820423_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qud

i ype of visit: b luompitance inspection C.J vperatnon review u btructure Lvaivanon v i ecnn]cat Assistance
Reason for Visit: +1 routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: o-- Arrival Time: 'D Departure Time: ,' O County: Region: C�
Farm Name: � �.� f�rLs Owner Email:
Owner Name:z! Phone:
Mailing Address:
Physical Address:
Facility Contact: zy"A 1we- eiW Title: aP cec rl Phone:
Onsite Representative: Sec.«
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capa' Pop.
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Finish
La er
Wean to Feeder
Nvn-La er
Dairy Calf
Feeder to Finish
/ /
- � '
Design Current
P.
Da'y Heifer
Farrow to Wean
Da Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Gilts
Layers
Beef Stocker
Non -Layers
Beef Feeder
Boars
_
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
,Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E No ❑ NA ❑ NE
❑ Yes
[:]No
[_]NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
0 Yes [ o
❑ Yes �o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

IFaciRty Number: - Date of Inspection:
Waste Collection & Treatment
$. Is heavy
No
NA
NE
storage capacity (structural plus storm storage plus rainfall) less than adequate?
E ] Yes
[']
❑
❑
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
Ej_No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Q N
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the sitnation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�o
❑ NA
❑ NE
S_ Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ej N
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[�'l�lo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
LJ i"o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑r "1 6
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): [}c-/ rt1 �• ur (Q ��
13. Soil Type(s): i�; 'X_ Z 'y D
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes []-Ko ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ff-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �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?
Required Records & Documents
❑ Yes EJ❑ NA ❑ NE
❑Yes [3-go ❑NA ❑NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E 1io
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[31qu
D NA ❑ NE
the appropriate box.
Q WUP ❑Checklists [] Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3-lQo
D NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q'No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [] Yes D'Nlo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

F"AcilityNumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3'<10 ❑ NA ❑ NE
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [31Go 0 NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Ikon -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 E] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �lo ❑ NA ❑ NE
Other Issues
29. 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, aver -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
[No
❑ NA
[] NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
Ej<o
❑ NA
❑ NE
❑ Yes
[j N
❑ NA
❑ NE
[] Yes Q-Ko
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawimszs of facility to better exuiain situations fuse additional oatres as necessarv).
Reviewer/Inspector Name-
Phone:;S I
Reviewer/Inspector Signature:
Page 3 of 3
Date: OF /t?—//—r-
21412015

- - i�ision of Water Resources
Facility,�Number L��J - ® O Division of Soil and Water Conservation
- O Other Age,�cy
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: eutine Q Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: —/ jj Arrival Time: �� Departure Time: �; County: �_<u Region: � 0
Farm Name- /��r /, �2.rjn�r � � Owner Email:
Owner Name: ill /)'%G _ Phone:
Mailing Address:
Physical Address:
Facgity Contact: Z—ACiA 177e_e & Title: ",-wn Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:iG
Back. -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design rrettt ;Design 3-Gttrrent Design Current
-
Swine x 4 r Capacity .0 Wet PANH Cap c iy: Eop. Cattle Capacity Pop-
_
�s��
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
X.Feeder
to Finish
r7
Dairy Heifer
Farrow to Wean
-urrent
Dry Cow
., r Design
K.
Farrow to Feeder
D , PP.oetlt ;'Ca�aci
P,o
Non -Dairy
Beef Stocker
91
Farrow to Finish
Layers
Gilts
Non -La era
Beef Feeder
'
Soars
Pullets
Beef Brood Cow
Turkeys
TurkeyPouhs
Other
Other
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes WNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ N1
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
DNA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
�,No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
Cg_No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: jDate of Inspection: r 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes r.No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): r,
Observed Freeboard (in): �4-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes allo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
KNo
❑ 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
[KNo
❑ 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
Eg.,No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo
❑ NA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes fig 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): ff2 eel Z ud,-?. A,'
13. Soil Type(s): 411 / %(-1014-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [3 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 M No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes � No ❑ NA ❑ NE
❑ Yes Eg-No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
J�jNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[RNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? if yes, check the appropriate box below_
❑ Yes
allo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
jls10
❑ NA
❑ NE
Page 2 of 3 2142015 Continued

