820445_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Type of Visit: UCompliance Inspection Q Operation Review U Structure Evaluation O Technical Assistance I
Reason for Visit: Olkoutine 0 Complaint Q Follow-up Q Referral O EmerF_eucy O Other O Denied Access
Date of Visit: LZg,75:'-1?j Arrival Time: 3 27 Departure Time:/ County: Region:
Region:
Farm Name: ]��iS�lz,•r~Q�'/�'L f��� Owner Email:
Owner Name:fj% rNa•� �i��%p Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: v-•��
Back-up Operator:
Title: ��n�`— Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
�'�
Design
,Curren#��,
��
I ;Desi
Cu;,raent
Design, Current
Swine '"
Capacity
Pop��'�l
Wet Poultry
� Capacity
Fop.
Cat#le Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
"`
" -
-
Dairy I Leifer
Farrow to Wean
n
Current"
Dry Cow
Farrow to Feeder
D . Foul :1
Cap aci
P.o .
Non -Dairy
Farrow to Finish
Layers.
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
r
Turke s
(itlter
; =
Turkey Poults
Other
I
10ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 KNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No NA ❑ NE
[:]Yes ❑ No
[:]Yes 1Z No
❑ Yes rll No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3
21412015 Continued

Facility Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[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
[Z_No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[,No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes La No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3-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) !xi 4�/mac Jh-,r
13. Soil Type(s): a`, wy GtJD , ;:�, ,V
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17_ Docs the facility lack adequate acreage for land application?
❑ Yes
[ a No
❑ NA
❑ NE
❑ Yes
[3 No
0 NA
❑ NE
❑ Yes
❑X , No
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
I & Is there a lack of properly operating waste application equipment?
❑ Yes
[}�C No
❑ NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
f�j No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
[] Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
Ld=kNo
❑ NA
D 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
E[ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[. No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: q !E"7 jDate of Inspection: J :f =1
24. Did the facility fait to calibrate waste application equipment as required by the permit? ❑ Yes C.No
25, is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? 0 Yes f allo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [�g No
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 [allo
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
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 Pg—No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes ® No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes CNo
34. Does the facility requite a follow-up visit by the same agency?
❑ Yes 2LNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA []NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA NE
❑ NA ❑ NI-
N A ❑ NE
a I� ( . Ex Ian an YF,.4 answers and/or;ao additronal reeommuendiitions or' ihnents.V y� R k
Use,draw ngs ©f f icWty to better explain situations (use addrtrnna ' yes as necessary). any otter co
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: '" Date:
^7 y
Page 3 of 3 21412015

I I
Division of Water Resources
Facility Number ®- sion of Soil and Water Conservation
� Other Agency
Type of Visit: mpliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral p Emergency Q Other O Denied Access
Date of Visit: � Arrival Time: p Departure Time: /s County: Region: 79P-1
Farm Name: _ !� wa/�J�1 p W 1 Owner Email:
Owner Name: 10p/—Mda? w /`-'�r7 Phone:,. ----
Mailing Address:
Physical Address:
r Facility Contact: ( A- vt 0 0'—'- IeP Title: Phone:
Onsite Representative: Integrator: 5�7fi rllj
Certified Operator: J Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
DestgnCurrent', ... DesignCurrent Design Current
Swine "" Capacity Pop WetJPoultry CapacI .... p Cattle Rapacity Pop.
r_
Zia—
Layerer Dai Cow
Wean to Feeder Non -La ye r Dai Calf
Feeder to Finish - Dairy Heifer
" -�.
Farrow to We �{� Des�gttCtirrent}s' D Cow
Farrow to Feeder-Drv-P-oultFvCra acth' =1?o Non -Dairy
Farrow to Finish Layers ti Beef Stocker
Gilts Non -Lavers - Beef Feeder
Boars Pullets Beef Brood Cow
-__ JIM--
� w :� Turkeys
Others _ Turke Poults J
Other Other r
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b- Did the discharge reach waters of the State? (if yes. notify DWR)
C. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes JK No ❑ NA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
❑NA ❑NE
❑NA ❑NE
d. Does the discharge bypass the waste management system? (If yes. notify DWR) ❑ Yes [] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes JK No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes � No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

[Facility Number: - q7l=Date of Inspection: /G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes 10 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No DNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® 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
Q No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
LK No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
� No
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes allo ❑ 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): ���SG[i �`?/ �/rG tz %� liJf
ry-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ® No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ® No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ® No ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ® No ❑ NA ❑ NE
20. Does the facility fail to have all components ofthe CAWMP readily available? If yes, check ❑ Yes [g 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 Z 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 RNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q3_No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - y Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
.i 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [3 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Jallo ❑ 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, 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/]nspector 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 [2 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes (LNo ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes E[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 pages: as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: 9/a-J3, 3
Date:
21412015

%-- y �o 1 to
Type of Visit: O'Coroutine
nce Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /L /I Arrival Time: O Departure Time: County: Region:
Farm Name_AJDI"Sf7�.� �rJ'z 5,s' c Owner Email:
Owner Name: N Phone:
Mailing Address:
Physical Address:
Facility Contact: �� ,9w A41.191 Title: 'o-WrLr/ Phone:
Onsite Representative: .�1_rl` Integrator: '`1165
Certified Operator: Certification Number:�a
Sack -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Cnrrent
Swine Capacity Pop. Wet Ponitry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
I
11-ayer
I
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Farrow to Wean L L
Farrow to Feeder
{;
-"
Design Cnrrent
Dairy Heifer
Dry Cow
Non -Da'
D . i'oultr, Ga aci P.o
Farrow to Finish
Gilts
Boars
ILayers
I
I
Beef Stocker
Non -Layers
Beef Feeder
Pullets.
Turkeys
Turkey Poults
Other
Beef Brood Cow
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 [3 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes El No
❑ Yes JZ No
[DNA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412014 Continued

