, Zn, etc)?
❑
PAN?
❑
Is PAN > 10%/10 lbs.?
❑
Total Phosphorus?
❑
Failure to incorporate manure/sludge into bare soil?
❑
Outside of acceptable crop window?
❑
Evidence of wind drift?
❑
Application outside of application area?
❑
page: 4

Permit: AWC970033 Owner - Facility : Roger Critcher Facility Number:
970033
Inspection Date: 08/01/18 Inpsection Type: Compliance Inspection Reason for Visit:
Routine
Waste Application
Yes
No No Ne
Crop Type 1
Com (Silage)
Crop Type 2
Crop Type 3
Crop Type 4
Crop Type 5
Crop Type 6
Soil Type 1
Soil Type 2
Soil Type 3
Soil Type 4
Soil Type 5
Soil Type 6
14. Do the receiving crops differ from those designated in the Certified Animal Waste
❑
0 ❑
❑
Management Plan(CAWMP)?
15. Does the receiving crop and/or land application site need improvement?
❑
0 ❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
❑
❑ 0
❑
determination?
17. Does the facility lack adequate acreage for land application?
❑
0 ❑
❑
18. Is there a lack of property operating waste application equipment?
❑
0 ❑
❑
Records and Documents
Yes
No No No
19. Did the facility fail to have Certificate of Coverage and Permit readily available?
❑
0 ❑
❑
20. Does the facility fail to have all components of the CAWMP readily available?
❑
E ❑
❑
If yes, check the appropriate box below.
WUP?
❑
Checklists?
❑
Design?
❑
Maps?
❑
Lease Agreements?
❑
Other?
❑
If Other, please specify
21. Does record keeping need improvement?
0
❑ ❑
❑
If yes, check the appropriate box below.
Waste Application?
❑
Weekly Freeboard?
❑
Waste Analysis?
❑
Soil analysis?
❑
Waste Transfers?
❑
Weather code?
❑
Rainfall?
M
Stocking?
❑
page: 5

• •
Permit: AWC970033 Owner - Facility: Roger Critcher Facility Number: 970033
Inspection Date: 08/01/18 Inpsection Type: Compliance Inspection Reason for Visit: Routine
Records and Documents
Yes
No Na No
Crop yields?
❑
120 Minute inspections?
❑
Monthly and 1" Rainfall Inspections
❑
Sludge Survey
❑
22. Did the facility fail to install and maintain a rain gauge?
❑
0 ❑
❑
23. If selected, did the facility fail to install and maintain a rainbreaker on irrigation equipment
❑
110
❑
(NPDES only)?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑
0 ❑
❑
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check the
❑
❑ 0
❑
appropriate box(es) below:
Failure to complete annual sludge survey
❑
Failure to develop a POA for sludge levels
❑
Non -compliant sludge levels in any lagoon
❑
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑
0 ❑
❑
27. Did the -facility failtosecure a phosphorous lossassessmentcertifidabon?
❑
❑
❑
Other Issues
Yes
No Na No
28. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑
❑ 0
❑
and report mortality rates that exceed normal rates?
29. At the time of the inspection did the facility pose an odor or air quality concern? If yes,
❑
0 ❑
❑
contact a regional Air Quality representative immediately.
30. Did the facility fail to notify regional DWQ of emergency situations as required by Permit?
❑
0 ❑
❑
(i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility?
❑
0 ❑
❑
If yes, check the appropriate box below
Application Field
❑
Lagoon / Storage Pond
❑
Other
❑
If Other, please specify
32. Were any additional problems noted which cause non-compliance of the Permit or
❑
0 ❑
❑
CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑
E ❑
❑
34. Does the facility require a follow-up visit by same agency?
❑
0 ❑
❑
page: 6

Date of Visit: 0 of Arrival Time: Departure Time: FF6 _1 County: W I ( Ke5 Region: W S R b
Farm Name: sQV IS P l ox a Owner Email:
Owner Name: 1aA-I /Cbe_t' �ji is �Qx$ I'ft�l�C_2 �tPJtone:
Mailing Address: 11 t(i 7 Q U 4 .7-1 So otsi / Do o=A a� d Mc— oZ 8 toI ir
Physical Address: So� 51A of 4Wy a�`61 `V�I2.Si— orUWy e21,5-
33b' S7- 71 O L
Facility Contact: 1;l4tdop- Sh ew I :Tr-, Title: + Q i c Phone33b — QS ' 383 q 14
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Certification Number: Curr? 0—t
Certification Number:
Latitude: 346 1 2/ OS t/Longitude: �0° S 9 a3'J
LUS Z- / lush;{�w (ue- / Hwy 2&9j 1/2m'lle on .
Design Current
Swine @ap`acity Pop.
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean [o Feeder
Non -Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
I) . P,oulh, Ga acity P,o P.
La ers
D Cow
Non -Dairy
Beef Stocker
Q
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke Points
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 N No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412015 Continued

