820475_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Rua

type of visit: (VAnompiliance Inspection U Operation Review U Structure Evaluation U l'echnical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up Q Referral Q Emergency O Other Q Denied Access
Date of Visit: Arrival Time: t' 4 Departure Time: ! !o County: SerW1396ff Region:
Farm Name: F� Owner Email:
�- 111I�
Owner Name: _� o 4I6 Phone:
Mailing Address:
Physical Address:
Facility Contact: Gf~4i`s & NV Title: Phone:
Onsite Representative: ( Integrator: N & `Y
Certified Operator: Certification Number: led a w
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Cnrrent
Design
Cnrrent
Design
Current
Swine Capacity Pop.
WetPoultry
Capacity
Pop.
C►attle Capacity
Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish Z 6D
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D : tP, ,ult ,
Ga aci
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
III Boars Pullets
Beef Brood Cow
.,
Turkeys.
Turkey Poults
Other
Other
Discharees and Stream Impacts
3 _ 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?
0 Yes Flo ❑ NA 0 NE
❑ Yes [] No
❑ Yes [:)No
QKA ❑ NE
[ l;1 A' ❑ N E
❑ Yes [:]No 2 NA ❑ NE
[:]Yes FNo
'f❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

40
Facility Number: -7 $ jDate of Inspection: /
WaswCollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [S-<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No � ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
IdentiCer:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L1 I'^
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes [: 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 RJ1'd'6 ❑ 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 Q,?i6 ❑ 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 [g-K° ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ZrNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q 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 ❑ Eviden
c
e of Wind Drill ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): !d
14. Do the receiving crops differ from those desi&mated in the CAWMP? ❑ Yes 1"' ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [!T"No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes l�J' o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes L;?'1Go ❑ NA ❑ NE
❑ Yes E No ❑ NA [] NE
Required Records & Documents
19_ Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2oo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available`? If yes, check
❑ Yes
[FIND
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21_ Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
P fo
❑ 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
[�o
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
ErNo
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

[facility Number: Date of Inspection.
24. DidThe facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ED.Nd— ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes io �❑ 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 .E5No ❑ NA ❑ Nl
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E? o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
IJ"wc
❑ 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
10
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ff No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑`No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewerflnspector 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
E ..Ko
0 NA
❑ NE
Comments (refer to question #): ETplain any YES answers aind]or any additional reco ' ma ndations•or any other comments.
Use drawings oflfacility to better explain sitn4t -o s _LOW
pages as pecessa - ,
ry)
C"IA,, ,dam --- T - :7o- r s�w�j s4 f f -2-7-1 ?
P
t 2, �� e,� 4
5
c4 66 D- 3c -- kSf
Reviewer/inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone`V` 33— 3331f
Date:
214120l

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: JZJ Arrival Time: ; / Departure Time: SS County: Region:
Farm Name: PJi� Owner Email:
Owner Name: � 4�GPhone:
Mailing Address:
Physical Address:
Facility Contact: Cz 4.�t �iw`e& Title: Phone:
Onsite Representative: _ Integrator: MIS - -
Certified Operator: �►fnr� ��Va� Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current �' s� y Designs Current
Capacity P.op.l V1Wet`PoultryCapactty Pop:
_gym T, .E w
"Design Current
Cattte Capacih Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -Laver
iry Calf
Feeder to Finish TVF
­ �;
F
Design Current
Dry Poult Ca actPo' :
Lavers
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Becf Feeder
Boars
Pullets
Beef $rood Cow
Turkeys
"
TurkeyPouets
Other I
Other
D_ ischar2es and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (I f yes, notify DW R)
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 � ❑ NA ❑ N E
❑ Yes
❑ No
fE]7NA
❑ NE
❑ Yes
❑ No
� NA
[:]NE
❑ Yes
❑ No
[A';6A
❑ NE
[:]Yes
�o
[:]NA
❑ NE
❑ Yes
rNo
❑ NA
❑ NE
Page 1 of 3 1412015 Continued

Facility Number: - ' Date of Inspection:
r �
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [ 0 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes D No NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): /1 5 57
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2<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 0 Yes [20f4o ❑ 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 E2rNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �iVo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [?(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [�No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [�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):
ON
60
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 desigm 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 uired 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
❑ Yes VNo
[] Yes [ rNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes
dNo
❑ NA
❑ NE
❑ Yes
[!fNo
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 'dNo ❑ NA [] NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Otber:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4?0
NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: 87JL. Date of Inspection: J-1
24. Did the facility fail to calibrate waste application equipment as required by the permit? [] Yes U'<o ❑ NA Q NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes UKo ❑ 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 <0 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes CX0 ❑ 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
VNo
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
CdNo
❑ 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
dNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[2(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!fNo
❑ NA
❑ NE
Comiuents (refer to question #): E><plain any YES answers andlor any additional recommendations or any other comments.
Use drawings of acilJig to better explain situations (used ddid�dition_a! pages as necessary}.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
4 1
Phone:7,1.0*3-3 33 Y'
Date:zz
-i U
21412015