Facili Number: - Date of Ins ection: 1159
Waste Collection & Treatment
,h 4.1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [9No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure S 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
ED-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
,E�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�Wo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�a No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0,No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
[3,No
❑ NA
❑ NE
maintenance or improvement?
1 L Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:)Yes
2 ..No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window/ ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop TYpe(s). GL#-j-- /aT ,� 1�Y r ✓�+�" •.�
1"r,Ll
13. Soil Type(s):47
14. Do the receiving crops differ from those designated the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
EB-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EgNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
jo No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
5jNo
❑ 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 'RNo
❑ 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 JZ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [ I-"
❑ NA E
❑ Weather Code
El Sludge Survey
❑ ❑ NA NE
o ❑ N❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - 1 Date of inspection: /,;�'
i 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List 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 Ig No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [Z No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Eg-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
CR 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
allo
❑ NA
❑ NE
permit? (i_e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
®-No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
KNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
PE[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 fo better explain situations (use additional paces as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone:
Date: �,—/_V—�0 /�S__
21412014
Page 3 of 3

WE=
Type of Visit: QKompliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:fL Arrival Time: : OD Departure Time: ' Q County:
Farm Name: p � w �a �M j+t3"t-ii Owner Email:
Owner Name: J doo" a-d— ��q/%� Phone:
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: ejq�,OA_; rt Phone:
Onsite Representative: L' _- Integrator: ,� r A -
-Certified Operator: s`e'-d Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Da Calf
to Feeder
Non -La er
"Feederto Finish
Dairy Heifer
arrow to Wean
Dry Cow
Farrow to Feeder
D . P.oal
Ca aci
Po
Non-Dal
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
Other
Turkey Poults
Other
Other
Discharges 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)?
❑ Yes n No ❑ NA ❑ NE
❑Yes
❑No
❑NA
ONE
❑ Yes
0 No
❑ NA
❑ NE
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
❑ Yes ® No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3
21412014 Continued

hacili Number: - LJ Date of Inspection: ,;�E -- — /
i Waste Collection & Treatment
5
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 Stru wre 4 Structure 5 Structure 6
Identifier:
Spillway?:j
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes E4 No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�A No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
®. No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[& No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application`? If yes, check the appropriate box below. ❑ Yes E[No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift []Application Outside of Approved Area
12, Crop Types): G ly +�t �fQ ���S�d /.�A /�. %LE1�r S ib �'� -rS / 5, r
13. Soil Type(s): 1AZ:1cr � -,
14. Do the receiving crops differ from those designatedin the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
E, No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
[] NA
❑ NE
❑ Yes ][ No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
❑ W UP ❑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 V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No
[] NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Ins ection: /a
i 24. Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes
®-No
[] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
0 No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑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
54No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Eg-No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
[:]Yes
%No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
0 Yes
[a No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
® Yes
0 No
❑ NA ❑ NE
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the pen -nit or CAWMP?
❑ Yes
®.No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
JB No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[0 No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommend 666a i'or any otherKcomimeirts.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: 9VZ2--11J_` _1T0 O
Date:
21412014
Page 3 of 3

Type of Visit: j6Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: IR Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:{ Region:Q'
Farm Name_kfsbb �DlM (SQW) Owner Email:
Owner Name: /Uylcr Phone:
Mailing Address:
Physical Address:
Facility Contact: 14Wy 0, T^ Title: Mj1A19Q f1_ Phone:
Onsite Representative: Sao ay1D _ Integrator:
Certified Operator: ShQMO„ Taylor Certification Number: a�y03
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
g _
Current Design Current
Design Current
Swine Capacity
Pap. Wet Ponitry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Daig Calf
Wean to Feeder
]Non
-Layer
Feeder to Finish
- -
Dairy Heifer
Farrow to Wean 1144t,
1_330Design
Current
Cow
Farrow to Feeder
Dr. P,oult , Ca acit P,o
Non-Dal
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Turkeys
Other -Turkey Poults
Other LjOther
Discharp-es and Stream lmnacts
1. Is any discharge observed from any part of the operation? ❑ Yes E`No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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 0 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes M No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

aciii 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): „ 19
Observed Freeboard (in): @-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
fR 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
W'es
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
[] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
� No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
lX No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CR 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 0 Evidence of Wind Daft ❑ Application Outside of Approved Area
nn"" y� ,, y� 1 n
12. Crop Type(s): C(YA . W riP Sa �n f . �)Afn I r��r �t &-h1le ..SInal f GO7h"I
T -
J
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
© Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[-]Yes
5d 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
5 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�R No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
® No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes o ❑ NA [D NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers ❑ Weather Code
® Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No [ja NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ® No 0 NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes f' 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
&C Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
E No
❑ NA
❑ NE
❑ Yes
❑ No
�R NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes CR No ❑ NA ❑ NE
❑ Yes [,'a No ❑ NA ❑ NE
® Yes ❑ No ❑ NA ❑ NE
❑ Yes No
❑ 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 drawings of facility to better explain situations (use additional pages as necessary).
Plea e_ cot or s(,,a� h sh-e 4o `be- o� dl c� 4, Yv��_nrYe of 1�rkl`'�� e
j, Piea,e_ loy,� it r�th �1 e�l�s� nr�-J��o r
/l Na; aura
3I, pram -� lei 6Ye caf�4_ j4 beta-e ad -af4bodar1 aft Pven�s'
I GAL PiMTa•_ re(adf.
Reviewer/Inspector Name: TzaaS d-Pr Phone: - �. � Q 1 I
Reviewer/inspector Signature: Date: 3
Page 3 of 3 1412011