Facili Number: . Date of inspection: g I
( 8
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l 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 thi integrity of any of the structures observed?
❑ Yes
[P No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
TT
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
fd No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
MNA
❑ 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
Ltd
❑ 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? 777CCC
11. Is there evidence of incorrect -land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
U NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
A No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�Q No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑LeaseAgreements ❑Other:
21. Does record keeping need improvement? Yes ❑ No ❑ NA ❑ NE
�1 � 04(Q t,i� F..veti I E \ "Lr e�,�„_ ff`3on-,-en?''y:� t1 ..-�+.'ent=,��
❑ Rainfall Ejttoekiag �� E "`" Minute !Rs-^ n9 ❑ Monthly and V Rainfall Inspections [ "' '"` c""'+rr
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 Qa'NA ❑ NE
Page 2 of 3 21412015 Continued

I�
Facility Number: q7 - • Date of Inspection: Q 3t3 0
O
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No
CRrNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
M"No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No
�y'�
`A NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
YN
❑ 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
[4 No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
Xy
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,J�TNri
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
XNo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments_ I
Use drawings of facility to better explain situations (use additional pages as necessary).
T
Pexrn'i- was originally iss�Qd to Claude SheW, Ire p�xrnii ine�e�s to
'i6sue_d J-& Crt+44_V— _Biros. PCOAuc-e/INC. Styr-e ecAme`t1h
hew) oWll�er5 i'1 ,Au usf aol,4. NOV fo\r goy(ure- tm aom+1 w-*(i
01 PN'M�+ CCor�lili�On V"e%., e
wa5-e_e_" ieJ in a01-7 ? ZF so) ealibro�.�-iort dve/h a-oIT.� I•Q
Soil +e.S�S due- i n oZoi9.
YW V.r a�J} c xvy u eoi 4r r c.0 9011 . p� `y rev
W fXD v� Y1n ti Crsv�S 6�1tPON Yt
Reviewer/Inspector
Reviewer/Inspector
Page 3 of 3
Name: `ma�iI554 IyOSmo..bfoaz- Phone�3
Signature )M" &UI�_')Tdd, Date:
21412015

Type of Visit: tQ Compliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance I
Reason for Visit: %Routine Q Complaint Q Follow-up 0 Referral 0 Emergency 0 Other O Denied Access
Date of Visit: f,l Arrival Time: Departure Time: 65S County: W i 1j Region: Y_5 2,z
Farm Name: Jay IS P t ace— Owner Email:
Owner Name: Cr i%c,hef- 1H 1-O5 PT Oh UG2J__xrCWne:
Mailing Address: —1 rp7 01d 41711 SOu-f+ . 1)P 6QOP' /O 1
Physical Address:
Facility Contact: G a0de� 5h)P- .l i Tr. Title: L11i10-n2..q p r o1- 61 Ci Phone: %3 5 7 — i b C
434- 383ff�
Onsite Representative: Integrator: ,
Certified Operator: Certification Number
Back-up Operator:
Location of Farm:
Certification Number
!s
Latitude: 360 121 05 Longitude:
a I q34
kr5. b\
Iwo 12-131
u5 a
R R I W I% v B (ve
R w y a(agl Z L nt 1(� on r�
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
C•urcen[
Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
�—
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
I)ry P,oaltr, Ca >_aci P,o P.
La ers
Gilts
Non -Layers
Boars
I
Pullets
jBeef Brood Cow
my� p0.5"�r'>✓
Other
Other
Turke s�
Turke Points
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 J�(No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
[—]Yes [—]No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
PXN'o
❑ NA
❑ NE
Page I of 3
21412015 Continued