atW mtmot�3D/ib RrJ
Type of Visit: om Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 15 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: f, Departure Time: County: Region: 7t--/42Z
Farm Name: � f�L,,,,A�, Owner Email:
Owner Name: f ` _�� Phone:
Mailing Address:
Physical Address:
Facility Contact: ' Title: Phone:
Onsite Representative: integrator: 0
Certified Operator: t f Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
-
M
Desi n
g "
Capacity
Current Desi gn 'Current
Pop. Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pap.
Wean to Finish
La er
Daia Cow
Wean to Feeder
Noa-La er
Dairy Calf
Feeder to Finish
,r#'. '
Design Current
D . P,_oult`, Ca a'ci P,o
Lavers
Dai Heifer
Farrow to Wean
-
Da Cow
Farrow to Feeder
Farrow to Finish
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars IPUIlets
Turke s
Other Turkey Points
Other Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes [EE ❑ NA ❑ NE
0 Yes
❑ No
E! NA
❑ NE
Yes
❑ No
[!I 'NA
❑ NE
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 [21'No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [-]Yes [3'<o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection:
Waste C01lection & 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 I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ZIT
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
E� 10 ❑ NA ❑ NE
❑ No Eq-RA ❑ NE
Structure 5 Structure 6
[] Yes M,-I% ❑ NA ❑ NE
❑ Yes ±No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
U-No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
(Ergo
❑ 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
[&1�0
❑ 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 [LJ4 ❑ 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 Approved Area
12_ Crop TYpe(s): J&�v�tr-d"'[
13. Soil Type(s):lnti
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Zallo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Clio ❑ 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?
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
[;J�No
❑ NA
❑ NE
❑ Yes
Po
❑ NA
❑ NE
[:]Yes E24
❑ Yes [3No
❑ W UP ❑Cheeklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. [:]Yes C2rRo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stacking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes6,N
o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Al A A m P r-. 4 4 -6
Facility Number: jDate of Inspection:
24. Did the'Tacility fail to calibrate waste application equipment as required by the permit? ❑ Yes OD -No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0'NO ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes [ N~o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [T3 N ❑ 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 E�No ❑ NA 0 NE
❑ Yes [4o ❑ NA ❑ NE
[:]Yes PrNo ❑ NA 0 NE
❑ Yes [2`90 ❑ NA ❑ NE
0 Yes [;�l�fo
[:]Yes [2%
[-]Yes ErNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments refer to uestron, Explain an YES answers; and/or any additional recommendatrous pX any ot>ber comments:
( 9 �= p � y
Use drawings of facility to` better explain situations (use additional pages as necessary).
Cqjk 40 --,v - q t L/
4KI,
3.1
Reviewer/Inspector Name:
ReviewerfInspector Signature:
Page 3 of 3
Phone: —1
Date: _N weA tb
21412014

• n.-0
711�.
i-ype of visit: tli:ompnance inspection tJ operation jceview V btructure >H;vatuation V i ecanicai Assistance
Reason for Visit: O'Routine O Complaint O Follow-up O Referral O Emergenev O Other O Denied Access
Date of Visit: 1L�1� Arrival Time: r{rap Departure Time; County: s4 pi
Farm Name: QLLf, e- 6-et 21 ok Owner Email:
Owner Name: H D3 W 4 ar' � Phone:
Mailing Address:
Physical Address:
Facility Contact; �.r- Sl t 4Xl Title: Phone:
Onsite Representative: t {
Certified Operator: if
Back-up Operator:
Location of Farm:
Latitude:
Regioni4w
Integrator: &i&
Certification Number: Sa`�
Certification Number:
Longitude:
Design C«urrent
Design
Curren#
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
I 11-ayer
Non -La er
Dairy Cow
Dairy Calf
Feeder to Finish
" _ ,.*
DajEX Heifer
Farrow to Wean
Farrow to Feeder
l
rRNoin-Layers
Design
Ca acity
Current
P.o
Dry Cow
Non -Dairy
Farrow to Finish
Gilts
Boars
Pullets
Beef Stocker
Beef Feeder
Beef Brood Cow
Other
—.Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c, What is the estimated volume that reached waters of the State (gallons)?
❑ Yes U;J'gD ❑ NA ❑ NE
❑ Yes ❑ No []INA ❑ NE
Yes [:]No ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes
❑ No
E3 A
❑ NE
2. Is there evidence of a past discharge from any part of the operation? 0 Yes
[ o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes
dNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2.1412011 Continued

FacilityNumber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1_4- o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ ❑ 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
Q-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
[j' o-
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�o
❑ NA
❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
EJ-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [7'—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 ❑ � r'�
Application Outside of Approved Area
5-( 012. Crop Type(s): - B_ U �
j` V
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?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
[:]Yes
[_9'I4'o
❑ NA
❑ NE
❑ Yes
[t�'No
❑ NA
❑ NE
[]Yes
[a'No
❑ NA
❑ NE
❑ Yes []"'No ❑ NA ❑ NE
❑ Yes D-�ko ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0'No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard , ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 126 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
TNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

v
Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:]Yes
[3'I1 o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
O-No
❑ NA ❑ NE
the appropriate box(cs) 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
�o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[D-Mo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes �o
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes Q-K°
❑ 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 [�Vo
❑ 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 ❑moo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [J No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes Quo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [ "No
❑ NA ❑ NE
Comments;(refer to question #) �Eaplaut any_YES;answers andloryany,additional-:recommendativns�ar'any other comments:'
Use.draisings of facility to"better lav Aituations use additional a es.as necessa
°.
` �05—
C�-AC
.�
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature: s Date: (M.� r,I J
Page 3 of 3 21412014