Facility No:`Farm Name !► Date
Permit L% COC ✓✓ OIC .� NPDES (Rainbreaker PLAT
FB Dro s
Annual Cert Daily Pipe)
Lagoon Name; S for's#lfw6y
1
2
13
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard ° ..
Slud a Surve Date:
Sludge Depth:
Liquid Trt. Zone ft
Ratio Sludge to Treatment:Voldme if> 0.45
,a
Date out of compliance/ POA? '
MAr-vm.ra
kingslze------
r - ..
®-------
Actual Flow
Soil Test Date Y4�raOt�c+{o� e Crop Yield �/ Transfer Sheets d
pH Fields ✓ Wettable Acres ✓ RAIN GAUGE
Lime Needed WUP Dead box or incinerator
Lime Applied, fi h�l I Weekly Freeboard ✓ Mortality Records
Cu=1 Zn-1 1 in Inspections J Check Lists
Needs S (S-1<25) ' 120 min Insp. ✓ Storm Water
Mppr^ic P r Wonthiar ('_nricc
1 ii. ,. rl. �' LPL•
Acres I „_PAN I Window I Max Rate I Max Amt
i
Nth '�j
I � nQ= 196 �5D
Verify PHONP1�il1MB Rj�§ Land affiliations
Date last WUP FRO.1 lid) FRO or Farm Records
Date last WUP at farm:! Lagoon
Lagoonq
App. Hardware i ? `° i' Top Dike Sa,� 1 1� 11 a� �6)� f
Stop Pump `iS<3 Ca ylo
Start Pump
lob 1
Conversion- Cu-I. 3o6o=0081b/ac; Zn-I 3000= 213 Iblac
so - - ,-7
le 9 ov cio
I,1a A 1 of l 1

f�t HS J,vJ (0 W J':) "dy
Type of Visit: 0 Compliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: 2 Routine 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: LS�lnlflL� Arrival Time: tijQ Departure Time: t)' County fQ�
Farm Name: i hol F&M J©W Owner Email:
Owner Name: &IalnC1 Nall& - Phone:
Mailing Address:
Physical Address:
Region: F_W_
Facility Contact: S hallilonVOY/Q' Title: fPhone:
Onsite Representative: S O'n ooi Ajayifoj _ Integrator: `
Certified Operator: s h ann IV Qi Certification Number: ac) 4 03
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
t,.s. ,-��3tgn CuDestgnCurrent Design Current
e rK We!!neKL§
n to Finish Capacity, Popk .Wet Poultry Capacity Pop Cattle : Capacity Pop.
°1 Layer DairyCow
Wean to Feeder Non La er DairyCalf
Feeder to Finish ,� __ DairyHeifer
Farrow to Wean Design Current D Cow
Farrow to Feeder ,D 1'ou! �Ca act P.o -Dairy
Farrow to Finish Beef Stocker
Gilts Beef Feeder
Boars a, Beef Brood Cow
;.:.
Other
Other
_T.:r_...sa.:,1:w. -: ,___-tea..-........�:::...._._..�.--F. ...e mJ--i✓. ... ...
La ers
Non -Layers
Pullets
Turke s
Turke faults
Other
Dischart=.es and 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
D No
❑ NA
0 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
E[ No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 2/4/201 ]Continued

1'acili lkumber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 15� 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): C?
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ff 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
01 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
5allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[] Yes
2'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
�a 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?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [�[No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs_ ❑ Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift J❑ Application Outside of Approved Area
12. Crop Type(s): C/n IS/A , c�C1,&� s, , k /zo* jf De.-o'- � Q : s/ra/1 0lrA ofeJ�-la_ -
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application'?
18. Is there a lack of properly operating waste application equipment?
Required_ Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes (a No
❑ Yes 15? No
❑ Yes NJ No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ Yes 5a No ❑ NA ❑ NE
❑ Yes [51 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E' 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 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 ONE
Page 2 of 3 21412011 Continued

Facility umber: -_94 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1�2 No
❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
W No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
0 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
Cj'NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
QFNo
❑ NA ❑ NE
permit? (i.c_, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
C'No
❑ NA ❑ NE
Comments (refer to question ft Explain -any YES answers and/or any additional recommendations or any other comnieints. T
Use drawings of facility to -better explain situations (use additional pages as necessary).
-7, Gal � iS "add ~ Q'/Jnr1 boti c� - Jnsr dl° o��s� dro.
S t lei f i h>°PcC s idle 7/�' /'-r
'4 1. 1mucl�
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
��01) Sc� ty ice_.- —
Phone:
Date: 5 o a O o-) ate),
21412011

Facility No. Farm Name hb-566 SO' T7,F Date�-
Permit COC ✓ OIC NPDES (Rainbreaker PLAT Annual Cert Daily Pipe)
Lagoon Name, S forspillway
1
2
3
4
5
6
7
Design Freeboard 1 Last Recorded in
Observed freeboard
a
Sludge Survey Date
Sludge Depth ft
g
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume ifs 0.45
Date out of compliance/ POA?
i.�t� �T:.:!>r'�l•��%i���.7���;i�ti��71i?TJIi
_Rinq_SLize (in)
Actual Flow
Design
Soil Test Date �1 j
pH Fields
Lime Needed S
Lime Applied DO
Cu-1 ✓Zn-
Needs S (S-1<25)
Crop Yield
Wettable Acres
WUP
Weekly Freeboard
1 in Inspections
120 min Insp. ✓
IMP 0
Mam-
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
Check Lists
Storm Water
•
. .
EINNVIN=�-.
.
l �`'•i
r..-
i:��i5�
'tom
•
/
�
l[nNEWI ,�:.11y
Verify PHONE NUMBERS and affiliations 9 Rr 4%
Date last WUP FRO FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Iblac-, Zn-I 3000= 213 Iblac

Type of Visit: "Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: ®'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergencv 0 Other 0 Denied Access
Date of Visit: Arrival Timer Departure Time: a r County: &NP101 Region:
Farm Name: T4(M (Solill Owner Email:
Owner Name: (x a/I jV Qy �Li� Phone:
Mailing Address:
Physical Address: 1,
Facility Contact: Qr` Title: 404 Phone:
Onsite Representative: .5h&jjj&j ity Integrator. H—D
Certified Operator: ShAnDl-, ' Certification Number: @1) f%Q3
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
-. �i..
e ign
Current Design Current Design Current
Swine ��+ acEty
Cap
.. J i
Pop. iiet Poultry Capacit}' Pop, Cattle Capacity Pop.
Wean to Finish
La er
Non -Laver
Dairy Cow
Wean to Feeder
_ :_
Design Current
Dai Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Dry' Ptoultry _
Ca iri Io P.
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Pullets
Turkeys
Beef Feeder
Boars
L 113eef
Brood Cow
c
QthN, L,
Turkey Points
Other
Other
Dischar /es and Stream Im acts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
❑ Yes [�j No ❑ NA ❑ NE
❑ Yes ❑ No
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes N No
❑ Yes §�T No
❑ NA ❑ N E
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