Facile Number: Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Jallo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes QNo
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 [8-No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes (.No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
[]NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes [RNo ❑ NA ❑ NE
❑ Yes �,No ❑ NA ❑ NE
r
❑ Yes ,g No ❑ NA ❑ NE
❑ Yes &No ❑ NA ❑ NE
❑ Yes
[, No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
[!�1Vo
❑ NA
❑ NE
Comments (refer to question#): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinss of facility to better explain situations (use additional vases as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /1_0 _3d3"p1.s7
Date: ^�`�/-.7
21412015

ql:;1-3
Type of Visit: (-1-Compliance Inspection V Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1�� Arrival Time: Departure Time: County: , Region:
Farm Name: f%'%�r1 ��YF r�� �,� Owner Email:
Owner Name: Y� y,� f'/�y�- /%%<�it� Phone:
Mailing Address:
Physical Address:
Facility Contact:� ,r..w Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
rRurrent
. Des'
Swine Capacity Pop. iVe# Poultry Capacity Pap. Cattle Capacity
Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dr. Pooult Ca aci P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Boars
Turkeys
Uther _ r
Turkey Poults
Other
Other
Discharzes and Stream Impacts
i . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes � No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
0 NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes [�2LNo
❑ Yes '153 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
).4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
N 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): 7
't`o
5. Are there any immediate threats 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
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ELNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
-E No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
E[No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes JKNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu.. Zn, etc.)
❑ PAN ❑ PAN > 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):la"
13. Soil Type(s): 2 Z C O74
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes U�[ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes J�j No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes RNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes
MNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CKNo
❑ 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 [g No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes M No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes O-No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: Date of Inspection: 4e "
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [gNo ❑ 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
LgNon-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 CKNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes allo ❑ 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
allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30_ Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
®..No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below_
❑ Yes
LO-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
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
ff No
❑ NA
❑ NE
Comments (refer t6 question #I): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional panes as necessary).
Reviewer/Inspector Name:
Phone_
Reviewer/inspector Signature:
Page 3 of 3
Date: Cv- IL-
2/4/20I5

Type of Visit: &Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: J� /, Arrival Time: ; O b Departure Time: County: iTL— Region: f� i
01
Farm Name: %j'f G �lJ f1 y-� �Lt i'�w - .� ¢- L Owner Email:
Owner Name: �/z-411 , /E2arzr /%fG ��lfz-. Phone:
Mailing Address:
Physical Address:
Facility Contact: 2«,X Title: .•— Phone:
Onsite Representative: 5�r Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
.Design Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Gapacity
Pop.
Cattle - Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
MI
jNon-Layer
I
Dairy Calf
Feeder to Finish
j)
:..
DairyHeifer
Farrow to Wean
Design
:Current
Cow
Farrow to Feeder
D , P,oul .
Ca aci
Po
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other,:
Turkey Poults
Other
Otlter
......:.. :..
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[:]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
[D NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E] No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
RINo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [.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): /g —
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
(,No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
RLNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[?!,No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
r'-� No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
L.nkNo
[] NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes JE[No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): f`'f•-
13. Soil Type(s): ;K�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ELNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [B�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
JQ'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
S�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
4No
❑ 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
2(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
112[ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
r"No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - q23 Date of Inspection:
/
' 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
M 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
[gNon-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
MNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[allo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Eallo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
D� 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
�Q No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
C&No
❑ NA
0 NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E�J_No
❑ NA
❑ NE
Comments (refer to,question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/inspector Name:
Phone:
Reviewer/] n spector Signature:
Page 3 of 3
Date: /p -- ) , L /—f—
21412011

ft
Type of Visit: 8'Compliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: p Departure Time: t , 3 D County: ter, Region:
Farm Name: ; Q niG _u �ti'-��- t!/n ,j d—� Owner Email:
Owner Name: �.QG �%%C- �t�. Phone:
Mailing Address:
Physical Address:
Facility Contact: 2-0z--! k %�G �',Gr r�-�~ Title: 6izzln ere— Phone:
Onsite Representative: rj`�u� Integrator: IZ2111tjre r1�
Certified Operator: Certification Number:
Sack -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
— - : � - -.. _ ,i� •cv �.
', Design Current Design z CurrentR} Design Current
Swore Capacity Pop. Wet Pttry 'Capacity P,op. Cattle' Capacity Pop.
Wean to Finish Layer iry Cow
Wean to Feeder Non -La er iry Calf
Feeder to Finish Dairy Heifer
Farrow to Wean Design Current Dry Cow
Farrow to FeederCa act Po Non -Dairy
Farrow to Finish La ers Beef Stocker
Gilts Non -La ers Beef Feeder
Boars = Pullets Beef Brood Cow
Turke s
Poults
Otherr 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 � No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [5"o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes allo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:Zo-4;Z-1df
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): Ylf
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
Z, No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
MR!
❑ NA
ONE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
LEJNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑Yes
I" No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
PSNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes LK 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):z-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes CS -No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes 123-No ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes allo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment'?
❑ Yes [3.No ❑ NA ❑ NE
❑ Yes [gNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes [jNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [&No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ 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 [5� No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C�j No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

lFacility Number:02� - Date of Inspection: 114
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes f5? No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F 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 structurc(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 [KNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Z No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes [INO ❑ NA ❑ NE
[:]Yes
� No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
[$ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawimis of facility to better explain situations (use additional pages as necessarv):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 2}/p —,4133 D0
Date: G%!f
21412011