Type of Visit: ®'Compliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance J
Reason for Visit: Q'rioutine O Complaint O Follow-up d Referral O Emergency Q Other O Denied Access [I
Date of Visit:! Arrival Time: " U Departure
Farm Name A iaf�C
Owner Name: _ Q Tad-w3 b�__'
Mailing Address:
Physical Address:
Time. County w a. Region:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: 3,.,V!U 9"'.4 Integrator:
Certified Operator: i ( Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
;�
DestgCurent
Design Curren#
Swine Capacity Pop.
Wet I'oult "ry
Capacity— Pop.
Cattle Capacity Pap.
Wean to Finish
La yer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
t°
"•
Design, Current"
Cow
Farrow to Feeder
D r v,Pohl
Ca aci Top.
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
I
INon-Layers
Beef Feeder
Boars
1pullets
Beef Brood Cow
,.
Turkeys
Other
Turkey Poults
Other
10tber
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑Structure ❑ Application Field ❑ Other:
❑ Yes U-14 "' ❑ NA ❑ NE
a. Was the conveyance man-made? [3 Yes 0 No [T]<A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes [] No [t], XA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [—]No [q NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ETNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E]"No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Waci]14 Number: IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L7 110 ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ErNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): D--_....-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2- 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 E 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 E No ❑ NA ❑ WE
(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 [2<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes n NNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�JrNo ❑ 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 / W� y k r"t `Ur-f
13. Soil Type(s):11�6 at (�
14. Do the receiving crops differ from tho a designated in the CAWMP?
[::]Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
0 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 ofproperly 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
B1 _o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0'9 o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps E] Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes MrNo
❑ 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 02"No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ErNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

I1
Facili - Number: - QLA c J1Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes LJ "o ❑ NA D NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any Iagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation 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 ENo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
[g1Vo
❑ 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
[j�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Q No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[3�o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[fNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2]"No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
0"No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3 21412011

Type of Visit: (0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: QIfioutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access [I
Date of Visit: Arrival Time: Departure Time: ►t County: �F..L Region-.L�'
Farm Name-, LAIC-6 146 Owner Email:
Owner Name: DegLA 04+0"x Phone:
Mailing Address:
Physical Address:
Facility Contact: 4,14 Title: Phone::]
Of
Onsite Representative: 1 Integrator: sq !,
Certified Operator: i Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
«" esesiga
...... ...:...
Current DesiCurrent
SIRpacity Pop.
Wet PoulkiCapacity Pop. Cattle Capacity Pop.
Wean to Finish
La er Dai Cow
Wean to Feeder
-Layer
Da Calf
Feeder to Finish
- Dairy Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
D . P,nttl . ,n
La crs
Ca aci P,o . Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
I jBeef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure [] Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify 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 Vo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [-]No
❑ Yes ❑ No
[:]Yes ❑ No
[:]Yes �Io
[3 ,NA ❑ NE
❑,<A ❑ NE
ED-f'4A
❑ NE
E]�<A
❑ NE
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection: 3 0
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 2e<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�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
[]R o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EE'l�o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Q No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[KNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [E o ❑ 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): c Lt' iC.i Cr/�+w [ [ rJ �-s 57
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Cg No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes [DAo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes [j]fi7o ❑ 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?
Reauired Records & Documents
❑ Yes [g-f�o ❑ NA ❑ NE
❑ Yes [T No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [R<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [E'&o ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes f15o ❑ 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 [9No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rambreakers on irrigation equipment? ❑ Yes [t]'No ❑ 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 [B-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [J�o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge Ievels
❑ 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 [+ ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �( ❑ 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? ❑ Yes [B o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [B"Ro ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes lB "o ❑ NA ❑ NE
Comments (refer to question #) Explain any YES answers and/or any additional recommendations or any other comments__ 4 ,;
Else drofawings facility to better eaiplain situations (use additional pages as necessary). _ f 40
� z
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes
[�io
❑ NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
❑ Yes
[] N
❑ NA
❑ NE
❑ Yesff
No
❑ NA
❑ NE
P- a-7
# ! o = q' o
Phone. 13�
Date: b OCR o 3
21412011

.1- 7101 [r.)L
Type of Visit: �om fiance inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ( 70utine O Complaint O Follow-up 0 Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: dr 1 Departure Time: t County: qzvjlRegion: FO
Farm Name: K P �,n i= 1Owner Email:
Owner Name: 1r0,(L+te%S QT-.1Vt_ Ca&k, AS1 Phone:
Mailing Address:
Physical Address:
Facility Contact: F_U nP Title: Phone:
Onsite Representative: Integrator: N
Certified Operator: Certification Number:
Sack -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Desi n Current
Desi
.Cnrrent
•
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity"
Pop.
Fettle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
-Layer
DairyCalf
Feeder to Finish
jDairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P.oultr
Ca aci
P,o
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Won -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
TurkSX Poults
Other
Other
Discharzes and, Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
(—]No
ZNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[]No
[Vf NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[:]No
[g NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[] Yes
ff No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:)Yes
C!fNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

� r
[Facility Number: TS ZL - 'i Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity ,(structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [a No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes [:]No E;rNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):l
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 5�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
[RrNo
❑ 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
[vrNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ed -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
[✓7No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E4 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): C aV!lc5tR\ %_tlZ�+�o A 4:A..t LkR7 J� _ T �16
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
YNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
gNo
❑ 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
YNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[]Yes
[dNo
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[,(No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[jfNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[]Yes
[� No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

FaciliNumber: jDateof inspection: 'L
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 permit conditions related to sludge? If yes, check ❑ Yes E�No ❑ NA 0 NE
the appropriate box(es) below_
❑ Failure to complete annual sludge survey 0 Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ff No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [dNo ❑ 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:
❑ Yes [;rNo ❑ NA ❑ NE
❑ Yes ffNo ❑ NA [] NE
❑ Yes gNo ❑ NA ❑ NE
❑ Yes [UNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [I No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes gNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [f No ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
21412011