I
W 4 r-
Facilitv Number: - Date of Ins ection: d 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [5�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): --
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes CR 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 f�j 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?
IR Yes ❑ No
❑ NA
❑ NE
8. Do any of the structures 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 P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
I0. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes W No
❑ NA
0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes 50 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside ofAccegt1bl Crop Window ❑ Evidence of Wind Drift ❑ Application
OutsideofApproved Area
12. Crop Type{s}: 3 U _ 1 �, Ill
car, ,S'Oy hPe l
C R Graf SG
13. Soil Type(s): Rol*.s�Th/
' r J
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [R No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes U No ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes fZ� No ❑ NA ❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes N No ❑ NA ❑ NE
❑ Yes [.5�No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
P No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[5�-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.
15a Yes
❑ No
❑ NA
❑ NE
Waste Application [] Weekly Freeboard []Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
JR No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
'� NA
❑ NE
Page 2 of 3 21412011 Continued

11
Fac Hity Dumber: $�. - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes JS�No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fai I provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? 1 f yes, check the appropriate box below.
VApplication 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
❑Yes
tallo
❑NA
❑NE
❑ Yes
❑ No
[�[NA
❑ NE
❑ Yes
f�j No
❑ NA
❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes �g No ❑ NA ❑ NE
f�j Yes ❑ No ❑ NA ❑ NE
❑ Yes Q No
❑ Yes 23 No
❑ Yes [R'No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
R seven -a ents-s -
Comments (refer to question ft Explain any YES answers' and/or any additional recommendations or any,Iffifiker comments.
Use drawings offacility to better explain situations (use additional pages as necessary)..
3� PSIS 4 - f 1 , r tl d� f b4ftve �: s l[JI !�
� cxt �c ca a fi � e
t` ��r n� ,n � � �
-7, ?ieGfSt, ro ✓�hhpq 0�71Lt e J c4�r- q�01�-fh J
kro �rro Jl� � u�d� cam l��f a�© �Id also a n
o r�s�rrn � war ied - IP id not ex(ev PAN, V-e'r I Of -le F�lvp� 14a-2
�m
l ends aid caa� rat a-� J exc7t ar now a bo�� .
Nowt, ML'w ; ha nd above)
w c h a -CCro -
f a► l .7
,� e- ® � l
Reviewer/Inspector Name
Reviewerhnspector Signature:
Page 3 of 3
Phone: t{ — ,wW of
Date: O
21412011

Facility No. 3)-9yr Farm Name
Permit . ._ COC ._ _,--,
I D,
FB Drops
'ycysh4,_ S0;--- Date
OIC_ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
Lagoon Name, S forspillway
1
2
3
4
5
6
7
De n Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
Slud a Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume if> 0.45
Date out of compliance/ POA?
hi -eh,
Design . ■
��------
- ow
Design r .�----_—
Soil Test Date ]DIIdin i Crop Yield Transfer Sheets '
pH Fields ,. 4 Wettable Acres cam' RAIN GAUGE
Lime Needed AX) WUP Dead box or incinerator
Lime Applied Weekly Freeboard ✓ Mortality Records
Cu-I -- Zn-I 1 in Inspections �� Check Lists
Needs S (5-1<25) tr>y� 120 min Insp. Storm Water
Needs P ��tt Weather Codes
MINIM
li
* II.
I INN�
1010010��
�!
■t'��
f`
MININ
M
NE
.'
�yiAl . • U
�r I-7llai��•�W�i�l�i'
■_�
Verify PHONE NUMBERS nd affiliations
Date last WUP FRO � I N ([ f FRO or Farm Records
Date last WUP at farm Lagoon #
App. Hardware Top Dike
�J f. V1 Stop Pump
hI� (�Q-le— -S0,Xt -6• Start Pump
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac
©e 'Y

r
Type of Visit 'Compliance Inspection Q Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit -Routine 0 Complaint 0 Follow up 0 Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Qt� Departure Time: a i jp County: 5 Region:
Farm Name:. V ��,� sha, 'fit , cO kT_ Owner Email:
Owner Name: _ Nlym a' _ _ fva� Phone:
Mailing Address:
Physical Address: 1
FaciUty Contact: Sh/lnt')oi AJoX (C - Title: Phone No:
Onsite Representative: S 7 Integrator:
Certified Operator: S Operator Certification Number: Q YD3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 = s = fl Longitude: = ° 0 1 = u
*Current
i!'7
Design . Current ,
Design CurrenSwine
iult. Gapacii Po ulationestgn
y ry_ty p
Cattle Capacity Population
❑ Layer
❑Dai Cow
ff
❑ Non -Laver
❑ DairyCalf
I Ll-
a° r�
❑ DairyHeifer
r
,� 3:
rypul
❑ Cow
❑ Layers
❑ Non -Dairy
❑ Beef Stocker
❑ Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Turlce s
❑ Beef Brood Co
Other'Ulm * ❑ Turkey Poults
❑ Other
Other
Number of Structures:
...,,:.-... ... - , P - ..
Wean to Finish
Wean to Feeder
❑ Feeder to Finish
Farrow is Wean
{ W
❑ Farrow to Feeder
❑ Farrow to Finish
❑Gilts
❑ Boars
Discharses &Stream Impacts
1.
Is any discharge observed from any part of the operation?
[I Yes
�RNo
❑ NA
❑ NE
Discharge originated at: El Structure ❑Application Field El 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
❑ Na
❑ 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)
El Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any pan of the operation?
[I Yes
2 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
qNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
I2/28/04
Continued