Facility Number: - - 33 • Date of Inspection: 1 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
*o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Y
l�
Structure 5
Structure 6
Identifier: �f
b Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Cjr�o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Z No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �(No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No [XJA ❑ 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 \jA o ❑ NA ❑ NE
maintenance or improvement? R
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes W o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): v
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
,�No
❑ NA
❑ NE
❑ Yes
N<O
❑ NA
❑ NE
❑ Yes
❑ No
IX NA
❑ NE
❑ Yes N No
❑ Yes W No
❑ Yes N o
❑ Yes 7o
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
W21. oes record keeping need improvement? ❑Yes No ❑ NA ❑ NE
aste Application D.W— b0���'df!!!d� Waste Analysis Soil Analysis Weather Code
Rainfall Stocking Crop Yield p� 120 Minute Inspections Monthly and 1" Rainfall Inspections 1464'.��a`�
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N<0 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No NA ❑ NE
Page 2 of 3 2141220'15 Continued

Facility Number: 17 30_j Date of Inspection: I I Y I W 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No IX 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 �o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes U(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 XNo
❑ NA
❑ NE
[—]Yes [Io
❑ NA
❑ NE
❑ Yes [WNo
❑ NA
❑ NE
❑ Yes L2t;"'o
❑ NA
❑ NE
90 Yes [:]No
[:]Yes No
❑ Yes o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments•,(refecto question Explain any YES answers and/or any additional recommendations or any other comments -
Usedrawines of ficility to better ezmlain situations (use additional panes as necessarvl.
cll • �tS (o SDI I �P J t &6 ht f Je,i-e cl. ?
a� a o I� Ca I i b ram a ►'� Gb 1M.p fie.-f'ec� � (�4. `� t.u2a-�e.-��-tht s Yr. T F wzs�t �i ie
a Cri�che� BrC6- Produce_-r'nG a©wr�5 10-YA 1=f bu+ Vna5 na'I'
Cv�vupl�tec� ChO_T� je, O� owtnea- s V) i P fmtrM. Gh &-A54 Pfu3v5tozbli
al a�15 �- aol� t-�co�-dS a.vq.(Labl� 7c� �
CL� - a
No a N_k t, e sc p aol�f, AJo
�/�i IzoI.S = �,. 3 (bs• N�TonI e °
Reviewer/Inspector Name:
Reviewer/Inspector Signatm
Page 3 of 3
Phone
Date: I I/ I i Z O 17
21412015

for Visit:
Date of Visit:
0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Arrival Time: F1 -O6A.� Departure Time: :L{Q,iwv County: t„jItXft Region: tj5ft
Farm Name: ,Xy rS P LAa Owner Email:
Owner'Name: 61--AO06 _'sk. Phone:
Mailing Address: LISS pEU,A.PL.WE 2n, tiflmoji; RtUat2 KY— 9-864g
Physical Address: SOU_MS(01 gg w 01c 88g8 Htu`( a6d
Facility Contact: GL4V0&- S HEW Title: Phone: 33 G • 95%' 7 �0
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number: aZ I L4 3 6
Certification Number: 6 1*s B\( ialsk 114.
Longitude:
Design Current
Swine Capacity Pop.
Wet.Poultry 1.Design
Capacity
Current
Pop,
C*attle.
Design Current
Capacity Pop,..
Wean to Finish
I
JLayer
I
Dairy Cow
Wean to Feeder
[Non -Layer
Dairy Calf
Feeder to Finish
"
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
a$ O O
Farrow to Wean
Farrow to Feeder
Design Current
Layers
Farrow to Finish
Gilts
Non -Layers
Boars
Pullets
-
Beef Brood Cow
Other
Other
Turke s
Turke Pouets
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 D< No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes [—]No
❑ Yes No
[—]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412015 Continued