(Type of Visit: 0Co pliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: v0 Departure Time: County: -
Farm Name: Zr�( Sul �+1 j a�`*'^s 6 Owner Email:
Owner Name: zz-C(" Phone:
Mailing Address:
Physical Address:
Facility Contact: � �(`� �� �� [.� Title: 'Ufft� Phone:
Onsite Representative: t' Integrator:
Certified Operator:
I
Region:= Ko
Certification Number: 11 8-a 6
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. West oultry Capacity Pop. Cable Capacity Pop.
Wean to Finish
jDairy Cow
Wean to Feeder
Non -La er
jDairy Calf
Feeder to Finish Z'02S
Design Current.
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Dr P,oult . Ca act Po' .LL
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Pullets
Beef Stocker
Beef Feeder
Beef Brood Cow
Gilts
Boars
Turke s
W. M. `: =
Other
Turkey Poults
ll Other
..�.=.i:.e.�sy:u�'s�sA:--:dxa.
am
Other
s:�:.a,:.w«".:.M.�=.•.._���..-�::�w:a+oe':j.r�au;ww:.,_s'
Discharges and Stream Impact
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 *f N�o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[] Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:)Yes [:]No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes Fq/No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes U! No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Fa ' i Number: ILI- Date of Inspection: 01-4
Waste Collection & Treatment
4. IDS storage capacity. (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [E] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes D No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): G�
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 C]"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 K No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes Q J No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [ffNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[D'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[P'No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑'%
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ "'N' o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[DIN' o
❑ 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
Ey"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 FTK-4o ❑ 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 [P''No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FP-4o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�o
❑ NA ❑ NE
25+ Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[B' Qo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
Cg No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
CBI�o
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
E 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
E3"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
[jkNo
❑ 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.
2'1'es
❑ 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
[ allo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
allo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
5-No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name
t
Reviewer/Inspector Signature:jc
Page 3 of 3
Phoned
Date:
21412011

Type of Visit: Mompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 046utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit; -- % Arrival Time: FF 00 Departure Time: p County: �V
Farm Name: Cull-eru rarjLi--1, _ i,• _ Owner Email:
Owner Name: r� k /iIG��� /% Phone:
Mailing Address:
Physical Address:
Facility Contact: �Z k et, Title: aWn Phone:
Onsite Representative: �t�Integrator:����s.�
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Region:
g
Sw ~N Dp t > Cu Put�Destg
ine' * _ Ca acr APo
Finish
o Feeder
to Finish
to Wean
to Feeder
to Finish
poars
ultry �tCapacn Current
Wet Pop sty , Pop.
Layer
Non -Layer
-_:. DesignCurrent
D , IPoult', ,,.C{a ac P,o
Layers
Design Current
Cattle Capacity Pop.
Dairy Cow
Dai Calf
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
r�hi* - ^
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Turke Points
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
[:]Yes allo ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ❑ No 0 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes [KNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21417011 Continued

Facili Number: - 44 Date of Inspection:
y Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E] No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): �/ g
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
( No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Z[ 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?
1. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes © No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s) —
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [Z No [] NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Cg No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes UNo ❑ NA ❑ NE
[]WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [-]Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
4 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0, No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge`? If yes, check [] Yes [& No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ® No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes ILA No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30_ Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility9 if yes, check the appropriate box below.
M 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 L-S No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
Yes
0 No
❑ NA
❑ NE
[:]Yes
fZ �No
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
Comutents (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 'Technical Assistance
Reason for Visit: outine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
Arrival Time:
; p D
Departure Time: ! Q C? County:
p» Region:
Farm Name: J
�i//r'h ��
�
Owner Email:
Owner Name:G(G� fy]Gyz Phone:
Mailing Address:
Physical Address:
Facility Contact: _,� �,Q� GC�u I _ Title:Phone:
Onsite Representative: A _ -
Certified Operator: 15_11 —�
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification ,Number:
Certification Number:
Longitude:
Capacity P .Pop. Wet P,o y CDesign Current Design Current Desi n Current
Swine "" ult � pacit�y Pop. G #tic Capacity Pop.
Wean to Finish
Laver
Dai Cow
Wean to Feeder
_
Non -Layer
iry Calf
Feeder to Finish
Farrow to Wean�Destgn
D
_
` f.ki �e
Current
D, P,oulCapact h�Po
Dairy Heifer
D Cow
Farrow to Feeder
Non -Dairy
Farrow to finish
Layers
Beef Stocker
Gilts
Beef Feeder
Boars
—.Non-Layers
Pullets
Bcef Brood Cow
Other =1 r-4—Turke
Other
Turke s
Poults-`
Other.
r .
Discharges and Stream Imoacts
1. Is any discharge observed from any pan of the operation?
❑ Yes
� No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gaIlons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
.6, No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse 'impacts to the waters
❑ Yes
K No
❑ NA
❑ NE
of the State other than from a discharge'?
Page I of 3 21412011 Continued