Facility Number: ` 2K — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C&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): 9
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
t"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
environment
Al threat, notify DWQ
7. Do any of the structures need maintenance or improvement?i
® Yes
ro ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
CgNo ❑ 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
C�-No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
UNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
1,�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. uo the receiving crops (litter trom those designated to the CAWMF?
U Yes
R¢No
LJ NA
L_I NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
R No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
allo
❑ NA
❑ NE
I S. Is there a lack of properly operating waste application equipment?
❑ Yes
Ci No
❑ NA
❑ NE
ReviewerlInspector Name i� 1 Phone: D —� )
Reviewer/inspector Signature: 4L &pg&Date:
Page 2 of 3 12128104 Continued

Facility Number: Sa — Date of Inspection )
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ERNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Oallo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes UNo ❑ 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
❑ No
[3iNA
❑ 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
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EiNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
aNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
SNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ErNo
❑ 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
N 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
CR No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
C:No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
fg-NO
❑ NA
❑ NE
Additional Comments and/or.: Drawings:
_.
34, CIO I 711-P1a &A fir � v4d -e- � gra7-Feld . Ptpf_ I r � be -Pe �I)j�, /. ,, py�
r �� cot("yam
7, ��°ae- rnow oAs;r _ boi k et'i , xc�ll�l`f- 1-Ij �' ,
Gord, f�am Cld f e(O-di.
(J v$)r o�d , Ma; �� �-o , r Dw�/'
yel [o w �CO� acor �-hy
Page 3 of 3 12128104

7)07
Facility No. � Fame
Permit "I" CO
ROM
.-
lvm-aol o-rC-N1
W5 P14r
Date 1 S alo
aa
OIC_ NPDES (Rainbreaker PL'l�T A�al Cert)
FB
Drops
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in q- r c d
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
San•P-f /h �t us, r 3 WCn )W ley A
De
Fl�>M�Ti�������Actual
Flow
Soil Test Date
pH Fields
Lime Needed
Lime Applied
Cu-1
Needs P
Crop Yield
I(rl� l a to"., tog
Zn-I ✓ ✓
Wettable Acres
WUP
Weekly Freeboard _,-
1 in Inspections
120 min Insp.
Weather Codes
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
_ . _ -
iffarr`OMEN�.7
,# %�i
cnL
_aM
WE
181 Ell
i.
Vr,-Mwffla
�
..:• �
l0 1
�I ��pJ u l f5 - for KWr ,,
Veri P�-IONE NUMBERS'and affiliations
Date last WUP FRO 71a�1(0-) Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 Vac; Zn-I 3000= 213 Iblac
App. Hardware

9J Q� --- �
e� �
p�
/`

IType of Visit • Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: ` �9 Arrival Time: 0i Departure Time: / ounty: Region: Fie
Farm Name: lexe,lar - r _ Owner Email:
Owner Name: / 41�n�Y')IaAJ 1V �Or' Phone:
Mailing Address: 3&.�(0 l
Physical Address:
FacHity Contact: /U4W �Co' Title: 1�1 MaAj Ac_l Phone No: &/O) W9 — A51 !
Onsite Representative: / lutegrator: 146
Certified Operator: SA *,cry N _ Operator Certification Number: 3
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= O ❑ ` = Longitude: =° = ` 0 u
Current
F§app�aNcirF
Design Current
DMsigmn-uri:ent
Swine npnEation
We# Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
1 10 Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean N
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
pry Pnuttry
ElLayersLa ers
Non -Layers
❑ Pullets
❑ Turke s
❑ Dry Cow
❑
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharues & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
t❑<o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a_ Was the conveyance man-made?
El�,
Yes
❑ No
,�`
t�A
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
9 A
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
El No
2 A
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
LIC
d
[I NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
[] Yes
9_,
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

`F Facility Number: YA—p Date of Inspection Y�9
Waste Collection & Treatment
,�,/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
ICJ No
❑NA[INE
a. If yes, is waste level into the structural freeboard?
[IYes
ElR No
A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ to
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
D'1rlo
❑ 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 environmentalthreat, notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
B o
ElNA [INE
8. Do any of the stuctures lack adequate markers as required by the permit?
ElYes
M4,
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
!!ek`No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2<o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
,.,.,
M1*`o
❑ NA ❑ NE
❑ Excessive Ponding [:]Hydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i 0 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift Elcs� Application Outside of
Area
12. Crop type(s) F;;!5C&e, PiS-f4rl_r �3 Mir AV' . �r
'u
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
,��,,��
R<
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P<o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
��No
El NA El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
,IL.��,,'IV��o
[9 o
❑ NA ❑ NE
Comments (refer to;.question #): Explain any YES answers and(or any recommendations or -an t e comments.,
Use drawings of facility to better explain situations. (use additional pages as necessary) i15
Reviewer/Inspector Name
Reviewer/Inspector Signpl
.�
Phone: 3
. A Date:
12128104 Continued

Facility Number: V — j Date of inspection
RMuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes B1 o ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
U<o
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Rio
❑ 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
ltNo
❑DNA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
iJ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[;Ko
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[1lo
❑ NA
❑ NE
26,
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Z'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
Zqq�C
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E'<o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M<o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
��,�
n o!
❑ 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
�,
GKo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
9<oo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
W-116-
❑ NA
❑ NE
Addrtioaal�Commeots�andlor Drawings "`�
I
r
I2128104