Facili Number: Date of Inspection: \ I5' 1C
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6'
Identifier: QRi 5
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 [N No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No [RNA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ® No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® 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): rypp
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes
© No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes ®No ❑ NA ❑ NE
❑ Yes ❑ No ®.NA ❑ NE
❑ Yes ❑ No ❑ NA R] NE
❑ Yes ❑ No ❑ NA ® NE
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ® NE
❑ Waste Application Freeboard ❑ Waste Analysis ❑ Soil Analysis ny',�:=` •s ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield El 129-hf+adizhp? ❑ Monthly and V Rainfall Inspections -vcy
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 ❑ No ❑ NA m NE
❑ Yes ❑ No UN NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: Ctj I Date of Inspection:
\O k ( 14
24. Did the facility fail to calibrate waste app cation equipment as required by the permit?
❑ Yes
❑ No
❑ NA '® NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No
CR NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
® No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
❑ NA ® NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 CAW MP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
:omments (reter to question #): Explain any YES answers and/or any additional recommenda
se drawings of facility to better explain situations (use additional pages as necessary).
- 2-otG sots 1-63T ? KCCO"S Mr/i AVgat.rt4Le I-C%em Mwr IVAC
aot5 4Rt,\%K%_WM. ? R&COKvS bids h4R\M8L6i COLM M&K I^C
- 09WN"R. V*S? Naws G WS B1 \aJ3k j (2
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes m No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ® NE
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
ons'or any other
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
comments.. -
— NOilFteik%kJ
o4F erWVa �-
OF oWMV_SNAP ? 43 ALL
owaC-0 8\1 0 kTC%k( qM5 PRoOF)tE
—44W CO%bf�
9MAVT V5
°I13o
I Itk TO `
13v I
kok,
PGRM'CM"
WRS
UINMLS Ira
P4*VC-
t'V 115
-MC
rtW ILEtoRQ1
W tu- N EaiJ
Tv
Q r chEc" O
I`d/2
` 01 G
4 �015
A)6;rr V is
Reviewer/Inspector
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 33 C - 40G' 4g�i 3
Date: to IS I (G
21412015

Type of Visit: 4FCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: -11- I Arrival Time: ; oo a Departure Time: 09/Z O County: toy tkes
Farm Name: ' �li S /1- Pic, C t; Owner Email: c �y g �/
Owner Name: t tr ��pt �"� J/�/ Phone: 33' / 0 !1— :37
Mailing Address: % 55 �� ��a/ �O " � /(� /( pu � .. ,y /I v C✓ d d O /
Region 5,40
Physical Address: �u/� f��{ 26S1
Facility Contact: �� cl Title: Phone: 936 — 957-71 o 0
Onsite Representative: Integrator:
Certified Operator: V Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
yzl A/ o„ Rell, a„kd-alNt 9j
#ivy2
pr- . ,le-
Gn if,,5
Swine
Wean to Finish
Design Current
Capacity Pop.
I
Wet Poultry
ILayer
Design
Capacity
I
Current
Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,oul
Layers
Design
Capa
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
910
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
I jBeefBroodCow
Other
01 Other
_TurkeyPoults
Turkeys
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 [S No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes Q No ❑ NA ❑ NE
[:]Yes E[No ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: 16 jDate of Inspection: t1 [ 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1/ Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: r1 i aC4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
® NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Auolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
JK� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
UjI-No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or W lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
/
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
NJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
cE!] No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement?
❑ Yes
JR No
❑ NA
❑ NE
® Waste Application E3AVee� ..eeklyXx=b.Qard ® Waste Analysis EaSoil Analysis
Weather Code
® Rainfall ® Stocking m Crop Yield ❑ 110 rai.,nte I„gcp tins ERIMonthly and V Rainfall Inspections
y
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
®. No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
® NA
❑ NE
Page 2 of 3
21412014 Continued

Facili Number: - 3 3 Date of Inspection:7-
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Fv No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No 0 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Q_No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
® No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
JZJ 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
_[Ej 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
(E�j 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
Z_No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
4K No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
cEg-No ❑ NA ❑ NE
5oll �,e4� )ue, 2019
Lul /bra �lon /Ne- Lo/S
C
S%i// ZG✓O un/e ?1 to
N
Reviewer/Inspector Name: c �a e I C /Lcrp� Phone: 3 776 - V 5�'7
Reviewer/Inspector Signature: Date: ��-/7 - 2 c/S
Page 3 of 3 21412014

for
0
Referral
Other O Denied Access
Date of Visit: i— ^"' /Airival Time: Departure Time: County-V I i Kje S
Farm Name:�.�, I i P (Q C Q Owner Email:
Owner Name: (tom t o t) d P, 5 k 0 o Tr (� Phone: q$ 3 83 y
Mailing Address: 15 E O e I12"�) / 7lan e_ /LLn-C'� Dora-lrl r\-! 1 P-1 Ire�l �/ (, )oZ-7 6 6 95�/
Physical Address: '4u. f{ S -*k' & w / c_IQ A (� @'
Facility Contact: e' l&jjd p� SAP. Lc) Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Region: Ob'r2 0
Phone: Of 5 7 — -7 1 iQ
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Cattle
DairyCow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Design
a aci_
Current
P,o -
D Cow
Non -Dairy
Beef Stocker
kk
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
Turkeys
TurkeyPouets
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 �(No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes fSQNo ❑ NA ❑ NE
Page I of 3 21412014 Continued