Facili Number: jDate of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes � No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): /
Observed Freeboard (in):`
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
RNo
❑ 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
K No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
LU No
❑ NA
❑ NE
maintenance or improvement?
1 _ 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): lja"_-
13. Soil Type(s): �_ Z /Ij
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes F2�j No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C� 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
'es
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes [allo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? [:)Yes [KNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Dg..No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of Inspection:
a
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Cj�_No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
0 Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26_ Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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 ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
CK-yes [:]No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional naQes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /13�'
Date:
21412011

I
Type of Visit &Compliance
Inspection
O Operation Review Q Structure Evaluation
O Technical Assistance
Reason for Visit
outine O Complaint
Q Follow up Q Referral O Emergency
O Other ❑ Denied Access
Date of Visit: 7 % Arrival Time: Departure Time: ` i7 U County:` 5i
Farm Name: &!lvt_ )CR✓'N'� S J t7t- Owner Email:
__, ' Owner Name: ,, r r AI C �r ✓� Phone:
Mailing Address:
Physical Address:
Region: i - D
Facility Contact: 7- dry IYiC &1_1— Title: Phone No:
No:
Onsite Representative: --- integrator: )Z 6 �-R--
01
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [= o ❑ 1 = ,, Longitude: = ° = 6 =
is
Design Cnrrent
Design Cnrrent
MM1Yesign Current
SRine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
N.
❑ Wean to Finish
❑ Laver
❑ Dairy Cow
❑ Wean to Feeder
1
11 JE1 Non -Laver I
ElDairy Calf
eeder to Finish / 41O
E]Dairy Heifer
❑ Farrow to Wean
Dry 1?oultty
❑ Dry Cow
❑ Farrow to Feeder
E]Non-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cow
El Turkeys
Other
❑ Other
❑Turke Poults
Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated au ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State'? (if yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
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?
D Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
C
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ERNo
❑ NA
❑ NE
❑ Yes
0-No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection
ja 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:
Spillway?:
Designed Freeboard (in): Qf
Observed Freeboard (in):
❑ Yes V�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
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 KNo ❑ 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
P9No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
RNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
®,No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
C�- No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) /*,//r!i(J;cy—_
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA ❑ NF
18. Is there a lack of properly operating: waste application equipment?
❑ Yes
❑ No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): _
AL
Reviewer/Inspector Name Phone: *%O #35 33D0
ReviewerAnspector Signature: Date: D
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? []Yes QjNo ❑ NA ❑ NE
20_ Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 1❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes RNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J4 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[RNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZLNo
❑ 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
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[,No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® 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
E No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
19 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit O Compliance inspection peration Review structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency t(her ❑ Denied Access
Dale of Visit: �� Arrival Time: [7 Departure Time: CC> I County: V' Region: t7
.01
Farm Name: ra L Owner Email:
Owner Name: _ + K— t-Le /ii4K _ Phone:
Mailing Address:
Phvsical Address:
Facility Contact: :��e! ` Title: �� Phone
No:
Onsite Representative: �5 integrator:
Certified Operator:Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o =' = " Longitude: = ° =' [= "
Design Current
Design irto
esign Current
Swine Capacity
Population
Wet Poultry
capacity Population
Cattle IMILC-FP—i Population
❑ Wean to Finish
❑Laver
❑ Dairy Cow
❑ Wean to Feeder
❑Non -Laver
❑ DaiLy Calf
❑ Feeder to Finish
❑ Daia Heifer
❑ Farrow to Wean
Dry Poultry,
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Lavers
❑Beef Stacker
❑ Gilts
❑ Non -Lavers
ElBecf Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Facts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State" (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes allo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE:
❑Yes
❑No
❑ Yes
.Q No
❑ NA
❑ NE
❑ Yes
J�fNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: —V31 Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
J5rXo
❑ NA
ElNE
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
N-No
❑ NA
❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
FLNo
❑ 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
W 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
Lallo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
BNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
23-No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s)
13. Soil type(s).,�,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ANo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
a No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
R1 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
El -No
❑ NA ❑ NE
Comments (refer to question #t): 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):
71,5, �f �`'� ' t:Ud S T r �v%rum �z-�o�r�s for Fr r-5-6r�� �t�o, �-� .
•
7�j5 ,-„2_ w4��, , 5;,4� t,�E-�i �- �al� was r �� �- ep r7k h; 7 ✓`z'���
lJOD ',uml/
o o-;-t 9 /Q 3tl
Reviewerllnspector Name �1'y� �-.� Phone: ��3-33l7Q
Reviewer/Inspector Signature: Date:
Page 2 of 3 1 12128104 Continued