DIMS z )a It Flo&
Iype of visit QJCompliance Inspection Q Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit gRoutine Q Complaint Q Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: 4 Q Arrival Time: Departure Time: County: &r'&Region: 1k0
Farm Name: N6rS h1L RVM �SOw1 Owner Email:
Owner Name: V0079, _ W 4 10- Phone,
Mailing Address: NON 6"d 071hru�
Physical Address:
Facility Contact: Sh& Y& Title: Mt. Phone No:
Onsite Representative: Integrator: fl` a
Certified Operator: !3hmnag Noy t _ Operator Certification Number: 61VA as Y03
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 e =' = u Longitude: = ° = I 0 4
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population.
❑ La er
❑ on -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream lmpacts
I. Is any discharge observed from any part orthe operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
-!'Uesign� �cu
Cattle Capacitjs;-Pi 111
❑ aia Cow
❑ Dairy Calf
❑ Dairy Heifer
E]DryCow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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 RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
& No
❑ NA
❑ NE
❑ Yes
JgNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: % — N t I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1p 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): 9
Observed Freeboard (in): —
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes W 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 15� No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4fi 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 ba No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes JRNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 5�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. -Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding RHydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
,J
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
J�allo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
DTIo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[Q-No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
RNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
C;No
❑ NA
❑ NE
Use drawings of facility t abetter expiatA s tvahons (use aat 1 p g s a necessaarhy� nsorany other comments.
Reviewer/Inspector Name FZ4d j C Phone:% g33-3300 }C3M�
Reviewer/Inspector Signature: Date: O
Page 2 of 3 V 12128104 Continued

t
I.Facilit3- —LNYJ Date of inspection ja Ij
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IRNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check ❑ Yes §0 No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E� No ❑ NA ❑ NE
❑ Waste Application [:]Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes CgNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No CRNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ERNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
1@ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
C&NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
&No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
NNo
❑ 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
IRNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[�No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
RNo
❑ NA
❑ NE
Add MR__ 9.9 me_nts andLor Drawings: _
G 101,4;�9 fair, r.a f`a��lir°� �lir�j-s
11, >lI0fek �e i C� r hyc�a�lfc Dome-jo�,ako , ?�Ps s ffeu. of
QVOit�. "T'n�sS'*ai 0,7 , PA1J VW Off
Iek rw & 3a 'tfo 9*6- -+0-6 �.
71 (90- 1 � cover,
fo--t
-imq mollek cov "A G1_ la I� s lbg
Lim-eart, 14 nq coos.
Page 3 of 3 12128104

Facility No.9 -YT FarnoBame P0-5fl&, SOW Date laILD106
Permit COC Awalr4mrleOIC� NPDES (Rainbreaker PLAT Annual Cert )
Po . Type Desi n Current
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Slud a Serve Date ] Q
Sludge Depth ft & %
war
Liquid Trt. Zone ft
3180
Calibration Date
1
2 13
3
4
5
6
7
8
Design Flow
Actual Flow
q30
D3
Design Width
3a 4
3!U
Actual Width
Soil Test Date -91�7 ✓ v 1 in Inspections ✓
pH Fields $. Crop Yield 6 120 min Inspections
Lime Needed t d s ft a o Wettable Acres J Weather Codes ✓
Lime Applied WUP ✓ Transfer Sheets
Cu ✓ Zn ✓ Weekly Freeboard RAIN GAUGE
Needs P b_ Rainfall >1"
Waste Analysis Date
- 60 Da
f 60 Da
N Amt Ib/1000 Gal
H
Pull/Field
Soil
CroP
RYE
PAN
Window
Max Rate
Max Amt
4
h' �►�t>r9r r
I
.)/4T r
110
f-
Poo
10--
too
Eurf WP, Ar,r
iiQ
113'011f
ftvwo,"9910y
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
( , Or Farm Records V
-Eagoon #
Top Dike
Stop Pump 4%3��u
Start Pump 50.3x—to`r
4M4C
`Q4 C
s�fs►h /AeTc�
App. Hardware thi- )01 1 0

13 W \a 11310-? Tl
QrDivision of Water Quality
Facility Number a y Q Division of Sail and Water Conservation
0 Other Agency
Type of Visit ((Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 18F Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Fla1-A 1 Arrival Time: 4,3Q Departure Time: ()Q County: s Region: Fko
Farm Name: �lGIrSw111� _ Owner Email:
Owner Name: 00 Phone:
Mailing Address: 3(aa t/d 2 hr60n Kf-J CQA-b4 Al G ag 3a
Physical Address:
Facility Contact: Shanf)l tjt Title: F�/* Hihaj-q Phone No: - 90- fL
Onsite Representative: Integrator: Jyuh—12r0wri
Certified Operator: -5h ann8h Operator Certification Number: as 4 0 3
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: E1o❑ 1❑ u Longitude: ❑ o= 1= u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
11 10 Laver
II ❑ Non -La cr
4 i I
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkevs
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 5d No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
C9 No
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
12129104 Continued A

(Facility Number:% DL — 14 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
YNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
19 No
❑ NA ❑ N E
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressees and/or managed
❑ Yes
LN 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?
19 Yes
❑ No
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[9No
❑ 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
W No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
XNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
CKNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Dtifi ❑ f' Application Outside of
12_ Crop type(s) V j✓/tfry¢$A"fivAP cyio f!V'r'_
13. Soil type(s) WA B Rod,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
firNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
19 No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
SrNo
❑ NA ❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
XNo
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
5rNo
❑ 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):
Reviewer/Inspector Name 2640 schlyi4 Phone: 9/D— y3:3 3300 _
Reviewer/Inspector Signature: Date: o� 0
12128104 Continued

L
Facility Number: $ — Date of Inspection lam
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E,1190 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP 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 CKNo ❑ 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
[2jNO
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
5�`NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CR 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
® No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
5;'NA
❑ NE
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
fRNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[1 Yes
EZNo
❑ 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
E'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
lrNo
❑ NA
❑ NE
General Permit? Oe/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
EJ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
JZNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
al, UUff- QOO-7 Wouk Avl ys 1 S 10* 0+soil lab , aoo(-aona had f� 4-7 o� 1 ea 5,bm Pd_
P&y.e�
R t- or� ya,); �. pe(otds bekr t+D �u� we- IODr� pay,es . (3 year rele�� o't �
�s. aQo-) sl e.st rvey *0 be d4re- bfferf_ ie &-.e"L 7
LfMe_ Nay apelie4_ 1A 14OW? arft(.6MoAdpj_ b sail ic��
y
I}es)„ Caparify c hc+�ed f'rorr
7, PJ� reap//eve. irn h ffo4 Iaraj .
Pie 00- ri vef 64 f,'Arr o k,'Je o` - be&,, a-k rz!y S;d to .
Pl�,�.te,s eel f hd m vl c� sCa d ba'e spa�S On 1 a,0&l d i k?, M 03+1 kox'gooa(ca*,
Plea, 01V 'fiftde o�-1 a9oor, balls,
Goo eti+pi- cso p ,
12128104