FacilityNumber: Date of inspection:
a,6 /
Waste Collection & Treatment MV
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[yNo
❑ 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: bry SFaGK
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
tg No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
MNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
Eg�<A
❑ 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
CyNo
❑ 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 Dd/No ❑ NA ❑ NE
❑ Excessive Pending ❑ 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): /''h;5A��
13. Soil Type(s): U
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 IN No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 777❑""] No NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
gNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
is No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
YNo
❑ NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? I*y s, h t, a.e ^�� ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis err ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections [?"Mmte-8mvcy-
22. Did the facility fail to install and maintain a min gauge? ❑ Yes I p No [] NA ❑ NE
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment? ❑ Yes T❑' No ANA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - 3 Date of Inspection: 9&4d61yi
24. Did the facility fail to calibrate was plication equipment as required by the permit? ❑ Yes I Jy No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes [—] No O�NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA 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
tS(No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
0No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[5j 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
[,gNo ❑ 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
CS(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
0No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNT?
❑ Yes
No ❑ NA ❑ NE
�tNo
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA ❑ NE
comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary). - -
" ao Ib
( km- A__kj�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
tA->UP II/XP-/ III
Phone:
0
Dale:
21412014 `�rZ�Z,(9k

i
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Lb {Arrival Time: Departure Time: County: 1 ( Region: �0
Farm Name: TbLN l.S Place, FoLrM Owner Email:
Owner Name: �/ I Q_ J(i Q� S h p-W t .Tr . Phone: 9 ,3 ` — 3 q 3 i
Mailing Address: I j oL •pj of n ei ". , I_ o a-T I YLQ �) YP� f�} t; 2 '4 6P 9
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
uS Ww \{ N,
o n
1
i
w y
m wU t�
Design Current
Design
Current
Desigu Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
Non -La er
Da' Cow
Da' Calf
Wean to Feeder
Feeder to Finish
Da' Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
- . P,oult ,
-a aci +
P,o ,
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
0
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lBeefBroodCow
Turkeys
Other
Torke Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 4-No ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
[-]Yes
[-]No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes [K No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412011 Continued

FacitiNumber: - • Date of -inspection.
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
77777i"❑'''"'
❑ 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: IL
^�^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J
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
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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes b6 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 IXI No ❑ NA ❑ NE
V" maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? //AAAA
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ®'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�(No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
[� NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
7779
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reunited Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[N No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
rXNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? 1Lj�es, v " rr r '•-'-•• ❑ Yes DjfNo ❑ NA ❑ NE
❑ Waste Application ❑ Waste Analysis ❑ Soil Analysis [�reesfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Moonthly and 1" Rainfall Inspections 0&64r covey
22. Did the facility fail to install and maintain a rain gauge? /� n�d [:]Yes [:]No NA ❑ NE
23. If selected, did the facility fail to install and maintain a bbre el on rmgafio~n�Iq�pment? ❑Yes ❑ No 1;4 NA ❑ NE
Pagel of 21412011 Continued