Type of Visit: 0 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 0 Denied Access
Date of Visit: 3 / Arrival Time: L4�- Departure Time:County: Region:
Farm Name; Owner Email:
R G
Owner Name: �h3 �l�S � �ib �►�rld4, � Phone:
Mailing Address:
Physical Address:
Facility Contact: �R!: l Q Title: Phone:
Onsite Representative: 6t
Ct
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator: 1V1kMjj6'r`�'l�
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Wet Poultry
La er
Non -Layer
Design Current
Capacity Pop.
Design C►urren
Cattle C►apacity Pop.
Da Cow
Da Calf
Feeder to Finish
Dr:►' loalt s
La ers
Design"Current
CSPA i P,a ,
DairyHeifer
Farrow to Wean
Farrow to Feeder
D Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
Other
Turke s
Turkey Poults
—
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes Ep No ❑ NA ❑ NE
[:]Yes [—]No
[] Yes [:]No
NA ❑ NE
P9 NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) U Yes U No NA Lj NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes jP No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [P No ❑ NA [] NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

04
' Facili Number: - Date of Ins ection:
Waste Collection & Treatment
4. is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifiero) 7_V043
�No ❑NA ❑NE
❑ No NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): _
Observed Freeboard
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
0 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 Application
10. Are there any required butlers, 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 Cropp Window
1 ,� �❑` Evidence
jooff Wind
ODrift ❑ Applliicatioon� �Outside o�fnApproved Area
12. Crop TYpe(s): L�� E 1 V'` "c �[ r 1 7 'Q , rJlk� !}'�L`�>�f S� / ./y,,AL fr(J .
13. Soli Type(s): EDL��
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
fp No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available'?
❑ Yes
No
❑ NA
❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑ Soil Analysis
1012,
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[ No
❑ NA
❑ NE
21 If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[] Yes
6SM4No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

• Facili Number: - Uate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes (F'M� No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�] No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
T
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
Ug 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
❑ N E
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
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'ansW�ersrand/or any addittonat recommendations oriany atlier comEnents.
Use drawings of facility to better explain situations; (use'.additional pages as necessary) 6
��_ I to A4_� Gtj o4_jr( D->- 2�Uv /.
Reviewer/Inspector Name-
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: l2 11
21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: $:,30 Departure Time: County: Region: lrl?O
/ �^ r9aw, wAkago �
Farm Name: �PC S Pam= n ! F1O CViA Owner Email:
Owner Name: ' !AS T A Phone:LliU It, • 064 5—
Mailing Address:
Physical Address:
Facility Contact: Qi� 4 01-gC L Title: i�R3EK Phone: 4 / 0-$7L -03w S
Onsite Representative:
Certified Operator: Sf_QaA �AiLT
Back-up Operator:�� Cis► -I `J�+vyA
Location of Farm: Latitude:
Integrator: Ml](iV!L%M dpoj. ft-)
Certification Number:
Certification Number: C/SS Uu Z
Longitude:
Design 4Carrent
Gapi3city Pop. 11, Poultry Capacity ' 'Pop. Cattle
esignSwine
Capacity Pop.
RWe
to Finish La er Dai Cow
Wean to Feeder Non -Layer Dai Calf
Feeder to Finish tJalpa =3: Dairy Heifer
Farrow to Wean DesignrCurrent Dry Cow
Farrow to Feeder D . Paoul Ca . aci: `=-r Rio - Non-Dai
Farrow to Finish Layers Beef Stocker
Gilts Non -Layers Beef Feeder
Boars
Boars
Pullets
Turkeys
Beef Brood Cow
x �:;,,
Qther_
TurkeyPoults
Other
Other
and Stream Impacts
�. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field
a. Was the conveyance man-made?
❑ Other:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes [ No ❑ NA ❑ NE
❑Yes
❑No
[PNA
❑NE
[:]Yes
[:]No
W NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
evidence of a past discharge from any part of the operation?
-e any observable adverse impacts or potential adverse impacts to the waters
, other than from a discharge?
❑ Yes
C ] No
0 NA
❑ NE
[] Yes
MhNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
2141,2011 Continued

[Facility 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
❑ No
❑ NA
[] NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: if_3 01WO atXy 40
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 610
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 answergd yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes]
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ 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 10 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): �nas2 (UFfz�D C �vf _
13. Soil Type(s): A A b
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [,T No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17_ Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [Z No ❑ NA ❑ NE
20. Does the facility Fail to have all components of the CAWMP readily available? If yes, check ❑ Yes fth 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 N No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: $2. - y1 S Date of Inspection: B /
I
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structures) 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
[11 No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[!Z 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
P 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
Go 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
JM 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
[-At No
[:3 NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendat€ons or any+other�cu1.
mments `
Use drawings of facility to better explain situations (use'additional pages as necessary) . r .;
�OZL RtP00.% owl: by IZ13%>%N
aol{ — sb\� 40 r'1YJ� �gl�r�5
{MC) TACT 1r\aE.s t V\a C%S `, n Al %
L'`a'% c'^ 43 t Z O ZWt, -VO INCAQE \ak 1LN%4:tor, Cu-j rqo^ z.AsX F of 13q l
Reviewer/Inspector Name
Z. -shz£%aS
-A n n rr. ca „ 4
Reviewer/Inspector Signature:
Page 3 of 3
a v `do- & J5-7
Phone: 910-g3} 333,7
Date: // /[ !1
21412011

q
Type of Visit 0 Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up 0 Referral Q Emergency O Other ❑ Denied Access
Date of Visit: I U1 ` 1 I D 1 Arrival Time:1D5:
Farm Name:
Owner Name: /VI IJAWA L.-1
Mailing Address:
Physical Address:
Departure Time: County: /73&yr Region: �o
1)� Owner Email:
2C043-2f. CO Phone:
Facility Contact: k.Wr Title: Phone No:
Onsite Representative: I Integrator: /! J44
Certified Operator: AW1Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 1=1 0 0 I ED H Longitude: = o ❑ 6 ❑ [/
Design Current
Desigtt Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Laver
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish ©
=
❑ DairyHeifer
Farrow to Wean
D . Poul
r} try
❑ D Cow
❑ Farrow to Feeder
❑.Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
El Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
Li Turke s
Other
Other ❑ F
❑ Turkey Pou Its
I0 Other
Number of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes VNo ❑ NA ❑ NE
❑ Yes
❑ No
UNA
❑ NE
❑ Yes
❑ No
eNA
❑ NE
NA
P
❑ NE
❑ Yes
❑ No
❑ Yes
29"No
❑ NA
❑ NE
❑ Yes
�M No
❑ NA
❑ NE
12/2&04
Continued