Facility ]Number; Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes B,No ❑ NA ❑ NE
the appropriate box.
D. WUP El Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes q No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes IN No ❑ NA ❑ NE
23. 1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [3 No ❑ NA ❑ NE
24. Did the facility fait 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
JR No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
Eq No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus Ioss assessment (PLAT) certification?
❑ Yes
gNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
UtNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
:1 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
q No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®,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
0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
42tNo
❑ NA
❑ NE
Additional Comments and/or
Page 3 of 3 12128104

HIGH FREEBOARD NOTIFICATION FORM
Staff please retain your original and place a copy in the High Freeboard Notification
Box located in Richard Canady's office.
Person Receiving Notification 12"a_fs
Facility Number rM -zA?=3_ Date Received )q�b 8, zn/ a
Farm Name C £ - P a o- ,_s Time 1?.30 R 44
Caller's Name Zq/-k
Caller's Telephone Numbers
Home# 990 -37Z 9
Farm #
/u 4. Cu H e. &r
Cell#
Pager#
For all callers PLEASE obtain a phone number where they can be reached at any time.
(Cell phone numbers, home phone numbers, farm phone numbers, pager numbers)
Tell the caller that a member of the CAFO unit or Paul Rawls will contact them as soon
as possible.
Freeboard (in inches)
Lagoon # 1 l Lagoon # 4
Lagoon # 2 Lagoon # 5
Lagoon # 3 Lagoon # 6
Do not instruct the caller on the action they should take. That is up to the caller. Remind
them that they are to remain in compliance with their Permit and Waste Utilization
Plan.
Make the caller aware that you are assigning a tracking number to their call. Give the
caller the tracking number and tell them to use this number for all future contacts about
this particular incident and when they call back reporting they are back into compliance_
High Freeboard Level Tracking Number is _
Thank the caller for their cooperation.
*Water Quality Staff Only*
If the caller indicates that the lagoon level is <12 inches, contact one of the CAFO staff
AND Paul Rawls. Do not Ieave a note, e-mail or voicemail without contacting the
CAFO staff AND Paul Rawls.directly on any report of <12 inches.
Treat any report of <12 inches as an emergency event.
*CAFO STAFF ONLY*
Establish a Filemaker/ 131Ms Entry number for this report. 2 01-Q QQ-7 .7 /-
Print the Filemaker/ B1Ms Entry and attach it to this form_

i
Type of Visit �Co5ommpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (1 Rout'ine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Dale of Visit. Arrival Time: �%' C� Departure'I'ime: 1.10O County er— Region:IV
Farm Name: /7/C Cl.ILL�h �i1rlYls S`r 4� Owner Email:
Owner Name: Z a C_k m e �4-e Z/6,zy Phone:
Mailing Address:
Physical Address:
Facility Contact: 22a rir\ I7%cC u l/e!? "Title:
Onsite Representative:
Certified Operator: <--i—
Back-up Operator:
Location of Farm:
Phone No:
Integrator• / r .-��
Operator Certification Number:
Back-up Certification Number:
Latitude: Longitude:
Ne
Design Current
Design Current
sign
Current
Capacity Population
Wet Poultry Capacity Population
Cattleopulation
�Gip'sicirvAp.
nish
❑ La er
❑ DairyCow
eder
❑ Dairy Calf
❑Non -Laver
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turke s
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Cow
Other
❑ Other
❑ TurkeyPoults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
allo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[,No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[NNo
❑ NA
❑ NE
other than from a discharge'?
12128104
Continued

i
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?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): / _
Observed Freeboard (in): I
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes MNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2�No ❑ NA ❑ NE
❑ Yes D?No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [Z No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
P,No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[KNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
LRNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ANO
❑ 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 ❑ EvidenceofWind ❑ Application Outside of Area
�Driift
12. Crop type(s)
13. Soil type(s) _ a AJQ 21
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
QNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IR No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:]
Yes
® No
❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
®. No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
� No
❑ NA El NE
Comments (refer to question 4): 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 9_•-_ Phone: 9119 -
Reviewer/Inspector Signature: Date: /— O i7

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes fo No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes � No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q? No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ERNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
I@ 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
21 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ERNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J@ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
DN 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
R 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
RNo
❑ 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
[Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Additional Comments and/or Drawings: .
12128104