Facility Number: - Date of Inspection: S
24. Did the facility fail to calibrate waste applic�lfon equipment as required by the permit?
❑ Yes
IN No
���❑
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
Oj�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
A No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
XNo
❑ NA ❑ NE
Other Issues
�[
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes VV No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes p(J No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes JX' No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �K No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations orany other comments.,_
Use drawings of facility to better explain situations (use additional paces as necessarv).
o%A�o2 Sol I fe - P.4nM.Q1ei-" o20is., (hJoZVI%
die " L3 ,
a I I t) a a� ao ► 3 ? 1/ �5
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 333Vj71. S as9
Date: gISl ;L613
214,12011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: l Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 20 rrival Time: S Departure Time: ® County: W I 1 i _8s
Farm Name: _T6_,..41.5 Place— Owner Email: Q �l
Owner Name: (Y, ( Q V 00 S !t 2 Lo Phone:
Mailing Address,
Physical Address:
Facility Contact: C I OL Uj e S h e 1.) , Tr • Title:
Onsite Representative:
Certified Operator:
Back-up Operator
Location of Farm:
Region: (,()5['�0
Phone: tJ" 7 - 7 / A h
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
whike / �(ue roG_j /
HWy ;L14 z
I/a htii le oK®
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
I ILayer
Design
Capacity
I
Current
Pop.
tattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I jNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr., $oul
Layers
Design
C•_a aci
Gucrept
P,o ,
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
lBeefBroodCow
Qther
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[-]Yes 0"No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes F9No
] No ❑ NA ❑ NE
❑ YesNo ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: • Date of Inspection: J ,1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes FYNo ❑ 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 [,-J(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 VNo ❑ 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 7I N No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ❑'" No
;4NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
9. Does any part of the waste management system other than the waste structures
require ❑ Yes 19 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
�-�
Yes 0 No
El1
❑ 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 Pending ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
[Rd4A
❑ NE
❑ Yes CR-Iqo
❑ NA
❑ NE
❑ Yes C Vo
❑ NA
❑ NE
Pi Yes ❑ No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements [-]Other:
21. es record keeping need improvement?
ante Applicat(On ldyFteeboaxtt- astp n Analysis oil
Rainfall tocking CropYield 120 Minute Inspections onthly
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No ❑ NA ❑ NE
Analysis EPO'e`ather Code
and V Rainfall Inspections ❑-Slu�
❑ Yes p I No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes 7❑ No ,�IA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 9 j - . • 1 Date of Inspection:
Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? IMF
❑ Yes
06 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
❑ No P�NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
C!yNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[�rNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[�(No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
&No l] 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
qNo ❑ 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
0 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No l] NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations orany other cowmen"ts.
Use drawings of facility to better explain situations (use additional pages as necessary).
L'alibra�'(io✓� Give P43.
al l�lll need 5olici c6a5fe Soon, — BLG
No c©c, &-�_) RVUC-(
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:2—
T
21412011

0
Reason for Visit: 2 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: rival Time: Departure Time: County: W I k f.PS Region: LL3S %O
Farm Name:A i� t"STP �q C� Owner Email:
Owner Name: C' LCi O
Mailing Address: CJ S
Physical Address:
Facility Contact: / Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone: q g q
Phone: q' S 7- 7 16 O
Integrator:
Certification Number:
Certification Number:
Latitude: (Q QS Longitude:
'�J6 b sqi a-3
�{aI N.
Swine
Wean to Finish
Design Current
Capacity Pop. Wet Poultry
Layer
Design
Capacity
Current
Pop.
Cattle
Dairy Cow
Desigityn Current
CapacPop.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, P,oult ,
La ers
Design
Ca aci
Current
P,o ,
Dry Cow
n-Dai
cke
Beef Stor
Q
Gilts
Non -La ers
Beef Feeder
Boars
I
jBeefBroodCow
Other
Other
Turke s
Turke Points
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 I No ❑ NA ❑ NE
[—]Yes [—]No
[—]Yes [—]No
❑ Yes [:]No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 21412011 Continued

Facili Number: - jDate 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 777T❑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 f 16' No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) +
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No I 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 I\/I No ❑ NA ❑ NE
maintenance or improvement? 4
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, Z etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window/ ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No IX NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ,( No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes I X I No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate oq ove 1ge Penn 'adily available? ❑ Yes 1$-A tcNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes I No ❑ NA ❑ NE
yl
the appropriate box. t �
❑WUP ❑Checklists E3Hesigrr ❑ Maps ❑ Lease Agreements ❑Other.
21. D s record keeping need improvement? IPyes,-c}t�pregrask� �s ❑ No NA ❑ NE
W e A fcauo ard— aste Anal sis it Analysis aste Transfers �Ul tV�eather Code
PP Y Y
ainfall EgKtocking Crop Yield 20 Minute Inspections 02thly and V Rainfall Inspections Easkndge-6nrvey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [t No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 1"" R.-`❑ NE
Page 2 of 3 21412011 Continued

Facility Number: -1313 j jDate of Inspection: i 3
24. Did the facility fail to calibrate waste appliCbtion equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑NA ❑NE
MINA ❑ NE
rV
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fist survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [XNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0 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
Ep No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
,,, [[[
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft. Explain any YES answers and/or any additional recommendations or any
other. comments.-;
Use drawings of facility to better exulainsituations (use additional paves as necessarv).
) te -
IF.
Fla
Reviewer/Inspector Name:
Phone: 071 5 a89
Reviewer/Inspector Signature:
Page 3 of 3
Date: III -31 a-O 1)
2/412011