Facility Number. —
Date of Inspection
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?
StructuT 1 Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes No ❑ NA ❑ NE
❑ Yes to NA ❑ NE
Structure 5 Tructure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 41
u
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.) 1
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes F No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7- Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ElNA ❑ NE
maintenance or improvement? If
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or t0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drib ❑ Application Outside of Area
12. Crop type(s) �4e
Vc +'•—(h2SC -—..� �`h . 1
13. Soil type(s) RRA fe-,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
19 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�ANo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
04 No
❑ _NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
$ No
❑ NA
❑ NE
Conim'ents (refer to question #): Explain any YES answers and/or anv recommendations orany other comments. f
Use drawtngs'of facility, to better explain situations. (use additional'pages as:necessary)
Reviewer/inspector Name rY ;: .. Phone: [phone]
I
Reviewer/Inspector Signature: Date;
121281044 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes o &NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes tAnnual
o[3NA ❑ NE
❑ Waste Application ElWeekly Freeboard ElWaste Analysis ElSoil Analysis ❑ Waste Transfers 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 CA W MP?
29. Did the facility fail to property 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
El NE
❑ Yes
o
NA
❑ NE
❑ Yes
No
11❑ NA
❑ NE
❑ 'Yes
� No
❑ NA
❑ NE
❑Yes
1�No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
4�No
`17No
El NA
El NE
El Yes
❑ NA
❑ NE
❑ Yes
t" No
❑ NA
❑ NE
❑ Yes
t�No
❑ NA
❑ NE
❑ Yes
-qNo
❑ NA
❑ NE
❑ Yes
(j No
❑ NA
❑ NE
Ad¢itonal Comments and/ror Drawings:-:'
Page 3 of 3 1.2128104 \\

Type of Visit Compliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Vis�i_tt 0 Routine O Complaint O Follow up O Referral O Emergency O Other ^❑ Denied Access
Date of Visit: j f �`/r}7 J Arrival Time: 1 p �3 Departure Time: ( ' County: r� Region: F-14�O�
Farm Name: —�C0 6-3 Owner Email:
Owner Name: h U _ Phone:
Mailing Address:
Physical Address:
Facility Contact: ' "Title: Phone No:
Onsi#e Representative: Integrator:
b t-0 r CLc
t
Certified Operator: % Operator Certification Number:
Back-up Operator -
B
ack -up Certification Number:
Location of Farm: Latitude: [� e [= g 0Ld Longitude: [� o 0. ='.
Design Current
Design Current
Design Current
CapaPoultry
Capacity Population
Cattle Capacity Population
MjWean to Finish
Wean to Feeder
Feeder to Finish �-
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -La ers
❑ Beef Feeder
PE] Boars
❑Pullets
❑Beef Brood Co
❑ Turkc s
Other
❑ Other
❑ Turke Poults
❑ Other
Number of Structures:
❑ Layer ❑Dai Cow
❑ Non -La er El Daily Calf
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
VpNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance than -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
n NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation`?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
PNo
❑ NA
❑ NE
other than froth a discharge?
12128104
Continued

Facility Number: j3atj
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure/2 Structure 3 Structure 4
Identifier: glob v tog
❑ Yes In No ❑ NA ❑ NE
❑ Yes ❑ No r NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 70
5. Are there any immediate tFireats to the integrity of any of the structures observed? ❑ Yes 'p 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 1] No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes to No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes � No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc_)
❑ PAN ❑ PAN a 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidene5eef Wind Drift ❑ Application Outside of Area
12. Crop type(s) Ylu.tdrt QvIS -S' ,,
".64-
tSoil type(s) g" -AR rAw'o r
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
l] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
T No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
W No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
B� No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or.:any recommendatlons,or any other comments.'
Use drawings of facility to better explain situations (use additional. pages as necessary) =
Reviewer/inspector lame — - �- _ . Phone:
Reviewer/Inspector Signature: Date: QO%
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [b No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes n No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IRNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes `M No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No JD NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
JpNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes]
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
0 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E�No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E� No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[5 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
h No
❑ NA
❑ NE
I2128/04