Type of Visit i9rCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit outine Q Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: 6- : A`r/rival Time: Departure Time: : D C County: �
Region: 0
Farm Name: M�a //,—.,L 25 Owner Email:
Owner Name: 7iACJS1���/E'/t Phone:
Mailing Address:
Physical Address: L
Facility Contact: 2G2 Ci6_ G �Lt ���''Z- Title: Phone �No:
Onsite Representative: -see-- Integrator: ��� Z��_
Certified Operator: Operator Certification Number: Z Z&�
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = [= 1, Longitude: 1:1 ° = f
Design Current 4 D tes gn Gurrent T Design Current
Swine. _ Capacity (Population Wet Poultry�CapacrtyPap�ulatian Cattle Capacity Population
❑ Wean to Finish ❑ La er � El Dairy Cow
❑ Wean to Feeder n-La er ❑ Dairy Calf
eeder to Finish" ; El Dairy Heifer
*° ❑ Dry Cow
❑ Farrow to Wean
Dry Poulrys� >.��:
❑ Farrow to Feeder ❑ Non -Dairy
❑ Farrow to Finish ❑ La ers � ❑Beef Stacker
❑ Gilts ❑Non -La ers ❑ Beef Feeder
❑ Boars ❑ pullets
❑ Beef Brood Caw
- ❑ Turke s
�_ . _ ❑ Turkey Poults
❑ Other ❑ Other r ,T Numb�e�r of Structures n
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation'?
❑ Yes
J,No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes.. notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
JKNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
99 No
❑ NA
❑ NE
a. I f yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ N E
Structure i Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): „3
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
04No
❑ 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
allo
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
FM No
El NA
El 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
13 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M-No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑Evidence of Wind Drift El Application Outside of Area
in�
12. Crop type(s) ./1e �` iz+Nems/ �i �
13, Soil types), ]Up 4
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [� No El NA [I NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Q .No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
BNo
❑ 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
Eallo
❑ NA
❑ NE
Coniments (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 -�w—� �r--�� Phone: 2Z�2- f33 33CC>
Reviewer/Inspector Signature: Date:
Page 2 of 3 12178104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JKNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Gallo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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 WMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge.. freeboard problems, over application)
32. Did Re vi ewerA nspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency'?
Comments and/or Drawings:
❑ Yes
EX No
❑ NA
❑ NE
❑ Yes
13 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
C& No
❑ NA
❑ NE
❑ Yes
IR No
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes I& No ❑ NA ❑ NE
❑ Yes
{N No
❑ NA
❑ NE
❑ Yes
E,No
❑ NA
❑ NE
❑ Yes
[&No
❑ NA
❑ NE
❑ Yes
ER No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality f C
Facility Number 0 Division of Soil and Water Conservation rF_1/'-o7
a Other Agency
Type of Visit ompliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ffY Routine 0 Complaint Q Follow up Q Referral Q Emergency O Other ❑ Denied Access
Date of Visit: I "mil Arrival Time: / D: 1 Departure Time: /%:'3 County: Region:, (D
Farm Name: Owner Email:
Owner Name:G-,a_Phone:
Mailing Address:
Physical Address:
Facility Contact: _2i! e-k 01 e_ _4� //oft Title:
Onsite Representative: .50-yt4
Certified Operator:�""`�
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number:
Sack -up Certification Number:
Latitude: = O =1 0 Longitude: [� 0 01 FJ
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La ct
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Dischare_s & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at_ ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
Design Current` '
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ NOD -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:Ell
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)
Z. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 21 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
KNO
❑ NA
❑ NE
❑ Yes
ER No
❑ NA
❑ NE
12128104 Continued

T Facilih Dumber: Date of Inspection
M
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
Identifier:
Spillway?:
Designed Freeboard (in): _Z let
Observed Freeboard (in): LA.-
Structure 2 Structure 3
Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes W No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes ® No ❑ NA ❑ NE
El Yes [@No El NA ❑NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 9 No ❑ NA ❑ NE
R. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 04 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 LgNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes [8 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 91 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu. Zn, etc.)
❑ PAN ❑ PAN > 10%or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ,Srmtv.rn jj 1td �i✓L1C%'7rlrz¢
13. Soil type(s) 'Xi
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [A No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [gNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?El Yes
CgNo
❑ NA
❑ NE
17. noes the Facility lack adequate acreage for land application? ❑ Yes
M No
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment'! ❑ Yes
0 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):
ll
�P�C T "� � �- �t'n,� RIGi.0 (�C�c��'� �n�-��J` �`) C DYY► rs r r'>< ,
A,
Reviewer/InspectorName y,� t�-- Phone: g _33r7�
Reviewer/Inspector Signature: Date:
12128104 Continued