Type of Visit VCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I -- yZ� Arrival Time: c%: 3O Departure Time: �!?:3�i�m County: w 1 Region: ry
Farm Name: JtV S11 Lace Jr,Owner Email: p/1 �7
Owner Name:14 u ESQ- .5,// V ) pp pp Phone: (ti) �0 7
Mailing Address: 9S5_ I)dAleIGrIC Rd. AarLA-1 9AAP_f, MG
Physical Address: /NCne
Facility Contact: taw Title:
Onsite Representative: rij
''�
Certified Operator: (/G ti f] � � C��, v r ,
Back-up Operator:
Phone NoQ-JTS7 -7140
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm:
, Latitude:' � �o Longitude: $o ®,
Wl6q2/it 16r9ii F�"- 04r -B/tG y
Q,fion O.I'nclef 23
-
c(owvK cjrLvd dr1✓e
Wean to Finish I I I1ILJ Laver
Dairy Cow
Wean to Feeder
, ❑ Non -La er
' ❑Dairy Calf
❑ Feeder to Finish
II❑
❑ Dairy Heifer
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Gilts
Boars
ischar¢es & Stream Impacts
Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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)
Is there evidence of a past discharge from any part of the operation?
Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
1 of 3
Cow
N
❑ Yes )No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[I Yes [I No El NA '❑NE
0
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Ely es No ❑ NA ❑ NE
12128104 Continued

' Facility Num• Date of Inspection / / 0 Z •
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes KNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier. 2n,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): I t
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes N�No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes VNo
❑ NA El NE
through a waste management or closure plan?
11
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
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ❑ No
XNA ❑ 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
k3No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
�..,(
❑ Yes �(J No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.) ''
[]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) (D fA
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
la'J No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
�No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ Nox NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
XNo ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
XNo ❑ NA
❑ NE
Comments (refer to question #)i Explain any YES answers and/or any recommendahons.or any other comments
Use�drawm s�of factGty to betterexplain situations. (use'addthonal_pages;as necessary) y ,, �
g m .. �n
a
Reviewer/Inspector Name -Pn.y f tI- ""I Phone: IG3G) 771- 52-95
Reviewer/Inspector Signature: Date: I I Dz A0 16,
Page 2 of 3 12128104 Continued

Facility Number: — �e of Inspection ([ Z [� •
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
�(
El Yes ,�J No
,M\
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
[I NA
❑ NE
the appropriate box. ElWUp El Checklists ❑ Design El ❑Other
\\\
p,
21.
Does record keeping need improvement?
Yes �No
❑ NA
❑ NE
Waste Application 9141eekly-Freebeerd Waste Analysis Soil AnalE3-Ww,
'ransfers
Rainfall Stocking Crop Yield s Monthly and l"
Rain Inspection ❑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//�❑l No
)(NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes /IXJ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes �y❑No );rNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes Jl�Q/No
[INA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes' N\ o
/
[I NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
o
❑ Yes tNo
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Elyes
❑ 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 )J 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
,,\lt__,,//
El Yes Ind 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 XNo
C\No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional Comments and/or Drawings:
2V CA �r�%h Cd�i7►'GP in �V(l �, �NLQi�'�1 /rqql q��%/
21, S.Cve/q 1 -i d jf �RYt 5 7�tLv �dEL /Pnq ,
2�. tart 1r,_ar d �+kr 6, e `tat Tj��� t•-�. ,,
Cep J'l� u .50[I VLV& r'L
N�� Ale) vJ�� J/
Page 3 of 3
i\
12128104

Type of Visit (,Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit XRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 11D1 /5 /ay_I Arrival Time: Departure Time: County: I ��-�J Region: 5 F�
i
Farm Name: /tTQ-t-�S I ta__-� Owner Email: '
Owner Name: Cl a )Ae- Phone:
Mailing Address:. 9 55 De-0 C1111 i"w-, 1 C..OI - i I`O n- t ✓1 RI1%e.,V, �r
Physical Address: 11 N O N O ! GT • 1 �y
Facility Contact: l j t� S 1 /J �,.f.•.Title^: Phone N- S 7— —1 16 Q
Onsite RepresentaIntegrator: 4'
UUM
Certified Operator: C� P S �IeAA % Tr - Operator Certification Nu r er.
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [�U ®. ©« Longitude: I aw ®1 E3 11
vs14� 1;
'
estgn Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer I
❑ Dairy Cow
❑ Wean [o Feeder
❑ Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
-
❑ Layers
La
Non -Dairy
❑ Farrow to Finish -
❑ Non -Layers
Beef Stocker �
❑ Gilts
❑ Pullets
Beef Feeder
❑ Boars
El Beef Brood Cowl
El Turkeys
Other
f
y 12701
Number of tructures:
❑ Turkey Poults
❑ Other
El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
- Ly No
❑ NA
❑ NE
Discharge originated at: [I Structure El Application Field [I Other
r
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)?
0
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
,y�f
I� No
[I NA
❑ NE
other than from a discharge?
/ ,
12128104
Continued