Type of Visit 0 Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine O Complaint Q Follow up 0 Referral O Emergency O other ❑ Denied Access
Date of Visit: U Arrival Time: Q ! 11 Q,�. Departure Time: �Ql County: F-S0,"' Region:
Farm Name: rT�LY P1_a�� and Owner Email:
Owner Nance: — Iqulrili, — &V kJr1Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: --1i 4
Certified Operator: r--tt V, P.�rt6
Phone No:
Integrator- A&V '~R�n , uC
Operator Certification Number: a6J
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = e = = " Longitude: = o = 1 = u
°`
Design Current
Design 1Current
Design Current
Swine
4 L r;ash
Capacity Populat�o WetlPoult'.
Capfacit}� Population
Cattle Capacity Population
Finish
Feeder
Farrow to Wean
❑ Wean to
❑ Wean to
Feeder to Finish
❑
❑
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑
Discharges &Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharges &Stream Impacts
I . Is any discharge observed from any part of the operation?
El Yes
PONo
❑ NA
❑ NE
Discharge originated at: El 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
QTNA
❑ 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
ElNo
�g
ILI NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
IgNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[3 Yes
t No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
I2/28104
Continued

r .
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 Cl NE
i
a. If yes, is waste level into the structural freeboard? ❑ Yes No 10 NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier: ;2 10
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):4 4
S. 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 ,
IgNo
❑ 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
Nm No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the pennit?
❑ Yes
bNo
❑ 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
t] Yes
PjNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No
❑ NA
❑ NE
maintenance/improvement?
1 I . Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
bNo
❑ 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 ❑ Evidence-Wind ❑ Application Outside of Area
f1of rDri_ft,
12. Crop type(s) � $S Mal f�^PJ 1,<M `�-� � {S@��c�C ,
T�
t ` &r-n�
13. soil types)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
MNo
❑ NA
❑ NE
1.5. Does the receiving crop and/or land application site need improvement?
❑ Yes
t$No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
19 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JEPNo
❑ NA
❑ NE
,Ctiutments'(refe�to`iq tion' #) Explain anyl5answers andl attrecom adahons,y
se drawut s of� acrlt to tuatronsa nse adsittwaa es asinecessa or an other comments
r� .. g if ty better -explain s� ,n( p g
3 � �'-'..::-SF�-:'.i�'JY��rn -.' .-'-. ' ; r ,� - ,,.�..:-:,, i..: ;.�� �- �-�►'` .. .�_. �.�5"s rr:"�+s,:u.- x -..
Reviewer/Inspector Name f AA01 n10 j Phone: C71D -465 ' OO
Reviewer/inspector Signature: A4 r. OAS Date:
A 7 _r 2 17n21fi.4 f'n,.ti.r a.na
a--v

Facility Number: Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �Po ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes -0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? I yes, check the appropriate box below.
❑ Yes
bNo
❑ 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
�] 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?
El Yes
d�nn
83 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified Operator in charge?
❑ Yes
RONo
❑ 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 93No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
D Yes
�Q 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
0No
❑ 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
,Q 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
1P No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
P No
❑ NA
❑ NE
Page 3 of 3 12128104

.1/
Division of Water Quality
Facility Number MEp� © Division of Soil and Water Conservation
- --
Q Other Agency
Type of Visit compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit • Routine 0 Complaint () Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
ry '
Date of Visit: 1 ( d Arrival Time: � � � Departure Time: i �, `�l7 iy'►+ry Connty: 54
Farm Name: — 1 d)_w G 3 _ Owner Email:
Owner Name: s rQ ►din _„ Phone:
Mailing Address:
Physical Address:
Facility Contact: tTr-S!2— lW Y Title: Phone No:
Region:
mil Onsite Representative: Integrator: At'&'q� /00'-0Wh
Certified Operator: r`� Operator Certiiieation Number- 1P46
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: = o = 1 Longitude: = ° = I = "
-Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Laves
Discharges & Stream Impacts
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
El Turkey Poults
❑ Other
Cattle
Design Current'
Capacity Population;';
G,
❑ Dairy Cow
❑ Dai Calf
❑ Daia Heifei
❑ Dry Caw
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
®I _
I. Is any discharge observed from any part of the operation?
❑ Yes
InNo
❑ 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
ONA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ONo
❑ 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?
12128104
Continued

Facility Number: ioz n5i Date of Inspection Z 31 brl
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?
ElYes ❑ No NA ❑ NE
St are i Struc 2 fracture 3 Structure 4
Structure 5 Structure 6
Identifier: �� oZE�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S—L( a f
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 4 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes �3 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 PNo ❑ NA ❑ NE
maintenance or improvement?
Waste Avolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 1 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V3No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind ,D,ri�ftt , _❑,�-Apppllicatiion" Outside of Area
12. Crop type(s) Pb ry ,,,-kL { AaL , . GYMI 1. L �Y n , �`A `8 . J6+-tf ea o
0(} Q�
13. Soil type(s) MD
14_ Do the receiving crops differ from those designated in the CAWMP? Cl Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes M^ No
❑ Yes 5allo
❑ NA ❑ NE
❑NA El NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name Phone: 0
Reviewer/Inspector Signature: 4 iff Date:
12128104 ' Continued

Facility Number: Date of Inspection 3t
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes FNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes KNo ❑ 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 F9 No ❑ 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 F No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes K) No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
OOFNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
InNo
❑ 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
U 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
09 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
P No
❑ NA ❑ NE
12128104

�I IML
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ORoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: !=FJ Arrival Time: I'h Departure Time: % = County: h-Lf3S Dtn Region: R20
�r r
Farm Name: �/l�b 5 940 g R L� CO g 3, a �� Owner Email:
j�
Owner Name: 1 ' `"ro r✓ �Z ' Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Q
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No-
Jlntegrator:_M,..,Ph4 Rrnw o,
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ ' = " Longitude: [::] ° a ' 0 w
Design Current ~ Dftik
esign' Current Design C•nrrent
Swine Cuparity Population W,et Poultry Capacity PcrpolatioQ Cattle Capacity Population
❑ Wean to Finish ❑ Layer I ❑ Dairy Cow
❑ Wean to Feeder ❑ Non -Layer I I ❑ Dairy Calf
Feeder to Finish ip 0 S "� x' "' ❑Dai Heifer
❑ Farrow to Weans `-�'" ❑ Dry Cow
❑ Farrow to Feeder r' ' 4 y'°a"'-�"� . `
❑ Non -Dairy
ElFarrow to Finish
El Layers ❑ Beef Stocker
❑ Gists I:4 ❑ Non -Layers
❑ Pullets ❑ Beef Feeder
❑ Boars ❑ Beef Brood Co
�t r ' ❑ Turkeys
Other e� ❑ Turkey Poults
❑ Other Other Number of structures:
Disci & Stream Im acts
1. Is any discharge observed from any part of the operation?
❑ Yes
Wo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
[4 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
[;FNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
fp No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[.No
❑ NA
❑ NE
other than from a discharge?
Page ] of 3
12128104
Continued