f
' Facility Number: Date of Inspection
1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JZ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW MP readily available? If yes, check ❑ yes 2) No ❑ NA ❑ NE
the approprrate. box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
[,%Waste Application ❑ Weekly Freeboard 14 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
C3 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
® No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
10 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[N No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9No
❑ 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
[2kNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
QkNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ®Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: dl o Arrival lime: Departure Time: County: s cy%.r so r" Region: F 12-0
Farm Name: Z 4Lc,k- G C\�e-iN . K rk Owner Email:
Owner Name: __L -4IL Cr X a_ Phone:
Mailing Address: I QO C 1 i 0 rM C r1 Fr
Physical Address: / 00 7 LVOoe
Facility Contact:
Title:
Phone No:
Onsite Representative: z sL a k _ . Integrator: Pr _+� z
Certified Operator: —Z a e. L lm 4 C..-ll r� _ram_ Operator Certification Number: 17JF16
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: ❑ o = 1 = tl Longitude: ❑ o ❑ 4 = {!
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La cr
❑ Non -La yer
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
I P14 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non-1-avers
❑ Pullets
❑ Turke s
❑ Turkev Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Dischar-e ori-inated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the convevance man-made?
Design Current:.
Cattle Capacity Popalatior
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there an), adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [K No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[K No
❑ NA
❑ NE
❑ Yes
U] No
❑ NA
❑ NE
12128104 Continued

Facility Number: a — ,3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _ — � o? — k Fr
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
® No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require ❑ Yes
® No
❑ NA ❑ NE
maintenance or improvement?
Baste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
M 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drif! ❑ Application Outside of Area
r
12. Crop type(s) _S #, •P" P" 9, �- t
`
13. Soil type(s)N o
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
® No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
® No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
® No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
® 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 facili;tyto better explain situations.. (use additional pages as necessary):
iYl r . 1M` G ti,.1�e�
�t P 14 ;... eoQ V1 c
W a.�C.X e,3 C. \\
`S r r'. ar�i ot� cv ,_V fC-s
C
1
1ratr w
.r�aYJ rit"`'v
trw.cn�►dam td
prY`uV%---
[\OSc
ok-C,
1
Reviewer/inspector Name Phone:
Reviewer/Inspector Signature: Date: tr /4 / 4S
17129104 Cnntinuod

Facility Number: ?.Z — AJ231 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 W No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ['Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections RfMonthly 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?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
N No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
❑ No
MNA
❑ 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
[j9 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
[a 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
[:1 NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/]nspector 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
(E No
❑ NA
❑ NE
Additional Coatments and/at Drawings;
G. i tJ a p c cA Z os, o k- 4A*� - L-1 a4 4- t- S %t 6 +-P-M.
G a •%�C ' 4'jk e, w C4+e- s y &+ a r•. 0' K IQ A 0 e, 41"+
:# >1rvti. 4:6 %\ ,P.- s c:% �i. lr o.�r µ d"�t tom.
I 4M q Vc
12128104

X
r•
-.. arc■
x �"�=t,�`•sz'-s"y3°` - O VkLet�N:J" xar-._ ..x. �:: $ .e;eyf=y�,K'*�'i.c,,,�*..V <� r �.x'r" ;.-}, r
Type of Visit 0 Compliance tnspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit *Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facilit} lumber B2 a i Date ot� i5it: y » del Time- d
�1; Sa„
,,......�� ro not Operational Below Threshold
L�'Permitted ❑ Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: Mc Cv/ten_ _Fr r.vl e S -% County: art sG., �Ro
Owner Name: Z a c �{ Al e C vIle n _ Phone No: - _ - ' 33 J I
Mailing Address: IOo 7 ly,,d _Sf,-e"e7. C/,',I ZoI , Me 02 R3.2 g
Facility Contact: ZGele M t (,Ile-i _ Title: Phone No:
Onsite Representative: Zc ele MC 6 ✓&FP7 Integrator: /ores f-
Certified Operator: L4e k M e Operator Certification number: 784
Location of Farm:
Q$-Wme ❑ Poultry ❑ Cattle ❑ Horse Latitude ' - Longitude ' •
Design Current
Swine ranarity Pnnniatinn
❑ Wean to Feeder
[D�Feeder to Finish
112 y
No
❑ Farrow tc lVear.
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Capacity Population Cattle Capacity Po elation
❑ Laver EE]
Dairy
❑ Non -Laver Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
JLJ Subsurface Drains Present JILJ Lagoon area 1L
❑ No Liquid R'aste Management System
Discharges & Stream impacts
1. Is anv discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the convevance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DNN'Q)
c. If discharge is observed. what is the estimated flow in eal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there anv adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway
Strucrure 1 Structure 2 Structure 3 Structwe 4 Structure 5
Identifier. _ 1_
r�
Freeboard (inches): 3 3
05103101
Field Area
❑ Yes [3l0
❑ Yes 0<6
❑ Yes aNO
❑ Yes LVivo
❑ Yes 9'1 o
❑ Yes El'�-o
❑ Yes [.Vivo
Structure 6
Continued