Facility Number: — • Date of Inspection •
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
X No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
�tNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ No
[)(NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElIl0 Yes
�/
No
El NA ❑ NE
El Excessive Ponding ❑ Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
7�
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[����,,,(((No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
El Yes
l)(1 No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
/❑` No
C% NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
PiNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
NNo
❑ NA
❑ NE
Comments (refer to questiod"#): Esplam any"YES answers and/or any er commeudairons or any thertc mments
Use drawings of facility to better explain situations. -(use additional pages as necessary)
J
Reviewer/inspector Name I(p Phone: 11 — ,1 %9
Reviewertinspector Signature: Date:

Facility Number: — 33 ]7dte of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check (❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El Other ,.,,//
21. Does record keeping need improvement? ❑ Yes 1 Y ❑ NA ❑ NE
0,, W//ante Application 0-Weekl9 Fmboa d— Li};Vl�aste Analysis Sooi�il,,Analysis � aste Transfers a—
R ainfall Ua'Stocking Crop Yield l20 Minute Inspections 2<Onthly and V Rain Inspections eather 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
X No
❑ NA
❑ NE
❑ Yes
❑ No
15�NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
I)dNA
❑ NE
❑ Yes
$ No
❑ NA
❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes 111 No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
,�No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
*o
❑ NA
❑ NE
y
11 1 I I 1
0
12128104

�7
Division of Water Quality
Facility Number 3 Division of Soil and Water Conservation 9 A'M
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: a a rrival Time: Departure Time: �'� County: W, l U5 Region: W5)w
Farm Name: 3-0.14. IS Plm e. Owner Email: (j
Owner Name: C Uu tk 2 s VIA l) 3 TY Phone: nJ �� b — 34934
Mailing Address: q SS be 1 I"Iatx,e 2oari q� eIyPX f N C a 3667
Physical Address: 4
% /�
Facility Contact: CIt�.Ude- Shet,Jiff• Title: q fIS q i . PhoneI —1I46
Onsite Representative: _
L1&k& SKtk.A-3 TV-.Integ'dtor:
Certified Operator: Cat lt1, 0— 5 fWA' i _'r • Operator Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
Other
❑ Other
Back-up Certification Number:
Latitude: = U = . = Longitude: = o = 1 I--] "
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
Beef SF.
oZ50
Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
r� 5
Number of Structures:res:
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 ANO ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ?❑ No El NA [I NE
❑ Yes NNo ❑ NA ❑ NE
❑ Yes '�grNo ❑ NA ❑ NE
12128104 Continued

�.
Facility Number: • Date of Inspection Ley j94_j_Q)M
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )(No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
tNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
ko
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
�rNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ No
VNA ❑ 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
)dNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
Are there any required buffers, setbacks, or compliance alternatives that need ElI�p Yes
No
XINo
El NA ❑ NE
maintenance/improvement?
/ `
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
V No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
BSI No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
I(NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
)�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
)dNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
1� Sl�cwe 5PIRwl 64h 6WJ ut Fci.M0 -
[Revie er/Inspector Name ) 5 0. U Phone:
Reviewer/Inspector Signature: Date: a:p
12128104 Continued

rFacility Number: Q -7 Af Inspection O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
•
❑ Yes L71 No ❑ NA ❑ NE
20.
Does the facility fail to have all compoon/enis of the CAWMP readily available? if yes, check
yes
❑ No
El NA
❑ NE
the appropirate box. El r�/I Checklists ❑ Design ElMaps ElOther
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑Yes
Wl'KNA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
tttifitatiyn—
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a min 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
PO No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
O�4A
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[(No
❑ NA
❑ NE
Otherlssues
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
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?
El Yes
,,,���---yyy���
pal 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
1ANo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
'�(No
❑ NA
❑ NE
Ad ' al Comments and/or Drawings:
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