4L
Facility Number: ga- t:{'7
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structurc 4 Structure 5 Structure 6
Identifier: A 00 � 3 2-co O
Spillway?:
Designed Freeboard (in): tq ti �q
Observed Freeboard (in): eva�� 4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ANo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes P No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes (� No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes /G] No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /"
9. Does any part of the waste management system other than the waste structures require ❑ Yes 10 No ❑ NA ❑ NE
maintenance or improvement?
Waste Analication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
1P No ❑ NA
❑ NE
maintenance/improvement?
IL _
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
PNo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
Area
12.
Crop type(s) co�'V, 0-dk F— h S . +� / /' � 1Q+.
le,
_ _ l
� l'i htn 00&5e d
13.
Soil type(s) pb�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
CnNo ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes
,� No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any,,other comments.
Use drawings of facility to better explain situations., (use additional pages as necessary): * ,
• . -'s ..,. f . _ �. 'gin
Reviewer/Inspector Name # bev-N4vbi Phone(I�O}
Reviewer/Inspector Signature: Date:��
Page 2 of 3 12128104 Continued

J _ \
Facility Number: g a— 7 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [P No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes �2 No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists [I Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ZjNo ❑ 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
t� No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �Q No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes © No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 09 No ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
R9 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
W No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerllnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[2 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
M No
❑ NA
❑ NE
Additional Comments,andlor Drawings:,
.. Z'
Page 3 of 3 12128104

Type of Visit IS Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 49 Routine Q Complaint Q Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Zc Arrival Time: Departure Time: County: SOL"t l Region: r�
Farm Name: Y&t ?—I & Owner Email:
Owner Name: _ ., crc7D- �, s'7i� pry. �L.�� Phone: -
Mailing Address: PO
Physical Address:
Facility Contact:
Title:
Onsite Representative-
CertiFied Operator: _ !��cc{ e_'Cram nA1
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
0 Feeder to Finish
& 2taO
`f
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
-Other
❑ Other
Design- ` Current Design Current
Capacity . Population Wet Poultry Capacity _Population
❑ Layer
❑ Non -Layer
Phone No: f
Integrator:, ✓�� ` — Rrut�
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 0E--I Longitude: = o= I❑ u
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other,
Discharzes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance than -made?
b. Did the discharge reach waters of the Slate? (If yes, notify DWQ)
Cattle
Design current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ DaiEy Heifei
ODry Cow
❑ Non- Daia
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Dumber of Structures:
d. Does discharge bypass the waste management system? ([f 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
n.No
❑ NA
❑ NE
❑ Yes
❑ No
;,NA
❑ NE
❑ Yes
❑ No
&A
❑ NE
6NA
❑ NE
❑ Yes
❑ No
❑ Yes P3�No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number:— y 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 C NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: __41 --&
Spillway?: _ �
Designed Freeboard (in): � Al?
Observed Freeboard (in): _' 6
5. Are there any immediate threats to the integnityl y of an of the structures observed? ❑Yes C� No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 1)�JNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes C!�No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Vi 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 XNo ❑ NA ❑ NE
maintenance or improvement?
Waste AoEtlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P9No ❑ 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
fib.., s
i 2. Crop type(s) �g4 5:.e� • rf tz<. v� - 4ra�C
13. Soil type(s) 61a. ,, 4-e_7 �
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes KNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes KNo ❑ 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
PNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
N No
❑ NA
❑ NE
uestion'�#)i "
_ - ... . - - .�:i -YL7-4:i--..:.�.T
Reviewer/Inspector Name - i Phone:
ReviewertInspector Signature: Date: ;z
/ 12/28104 Continued

�Faeility Number: �j,1 - Date of Inspection `F ,
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Iallo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3No ❑ NA ❑ NE
the appropirate box. ❑ gyp" ❑ Check l s s ❑ Design
g �❑ Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2.No ❑ NA ❑ NE
❑ Waste Applicatioil ❑ Weekly Freebofd ❑ Waste Analysis ❑ Soil Analysis-' ❑ Waste Transfers',[] Annual Certificatioty
❑ RainfaW ❑ Stockings' ❑ Crop Yield -❑ 120 Minute Inspectiom ❑ Monthly and V Rain Inspections— ❑ Weather Code_-
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23,
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Z No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U3 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
W No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
®.No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ ,No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
[9 No
❑ NA
❑ N E
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
fiO 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
ENo
❑ 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
91 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
O,No
❑ NA
❑ NE
A'ddltionat�Cgmmeuts andJncbrawings
12128104