/ n n ,
.e
Wvtsio Dt�n of Water Quahty � t
Fact��ty;Ni�mber' Q Drv�s�on ofSoil and''Water Conservatron'_
j�11_- , moth eAgency
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: 1/2-/T-476 Arrival Time: /�,' S Departure Time: /� L D Count}': Al Region: ��
Farm Name: Owner Email:
Owner Name: N0 e Al Phone:
Mailing Address:
Physical Address:
Facility Contact. Title: Phone No: pp
Ousite Representative: TAigA( rQ Al /YCe.. AY Integrator: A14E+✓,Q4 pYirt,J A/
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: = o = a = as Longitude: 0 ° ❑ a ❑ u
Design Current Design Current
Capacity Population 1"t Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
12 o O
1 Zoo
El Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Cattle
] Dairy Cow
] Dairy Calf
] Dairy Heifer
Dry Cow
LJ Beef Stocker
❑ Beef Feeder
❑ Beef Brood C
Number of Structu►es [
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes [% No ❑ NA ❑ NE
❑ Yes
[$ No
❑ NA
❑ NE
❑ Yes
FNo
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
EpNo
❑ Yes
F� No
❑ NA
❑ NE
[] Yes
P9 No
❑ NA
❑ NE
12128104 Continued

Facility Number: Z —
Date of Inspection
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes fVNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes $ff No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �5-ow
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z g
5. Are tbere any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 9fNo El NA ❑ NE
through a waste management or closure plan? r
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 [XNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [FNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 5lo ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[PNo
❑ NA ❑ NE
maintenance/improvement?
1. 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 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of�Acceptable Crop Window ❑ Evidence of Wind Drib ❑ Application Outside of Area
12. Crop types) WiA.�tt/ ; Af4VLA4dSGMAic v' �MA/cc� _ 0<5 G-( t /"/�
, v 4F.-
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
i No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[P No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[T No
❑ NA ❑ NE
Reviewer/InspectorName �; / {� . � Phone: [phone]
Reviewer/Inspector Signature: r1N AAA
Date: % 2 (S— Z 0,0 (�
Page 2 of 3 12128104 Continued

i . .
Facility Number: Z — 41951 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C8 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes &Tio ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C9No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [9 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
[F No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
QPNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
17No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
RNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
7No
❑ 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
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
HNo
Cl NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

i -
0 Digsion of Water Quality
Facility: Number Q Division of Soil and Water Cc►nsei vation ` p
�. 0 Other Agency,,..,.
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: S'i� v� Arrival Time: �: S� Departure Time: County: �!21 ASL74 Region:en
_
Farm Name: L,^.'det 1
Owner Email:
Owner Name: _ a43,11 a loc Phone:
Mailing Address: 360 Honer- one,: � v7�` IP[� G/.'a ��1 if/L .28_3 .�
Physical Address:
Facility Contact: N.,.,Iel_ Title:
Onsite Representative: Nztvkr
Certified Operator: lot -
Back -up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
arrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No: `f 1 0'0
Integrator: � +�vP:✓h
Operator Certification Number: .2-.) E/o_3
Back-up Certification Number:
Latitude: [� o [� i [= t/ Longitude: [� o =1 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkeyPoults
❑ Other
Discharges & Stream Impacts
I - Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (Il'yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ DaiEx Heife3
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: U_J11.
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 [4nfo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑No❑
NA
El NE
ElD Yes
__,, ,
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: _ y Date of Inspection S G a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
�-�
D o
❑ 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?: ho
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
D io
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[3 o
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
0, o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[ago
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
0'l;ro
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
Rl�o
Cl NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
,.,/
[3 1Vo
❑ 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 El Evidence of Wind Drift El Application Outside of Area
Ii,�;� pr►,���,F3F It•Y
IItly f
12. Croptype(s) �c°� �c+st'_ FesCye
,;,rlC� 106611'1_ a
13. Soil type(s) � fA A 4
_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
E3,<o
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
D<o
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
❑ No
❑ NA [a'FTE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA [TRE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
U4116'
❑ NA ❑ NE
��<'Ei:plaintany:yE
Reviewer/Inspector Name mar a _:�� . - Phone: 1117i1Z ! Stil e•f�30
Reviewer/Inspector Signature: Date: 4 IL.
12128104 Continued

Ir
Facility Number: 9r2 Date of Inspection S` - k •0.5
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Q-Mo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 91les ❑ No ❑ NA ❑ NE
the appropirate box. ❑❑ Ch tsts Q'Yfesign ❑❑ref
21. Does record keeping need improvement? If yes, check the a progiate box below. ❑ Yes �o ❑ NA El NE
El❑ wek1y-li�ee�e ❑ wage � :s- ❑ sm+,u sss— ❑ wwA&Trm3ftm ❑ ion
❑-R�❑fig ❑ weathereede--
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29_ Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
[21�o
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
DINE
❑ Yes
❑ No
❑ NA
a E
❑ Yes
❑ No
❑ NA
ME
❑ Yes
EKo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
C-KE,
❑ Yes �Dlq'o El NA ❑ NE
❑ Yes L7 No ❑ NA ❑ NE
❑ Yes L_I No ❑ NA ❑ NE
❑ Yes O'No ❑ NA ❑ NE
❑ Yes
[allo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Addihiinai Comments.attdlorDrawings:.
e,•
! [1 [ Fj F C oil/
cot-isIu% 16,6 NJ" tt„�
C-11 �;s /�r,/f
1212&04