Facility Number: S.:Z
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel 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 part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum Iiquid level
elevation markings?
Waste .application
I0. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type S✓,.,Mr.- XgmuA / ? w,'.,/ee A11n✓i,/ IQolA Ore 6rs.=s-1)
❑ Yes B-into
❑ Yes D—No
❑ Yes BWo
❑ Yes O No
❑ Yes 0 No
❑ Yes D-No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes EINo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Q o
b) Does the facility need a wettable acre determination? ❑ Yes S No
c) This facility is pended for a wettable acre determination? ❑ Yes �
15. Does the receiving crop need improvement? ❑ Yes Bwo
16. Is there a lack of adequate waste application equipment? ❑ Yes Bflo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 91 o
I9. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, [I Yes E No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes 31140
Air Quality representative immediately.
CommeAts (refer to questtbn_#) Expiam any YES answers and/ar any recommendations or ... adder comritents. -.d gA� e� '
:Use drawings of facility to better cxglain s�taat,ons. (nse hdditeonal pages as necessary). [Meld 6opy Final Notes r
r
AL
r
Reviewer/Iaspector Name-
Reviewer/InspectorSignature: Date: y-:)')- OY�
12112103 Continued

t Facility Number: $� _ y,� Date of Inspection o
Reguired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard" ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes EM
❑ Yes Q-No
❑ Yes [ o
❑ Yes ❑-No
❑ Yes O-No
❑ Yes ONO
❑ Yes L3'No
❑ Yes 3-Mo
❑ Yes 0-110-
a-Yes ❑ No
es ❑ No
❑ Yes [ Wod
❑ Yes allo
❑ Yes
❑ Yes B-No
12112103

Facilih- Number date of Visit: — �- 03 Time: � d .S
Not Operational 0 Below Threshold
M Permitted E3 Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: 1✓1�C{,,I1<N 1 Gry�1 S`i}� 2�- C County- _ "10-SO AJ-
Owner Name: Z a Y� ` +� Phone No: _ 5 4— 3 3 a f
Mailing Address: 1 D U7 L 114 C I -,,,, � 0Jr-.?-?p
Facility Contact: a CA- M c l? VJ Title:
Onsite Representative: S a tn,::
Certified Operator: 7 -cc_ ik- i►✓1 C e� i cv
Location of Farm:
Phone No:
Integrator: A e- S TC
Operator Certification Number: 17 (0 7
jl Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current Design -'Current -:Desi�,m ; -Current -
Swine Ca acitr Population , .Ponitrti Ca acity Population Cattle �Ca aeity :Population -
Wean to Feeder ❑ Laver I 1 ❑ Dairy
UZI Feeder to Finish % d W> 1 .Z 41.7 ❑Non -Laver JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number.of Lagoons �1J-` .'' =+ ❑ Subsurface Drains Present ❑ Lagoon Area ❑ S ray Field Area
Holding Ponds 1 Solid Traps - ❑ No Lt uid Waste Management Svstem -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑Yes Effl No
Discharge originated at: [] Lagoon ElSwav Field El Other
a. If discharge is observed, was the convevance man-made? ❑ Yes Ix No
b. If discharge is observed, did it reach Water of the State? (If yes. notify- DWQ) C1 Yes ❑ No
c. If discharge is observed, what is the estimated flow in gailmin? ju
d. Does discharge bypass a lagoon system? (If yes. notify DWQ) ❑ Yes ❑ No
2, Is there evidence of past discharge from any part of the operation? ❑ Yes P No
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes EYNo
Waste Collection S Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ SDiilwav ❑ Yes O No
Structure l Structure 2 Structure a' Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: f ,2 — ya3
Date of Inspection
5" Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion.
seepage. etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or endronmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any sructures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
1 1. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes No
❑ Yes No
❑ Yes []] No
❑ Yes No
❑ Yes ® No
❑ Yes q No
❑ Yes ® 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
M No
16. Is there a lack of adequate waste application equipment?
❑ Yes
5 No
Required Records &• Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ® No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel )kUP, checklists. design, maps, etc.) ❑ Yes R No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes [0 No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes R 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?
(ief discharge, freeboard problems, over application) ❑ Yes JpNo
23. Did Reviewer/Inspector fail to discuss reviewhnspection with on -site representative? ❑ Yes U No
24. Does facility require a follow-up visit by same agency? ❑ Yes 5 No
25. Were any additional problems noted which cause noncompliance of the Certified ANS'MP? ❑ Yes M No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
Comments (refer:to_question 0: EYpla"y YESµanswen andvor. any. recommendations or, anyother comments. .
Use dra%ings.of facility to better ezpWn'situatious (tese additional pages as necessary);:� Field Cory ❑ Final Notes
iSGltiS3CdC �Q+�poti Mc�FJ�".
n �� � �i �O r @GUrcX S
Reviewerllnspector Dame
Re,dewer/In Spector Signature: Date:
05103101 Continued