... ,---T.v�r. - ,....gin-' _• ^v. .c. .. . , . �... i e-..»... .- ..._ ... _--.:: v,rr .a..=�.i...-..., w -
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit • Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
—__Date ot Visit: 7f-p�--���-°-- Time:
Facility.Number 7S
-- - .� not O erational 0 Below Threshold
19 ermitted d'ICerfif ed 0 Conditionally Certified ❑ Reggistered pate Last Operated or Above.Threshold:
Farm Name: _ 2" a/aif Countv:
Owner -Name:
Mailing Address:
Facility Contact:
Title:
Phone No:
Phone No:
Onsite Representative: Integrator: . rn V� r jQ L� � 1� � a w .J
Certified Operator: 1,:1, v�_ �. Operator Certification Number: 4�D`_5— `isr
Location of Farm:
Swine ❑ Pouttry ❑ Cattle ❑ Horse Latitude Longitude �` C�• ��
Design Current
Design Current Design Current
Swine Ca adty Population
Poultry
Capacity Po utation Cattle Capacity Population
❑ Wean to Feeder
JEJ Laver
I T
I
❑ Dairy
❑ Feeder to Finish
JEJ Non -Laver
I
Non -Dairy
❑ Farrow to Wean
® Farrow to Feeder
v av
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons ® ❑ Subsurface Drains Present::][] Lagoon area- ❑ Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges 8- Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [M No
Discbaree originated ar: ❑ Lagoon ❑ Svrav Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b- If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in eat/min? A1114
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is thcre evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there anv adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collertion & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑Yes r No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ? / O q
Freeboard (inches):
05103101 Continued

Facility Number: — 4y7s Date of Inspection D
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 any of the structures need maintenance/improvement?
S. Does any pan of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
«'aste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type (1,111.11 / 4"It talc I .S o V 1 eao / 4 r a.2 iry I -s G
❑ Yes [0 No
❑ Yes (P No
❑ Yes En No
❑ Yes Q No
❑ Yes No
❑ Yes [13 No
❑ Yes M No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
® No
b) Does the facility need a wettable acre determination?
❑ Yes
[ No
c) This facility is pended for a wettable acre determination?
❑ Yes
® No
15.
Does the receiving crop need improvement?
❑ Yes
j No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Reouired
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?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
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.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
® No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[,U No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
IF No
25.
Were any additional problems noted which cause noncompliance of the Certified AVJMP?
❑ Yes
10 No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this tiisit.
COZiitttetltS_(r'eflr to;Qrtestlon 11) Explarn Bay 1�ES �rrsa;S and/or sqy recommen�ttions <Ir anV,,02hlP oommints. _� `��
Lse"drag s of Taclity to better ezpinw silua�ons: (use addihona!°pages ss necessary) ® Field Conv ❑ Final Notes ) -'
l� C hnPrretn C4 L� I S� �7 c i+ c r �f cq 4 _4 I v
D� ?'ke laciGol> J6a,Ik. ,
C_ Vd0hcdG '6CYr+�-t�� S ew/ d� �OSSI�It LN f Ccl2 tb l� �G�r ldh SFti��.�
y�4.
T
Reviewer/Inspector Name
Re-dewer/Inspector Signature: Date: 7-
05103101 Continued

Site Requires Immediate Attention:
Facility No. 8 z - ti -,
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE. "T-xy ZS , 1995
Time: iy .. w
Farm Name/Owner: r +�� _ _ �-�-5 F o �v r, .t+c LA
Mailing Address: 0 ia- "CZ,
County: S KM V s o tq
Integrator._ C%gR4-%-s r-oo1m FFa,PtrV-5 Phone:
On Site Representative: 7vu -r--�­tlme Phone: Rto
Physical Address/Location: � lR Lk
Type of Operation: Swine X Poultry Cattle
Design Capacity: to Number of Animals on Site: t a o
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude:
Circle Yes or No
Does the Animal Waste Lagoon h ufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Pagoon(s)?
r No Actual Freeboard: -at --Ft. ----inches
Was any seepage observed from the Yes or No Was any erosion observed? Yes or No
Is adequate land available for spry ') Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:stG.-1
Does the facility meet SCS minimum setback
V:= C.-s �r%xrC­ _ rY.
200 Feet from Dwellin ? (Yak or No
100 Feet from Wells?ZoorN6
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream?
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue ne: Yes No
Is animal waste discharged into water ostate by man-made ditch, flushing system, or other
similar man-made devices? Yes No If Yes, Please Explain.
Does the facility maintain adequate waste management recur (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)' Yes r No
Additional Comments: _re <C—M-
M' C- ti pr: L / ' 1 /c_ AG e-�e_ `7
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No. 81. - K-15
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 3�vY a5 , 1995
Time: 10. 00
Farm Name/Owner: * rp z t a
Mailing Address: _ - PO 3 Z� ta. j\ •�� 85� �� a N 3 `c3
County: S KM 9 s o w -
Integrator: CKRR4 r-ao p s F Ak crs Phone: It k o - 5 -OkLkk
On Site Representative: r'"-j Phone: 'k� a
Physical Address/Location: 'S'-V,- k q L� 9 �--� - 5F_ L 9
Type of Operation: Swine X Poultry Cattle
Design Capacity: t o oy Number of Animals on Site: 1 0ov
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: "
Circle Yes or No
Does the Animal Waste Lagoon h-
(approximately 1 Foot + 7 inches)
Was any seepage observed from the
Is adequate land available for spray? i
Crop(s) being utilized: ( a o
Does the facility meet SCS minimum
sufficient freeboard of 1 Foot + 25 year 24 hour storm event
or No ACOW Freeboard: 4 Ft. Inches
$n(s)? Yes o No as any erosion ob ed? Yes or la
ar No Is the ver crop adequate? (Yes)Dr No
evi
setback criteria? 200 Feet from
No
100 Feet from Wells? Yes -r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? es o No
Is animal waste land applied or spray irrigated within 25 Feat of a USGS Map Blue tine, Yes o No
Is animal waste discharged into water of state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No
Additional Comments: l . � CX-t-{
LA
M%cH ,r-L w�c_wr-r
Inspector Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.