...ram_ . = �;-�� _ . •� . �: �_ -�:.__ �. ::_1 _�•� �• �.a3._...:r : ,. _... . _ � _ _ . _. - =..
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Faciliry Number Date of Visit: r+ O Time: g GD
)lot O erational 0 Below Threshold
® Permitted ® Certified ❑11 Conditionally- Certified O Registered Date Last Operated or Above Threshold
Farm Name: i e)!!. A" Counn•: SQ FIZo
Owner Name: cSAahr►oAJ � 1Vaf/ldY Phone No: �V s61i � �s'�
Mailing Address: �G D t-4101e6r Le
Facility Contact: Title:
Onsite Representative: -�tD t_
Certified Operator: 5 �+ ct IN rt e✓n ` a r
Location of Farm:
Phone No:
integrator: iYILt+per,- B t'ot�,_3N
Operator Certification Number:
��y03
�RfSwine ❑ poultry ❑ Cattle ❑ Horse Latitude 0 �° �- Longitude ' 1
Design Current
Swine C:anscih• Pnnulatian
Wean to Feeder
Feeder to Finish
El Farrow- to «'ean
© Farrow to Feeder
Zvo
3O0
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca achy Population
❑ Laver I JEJ Dain
❑ iron -Laver I JQ Non -Dairy
❑ Other
Total Design Capacity
Tatar SSLW
Number of Lagoons 10 Subsurface Drains Present—JID Lagoon Ares (] Spray Field Area
Holding Ponds / Solid Traps No Liquid Waste Management System
ischaroes & Stream Impacts
1. Is any discharge observed from any par of the operation?
nisehar_e originated at. ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State? (if yes. notify DWQ)
c. If discharge is observed. what is the estimated flow in Qalimin?
d. Does discharge bypass a lagoon system? (if ves, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the lVaters of the State other than from a discharge?
Waste Collection & Treatment
4, is storage capacity (freeboard plus storm storage) less than adequate? ❑ Svillwav
Structure I Structure ? Strucmre 3 Structure 4 Structure i
Identifier:
Freeboard (inches): 7 a
❑ Yes CM No
© Yes ❑ No
❑ Yes ❑ No
_ JV
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes q No
❑ Yes [A No
Structure 6
05IV3101 Continued

Facilih• Number: g� —
Date of Inspection 7e/1-2
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ 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?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes U No
❑ Yes [19 No
❑ Yes No
❑ Yes No
❑ Yes Q9 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [R No
11. Is there evidence of over application? ElExcess P�ding ❑ PAN /❑ Hydraulic Overload El Yes ®No
12. Crop type AC.S c u e/ t" I file- tl/ C a a.3-IF, 1
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
Q No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[!j No
Rtguired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[A No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
® No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified Alkt'MP?
❑ Yes
No
® No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Camments'(refer to"qutstion # •:.Ex lem so YES ansiytrs or an Y sttd/_recommendations OF-sinv atittr=comments._ -
.-
_ _
Use dr iviQgs of fact�tty to'better eiplato siRnatiot>ts. ruse atfdid0nal gageai as accessary) ® Field Conv ❑ Final Notes }
[. yt i'o Yhov 4c a •t C SC"e- lPo r co r+�-..rVt� 10 F%. ate• a� t�� k
Ca L[. 0rc711 h9t1 -
Reviewer/Inspector Name - - - -_
Rexiewer/Inspector Signature: Date:
05103101 Continued

�'=�" ``,,��:- ' � �� -� � � � Dtvisia�n of WaT>�er QetaEtty �.-�.�'" ,�,� �;� ��.�� .;�••-., , �--:� � `ram,
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other © Denied Access
IFacilir•. Number Datr of Visit: rerr Time: - Q
not O 0 erational Q Below Threshold
13Permitted ® Certified O Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: / w Countv: _ gA'fOl�rt
Owner -Name: _ fyoopla t q /� 1Alar,1Jlr Q j Phone No: qIa' 56 ! -
1lailinc Address: _ _ L� UQ 'E0NN�!'i9 I� rl
Facilit-3- Contact: Title:
Onsite Representative: _5 vL Nif o d A/SV10 r
Certified Operator: 1yOtWIQt'1 /
Location of Farm:
Phone No:
Integrator: a/! J/ Gil
or I
Operator Certification Number: .2��sia
30 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �' �•
Design Current Design Current Design Current
Swine Ca aciri• Population Pouhry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Laver ❑ Dairy
El Feeder to Finish 10 Non -Laver I I 10.Non-Dairy
❑ Farrow to Wean
Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 S rar Field Area
Holding Ponds /Solid Traps ❑ No Li uid waste Management Svstem
Discharees & Stream Impacts
l _ is any discharge observed from any part of the operation?
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes. notif}' DWQ)
c. If discharge is observed. what is the estimated flow in QaUrnin?
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 any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure ;
Identifier:
Freeboard (inches): 125�!
05103101
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
ONO
❑ Yes
0 No
❑ Yes
®No
Structure 6
Continued

Facilita Number: —If q_5 Date of Inspection �- 3
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion.
seepage. etc_)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need mainienancelimprovement?
S. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any sructures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markines?
Waste Applicatinn
10. Are there any buffers that need maifitenancehmprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type UrL)L' A Ilef 04S Ax .Q i.
❑ Yes 14 No
0 Yes W] No
❑ Yes 9) No
❑ Yes (2 No
❑ Yes EM No
❑ Yes No
❑ Yes No
11 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 faciliry need a «^enable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
W No
15. Does the receiving crop need improvement?
❑ Yes
M No
16. Is there a lack of adequate waste application equipment?
❑ Yes
[4 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 WUP. checklists- design. traps_ etc.)
❑ Yes
] No
19_ Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[f No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
M No
? 1. Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
23_ Fail to notifi- regionai DWQ of cmergency situations as required by General Permit?
❑ Yes
No
Oe discharge. freeboard problems, over application)
_ . Did Reviewer`Inspector fail to discuss reyiew,inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow• -up visit by same agency?
❑ Yes
MNo
25. 'W cre any additional problems noted which cause noncompliance of the Certified AWMP?
[] Yes
9) No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. 71
Comments'(refei to gaestiati #). 'Eiiplaia Spy YES auswt s sndlor.aiiy t ntntnesiaadons' ay ra�amestts: �
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05103101 Continued